[Featured Image: A painting of a woman’s distressed face surrounded by medications and pills, with a colourful and busy background, done by Paloma Calo.]
Abortion rights have always been a topic of great salience and subject to lots of controversy. The question is on the definition of human life and is very much an ethical concern. I shall here discuss the place of abortion rights in a global movement for women’s independence and emancipation, the origin and diversity of existing methods to get an abortion, access and barriers to this fundamental right.
Abortion has always existed. But the social acceptance of this choice is very much variable among time and place. In the history of western societies, we can easily see religion as a very effective and compelling way to dominate women, starting by the control of the bodies and of individual health. But in our current patriarchal, capitalist world, domination of women finds very diverse paths: whether or not safe abortion is a guaranteed right in the country you live in, and if you want to get an abortion, you will be subject to external coercion. Whether it be pressure from family, your entourage or the implicit rules and diktats of the society you’re integrated in, there is an entire set of tensions that will influence the individual choice. Legislation of abortion should be there to guarantee the free will of the person in need of abortion, in a way that better suits the specific situation, away from variable convictions of the alterity. Abortion is an individual right, a personal, intimate and very unique experience: not two abortions are the same. It is why, not even considering external coercion and pressure, psychological support is so important and valuable.
Nowadays, we observe two types of countries: the ones who guarantee safe abortions, the others who criminalize it. It is worth noting that the WHO declared access to safe abortion a fundamental human right. In countries where abortion has been decriminalized, the path that led to such a legal protection started with access to contraception; still, the contraception pressure and incentive relies on the female. In France, 53 years after the decriminalization of the use of contraception (Neuwirth Law, 1967), female contraception is largely predominant, and the use of male contraception remains very marginalized because it is considered too dangerous. Guess what, female contraceptive pills are quite unhealthy too, and are the most popular and most prescribed contraception! *Oh, would men be less concerned about contraception because they feel and fear less the social incentive on family and sexuality? That’s a question we will not address here, I guess you’ll decide for yourself.*
Still in the case of France – but it’s generally the same scheme of legal process elsewhere – resort to abortion has been decriminalized, and authorised in some very specific structure, later on enlarged to private structures and from time to time, more practitioners were able to process abortions (medical, then instrumental). Still, it is very recent that people in need of abortion are not legally discouraged from it. Doctors have an unconditional right to refuse to process abortion for any personal or ethical reasons, and as the main authority in the room it might largely undermine the individual confidence in going through abortion.
Abortion is largely subject to external factors: the economic and social situation of the individual determines its needs of anonymity, emotional and psychological support. When the termination of pregnancy is controversial, -in the family, in the couple- practical access to the centre is a very essential matter. Yet, neighbourhood centres might only perform medical abortion, which is very limited in time. And if the person in need of abortion encounters difficulties in its own entourage, it is very likely that its autonomy in moving is constrained.
The question of choice is very central to the topic. What influences it, and how could we undermine the sequels of a potentially traumatic experience. Most of the time, the individual is in a situation of distress, and very much under the influence of the practitioner that decides of the possibility of abortion, and of the method processed. The very peculiar nature of abortion enhances the need for understanding and control of the process; to be the decisive actor and master of the different choices might be crucial in the aftermath of the termination of pregnancy, so that the reflexion on the process a posteriori isn’t shadowed by the potential influence of a third party.
In practice, public service often lacks resources and is restrained in the support of the individual requiring a termination of pregnancy. Private institutions are highly correlated with a better experience and satisfaction of the patient; they tend to be more recommended by GPs. But beyond the dichotomous debate around private and public services, and their differences in terms of support, advices, privacy and refund (when abortion services are totally refunded, which is not always the case), we now witness a growing debate around telemedical abortion.
Telemedical abortion presents the opportunity for the individual to resort to medical abortion at home, after online medical consultations. Depending on the condition of the individual, the medic prescribes some external exams (that can be realized in whatever medical centre) to ensure a medical abortion is safe. The individual can go have those required examinations and ensure that it has the necessary help in case hospitalisation is required along the abortive process. Medical abortion is a simple process: when it is the mental health that is at stake, the sensibility, confidence and comfort of the patient is of great importance.
Under the recent health crisis, telemedical abortion was legalised for the period of lockdown in France and England. In France, this right has been reviewed and banned as soon as the first lockdown ended. So, recourse to tele-medical abortion is very appreciated by individuals who do not benefit from a governmental system of safe abortion, and is a favourable alternative to traditional termination of pregnancy in countries where abortion rights are guaranteed, that favoured privacy and value the choice of the individual. However, it is despised by a large part of practitioners: the system appears dangerous, the individual might be lying and incapable of going through such an operation. But most of the time, it is because they do not know the formalities of tele-medical abortions that are proven to be safe by third party organisations. So, in acknowledging women’s right and choice when coming to their own body and health, tele-medical abortion is a great illustration of the lack of control of the person concerned over a potentially traumatic process: a fight for very basic human rights to defend their health is still needed.