Episode #80 - Abortion

VGS   What are safe abortions? What are unsafe abortions? And when we restrict access to abortion, either legally or otherwise, does that reduce the number of abortions? Hello and welcome to Science in 5. I'm Vismita Gupta-Smith. We are talking about abortions today with our expert, Dr. Bela Ganatra. Welcome, Bela. Let's start with safe abortions. What are safe abortions?

BG   Basically, there are two ways in which this simple health care intervention can be provided safely, either through a procedure which can be done by doctors, nurses or midwives at a local health care center or by using tablets. Mifepristone and misoprostol are the tablets. And these tablets have been studied now for several decades, and we have strong evidence about their safety.

They rarely cause serious side effects and they do not cause any long term effects, like on fertility. So based on all of this evidence, we're now able to say that these tablets can be provided in a variety of ways: in a facility with a health provider, through interactions remotely via telemedicine, or if you're early enough in pregnancy that's less than 12 weeks, even through self-managing the process at home.

VGS   Bela, describe unsafe abortions for us.

BG   So the conditions under which I described safe abortions happen, can be compromised for example if the procedure is done by an untrained person or in the case of tablets, if we are not sure that there is access to quality medicines. We are seriously concerned about the problem of falsified and substandard medicines. Or if you don't have access to accurate information or backup support if you should need it or want it.

But further than that, we can come to the really dangerous and risky methods when people use all sorts of other medicines, chemicals, concoctions, herbal medicines that are either taken by mouth, injected or inserted into the vagina. At best, some of these are ineffective, but then they delay your access to time-sensitive, effective care, and at worse they can be seriously dangerous and even kill you.

VGS   Bela let's talk about situations where legally women don't have access to safe abortions. Does that impact the need for abortions?

BG   When you restrict access at the point at which women need care, you are not actually addressing the underlying reasons that brought them to seek the care in the first place. So no, there's no evidence that the rates of abortion, in fact, decrease in such situations. And what is actually concerning is what really happens when we drive the abortions that do happen from the safe towards the unsafe end of the spectrum.

Inequalities in access to care increase. And of course, some women and girls are affected much more than others. We also deny care altogether to some women, and that itself can be life threatening. And also we expose them to other risks because restrictions to access are often combined with laws that criminalize women. That is, women can be punished, prosecuted, even put in jail for simply seeking health care.

That's not right. But of course, there are ways to address this issue. The solutions are scientifically known as well. We need to be sure that women and girls and all individuals do get access to safe abortion when they need it. But this has to be within a comprehensive range of services, family planning and contraception to help prevent unintended pregnancies, sexuality education. In fact, the entire range of comprehensive sexual and reproductive health care. When we do this, when our policies center, the needs of individuals, when we put women and girls at the center of our decision-making, we care about their health we can eliminate the problem of unsafe abortion.

VGS   Thank you, Bella. That was Science in 5 today. Until next time then. Stay safe, stay healthy and stick with science.