By Ilaria Bertini
The entire world is facing one of the greatest challenges of our time: the COVID-19 pandemic. Less than two weeks ago, the UK Government announced some of the strictest measures in its history to limit the rising number of infections in the population. The National Health Service (NHS) has been forced to rearrange its priorities, to deploy extra staff in essential units, to confront the fact that frontline healthcare professionals will be the most exposed to contagion with consequences for them and the entire system. Some hospital wards have changed their function overnight, becoming intensive care units for COVID-19 patients, and many healthcare professionals have been deployed on different wards and with different duties to face the rising number of COVID-19 infected patients admitted. However, the population has not emerged overnight from pre-existing medical conditions or other healthcare needs (from cancer treatments to routine pregnancy care), making the current crisis even more difficult to handle.
On 30th March, the Government announced that in order to ease the pressure on NHS staff and to protect people from infection, it would, among other initiatives, change the regulations on abortion pills temporarily with a ground-breaking effect in England. Until now, a pregnant woman seeking an abortion within the first ten weeks of gestation could opt for a medical abortion, which consists in taking two pills at different times. In England the first pill, called mifepristone, was taken in a hospital or clinic under the supervision of a healthcare professional while the second pill, called misoprostol, could be taken at home.
Under the new regulations, the consultation takes place over the phone or by video link and the registered practitioner can prescribe both pills to be taken at home. The benefit of this procedure is that the pregnant women do not have to come into close contact with anyone, dramatically reducing the risk of infection in the first instance. However, at least three drawbacks can be envisaged.
First, as a recent article on the LSE Politics and Policy blog highlighted, “self-isolation may lead to an increase in sexual activity amongst some, not to mention the increased risk of sexual violence within quarantine settings”. However, the fact that “this change in regulation was heralded as a major breakthrough for emergency management of COVID-19 and meeting women’s reproductive needs” remains controversial. In fact, it might be true that having a medical abortion at home means terminating an unwanted pregnancy in a short timeframe. But what may have brought the woman into a potentially abusive situation where she may be under pressure to abort may remain entirely hidden.
A second consideration is that we need to take into account the extraordinary circumstances that the population at large is currently experiencing. The lack of social interaction, the fear posed by the present situation from both a health and an economic perspective, the impossibility of planning ahead and the related difficulty of spending an unprecedented amount of time in the home setting can be a major cause of stress and anxiety. This scenario might affect the judgement of anyone taking an important decision that affects their future life and the lives of others. In particular, limiting any discussion with healthcare professionals to a video or phone call can leave the pregnant woman isolated in a mentally and physically very stressful situation.
Finally, from a medical perspective, the present reality shows how much the NHS is under pressure, to the point that it has asked retired staff to come back to work and new temporary hospitals to be built. Emergency calls are already overwhelming the helpline services and the ambulance service cannot guarantee a quick response. This means that any emergency occurring at home in relation to medical abortion will be much less likely to receive a prompt response. In particular, such emergencies can be very serious if the pregnant woman is in fact more than ten weeks pregnant when she takes the pills. With the new regulations in place, it is also no longer possible to access a pre-abortion ultrasound scan to accurately date the pregnancy and ensure that it is developing inside the uterus.
In other areas, there is some recognition of a need to strike a balance between existing needs in terms of mental and physical health and the risk that the novel coronavirus poses. The new clinical guidance issued by the Royal College of Midwives (RCM) concerning the reconfiguration of some services offers a clear example. On the one hand, it recognizes the great importance of the presence of birth partners (with the exception of partners with confirmed or suspected COVID-19 infection) inside labour and birth rooms. In fact, the RCM states that “Having a trusted birth partner present throughout labour is known to make a significant difference to the safety and well-being of women in childbirth. At times like this, when coronavirus is heightening anxiety, that reassurance is more important than ever.” On the other hand, the RCM underlines the importance of making sure that during this crisis women’s health and safety remain paramount. For this reason, home births are suspended in many areas because of “acute staff shortages and concerns about capacity in the ambulance service to provide transfers should an emergency arise during the labour or birth. In London, for example, the London Ambulance Service has already made it clear that it is unable to support transfer at the present time.” In the light of this scenario the question arises as to whether the new regulations on medical abortion are the result of a careful assessment of the interests at stake or the effect of a decision informed by a desire to put in place a long-advocated procedure.
Author: Ilaria Bertini
Affiliation: BiosCentre, London (UK)
Competing interests: None