Women seeking abortion care have been facing so many barriers to access safe abortions since ages. The COVID-19 virus is dramatically changing everyday life for people across the world, including those seeking abortion services. At present, people have anxiety over possible interruptions or limitations for accessibility to abortion care amidst self-quarantining, prolonged lockdowns and social distancing due to COVID 19 outbreak. People also have some pressing questions on the health care system about how the coronavirus pandemic may hinder those seeking abortions. Health centers may be operating in a limited capacity to provide abortion care since many clinics are increasing visits for those with respiratory infections. Though the effect the virus has on a clinic’s ability to operate can be substantial, it is important to note that measures to provide abortion services as a part of mainstream reproductive health care are rapidly adjusting to the pandemic.
As people are now staying home from work, watching their children, managing house chores or who are home from school, are less flexible in their schedules to make it to the hospital for abortion care. Abortion care should be accessible to all women without delay as abortions become more complex to medically terminate with continued unwanted pregnancy. Abortion is time-sensitive and essential health care. Delaying abortions leads to more complex and expensive care. Abortion care should not be considered elective and all measures to minimize any delays should be considered. The Government of India has recognized safe abortion as an essential service during COVID 19 outbreak. As per the guidance note recently released by the Ministry of Health and Family Welfare, ensuring provision of essential health services during the COVID-19 outbreak enlists safe abortions as part of essential reproductive health services. The guidance states: “all appropriate health facilities should ensure provision of medical and surgical abortion services with appropriate infection prevention measures comprising counselling for post-abortion care and provision of contraception”. Wide dissemination and implementation of the guidelines across all levels of the health system is utmost essential.
The importance of immediate and safe access to medical abortions is well established. The situation does not place an option for denial or delay of an abortion. Inaccessibility to safe abortion services can push women to seek services from an untrained provider risking her health and body. Further, incomplete abortions and other complications post unsafe procedures can demand emergency services and increase the burden on the health system. Women opting to delay their abortion will only worsen the necessity for a late-term abortion that is usually more complicated, more expensive and less available or impossible. The majority of abortion care provided in clinical settings are equipped to be able to provide safe abortion without delay and with all precautions against coronavirus infection. People visiting medical quacks or illegal practitioners for discreet unsafe abortions put themselves at higher risk for COVID-19, given the extra travel, extra visits and lack of safety precautions. This promotes the spread of infection and endangers their families and communities too.
Women with unwanted pregnancies, those self-isolating or caring for family members simply cannot leave their homes at these times. Women are incredibly anxious about what they should do in such desperate circumstances. The country being in an extended lockdown, highly restricted movement and unavailability of public transport services, the question of a woman in need of an abortion to reach a health facility is bleak, especially in the context of persisting stigma around abortion and lack of feminine independence. Even on reaching the health centre, safety levels involved in waiting to see a doctor and priority of being attended to in these times may be grim and unanswered.
Physical distancing in waiting rooms, using increased precautions for hygiene and other measures at abortion care centres is mandatory to protect patients, staff and health-care providers from becoming infected. Demand for multiple, medically unnecessary appointments are to be restricted by health care centres. Normally, a woman may have to visit the centre few separate times for a medical abortion. At times of this pandemic, it is pointless to risk anyone’s health or the health of their families by traveling, waiting for consultation or collecting reports when same advisory can be availed through telemedicine. Increased capacity to provide abortion by telehealth or removing requirements around abortion like in-person consent, ultrasound and lab testing before an abortion to reduce patient contact are being worked upon. As directed by the National Centre for Disease Control, reputed abortion centres offer legal, healthy and upgraded safety procedures to facilitate corona virus infection controlled abortion care.
As always, safe options for pregnancy termination are either medication or procedural abortion and this decision should be made in consultation with the reproductive health care provider. Medication abortion through telehealth is as safe as in-person treatment. Telehealth also ensures that the patient receives all information, support and options that they might need. Telehealth also reduces the need for travel and can reduce the cost of treatment. Though telemedicine is not the solution to all the challenges posed by this pandemic, it seems to be an effective medium where medical practitioners can evaluate and manage patients. Telemedicine practice can prove to be an advantage with multiple benefits that allows a woman to access timely expert medical advice, legal and safe abortion service while preventing the transmission of coronavirus infection thus reducing the risks to both healthcare workers and patients. A woman wanting to terminate her unwanted pregnancy may call a reputed abortion clinic ahead to know if they can provide telehealth or check the website to know changes in protocols that may adjust to conditions with the pandemic.
There has always been a mark of disgrace and silence around abortions and women are more vulnerable now. The lockdown has reduced access to domestic support services and brought a strain on predominantly female carers. Domestic violence and forced sex have surfaced as critical issue in a lockdown situation and safe abortion services specific to the scenario, play a significant role in women’s health. Fears are growing that number of unsafe abortions and consequent maternal deaths could rise in the crisis. Our country states that abortion services are essential and urgent and it is encouraging doctors to consider the use of telemedicine as part of practice. The national health care system has recognised women’s need for abortion services beyond the impact of the pandemic. Therefore it is important to insist that even during this time, women have to make the right choice and decision to save themselves from potential damage to their health and body.