In the context of restrictions brought about by COVID-19 and Texas’ six-week abortion laws, the access to safe reproductive and sexual health choices has been brought back again to global focus. Apart from the traditional beliefs and legal norms concerning abortions, the different methods of abortion have also come to be an integral part of the discussion.
Self-managed abortions, also known as abortion by pills or medical abortions, is seen as one of the most effective ways to end an unintended pregnancy, even in countries with strict abortion laws. Self-managed abortions are defined as self-sourcing of abortion pills, outside of the clinical environment. It could be done from the comfort of one’s home or anywhere else that’s convenient to the abortion seeker.
The pills used for medication abortion are called mifepristone or misoprostol that are usually available at the local pharmacy stores. Listed as the essential medicines by WHO since 2005, these medicines are safe and are highly effective. It’s important to note that the pills have a high success rate. According to a study, less than 1 per cent of 20,000 cases of abortion with pills resulted in any kind of complications.
The process of self-managed abortion is similar to a natural miscarriage and the bleeding and pain feels the same as in a natural miscarriage. The abortion pills could be taken within 13 weeks of the pregnancy. The duration of pregnancy could be known through an ultrasound or could also be determined at home by calculating the number of weeks and days from the first date of your last menstrual period. Medication abortion can be done at home and the assistance of a healthcare provider is not necessarily required unless one is facing severe side effects. However, it’s advised to visit the medical practitioner after 14 days of taking the pills to ensure if the abortion was successful.
Heavy bleeding, fever, nausea, and cramping after the abortion are common side effects of abortions with pills. The heaviest bleeding occurs 4-6 hours after taking the pills. To reduce the pain, usage of a painkiller and heating bag is advised. Either pills used during periods could be used to reduce the pain or paracetamol, mefenamic acid or ibuprofen family of medicines could be taken. After taking the abortion pills, It’s also important to be free of any responsibility like childcare, jobs or any domestic work and have a good sleep in a quiet atmosphere.
The pills do not affect one’s ability to get pregnant again in any way. A person can ovulate or get pregnant as early as just after 11 days of undergoing a self-managed abortion. To reduce the risk of infection, it’s advised to have vaginal intercourse only when the bleeding stops completely, which could take up to 10 days.
Self-managed abortions have come to be one of the safest and most accessible ways to undergo the procedure outside of a medical institution. People prefer this method as abortion pills are comparatively easily accessible and it also ensures privacy, autonomy, and confidentiality. This is especially significant in avoiding social stigma in conservative societies wherein the exercise of sexual and reproductive autonomy by a woman, is looked down upon. While people who want to undergo self-managed abortions are faced with several challenges such as stigma, criminalisation of the practice and lack of awareness of the process, the COVID-19 virus and its repercussions have also exacerbated the problems faced by abortion-seekers.
Countries across the world implemented a nationwide lockdown in March 2020 due to the rapid spread of the coronavirus. Many women, with restricted access to contraception and abortion services, some stuck with abusive partners in their households in the lockdown, were affected the most. A lot of public healthcare centres were quickly turned into COVID-19 care or quarantine centres and services related to sexual and reproductive health were abruptly halted.
Moreover, restrictions on travel and commute not only created difficultly in accessing abortion pills especially for people living in rural areas, but it also limited the supply of abortions pills. The availability of contraceptives were delayed by supply chain disruptions. In India, the cross-border travelling restrictions resulted in the unavailability of abortion pills in the local chemist shops or health facilities.
According to a report by Foundation for Reproductive Health Services India, a number of states in India witnessed a shortage of abortion pills during the lockdown. In Haryana and Punjab, only 1 percent of pharmacies had the pills while in Madhya Pradesh and Tamil Nadu it was just 6.5 per cent and 2 per cent respectively.
One such case was that of a woman in Mumbai who could not avail a pregnancy test kit in time and by the time she could get access to a public hospital, it was too late for a medical abortion. Around 1.85 million women in India couldn’t avail abortions, as per a May 2020 study conducted by Ipas Development foundation. The study noted that about 80% of these 1.85 million women couldn’t access the procedure due to the lack of availability of abortion pills in the pharmacies.
Women are faced with many challenges surrounding social stigma about abortions and orthodox beliefs that dismiss the use of medical abortion pills, and this made access to safe abortions even more difficult. The process of self-managed abortion requires women to be in a safe and supporting atmosphere and in many households, with an evident increase in domestic violence and lack of privacy, this too was denied to women.
According to a 2017 report, around 15.6 million abortions took place in India in 2015 and out of these around 12.7 million were medication abortions. The COVID-19 pandemic has resulted in women either undergoing unintended pregnancies, carrying a late-term or undergoing unsafe abortion methods or having to birth children against their choice.
Instead of giving priority to abortion care in the healthcare plan during the lockdown, many governments across the world did not consider this a matter of priority. Instead, they implemented measures that made the process of abortion more difficult than it was before. For example in the USA, some states introduced restrictions that account for effectively banning abortion care services. Similarly in Poland with the most restrictive abortion laws in Europe, controversial anti-abortion legislative norms were proposed during the lockdown.
While COVID-19 made abortion highly difficult for few regions in the world, it also gave rise to telemedicine. The United Kingdom introduced guidelines that allowed women and pregnant people to manage their own abortion. Under this regulation, people can book an online consultation with a registered medical practitioner in the UK to gain more knowledge on self-managed abortions and safely perform the process at home. Furthermore, people received the mifepristone and misoprostol pills at home by mail.
Though the regulation is temporary for only two years, it is seen as an effective option to be followed even after the pandemic. This could be followed globally as this method not only furthers the awareness for self-managed abortions but is also extremely helpful in a situation like a lockdown. This method could also be helpful in avoiding unsafe means of ending pregnancies. When a safe abortion method is not available, sometimes people resort to unsafe measures like ingesting herbal concoctions or medications from unknown sources out of desperation and helplessness.
People should be made more aware about methods of self-managed abortions or medication abortions by pills and in conditions like COVID-19, governments should include sexual and reproductive health in their crisis management plans. Many women have suffered from the unavailability of medical abortion pills during the pandemic and these conditions could be avoided by increasing the focus on abortion care.
This piece is written in partnership with HowToUse Abortion Pill, who works to share facts and resources about abortion pills – what to consider beforehand, where to acquire quality abortion pills, how to use them safely, what to expect, and when to seek medical help if necessary. They equip women with the information they need to safely navigate abortion on their own terms. Ally, the safe abortion assistant from HowToUse, is available 24/7 to support you through abortions with pills. You can speak to Ally in Hindi or English, and support is available through a free WhatsApp number +1 (833) 221-2559 OR directly on http://www.howtouseabortionpill.org/.
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