Telemedicine abortion as a tool for victims and survivors
Despite abortion being decriminalised in Northern Ireland in October 2019, and regulations in place shortly after, the battle for access to services is far from won. While each Health Trust currently offers Early Medical Abortion up to 12 weeks, and surgical services are being rolled out, Northern Ireland remains the only part of the UK and Ireland that has does not provide an abortion telemedicine service for women and pregnant people.
In the midst of a global pandemic, telemedicine emerged as a key way to sustain essential reproductive healthcare services as it avoided unnecessary contact which could have led to women, pregnant people and healthcare workers contracting Covid-19. Beyond the pandemic, telemedicine can help accommodate people who can’t travel to clinics for geographical reasons, as well as people with limited financial and transport means, people who have working and caring responsibilities, asylum seekers and migrants without travel documents and people in situations where coercive control and domestic violence are prevalent.
While telemedicine is a safe and effective solution for tackling unwanted pregnancy it can be particularly useful for survivors of sexual trauma and violence. Those in domestic violent or coercive control relationships have told us that they cannot simply walk into a clinic or travel without fear of repercussions.
Intimate partner violence is a risk factor for unintended pregnancy and abortion. There is a wide range of behaviour in abusive relationships that impacts reproductive choices, including by causing the pregnancy in the first place (for instance through rape, denial of access to contraception, or contraceptive sabotage) as well as restricting movement and contact with others, which can include calling or attending healthcare providers. Over a third of domestic violence cases start or worsen when someone is pregnant, 20% of women in the domestic violence charity Refuge’s services are pregnant or have recently given birth[1]. Several studies have cited the involvement of wider reproductive coercion reported by women seeking terminations of pregnancy, including one that said 13% of women in violent relationships said that pregnancy ‘had been imposed’ upon them (compared to 2% of women not in violent relationships)[2].
Easy access to telemedicine abortion care can mitigate immediate harm. For those living in abusive or controlling situations accessing in person appointments can be impossible, whereas Telemedicine can be done discreetly at home and allows someone living with violence to safely take the pills without having to reveal they had an abortion. This guards against reproductive coercion, including birth control sabotage and emotional blackmail.
Home abortion with pills would help ease many of the issues caused by intimate partner violence, rape, incest and coercive control. As well as addressing barriers to physically accessing appointments, some women and pregnant people may find it easier to disclose when in the privacy and familiarity of their own surroundings. In can go some way to helping victims and survivors regaining control of their lives after the crisis of an unplanned pregnancy when they make the best decision for themselves about whether to continue a pregnancy or not.
Large numbers of those who call Alliance for Choice are victims and survivors of a range of domestic abuse and violent interpersonal relationships, including financial and contraceptive coercive control. Forcing women and girls to become pregnant against their will by hiding or destroying their contraception (including cutting out implant from arms), by denying them the ability to leave the house alone and controlling their finances, means accessing an abortion can be dangerously difficult and terrifying.
It is absolutely crucial that abortion services are fully commissioned in Northern Ireland to prevent further harm to women and pregnant people here. We need the introduction of telemedicine and home use of pills in addition to the services already in place. Telemedicine is safe and effective, and already used by health services around the world. Aside from that, reputable providers Women on Web and Women Help Women have been conducting remote consultation and providing pills by post for at home self managed abortions for decades, often illegally, however following decriminalisation this option is available to victims and survivors in NI without breaking the law. Our abortion doulas are available to provide information and support for people self managing their abortion at home.
For up to date information on what abortion services are available visit the Alliance for Choice website here
For information on our Abortion Doulas visit the Lucht Cabhrach website here
About the author - Alliance for Choice believes everyone who needs an abortion should have free, safe and legal access in their own country, without stigma. We campaign for barrier free access to abortion, comprehensive, unbiased sex education for young people and an end to the harassment of people using reproductive health services
[1] Refuge Performance Report, 2017-18
[2] Hall M, Chappell LC, Parnell BL, Seed PT, Bewley S (2014) Associations between Intimate Partner Violence and Termination of Pregnancy: A SystematicReview and Meta-Analysis. PLoS Med 11(1): e1001581. doi:10.1371/journal.pmed.1001581
