Accessible abortion: The drug mifepristone (above) allows women to self-terminate their pregnancies. (Phil Walter/Getty Images)
WOMEN’S HEALTH
The Covid-19 crisis has disrupted almost every aspect of life, but not sex. Both wanted and unwanted intimacy occurs during a pandemic. With reduced mobility and less access to clinics and hospitals, ensuring quality and timely reproductive healthcare is more important than ever.
The virus has highlighted stark inequities in medicine — and not only in emergency care. Even before Covid-19, adolescent girls, migrants, minorities, people with disabilities, and LGBTQI+ people faced discrimination in doctors’ waiting rooms.
The crisis is an opportunity for policymakers to support initiatives that give women and girls more power over their immediate needs and improve access to critical services in the long term.
The first priority is to make oral contraceptives available over the counter. This will increase safety, access and use. In most countries, a prescription is required, which prevents women from being fully in control of their bodies. This may also interfere with a patient’s access to care free of abuse or privacy violations. This is especially true for teenagers, gender-nonconforming people, domestic-violence victims, and others who fear discrimination or disrespect in clinical settings.
The benefits of making contraceptives more widely available far outweigh the low risks. Evidence shows that women and gender nonconforming people can screen themselves for counter indications using simple checklists that accompany medication.
Permitting people to obtain a year’s supply of contraceptives, so they can self-administer injectables such as Depo-Provera would benefit those in violent situations and others who may struggle to access healthcare. Eliminating third-party authorisation requirements and lowering costs for contraceptives would help, too.
Second, we must make abortion more accessible. Regressive policies and recent lockdowns have made in-clinic abortions less available, even though this is an essential medical procedure. Policymakers can and should take simple steps to eliminate unnecessary obstacles to abortion using pills, which would expand women’s freedom and reduce clinic visits.
Medical abortions are safe and effective. Millions of women self-terminate pregnancies every year, whether using a combination of mifepristone and misoprostol, or misoprostol alone. There is no need for an office visit.
People seeking abortions can assess whether they are eligible, follow instructions on correct dosages and determine if the abortion is successful. All they need is accurate information, medication and access to back-up healthcare if necessary.
The best way to increase abortion access is to make mifepristone and misoprostol available over the counter. At a minimum, policymakers should make them easier to attain through telemedicine. This is viable and safe as long as consumers are educated about what to expect and can receive post-abortion care without judgment, stigma or fear of prosecution. People who self-manage their abortions should not be harassed or penalised.
Quality maternal care also is crucial for women in the coronavirus era. Pregnant women face the same stresses as everyone in a pandemic. They face possible job insecurity, loss of income, health-coverage changes and threats to their health. And then there are unique concerns about the health of their foetuses and newborns.
In many places, overburdened healthcare systems can’t provide pregnant women with the level of maternal care they expected — and received — before the pandemic. To address this gap, practitioners should help pregnant women practice greater self-care by providing the right tools and information, such as telemedicine, online education, home visits by midwives and other providers, psychosocial support and ample screening.
These measures will ensure that pregnant women can better monitor their own health, manage common symptoms, identify signs of complications and know when to seek care. And when they do, they must be able to travel to healthcare facilities, even where lockdowns are enforced. This means ensuring emergency transport and personal protective equipment for pregnant women and those who accompany them.
Moreover, policymakers should expand initiatives that demedicalise birth. Attended home births for low-risk pregnancies, the guaranteed presence of midwives, dedicated birthing facilities linked to tertiary care and home visits for antenatal care help to ensure safer deliveries for mothers and providers alike. Many countries have emphasised institutional care, even though demedicalising childbirth is beneficial in the best of times, not just in a crisis.
We must avoid enacting knee-jerk measures. It would be regressive to restrict or ban partners or doulas from labour; separate infants from mothers who have, or are suspected to have, Covid-19; or interfere with early skin-to-skin contact, including breastfeeding. The World Health Organisation has urged providers to refrain from such measures while caring for pregnant women, parents and infants. This is critical to prevent an increase in obstetric violence or worse outcomes for women and their newborns.
Governments that do not eliminate barriers to care risk fractured health systems that cannot tend to everyone’s needs. In the long term, investments in self-empowerment will strengthen health systems and the quality of care. With education and support, people can manage their sexual and reproductive healthcare needs. Policymakers need to give them the power and tools to do so. — Project Syndicate
Shannon Kowalski is director of advocacy and policy at the International Women’s Health Coalition