Misoprostol drug, the most common abortion pill

Reproductive rights

Catalonia’s temporary tele-abortion services are a game-changer for women with limited access

New legislation introduced during the pandemic in Europe, including Spain's northeast region of Catalonia, allows women to conduct nearly every abortion appointment online.

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Misoprostol drug, the most common abortion pill, Jan. 22, 2021.

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Victor R. Caivano/AP/File photo

When 41-year-old Ana Vargas found out she was pregnant this February, her decision to abort didn’t come easily.

Her experience with an abortion four years ago was unpleasant. She had to make the one-and-a-half hour journey by train three times for various appointments from her small Catalan town to Barcelona. She didn’t receive any information about her abortion options and said the doctor at the public hospital treated her with disdain. 

“When you make this decision, you want it to be over as quickly as possible. ... You don’t want to have to travel much or explain yourself to others.”

Ana Vargas, 41, Catalonia

“When you make this decision, you want it to be over as quickly as possible,” she said. “You don’t want to have to travel much or explain yourself to others.”

Related: In Italy, religious organizations' 'fetus graves' reignite abortion debates

This year, Vargas thought about the added stress of going through all of this again during a pandemic. But she soon found out that online consultations for abortion services in her region are now possible. 

When Europe went under a COVID-19 lockdown in March of 2020 and hospitals began to overflow, health care departments faced the dilemma of what to do with non-coronavirus patients in need of urgent care, such as people seeking abortions. Some European countries decided to alleviate hospitals by allowing online consultations for abortion services — including Spain’s northeast region of Catalonia, which has its own autonomous government.

In Spain, there’s a mandatory three-day waiting period for people seeking abortions; patients have to go into the clinic to fill out paperwork, and then again, three days later, for the actual procedure. Depending on the pregnancy, more appointments may be necessary.

But temporary legislation in Catalonia has now allowed people like Vargas to conduct every appointment, except for the abortion itself, online — essentially reducing the number of in-person visits to one. Vargas said that, for her, this made a huge difference.

“It was nothing like my previous experience,” she said. “This time, it was easier and more anonymous — and even quicker.”

Related: Abortion increasingly hard to access in Turkey

To facilitate the process, Vargas sought help from a reproductive health care organization, the Centre Jove d’Atenció a les Sexualitats (Youth Center for Sexuality). The center, set in a quiet Barcelona neighborhood, provides support and services for sexual and reproductive health care needs to anyone living in the Catalonia region.

“We received more than 400 calls between January and September of 2020,” said nurse Paula Barrante. “That’s compared to 250 for the same period the year before. So, requests for abortion services nearly doubled in the first six months of the pandemic.”

That’s not necessarily because more people were seeking abortions, she adds, but because health care clinics were overwhelmed with coronavirus patients, so people turned to centers like this one. Barrantes said 82% of the abortions carried out through the center during those months were done through telemedicine.

“We want this measure to stay in place permanently, because it makes abortion more accessible for people living in towns with limited services."

Paula Barrante, nurse, Youth Center for Sexuality

“We want this measure to stay in place permanently, because it makes abortion more accessible for people living in towns with limited services,” she said. 

Related: Abortion is a protected right in Spain. But the govt blocked a website that provides accesss.

Barrantes echoes what many abortion rights activists across Europe are saying, after more than a year of seeing results from abortion telemedicine. 

Countries like Great Britain, Ireland and France, which already had progressive abortion laws, implemented these measures as a way to ensure accessibility to abortion services during the pandemic.

In Great Britain, the government went one step further by allowing people to have medical abortion pills sent to their homes for self-managed abortions, as long as they are 10-weeks pregnant or less. While some right-wing Christian groups criticized the move, calling them dangerous “DIY abortions,” gynecologists like Jonathan Lord say telemedicine can actually make abortions safer.

“The evidence is just overwhelming and compelling that it is a better thing, it’s kinder, it’s safer, it’s more effective." 

Jonathan Lord, consultant, National Health Service, United Kingdom

“The evidence is just overwhelming and compelling that it is a better thing, it’s kinder, it’s safer, it’s more effective,” said Lord, a consultant for the UK’s National Health Service (NHS). 

Lord and his colleagues at the British Society of Abortion Care Providers looked at 52,142 medical abortions done last year through the NHS and found that the waiting period from referral to treatment for people seeking abortions through telemedicine was 4.2 days shorter than those going through in-person appointments. As a result, more abortions were provided at, or before, six weeks.

“It means they had less distress, because the earlier stage you do it at, the fewer the complications, and the less of an ordeal it is,” said Lord. 

Providing the option of abortion telemedicine through the public health care system also gave access to people who had previously been too vulnerable to attend in-person appointments because of barriers like geographical location or controlling partners. 

Lord said that, before the pandemic, the nonprofit organization Women on Web, which sends abortion pills through the mail to people who have difficulty accessing services, had been receiving 30 to 40 requests a month from people living in the UK. After the tele-abortion legislation was implemented, however, he said that number went down to “pretty much zero.”

“The more we can get people into the regulated health care sector, the safer they’ll be,” said Lord. “So that we can provide all the safeguarding, all the identifying the vulnerabilities and offering support there. Not to mention the other things that are very useful for patients, like access to contraception or health screenings.”

Earlier this year, the British government held a public consultation to study the possibility of permanently implementing abortion telemedicine — so far, it’s the only country in Europe to do so.

But in Spain, where most of the country did not have the option of tele-abortion, people continue to face barriers when accessing abortion, said senior attorney Aintzane Márquez from Women’s Link Worldwide.

“The experiences from countries such as the UK have shown that access to abortion through telemedicine is safe and effective, and it breaks a lot of barriers."

Aintzane Márquez, Women’s Link Worldwide

“The experiences from countries such as the UK have shown that access to abortion through telemedicine is safe and effective, and it breaks a lot of barriers,” said Márquez. 

“Telemedicine should not, or cannot, fully replace face-to-face care if women think that this is something that they might need. But the laws should adapt to these practices, and that is what we stand for.”

Nurse Paula Barrantes said abortion rights activists in Spain are focusing on other priorities in terms of expanding access, like getting rid of the mandatory waiting period and allowing people under 18 to abort without their parents’ consent.

It may be a while, she added, before Spain can think about permanently offering abortion telemedicine through its public health care system.

This story was produced in partnership with the International Women’s Media Foundation.
 

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