Dr. Manisha Kumar is a family medicine doctor and the coordinator of the Task Force for Safe Abortion Care, a project that aims to increase access to contraceptive and safe abortion care services offered by Doctors Without Borders (MSF) projects
I became an abortion provider almost 10 years ago. Since then, I have helped countless people around the world access safe abortion care. I’ve also witnessed the devastating complications from unsafe abortion when people do not have access to this essential health care. Unsafe abortion is one of the main causes of maternal death and suffering worldwide, and the only one that is almost entirely preventable.
An abortion with pills is a game-changer. The simple regimen, taken over 24 hours, has the power to completely revolutionize access to safe abortion care, especially in low-resource and humanitarian settings, where Doctors Without Borders (MSF) works. Used by millions of people for over 30 years, we have decades of research and experience showing how safe and effective abortion pills are. They successfully end pregnancy more than 95 per cent of the time and the risk of severe, life-threatening complication is less than 1 per cent. They are inexpensive, easy to use, and so reliable that most people can take the pills at home without any problem.
Unfortunately, they’re also the best-kept secret about abortion, and many people still don’t know what an abortion with pills is, how it works, or how safe it is. Legal restrictions and bans, social stigma, and unnecessary medical requirements also limit access. These barriers disproportionately impact the most marginalized: black people and people of colour, the poor, adolescents, people living in rural areas, and those affected by crisis or conflict.
To increase access to safe abortion care, in 2017 MSF streamlined its protocols for an abortion with pills and removed routine medical testing, such as ultrasounds and blood tests. In MSF projects, safe abortion care is now essentially a conversation between two people during which accurate information is shared and pills are provided for the person to take at home. Since we started this new model of care, we’ve seen a rapid increase in the number of people we are able to care for: from 781 in 2016 to more than 30,000 in 2020.
We are now exploring ways to reach even more people and further support self-managed abortion with pills, which means obtaining and taking abortion medications outside a formal medical setting. It covers a spectrum of practices that have different levels of interaction with the health care system. Many people prefer self-managed abortion for a range of reasons, including increased privacy and confidentiality, more autonomy and control over the process, and easier access—especially if they live far away from a facility that provides abortions. There is growing evidence that self-managed abortion with pills is as safe and effective as facility-based care.
Health care providers and organisations can support self-managed abortion in several ways. For example, some MSF teams have worked with community health workers and peer educators to ensure people living in remote areas can access safe abortion care in their communities without having to travel to a health care facility. We are also piloting a telehealth hotline where MSF staff provide information and support for abortion over the phone.
From this experience, we have learned that you don’t need clinical tests, medical equipment, surgical capacity, or even a health facility to make an abortion with pills safe.
All you need for a safe abortion with pills is three elements: accurate information, quality medication, and mutual respect and trust.
Accurate information about an abortion with pills should be common knowledge—it should be easy to find by everyone. But this is not the reality, and misinformation and myths are everywhere.
To address this knowledge gap and share accurate, evidence-based information, MSF and HowToUseAbortionPill.org have created a new video series designed for anyone looking to learn more about an abortion with pills up to 13 weeks of pregnancy. The videos help people know if they can use abortion pills to end a pregnancy, how to use the pills, what to expect, when to seek additional care, and how to know if they worked. They can be used by people looking for guidance on how to safely self-manage an abortion, people planning to receive care at a health facility, those who simply want to better understand the process, and everyone in between. The videos are free, open access, use accessible non-medical terminology, and are available in 27 languages to ensure that as many people as possible can benefit from the information shared.
For reasons that have more to do with social norms and politics than patient safety or well-being, the second element, quality medications, can be difficult to come by. Even though they are on the World Health Organization list of essential medications, the quality, cost, and availability of the medicines vary considerably by country and location. There are some online resources that can help people find them, but in reality, abortion pills are so safe, important, and widely used that they should be as easy to access as over-the-counter medicines found in drug stores.
Mutual respect and trust is arguably the most essential element—and also the most elusive. It means challenging assumptions about people who have abortions, expanding our comfort levels, and trusting pregnant people to make their own decisions about the care they need and how they want to receive it.
To break the stigma around abortion and amplify the voices, needs, and lived experience of people who have had abortions, on International Safe Abortion Day, September 28, MSF is sharing first-person abortion stories from the places we work. We hear from people all over the world—from Colombia to the Democratic Republic of Congo, Greece to India, people of many religions, young and old, those with and without children—about their abortion experiences.
These stories challenge the tendency to reduce the abortion experience to a single narrative that stereotypes, blames, and stigmatizes those who have abortions. When we hear from people who have had an abortion in different settings around the world, we gain a deeper appreciation of how crucial and life-saving access to safe abortion care is. It also shows that people are already self-managing their abortions to some extent.
Our role as health care providers should be to make abortion care as safe, comfortable, and dignified as possible. This means enabling people to decide for themselves how, when, and where they have an abortion and with whose support, not being gatekeepers to this essential health careDr Manisha Kumar, head of MSF’s Task Force on Safe Abortion Care
Self-managed abortion is about more than increasing access: It's about upholding people’s autonomy and ensuring they can take the lead in their own care.
People everywhere should have access to respectful and safe abortion care.
The information and materials provided by MSF in these videos are intended for general information, general discussion, and education only. Nothing contained in these MSF materials is intended to be a substitute for professional medical care. By providing this information, MSF is not engaged in the practice of medicine, nursing, or the provision of any health care service.
MSF hereby disclaims any and all liability to any party for any direct, indirect, implied, punitive, special, incidental or other consequential damages arising directly or indirectly from any use of the materials shared, which is provided as is, and without warranties.
We hear from people all over the world—from Colombia to the Democratic Republic of Congo, Greece to India, people of many religions, students, midwives, people with children, and some without children.
Read them here.
To mark International Safe Abortion Day, September 28, we want to help break abortion stigma by sharing some first-person stories from women in the places where MSF works. We hear from people all over the world—from Colombia to the Democratic Republic of Congo, Greece to India, people of many religions, students, midwives, people with children, and some without children.
Read them here.