Abortion in Europe: COVID-19 dusts off long-standing issues
Before and after COVID-19: how the health crisis affected abortion in Europe
Eleven digits populate the streets and the walls of Polish cities: 48 222 922 597. What do they mean? It’s a phone number that belongs to Kobiety w Sieci (in polish “women on the web”).
The latter is an association that helps women obtain information on abortions. From last year the number of web visitors to the Kobiety w Sieci website suddenly increased. Why is that?
In October 2020 the Polish Constitutional Court eliminated a law allowing abortions for fetal abnormalities which made up about one thousand of the annual abortions taking place legally in Poland. As a consequence, the only legal reasons remaining for having an abortion were rape or saving the mother’s life. It was not long before associations like Kobiety w Sieci and Abortion Without Borders grew in popularity and helped to find solutions by offering advice, delivering pills and arranging trips to other countries to perform abortions safely, but all of this would have not been possible without the free movement of people and goods in the EU. A similar situation took place in Ireland, where abortion was legalised only in 2018. Before that, a network in the UK guaranteed Irish women access to safe abortions.
It becomes immediately clear that making abortions illegal does not stop women from having them, on the contrary, it fosters the growth of an underground network within different countries, which is made possible thanks to the EU Schengen Treaty.
Unfortunately, not every woman has the privilege, the assistance or the possibility to access these services. Consequently many decide to resort to more dangerous and unsafe solutions, which can pose a threat to their health and even their lives. A sad example of this phenomenon has been provided by history and more specifically by Romania. When Ceausescu rose to power, he immediately decided to ban on abortions. These were still performed illegally by some doctors or even in households with no medical assistance and the consequences were horrifying as 9,000 women died due to unsafe procedures from 1966 to 1989 according to the paper The remarkable story of Romanian women’s struggle to manage their fertility, published by the East European Institute for Reproductive Health.
Even when there is no ban on abortion and 95% of European women live in countries where abortion is legal, there are still various problems and contingencies. For example, socio-economic status or cultural and religious background can play a significant role in preventing and stopping women from exercising their rights. But even in the absence of these problems a new major global event was about to disrupt and worsen an already alarming picture.
At the beginning of March 2020, European governments started to enforce restrictive measures to contain the spread of COVID-19 on the continent. National borders were closed, freedom of movement was limited, and local or countrywide lockdowns were imposed. These regulations had a severe impact on women who lived in countries or regions where abortion was partially or totally banned (among those: Andorra, Liechtenstein, Malta, Monaco, Poland, and San Marino), as it meant that they could not cross borders to reach adequate facilities that could perform this service. However, even in countries where abortion was legally allowed for medical and non-medical reasons, access to this service was hindered by the pandemic. As the number of infected people rose in Europe, hospitals and clinics suspended or limited the provision of this procedure due to a lack of personnel or reassignment of medical staff towards reserved to Covid-19 care, especially in countries where this time-sensitive procedure was deemed to be a “non-essential” service. A lack of centralized information about available providers and the modality of the dispensation of this service resulted in a heterogeneous response to this issue and left space for an individual interpretation of the regulations. Additionally, several countries still required multiple in-person visits and/or hospitalization to get an abortion, a practice which was burdensome for both overwhelmed hospitals and women themselves, as it meant that there was a higher risk for them to be exposed to the virus. On top of that, in countries such as Italy, where both a national and international travel ban were implemented, people had to justify their movements to authorities. This itself was a deterrent for women since it would have violated their potential desire to keep the pregnancy private. Moreover, one of the main issues concerning Italy is the vast presence of the so-called conscientious objectors. They are doctors, nurses and assistants refusing to perform abortions as it supposedly goes against their moral beliefs. They constitute 96.4% of all gynecologists in Molise, 88% in Basilicata, 83.2% in Sicily and 85.2% in the city of Bolzano with an average of 68.4% in Italy. Sometimes, it is almost impossibile to have an abortion in those geographical areas making necessary to move to other regions in order to get it. This becomes even more worrying when compared to other European countries. For example, the conscientious objectors in Germany make up just 6% of gynecologists, 3% in France, in Sweden or Finland they are almost non-existent.
Furthermore the pandemic also affected the market for contraceptives. On one hand, factories were forced to suspend or to rescale their production because of a shortage of workforce and raw materials. On the other, a fear of contagion and prohibitive costs hampered women’s access to these devices. As adequate treatments were denied or limited, women either had to carry on un unwanted pregnancy to term or resort to unsafe procedures.
The World Health Organization (WHO) recommended self-managed medication abortion, that is the use of misoprostol and mifepristone, to women who were less than 12 weeks pregnant and had access to formal health care if needed. However, not every European government took into consideration WHO’s suggestions. Women on Web (WoW), “a Canadian non-profit organization, providing help and information on safe abortion and contraception”, registered a significant increase in requests for medication abortion during the first lockdown in Europe. The rise in demand was observed in countries where the service was provided mostly in hospital settings and where strict stay-at-home regulations were enforced, such as Italy, Hungary, and Portugal, along with countries where abortion was not allowed or limited, like Malta and Northern Ireland (in this case, though, the demand levelled off after the government approved abortion services). In countries where abortion was available, but countrywide lockdowns were not implemented (Germany and the Netherlands), registered results were consistent with previous forecasts. In the case of Germany, compulsory pre-abortion counselling was provided via phone or online, but the procedure had to be carried out in a hospital or a clinic, raising all the problems mentioned in the paragraph above. However, there were virtuous examples. The UK completely reverted to telemedicine and approved self-managed abortion, providing also postal delivery of medication. France loosened restrictions and permitted home use of mifepristone and misoprostol, extending the gestational legal limit to 9+6 weeks, and allowing the use of expired prescriptions for contraceptives at pharmacies.
After all the final lesson is that limiting abortion by banning it or making it less accessible does not affect the demand for this service. On the contrary, the WHO estimated that a 10% drop in services related to sexual and reproductive health could result in 15 million unintended pregnancies, 3.3 million unsafe abortions and 29,000 additional maternal deaths around the world. Nonetheless, it is impossible to know the exact number of people who requested an abortion since records are not public. The United Nations stated that the denial of access to abortion represents a violation of human rights and, therefore, all barriers must be removed. When will governments fulfil their commitment to protecting their citizens’ rights?
by Silvia del Rizzo and Benedetta Stoiculiasa
