Abortion access for unwanted pregnancy during COVID-19
By Dr Mark Houghton
Are women at risk from sudden changes to reproductive healthcare access during the COVID19 pandemic?
The Covid-19 pandemic has swiftly swept the world into its grip. It has forced countries to a standstill and is stretching health services to their limits.
Research from the Guttmacher Institute suggests that the pandemic is placing all areas of health at risk and has ‘major implications for people’s reproductive priorities and actions’ [1].
This article will explore some of the legal changes that have been made to abortion access, because the implications and risks are important for women to consider.
It will also explore some of the health implications of being pregnant during COVID-19.
Home abortion
The pause on all non-emergency procedures in the UK has raised questions about access to reproductive health services. As a result, significant changes to abortion access have been made through the introduction of at home medical abortions [2].
There was initially a lot of back and forth in the lead up to this decision, the law was first changed ‘in-error’ on the Government website on the 23rd March and swiftly deleted, before being made official a few weeks later [3].
The UK law previously stated that for the medical abortion procedure, the first pill (mifepristone) was to be taken in hospital with only the second pill (misoprostol), to be taken at home. The new regulation means that both abortion pills can be taken at home.
As with any medication it’s important to familiarise yourself with all the facts and risks before taking them. This is especially important now considering that side effects for women taking the abortion pills will now be experienced at home.
Risks and things to consider
If you are considering an abortion using the newly legalised home abortion method, it's important to make yourself aware of all the implications before making a decision.
Risks of infection:
The Royal College of Obstetricians and Gynaecologists (RCOG) says that ‘one in 10 terminations infect the woman’. [4]
This in turn can cause problems such as painful Pelvic Inflammatory Disease (PID), higher risks of infertility and in serious cases can cause haemorrhage. [4]
It is recommended that women are checked for Chlamydia and other STIs in all women having abortion because it can present a higher chance of infection [6]. It is not yet clear if these tests can still continue during COVID-19 social-distancing measures.
Experiencing pain:
Research suggests that "many women undergoing early medical abortion experience pain of a severity that requires narcotic analgesia; almost a quarter of women experience pain that they rate as almost being as bad as it can be." [5]
The evidence shared here is not intended to scare, but to educate. Allowing women to make well informed decisions about their healthcare.
COVID-19 and pregnancy
When it comes to COVID-19 and pregnancy, the information is scarce. [7]
On 3 April, the RCOG updated their guideline on COVID-19 infection in pregnancy, which provides detailed recommendations for care. [8]
The general advice for women who are in the third trimester of their pregnancy - after 28 weeks of gestation – suggested they may experience more severe symptoms of COVID-19 than the earlier stages of their pregnancy.
However, it's important to note that women at any stage of pregnancy are not at an increased risk of contracting the virus.
The experiences of stress, fear and uncertainty that someone might have about an unexpected pregnancy might be intensified because of the COVID-19 outbreak. As a result, these feelings may overshadow other options such as parenting or adoption/ fostering.
If you are pregnant unexpectedly and you’re wondering:
Who can support me to become a parent?
Can I still consider fostering or adoption?
Is it harder to get financial support now?
It’s important to seek medical advice and support, as well as contacting your local Citizens Advise centre in order to get answers to your important questions.
Healthy Choices
Across the world, changes to abortion access either through restriction or relaxation of laws shows the many ways in which female reproductive health is continually up for grabs.
Considering this, continued access to contraception is important for reducing abortion rates and protecting the health of women.
At The Choices Community we believe that in order to make healthy decisions women and their partners need three essential tools:
A range of safe options available
Up-to-date medical facts about these options
A comparison of abortion with birth along with the full risks for informed choice.
We are working to keep you informed on medical evidence for the safety of abortion and birth.
We want to provide you with all the essential knowledge and pathways to make healthy decisions for yourself or those in your care.
Do you have questions about your access to reproductive healthcare during the COVID19 pandemic?
UK: Please refer to the NHS website or consult your GP.
Outside the UK: Please refer to your local government website and speak to your Family Doctor
References
Ahmed, Z and Sonfield, A. 11 March 2020. ‘The Covid-19 Outbreak: Potential Fallout for Sexual and Reproductive Health and Rights’, Guttmacher Institute. accessed at: https://www.guttmacher.org/article/2020/03/covid-19-outbreak-potential-fallout-sexual-and-reproductive-health-and-rights
Mohdin, A. 30 March 2020. ‘Relaxation of UK abortion rules welcomed by experts’, Guardian accessed at: https://www.theguardian.com/world/2020/mar/30/relaxation-of-uk-abortion-rules-welcomed-by-experts-coronavirus
Hern, A. 24 March 2020. ‘UK abortion law briefly changes during Covid-19 outbreak’, Guardian accessed at: https://www.theguardian.com/world/2020/mar/24/uk-abortion-law-pills-home-covid-19-outbreak
RCOG. 23 November 2011. ‘The care of Women Requesting Induced Abortion London (Evidence-based Clinical Guideline No. 7)’, Royal College of Obstetricians and Gynaecologists, accessed at: https://www.rcog.org.uk/en/guidelines-research-services/guidelines/the-care-of-women-requesting-induced-abortion/
Penney, G. July 2006. ‘Treatment of pain during medical abortion: Review of 5 studies’, Contraception; 74 (1): 45-7 accessed at:
Achilles SL, Reeves MF. October 2010. ‘Prevention of infection after induced abortion’, Contraception; 83 (4): 295-309 accessed at:
Luo, Y and Yin, K. 24 March 2020. ‘Management of pregnant women infected with COVID-19', The Lancet: Infectious Diseases accessed at: https://www.thelancet.com/journals/laninf/article/PIIS1473-3099(20)30191-2/fulltext
RCOG. 3 April 2020 ‘Coronavirus (COVID-19) Infection Pregnancy: Information for healthcare professionals’, Royal College of Obstetricians and Gynaecologists, accessed at: https://www.rcog.org.uk/globalassets/documents/guidelines/2020-04-03-coronavirus-covid-19-infection-in-pregnancy.pdf