Civil Disobedience and Abortion Services After Roe v Wade: Legal and Ethical Considerations.

The future of Roe v Wade is uncertain. If it is overturned, protection of reproductive rights will be determined by the acts of individual state governments, some of which have already signaled that they will ban or severely restrict access to abortion. Health care professionals working in states that maintain the laws that applied in the time before the overturn of Roe may wish to provide assistance-anything from consultation to shipping medications-to women living in more restrictive venues. However, it is important for health care professionals to be aware of the legal consequences of those acts, as well as ethical considerations, when deciding whether to adhere to or to defy laws that they believe threaten the well-being of women. It is likely that legal consequences will vary with the type of act in which a physician engages. This article will review legal considerations, to the extent that they can be known at this point, as well as the ethics of civil disobedience.

State and federal abortion restrictions increase risk of COVID-19 exposure by mandating unnecessary clinic visits.

OBJECTIVE: To quantify the number of medically unnecessary clinical visits and in-clinic contacts monthly caused by US abortion regulations. STUDY DESIGN: We estimated the number of clinical visits and clinical contacts (any worker a patient may come into physical contact with during their visit) under the current policy landscape, compared to the number of visits and contacts if the following regulations were repealed: (1) State mandatory in-person counseling visit laws that necessitate two visits for abortion, (2) State mandatory-ultrasound laws, (3) State mandates requiring the prescribing clinician be present during mifepristone administration, (4) Federal Food and Drug Administration Risk Evaluation and Mitigation Strategy for mifepristone. If these laws were repealed, "no-test" telemedicine abortion would be possible for some patients. We modeled the number of visits averted if a minimum of 15 percent or a maximum of 70 percent of medication abortion patients had a "no-test" telemedicine abortion. RESULTS: We estimate that 12,742 in-person clinic visits (50,978 clinical contacts) would be averted each month if counseling visit laws alone were repealed, and 31,132 visits (142,910 clinical contacts) would be averted if all four policies were repealed and 70 percent of medication abortion patients received no-test telemedicine abortions. Over 2 million clinical contacts could be averted over the projected 18-month COVID-19 pandemic. CONCLUSION: Medically unnecessary abortion regulations result in a large number of excess clinical visits and contacts. POLICY IMPLICATIONS: Repeal of medically unnecessary state and federal abortion restrictions in the United States would allow for evidence-based telemedicine abortion care, thereby lowering risk of SARS-CoV-2 transmission.

2020 developments in the provision of early medical abortion by telemedicine in the UK.

The COVID-19 pandemic has necessitated the rapid implementation of telemedical health services. In the United Kingdom, one service that has benefitted from this response is the provision of early medical abortion. England, Wales, and Scotland have all issued approval orders to this effect. These orders allow women to terminate pregnancies up to certain gestational limits, removing the need for them to contravene social distancing measures to access care. However, they are intended only as temporary measures for the duration of the pandemic response. In this paper, we chart these developments and further demonstrate the already acknowledged politicisation of abortion care. We focus on two key elements of the orders: (1) the addition of updated clinical guidance in the Scottish order that suggests an extended gestational limit, and (2) sunset clauses in the English and Welsh orders, as well as an indication of similar intentions in Scotland. In discussing these two issues, we suggest that the refusal of UK governments to introduce telemedical provision of early medical abortion previously has not been based on health concerns. Further, we question whether it would be appropriate for the approval orders to be lifted following the pandemic, suggesting that to do so would represent regressive and harmful policy.

Legal and policy responses to the delivery of abortion care during COVID-19.

Access to abortion care has long been a global challenge, even in jurisdictions where abortion is legal. The COVID-19 pandemic has exacerbated barriers to access, thereby preventing many women from terminating unwanted pregnancies for an extended period. In this paper, we outline existing and COVID-specific barriers to abortion care and consider potential solutions, including the use of telemedicine, to overcome barriers to access during the pandemic and beyond. We explore the responses of governments throughout the world to the challenge of abortion access during the pandemic, which are an eclectic mix of progressive, neutral, and regressive policies. Finally, we call on all governments to recognize abortion as essential healthcare and act to ensure that the law does not continue to interfere with providers' ability to adapt to circumstances and to guarantee safe and appropriate care not only during the pandemic, but permanently.

COVID-19 and abortion: The importance of guaranteeing a fundamental right.

Because of the COVID-19 Pandemic many problems have emerged in the organization of the National Health Systems. In Italy, a very serious problem is emerging which needs a rapid solution. Italian women are finding increasingly difficult to access abortion. These difficulties are related to the organizational changes that have occurred in many hospitals due to the emergency COVID-19. A possible solution would be to resort to the procedure of pharmacological abortion which, however, in Italy, is characterized by many limitations imposed by law. To protect the right to health of all women will need a reorganization of abortion procedures in Italy with implementation of telehealth services.