Abortion: when telemedicine helps bypass restrictive legislation

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Abortion: when telemedicine helps bypass restrictive legislation

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Even in countries where it is not banned, abortion is a right that is disputed and constantly questioned. One can only see the passions it unleashes in Poland, Ireland, the United States, but also in France. The right of women to dispose of their bodies is far from being guaranteed, even in countries that allow it. And in many countries, it is still completely inaccessible, forcing women to consider other options for terminating an unwanted pregnancy. Tele-medicine services, such as Women On Web, are now emerging to help women get an abortion in secret.

The right to abortion mobilized nearly 80,000 people according to the Police, 100,000 according to the City Hall, in Warsaw on Friday, October 30. One of the most massive demonstrations Poland has seen in recent years.

The reason behind this popular discontent? The Constitutional Court, closely controlled by the PiS, the ultra-conservative ruling party Law and Justice, tried to restrict the right to abortion, even though Poland already has one of the most restrictive anti-abortion laws in Europe, before changing its mind in the face of the scale of the protest. This law intended to ban the voluntary termination of pregnancy (abortion) in cases of serious foetal malformation, ruling that it is incompatible with the Constitution. Once passed in the Official Journal, only abortions in cases of rape and incest or when the mother’s life is in danger would have been allowed.

But Poland is not the only country to want to restrict the right to abortion. Several countries are moving backwards when it comes to the right to abortion.


Abortion in the world: where do we stand?

Even in countries where it seems to be well established, the right to abortion continues to divide. One only has to look at the influence of the pro-life movements, or pro-life, in the United States but also in Europe. In France, the recent debate on the extension of the legal time limit for abortion from 12 to 14 weeks, voted in the National Assembly on first reading, has rekindled tensions and reminded us how fragile this right is.

As a reminder, abortion is totally prohibited in 26 countries. It is for instance forbidden in Malta in Europe, in several African countries such as Congo, Djibouti, Egypt, Madagascar, the Democratic Republic of Congo or Senegal, in several South American countries such as El Salvador, Honduras, Nicaragua, the Dominican Republic, but also in the Philippines and Laos in Asia as well as in Iraq. Other countries allow it only if it is a danger to the mother’s health or if the pregnancy is the result of rape or incest, as in Brazil, most states of Mexico, Côte d’Ivoire, Chile, Iran, Malaysia, Thailand and Indonesia. In the United Arab Emirates, Yemen, Saudi Arabia, Syria and India, permission from the husband and/or parents is required to perform an abortion.

Abortion is legal on request in 67 countries. And even out of these 67 countries, there are some limitations, such as the need to provide parental permission for minors, as is the case in Spain. Finally, the law can vary greatly from state to state in federal states such as the United States and Mexico.

Proof that the right to abortion is far from being won, 32 countries recently signed a joint declaration “for women’s health and family strengthening” tackling abortion. “There is no international right to abortion, nor any obligation on states to finance or facilitate abortion” they stressed in a charter signed by the United States, Brazil, Poland, Hungary, Egypt, Pakistan and Indonesia. This downward trend could further increase the number of unsafe abortions. According to the World Health Organization (WHO), 73.3 million induced abortions per year were recorded between 2015 and 2019. And according to estimates, 45% of them were at risk. Almost all of these unsafe abortions took place in developing countries, particularly in South and Central Asia.

The WHO estimates that between 4.7% and 13.2% of maternal deaths each year are due to unsafe abortion. For Hazal Atay, a researcher specialising in gender in the Middle East and North Africa and coordinator of the Women on Web project, which helps women to have an abortion in the most restrictive countries, tele-medicine makes abortion possible in places where it is currently prohibited or inaccessible.


Screenshot of the reproductiverights.org website / State of of the right to abortion in the world in 2020

The rise of medical abortion

There are currently two ways to have an abortion: surgically or by ingesting medication. This second option is called a medically induced abortion and can be performed in a hospital or at the patient’s home, with or without the presence of a doctor or nurse. Women who have a medical abortion are given two pills: a prostaglandin (misoprostol) to be taken 36 to 48 hours after an anti-progesterone (mifepristone).

In France and in most countries that authorise it at the patient’s request, medical abortion can be carried out until the end of the 5th week of pregnancy, i.e. a maximum of 7 weeks after the start of the last period. However, this period can be extended to 7 weeks of pregnancy or 9 weeks of amenorrhea. Surgical abortion can be performed until the end of the 12th week of pregnancy, i.e. 14 weeks after the first day of the last period. Medicated abortion causes cramping, bleeding and expulsion of the foetus. Effective in 92 to 96% of cases according to the French High Authority of Health, medical abortion presents little risk, so much so that the World Health Organization (WHO) estimates that it can be practiced safely at home up to 9 weeks of amenorrhea.


Women on Web is helping women who want to abort

Thanks to telemedicine, solutions are emerging outside the legal framework. Abortion is now only a few clicks away. “Women who want an abortion and have access to an internet connection can now get an online consultation quickly,” notes Hazal Atay, coordinator of the Women on Web project. Once patients have completed an online questionnaire, and if there are no contraindications, the abortion pills are mailed to the address chosen by the patient, which may be their home address, a friend’s home or a collection point.

In addition to offering a wealth of information and resources on abortion, the site provides a space for women who often have no other person to turn to, such as Kady*, a 21-year-old Malian student from Bamako. The young woman called on the services of Women on Web a few months ago when she found out she was a month pregnant: “I had no one to talk to about it. I couldn’t confide in my friends, my partner or my parents. “Here it is illegal to have an abortion and very dangerous to do so. I was in a relationship with someone, we wanted to get married, but my father refused to marry us, so I had no other choice,” she continues.

The lockdown and the Covid-19 crisis have further complicated access to abortion in France and throughout the world. For Emily*, an American living in Mexico, Women on Web provided a solution to a situation that seemed desperate. “I live in the state of Oaxaca in the south of Mexico. Abortion is only legal in the state of Mexico. But with the Covid crisis, the states were on lockdown, public transport was at a standstill. It was impossible for me to go to a clinic in the capital,” she explains. “I found myself alone, unable to talk to my Mexican husband, who comes from a very traditional family.” For Emily, the procedure was easy: “I took the medication, I bled and had a stomach ache for several hours, like a painful period. The next day I was back at work, and a few days later I was back on my surfboard.


A solidarity initiative to circumvent bans

Since it was established in 2005, Women on Web has helped some 100,000 women to have abortions in countries where it is restricted or prohibited. And the numbers have been rising in recent years. In 2017, 8,728 women underwent an abortion thanks to Women on Web. In 2018, there were 10,513 and in 2019, 13,000. This upward trend is due to the fact that many countries, such as Poland and the United States, are falling behind in terms of abortion rights. Patients who use the services of Women on Web are invited to make a donation of at least €70. This funding is then used to feed a solidarity fund, which helps other women who do not have the financial means to deposit such a sum, like Kady.

The content of the site is translated into 17 languages, including Tamil, Farsi and Tagalog, and the hotline is available 24 hours a day. However, access to the site is blocked in several countries such as South Korea, Brazil, Iran, Spain, Saudi Arabia and Turkey. To get around this censorship, women can use the Safe Abortion application on their smartphone or visit one of the twin sites of Women on Web.

*First names have been changed to preserve the anonymity of the women who agreed to testify.


Through these Stories, Azickia aims to highlight social impact initiatives, in France and around the world, while not necessarily adhering to all the opinions and actions implemented by them. It is and will remain in Azickia’s DNA to fight against all forms of discrimination and to promote equality for all.

Creative Commons LicenseThis work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivs 3.0 France License.


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