COVID-19 and reproductive justice in Great Britain and the United States: ensuring access to abortion care during a global pandemic

Abstract

In this paper we consider the impact that the COVID-19 pandemic is having on access to abortion care in Great Britain (England, Wales, and Scotland) and the United States. The pandemic has exacerbated problems in access to abortion services because social distancing or lockdown measures, increasing caring responsibilities, and the need to self-isolate are making clinics much more difficult to access; and this is when clinics are able to stay open which many are not. In response we argue there is a need to facilitate telemedical early medical abortion in order to ensure access to essential healthcare for people in need of terminations. There are substantial legal barriers to the establishment of telemedical abortion services in parts of Great Britain and parts of the United States. We argue that during a pandemic any restriction on telemedicine for basic healthcare is an unjustifiable human rights violation and, in the United States, is unconstitutional.

Legal and policy responses to the delivery of abortion care during COVID‐19

“…In Cambodia, abortion may be carried out in a hospital, health centre, or clinic which is authorized by the Ministry for Public Health, which must have the capacity to provide emergency medical treatment and means of transport to hospital 32 . Similar laws are in place in several US states (including North Carolina, North Dakota, Tennessee, and Wisconsin) 5 . There are also policies by pharmaceutical regulators that further complicate the remote provision of these medicines.…”

“…Failure to ensure service provision has a ‘disparate impact on those with low or no incomes and or who lack housing, migrants, refugees, people with disabilities and adolescents and compelling pregnancy worsens health outcomes, particularly in the case of COVID‐19’ 3 . We have also argued elsewhere that the impact of barriers resulting from COVID‐19‐controlling measures are more likely to be experienced by people who are already structurally disadvantaged, have a disability which means that they feel less safe leaving the home, or have caring responsibilities 5 . There are concerns that vulnerable women who are victims of domestic violence and coercive control, or who are living in communities and cultures in which abortion is heavily stigmatized, will find abortion much harder to access as they struggle to leave the home without explaining to family members where they are going 5 .…”

“…TEMA has been found consistently to be safe, effective, and acceptable to women 18 . Because TEMA is safe, and because it can ensure access during this time, we have argued elsewhere that provision of this service is necessary 5 . In some places TEMA is being safely facilitated by local/national providers including Colombia, Great Britain, South Africa, and parts of the US.…”

“…First, in some countries there are explicit bans on the provision of TEMA. For example, some states in the United States (including Arizona, Arkansas, Indiana, South Carolina, and West Virginia) 5 . Some countries have also taken action to limit the assistance that might be provided to women by transnational abortion providers; the criminal process is sometimes utilized to punish those who are caught accessing care this way (this was a particular drive for aggressive prosecutions in Northern Ireland prior to the decriminalisation of abortion in 2019) 25 .…”

“…Some countries have acted (temporarily) to remove existing legal barriers to TEMA, namely a requirement that women attend a clinic in person to receive and/or take abortion medication, in response to the pandemic. In Great Britain, for example, abortion regulation was specifically relaxed in England, Wales, and Scotland to allow abortion providers to begin a ‘pills by post’ service 5 . In Ireland, there was a mandatory requirement that women attend two appointments with their primary care provider three days apart to access abortion, and the law specified that abortion may be carried out where the medical practitioner is satisfied that the pregnancy is less than 12 weeks of gestation ‘having examined the pregnant woman’ 35 .…”