What if you could abort an unwanted pregnancy in the comfort of your own home with a healthcare provider guiding you through the process over the phone?

As South Africa went into lockdown due to the Covid19 pandemic, Dr Melusi Dhlamini, an executive director at Marie Stopes Clinics, initiated these services for women who needed to terminate their pregnancies. This kind of abortion is called self-managed or self administrated medical abortion, sometimes called tele-abortions.

“We started this during lockdown — under level five of lockdown — so nobody was able to move around. And it was quite helpful for people because some people were stuck at home. And nobody wants to carry a letter that says Marie Stopes,” Dhlamini says. “They didn’t want to leave home without explaining to people that they are going to do an abortion and now the nice part about this was that all you had to do is just get a delivery at home.”

How it works

The World Health Organisation (WHO) defines self-managed abortion as a termination of pregnancy that happens outside a medical setting like a hospital or clinic without the direct supervision of a healthcare worker. It involves the insertion of either a combination regimen of mifepristone and misoprostol or a misoprostol-only regimen. These are normally used by doctors or midwives when performing the first-trimester termination of pregnancies.

Dhlamini says that it is imperative that the pregnancy is under nine weeks otherwise the medication will not work. In a call to the Marie Stopes call centre, a consultant on the other end of the line will determine if the abortion is viable through a series of questions. If the candidate’s case is suitable and the pregancy is less than nine weeks along, the agent then makes a booking. On the day of the appointment, a trained nurse will call back the person seeking an abortion.

The nurse will screen the patient again to make sure they are eleligibility for self-managed abortion and to exclude the risk of ectopic pregnancy, undesiarble drug interactions or excessive bleeding. The nurse also explains the procedure and answers any questions the patient may have.

After talking to the nurse, the person seeking an abortion can choose whether they want to collect the medication from a Marie Stopes facility or whether it can be couriered to them. Collections cost R1500, and R900 for students. Couriering the medication costs R1750.

The advantages of self-managed abortion

One of the benefits of self-administered abortion is that one can do it in the comfort of their home.

“The client can decide the kind of environment they want to be in or the kind of support that they want and the comfort that they need. It really gives people autonomy over the process,” Dhlamini says.

Self-administered abortions have the potential to expand the reproductive rights of women.

According to 2018 study published in the journal of Contraception, self-administrated abortion has the potential to both reduce maternal mortality and morbidity from unsafe abortion.

The study also says that in self-managed abortion ca help women in countries where abortion laws limit access to the services, creating community-level access.

“Ironically, in legally restrictive settings medical abortion is currently more under women’s control than in settings where medical abortion is used within the official healthcare system. In many countries with legal abortion, abortion pills are subject to strict regulations of supply and provision, with penalties for those that transgress those limits,” the study states.

Will the SA government go this route?

Although tele-abortions are not available in the public sector, Dhlamini says that the public health system could potentially implement these. But, it is a fight and activists are already pushing for implementation.

“They have the capacity to do it. One thing that I’ve realised with the project with that it’s actually quite easy to do,” says Dhlamini. “They have the option to use the postal services or patients can opt to collect the pill. South Africa has easy access to cellphones compared to many countries. It will even help reach the most remote places in South Africa who need abortion services.”

According to ministry of health, tele-abortions are not yet in the pipeline.

“The department acknowledges innovation and new information on the public domain, however, for the department to implement new innovation, there must be supporting documents as well as amendment of the current legislation,” the health department’s spokesperson Popo Maja.

Public health services are guided by the Choice on Termination of Pregnancy Act, which governs where, how and who carries out abortions.

“The department renders such service under the said script,” says Maja. – Health-e News