The news that safe abortion is likely to be illegal in the USA, in vast swathes of the Midwest and south, is chilling. The right to control what happens in one’s own body is a basic human right.
In this blog I would like to move the conversation on to how to continue empowering women to make choices over their bodies, through using great advancements in the science of women’s health, both in contraception and in abortion.
Abortion is never a first choice. It inevitably means that a woman (or teenager or even a child) has to make a choice to stop a bodily process which would lead to a new life, which if circumstances were right, might give great joy to the mother and her family and friends. Great advances in contraception have made it possible to prevent women and girls having to make that choice, because they can control their fertility more easily. I remember the old days when girls would get pregnant out of complete ignorance, and had no choice but to have the baby. Sometimes they wanted to keep that baby, yet the “morals” of the day dictated by religious institutions so that they would be punished for getting pregnant and had to give their children up for adoption. Some of those women are now telling of the awful effect on their lives. That was another form of misogyny practiced by old men in positions of power in the big Christian establishments, which was quite happy with young boys having sex but punished the girls who then got pregnant.
These days we accept that young people will have sex when they feel ready for it, and where there is consent and no coercion. So why not make sure that girls are protected at the start? In my view it should be completely acceptable for all girls at the onset of puberty to be fitted with a long term contraceptive in their arm. At the moment they can take the pill when they feel at risk of a pregnancy, but a long lasting hormonal implant would protect girls from the word go, and prevent the disastrous curtailing of their opportunities. The implant is over 99% effective, and lasts for 3 years, and can be taken out sooner if desired. It can help reduce heavy periods and is completely safe. So the question is “how can it be made more acceptable?”. In developed countries it would need education programs to advertise the benefits, which include preventing early marriage and economic benefits not only to the young girl, but also to the country as a whole. The cost, as now, would be born mostly by international charities. It will be hard in countries such as in Africa, as I have written about in a previous blog. Access to education for girls may be severely limited, and many are married before they reach their eighteenth birthday. It will be a long hard road, but activists are continuing their work.
As a result of the likelihood that Roe v Wade will be overturned in the USA, women are getting together to fight, not only in the USA but all over the world where abortion and contraception is restricted or prohibited.
The International Planned Parenthood Federation (IPPF) has published information about “safe at home” medical abortion services, which is being circulated world wide. It is not well known that a high proportion of very early abortions are now being organised on-line in many countries; the consultation with a doctor is done online and the drugs posted to the woman in her own home. The method is recommended by the World Health Organization and the FDA ,and is perfectly safe, with a protocol that involves taking two drugs, Mifepristone and Misoprostol, in tandem. The woman then has an early miscarriage at home. It was done legally during lockdown in the UK, up to 10 weeks gestation without attending a clinic. It is also done extensively in Northern Ireland, which refuses to organise abortion services. Of course sometimes it has to be done off the radar as anti-abortion activists will try to prevent it. But the situation in the USA and in many other part of the world is getting worse, with the rise in misogyny and sexual abuse, and we have to use such medical advances to fight the terrible consequences of making abortion impossible to get. So organizations such as “Liberate Abortion”* which gives information about abortion services and “Aid Access”* which gives practical help, are gearing up to expand even more for the USA. For the rest of the world, there is “Women on Web”* . There is a “Safe Abortion” app too.
Aid Access is run by Dutch physician Rebecca Gomperts and has provided a cheap and readily accessible telemedicine service to people in the USA since 2017, using a pharmacist in India who ships it to the patient in the US. India is the world leader in production of generic medication, and the drugs are of high quality, yet very cheap, so many more women can afford it.
Dr Gomperts says, “It is a medicine that should be available over the counter. It’s safer than many of the painkillers that you can buy in any pharmacy. The reason why it’s not possible has to do with politics and not medical science.” In richer countries girls are using apps to track their menstruation, so they know very early that they are probably pregnant. If there is a positive pregnancy test, then they can take abortion pills really early. Clinically it is indistinguishable from delayed menstruation, or slightly later, a miscarriage. The World Health Organization recently submitted advice that women can safely self-manage medical abortion until 13 weeks of pregnancy, so it really does empower more women and girls. Without the availability of such methods, women will turn to old fashioned methods of procuring an abortion which cause severe complications such as incomplete abortion with excessive blood loss and infection which often leads to death. And why should any politicians seek to control the intimate details of a women’s menstrual cycle? Often people with such views are the very ones who say that they are against the state having any control over people’s lives. What hypocrites they are!
So modern technology is definitely a force for good in allowing women to keep control of their own bodies, and fight off the challenges from groups that are anything but pro-life — they do not care about babies born into needless poverty once they are born, nor women who die because they are not allowed a timely abortion. The big challenge now is to spread these techniques to those who need them the most, women living in poverty in third world countries who are condemned to bear children that won’t have a future, especially if overpopulation and overconsumption mean that their homelands are disproportionately affected by climate change and they can no longer make a living. It will need more organizations like the ones above to distribute long term family planning to these areas, but education is key. Men and women need to know that these methods can guarantee a better life for all. A tall order of course, but the alternative is horrendous. A world with many Afghanistans with no rights at all for half the population, more fighting, more poverty. Not a future for anyone to look forward to.
Elen Samuel, doctor and writer 