Telemedicine abortion service to expand access to care

 Whomever you are and wherever you live in Aotearoa New Zealand, you have the right to end a pregnancy if you want or need to. One way to do so is through early medical abortion, which uses pills and allows for self-managed abortion at home. This option has been available via telehealth for some time but has become more common in recent years, especially since the start of the COVID-19 pandemic. 

 A new service called DECIDE, launched in April by the Ministry of Health, is helping to expand existing telehealth services and close overall gaps in access to abortion care. DECIDE provides consultations and medications for early medical abortions, along with related services, including consultations, information, referrals, counselling, and after-care support. This service cannot replace in-person care, which will always be necessary in certain cases, but helps to enlarge access to safe and timely abortion. This is a great step forward for equitable sexual and reproductive healthcare. 

 There is a growing evidence base on telehealth abortion services, especially due to its increased of rollout across the globe due to COVID-19 restrictions. International research shows that telehealth abortion care is extremely safe and effective. Self-managed medical abortion conducted by telehealth is just as safe and effective as when the procedure is completed in person at a doctor’s office, clinic, or hospital. This option is not associated with higher risks of complications compared with pills accessed in-office. In fact, only 2% of medication abortions result in complications, and most of those are minor. Plus, most patients report being satisfied with their experience.

The research also suggests several advantages to telehealth abortion services, namely:

  • allow more privacy and autonomy (avoid harassment, conscientious objection, disclosing choice if unsafe)
  • help ensure timely care
  • greater flexibility reduces burdens of cost, travel, and time
  • reduce pregnancy-related deaths

 

 Telehealth services are especially beneficial to those who may not otherwise be able to access abortion care. This may be due to low resources, disability, caregiving or work responsibilities, or geographical distances, especially if disclosing an unintended pregnancy is difficult or unsafe. Indeed, researchers report that barriers limiting abortion access most profoundly affect communities that already face health care and social inequities and can therefore widen existing socio-economic inequalities.

 It is also important to note that access to early medical abortion through telehealth ensures timely care. While abortion is among the safest medical procedures, the earlier it is done, the fewer complications there could be. Reducing wait times for abortion, which has been a major problem in the past, can also help alleviate some of the stresses associated with unintended pregnancy.

The country is already seeing higher rates of earlier access to abortion and the final rollout of the DECIDE services will hopefully maintain this trend and contribute to more equitable access to sexual and reproductive healthcare for all.

The Right to Choose is not Enough: A Cautionary Tale

The Right to Choose is not Enough: A Cautionary Tale

by Tracy Morison

Abortion on request has been legal for more than 25 years in South Africa. Yet, despite the country’s highly liberal laws, every year pregnant women die needlessly due to complications from unsafe, illegal abortions. These deaths make up about a quarter of the official avoidable pregnancy-related deaths counted by the Government, and they have increased in the last decade. Unfortunately, it is quite likely that some deaths related to unsafe, illegal abortion go unreported, so the number could be higher. Official estimates suggest that more than half of all abortions are informal, illegal and unsafe.

 Abortion stigma is a major barrier to access. Public sector nurses frequently chastise patients seeking an abortion rather than giving birth or for ‘using abortion as contraception’, or publicly humiliate them, or disregard their privacy and confidentiality. Some women would rather risk using a private but illegal service than become a social pariah among their communities or families, especially if they are young. 

“The underlying causes of morbidity and mortality from unsafe abortion today are not blood loss and infection but, rather, apathy and disdain toward women” 

(Grimes et al 2006, The Lancet).

Worse, the facilities that are supposed to offer services just don’t. Sometimes this is because no one is willing to offer services. As conscientious objectors they don’t have to. Sometimes there is a lack of political will to provide the support needed to keep a controversial healthcare service running, at the risk of alienating conservative voters.

At last count less than half of the clinics the government says should be available actually are. Some are under-resourced and some cannot find staff who do not conscientiously object. Clinics that are open are overburdened. A recent news article reported that pregnant women had to queue overnight at one clinic. Many people  simply don’t have the time, money, or freedom to travel to get public care or to access private care. Their only option then becomes an illegal abortion, which is sadly far more accessible. South African activists say that this situation is maintained by a conspiracy of silence.

The point of the story is this: the right to choose alone is not enough. They remain words on paper if they cannot be exercised.

The point of the story is this: the right to choose alone is not enough. They are just empty words on paper if the right cannot be exercised. The government must be held accountable for maintaining a system that supports people’s ability to exercise their rights and make choices about their reproductive lives.

So far, in Aotearoa New Zealand, we have seen some promise of this in the development of the new Telehealth Abortion service, DECIDE, which will increase access to care by allowing early medical abortion at home. Also promising is the strong cross-party support shown in the passage of the safe areas Bill—which will regulate harassment and intimidation of people accessing and delivering abortion care.

The right to abortion as healthcare was a hard-won right and one that cannot be taken for granted. It is imperative that services are literally, and not just theoretically, accessible; that service standards are upheld, offering patient-centred care; and that the rights of those who object to abortion do not trump the rights of others who choose it. It is up to us to speak up if something is not right or to report problems and concerns. It is up to us to ensure that we do not become part of a conspiracy of silence that makes our right to choose meaningless.

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 There are only data collected on cisgender women at present.