Public call. On the Internationa Safe Abortion Day

On the International Safe Abortion Day, 28^th September, the Association of Abortion Accredited Clinics (ACAI-Spanish acronym), would like to point out that:

THE EXPANSION OF TELEMATIC MEDICAL ABORTION, WHICH HAS BECOME INCREASINGLY COMMON DURING THIS PANDEMIC, MAY END UP DEPRIVING WOMEN OF AN EFFECTIVE AND SAFE METHOD SUCH AS THE SURGICAL TECHNIQUE, LEAVING ABORTION USING MEDICINAL PRODUCTS AS THEIR ONLY ALTERNATIVE.

THIS POSSIBILITY WOULD PREVENT WOMEN’S MEDICAL, PERSONAL OR FAMILY CONDITIONS BEING TAKEN INTO ACCOUNT AT THE TIME OF ACCESSING ABORTION AND WOULD ALSO REDUCE THEIR FREEDOM OF CHOICE IN TERMS OF THE METHOD USED.

For this reason, the professionals at ACAI consider it essential that these two complementary methods, surgical and medical, are conserved and protected and call on the organisations for the Defence of Sexual and Reproductive Rights and on the Health Authorities to consider the following aspects:

• The voice of women must be heard. Women have the right not only to terminate their pregnancy or not, but also to choose the method they wish to use, in view of the week of pregnancy, their health conditions and their personal and intimate situation; even in times of a pandemic.[1]
  Women have the legal right to know about all available abortion techniques, so that they can take an informed decision.
  ACAI understands and defends the priority given to the medical technique in certain contexts and situations, amongst others: if women live in countries with restrictive abortion laws or if a woman has to travel a long way or overcome major bureaucratic obstacles to terminate a pregnancy. It is understood that these and other adverse circumstances often make the medical method the only safe option.
• We are aware that, in addition to the factors mentioned in the previous paragraph, there are other elements that support the medical method: the lack of training of professionals, the absence of generational replacement, ethical and/or professional conscientious objection and the interests of the pharmaceutical industry.
• However, ACAI considers it detrimental to women’s health and freedom that in countries where abortion is a free of charge, legally and socially supported health practice, recognised under the National Health System, albeit with access channels that can undoubtedly be improved, but which are legal and consolidated, one method be imposed over another. We consider this to be the case since:
• A woman has the right to choose her method of abortion, hence her view on the techniques must be considered. She has the right to be heard because it is her medical circumstances and her family and personal situation alone which ought to determine her choice.
• The two methods most commonly used in the health practice of abortion: medical and surgical are necessary and complementary to safeguard women’s health, as established by the WHO.
• Surgical abortion is the technique of choice for 70% of women, largely because of its effectiveness, safety, speed and low incidence of side effects and complications.[2]
• Whilst it is an effective technique, the failure of the medical method is between 3% and 5%, and in 1% of the cases of on-going pregnancy.[3]
• Health care providers who perform abortions must be trained in all abortion techniques so that they can offer both methods and deal with complications, failures, side effects, etc. If we want to provide a quality service, health care providers must be part of specialised units that will support the procedure, because abortion is a complex social and health technique that encompasses several aspects of women’s lives, a part from strictly health considerations, social, psychological and intimate (which implies preserving confidentiality) aspects must be addressed. All these aspects must be duly treated, understood and addressed, separately and in due time, with the help of professionals from various fields, endowed with experience, empathy and without prior moral or religious judgements.
• We run the risk of the medical method becoming a support for conscientious objection: The use of medical abortion could result in minimal involvement of health care providers in the abortion process, since it is the woman herself who «practically performs the abortion». The low medical involvement allows professionals who do not want to perform abortions to «solve the situation» by staying on the side-lines, as they could simply provide the corresponding doses of mifepristone and misoprostol. Thus, the generalised use of the medical method finds support among health care providers who oppose abortion, or among those who do not want to link their professional career to its practice.
• A woman who opts for the medical technique should receive adequate medical care. A woman must not only be supported medically before, during and after the process; she must also that her doubts and complications will be dealt with by the health care providers who have initiated the process and who should have the relevant specialisation.

We would like to conclude this public appeal, pointing out our respect for those women who freely choose the medical method for their abortion. However, recognising that for some of these women the first-hand control of their abortion is a means of empowerment, we believe that women’s real empowerment in this area lies in their decision to choose whether or not to terminates their pregnancy and to choose the method used. Additionally, we must not forget that many women wish to be accompanied face-to-face by health care providers during their abortion process. The latter’s medical experience provides them with security and confidence which is why they prefer an surgical technique. Let us respect their decision. Thus, imposing, limiting or giving a generalised preference to one of the two methods over the other are strategies that undermine women’s empowerment and are disrespectful of their freedom of choice.

[1] ^[1] Comparative study of the pharmacological and instrumental method in the termination of pregnancy. Users’ perception of the methods. https://www.acaive.com/pdf/ESTUDIO_comparativo_aborto_Farmacologico-Instrumental-Hasta-7-semanas.pdf

[2] ^] “Métodos seguros para interrumpir el embarazo ¿instrumental o farmacológico?” (Safe methods of terminating pregnancy: medical or surgical) Video on medical or surgical techniques https://www.youtube.com/watch?v=3JyiBb7Y9cg

[3] This is deemed a failure of the method as the continuation of the pregnancy or abundant bleeding with persistence of ovular remains require aspiration to solve the situation. In this regard, we would like to clarify that the international consensus considers an on-going pregnancy a complication in both medical and surgical abortion, as well as incomplete abortion that presents symptoms of severe pain, haemorrhage or persistent bleeding, requiring a new aspiration or new doses of misoprostol. Position endorsed by the WHO in its guide: “Safe abortion: technical and policy guidance for health systems». WHO 2012.

ACAI considers as «complications» those incomplete abortions that present symptoms: pelvic pain that does not go away with analgesia, excessive bleeding (haemorrhage) that has to be treated by repeating doses of misoprostol or by aspiration again and not those where only an ultrasound diagnosis of embryonic remains is made, but that are asymptomatic.