Following the extended deadlines for having drug-induced abortions at home from 5 to 7 weeks of pregnancy, Alliance VITA, is sounding the alarm to protect human dignity.
Apparently the number of consultations and abortions has declined during the two-month confinement period. Nonetheless, does this constitute a “decline in guaranteeing women’s free choice to abort” as Family Planning claims? What a strange dialectical shortcut, rather a provocation, which hides a different reality.
Under pressure from activist groups, the new French Health Minister spoke of “an alarming drop in the number of abortions“, without providing any confirmation by quantitative analysis or proof that it is difficult to abort.
The “drop” in abortion numbers, which has yet to be confirmed, may also indicate that some women prefer to keep their baby, even in the case of an unplanned pregnancy during the COVID-19 infection. It is a fact that the pandemic and its’ risks may change one’s outlook on life.
In fact, pregnant women in confinement were much more concerned about having access to social services rather than to medical services (especially since abortion had already been designated as “emergency care”). This was demonstrated by the tedious work accomplished by Alliance VITA to provide pregnant women with a list of support centers that were still working, especially for victims of domestic violence, and for finding emergency shelters.
This is the context in which Alliance VITA challenged the State Council on the April 15th decree established by the Health and Solidarity Minister because the measures it contains put women at unreasonable risks. This decree extended the deadlines for having a drug-induced abortion at home from 5 to 7 weeks of pregnancy during the COVID-19 health emergency. In France, drug-induced abortions may be legally carried out at home until 5 weeks of pregnancy and, in hospital, until 7 weeks. Beyond these time limits, only surgical abortions can be performed.
Wrongly described as being less traumatic, drug-induced or “medical” abortions have both physical and psychological risks. The procedure involves taking two different drugs. First the woman takes Mifegyne® in the presence of a doctor or midwife, followed by misoprostol 24 to 48 hours later to expel the fetus. The latter is either taken at the hospital or possibly at home prior to 5 weeks of pregnancy.
What some women experience when they see the fetus expelled can leave a lasting memory. It is particularly difficult when it takes place at home. It is not uncommon for women to hesitate to take the second tablets.
Furthermore, beyond 5 weeks of pregnancy, the drug protocols are very explicit, due to increased risks, which explains why hospitalization is normally required. The more advanced the pregnancy, the more severe the pain, accompanied by an increased risk for heavier bleeding and hemorrhaging. A 2016 study on pain by “INSERM”, (French National Institute of Health and Medical Research) reported that one in four women experienced “very intense” pain on the third day post-abortion and had been worried about the bleeding provoked by the drugs. Another reason for contesting the decree is that abortion protocols beyond 5 weeks of pregnancy have been modified compared to those practiced in healthcare establishments. In particular the decree recommends for the woman to double the usual recommended dose of misoprotol, (off-label prescribing), although such doses are explicitly contraindicated in the 2018 guidelines for good clinical practice.
Forsaking women to solitude
The COVID-19 pandemic should not be exploited as a pretext to undermine women’s health and safety by increasingly trivializing abortion. Promoting drug-induced abortions at home beyond the usual statutory limits, while being confined, is violent: women are left alone and isolated. Another aggravating factor is that the decree also specifies that compulsory medical consultations can be carried out by video, usually by telephone. Afterwards the drugs prescribed for the abortion are dispensed by the pharmacy, directly to the woman; whereas previously, these drugs were only dispensed by a doctor or a midwife. Therefore, pharmacists are put on the front line, without any specific training, ordered to dispense medication, in some cases without medical marketing approval, thereby implicating their personal responsibility, especially in regard to young minors.
These new provisions reinforce the idea that the decision to carry out an abortion is innocuous. They disregard the violence of an act in which – we mustn’t forget – life is at stake.
Even when the confinement period ended, and abortion procedures were readily available at health facilities, on May 22, the State Council’s ruling prolonged the decree, thereby rejecting Alliance VITA’s request for suspending these measures.
Abortion is not inevitable
We cannot reconcile ourselves with family planning’s discourse of “an emergency takes precedence over reducing risks”. The argumentation of our request regarding the abuse of power for this decree is still being examined. The decree’s measures put pregnant women at a disproportionate risk instead of offering a better assistance to those who choose to continue their pregnancy and who want to avoid abortion.
The real health emergency is for pregnant women to have the support they need, to be kept safe, and to have the necessary assistance should problems arise. It is also essential to protect women from all types of violence. Among these acts of violence, it is sad to see an increasing pressure either from men or from near relatives who try to push women to abort.
The greatest affliction for pregnant women in 2020 is to be forced to abort, reluctantly, as if abortion was inevitable.