On telemedicine abortion
- Two women using telecommunication technologies ©insta_photos/Shutterstock
Hazal Atay is a researcher and Ph.D. candidate at Sciences Po’s Center for Political Research (CEVIPOF). Complementary to her Ph.D., she studies telemedicine abortion and works as the Helpdesk and Outreach Coordinator of Women of Web, a non-profit organisation providing help and information on safe abortion and contraception.
You study the issue of abortion by telemedicine. What is at stake?
Telemedicine abortion entails using of telecommunication technologies for provision of medical abortion. The advent of medical abortion - abortion with pills - in late 1980s changed the terms and conditions of abortion access and rhetoric. When the pills were invented, it was speculated that this was the most controversial discovery of the 20th century. Telemedicine abortion takes that discovery further, by enabling individuals to self-manage their abortions at their home without direct supervision of a medical practitioner. Research has shown that the outcome of medical abortion through telemedicine is similar to those to in-person care, and the World Health Organisation (WHO) affirms that individuals can self-manage their abortions up to 12 weeks of their pregnancy. Despite this scientific evidence and organisations like the WHO endorsing telemedicine for abortion, alongside pressure from civil society, we still encounter an overregulation of the abortion pill and a drawback against telemedicine. This has been challenged thanks to research and activism, and most recently due to the pandemic, as telemedicine appears to be prominent to ensure access to essential health services during pandemic and amid lockdowns.
In times of COVID the issue of legalising abortion through telemedicine has been addressed by the WHO and some countries like France and the United Kingdom. Can you tell us more?
We saw many attacks to abortion rights in times of COVID. In the United States, there has been an attempt to classify abortion as a non-essential service to restrict access to it during the pandemic. The WHO responded to this quickly by including abortion care in its Interim Guidelines for maintaining essential health services: operational guidance for the COVID-19 context. The WHO recommended the expansion of telemedicine to ensure safe abortion access and suggests that telemedicine abortion is non-invasive, cost-effective and acceptable, and improves autonomy of individuals. Prior to the these gudelines, few countries led the way in allowing telemedicine abortions during the pandemic. As early as March 2020, home abortions were allowed in the United Kingdom, and in April teleconsultations were permitted for abortion provision in France. These advances were made possible as a result of long-lasting scientific research and the work of civil society organisations. They are also very significant because they might serve as advocacy tools and best practices for policy discussions for the post-pandemic world.
You recently conducted a study on the German health sector with colleagues. What were your findings?
We recently finalised a study together with researchers and medical doctors from the Karolinska Institute of Sweden and a telemedicine abortion service called Women on Web to examine the potential of telemedicine abortion for Germany. Within the framework of this project, we have been able to mobilise Doctors for Choice Germany and Alliance for Sexual Determination to work together to put forward some policy recommendations to amend the current abortion regime. The abortion law in Germany is problematic in so many ways: abortion is technically illegal, as it is regulated by an exception to the Penal Code. Moreover, Germany still has a mandatory pregnancy-conflict counseling, called Schwangerschaftskonfliktberatung, required before abortion. At the moment, telemedicine abortion is not allowed in Germany. All of these obstacles reinforce the abortion stigma and limit access to safe abortion, particularly for those vulnerable groups such as adolescents and undocumented immigrants. Our findings show that individuals choose telemedicine abortion over local services both from a place of empowerment and disempowerment. While some resort to telemedicine because they value control and ownership over the abortion procedure, some resort to it because they encounter barriers in accessing abortion care locally. Either way, telemedicine abortion appears having a significant potential to increase access to safe abortion. We hope that this study can serve as a reference for change, addressing both the unmet need for safe abortion and potential of telemedicine for the German health sector.
What are your thoughts on the current situation in Poland?
Poland has a very strict abortion regime, and the recent ruling aimed to further restrict access to abortion. We know that abortion restrictions do not stop abortions from happening, but rather render them unsafe. In the past, researchers argued that unsafe abortion is a preventable pandemic. Around 56 million abortions occur each year, and almost half of them are unsafe. As a result, we observe an increase in maternal mortality and pregnant people suffer from complications of unsafe abortions. Abortion restrictions hit people from lower economic background the most. People who can afford can travel abroad to access services or pay exorbitant prices to have it in a clandestine manner.
It was very inspiring to watch the protests in Poland. Two things were very interesting for me; one is the defiance of the local groups against the abortion ban. Several groups mobilised, including Women on Web for example, to collect donations to offer free abortions in Poland. Today, medical abortion and telemedicine provides us this opportunity. This has also been the case with the Irish abortion referendum where activists argued that they will have abortions anyway, by traveling or ordering abortion pills online. I think this is very empowering. Secondly, it is also interesting to see the cordial relationship among abortion rights, democracy and the rule of law. When democracy is under threat, abortion rights are often the first to be attacked. Abortion is in fact like a litmus test of democracy, and we discuss it, if not always, at least during each election. It is a topic candidates habitually differentiate themselves and their ideologies. In Poland, we see once again how abortion rights are not only at the core of healthcare systems, but also at the core of our democracies. As groups protest for abortion rights in Poland today, they also claim judiciary independence and impartiality. These protests are not only against the encroachment of the government over women’s bodies, but also over democratic institutions and courts.