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By Fòs Feminista
Spanish translation below.
Over the last two decades, the introduction of medication abortion has revolutionized abortion practice, offering a path to improving access to health care by putting the power to decide to end a pregnancy, and a safe means of doing so, in the hands of those who want or need an abortion. Self-managed abortion is the use of abortion pills (either mifepristone and misoprostol combined or misoprostol alone) to end a pregnancy without the need for a medical practitioner. Self-managed abortion is an avenue for individuals to terminate a pregnancy outside of formal medical settings. For medication abortion to be safe and effective, individuals must be equipped with information about how to use the medication properly,what to expect, and precautions to consider, including when it is necessary to seek medical care. Access to quality medication is also crucial. With these requirements met, medication abortion is an extremely safe way for individuals to terminate a pregnancy. In fact, the World Health Organization has included comprehensive abortion care, including self-care practices, in the list of essential health services that should be part of every country’s universal health coverage plans.
Self-managed abortion has disrupted the idea that medical providers are the only legitimate agents for abortion care delivery, and it contributes to a growing trend towards demedicalization wherein women and other people who can get pregnant have a central role in controlling their abortion process. In addition, the recently published Abortion Care Guidelines by the WHO provide strong scientific and political support for self-care abortion practices.
Fòs Feminista is a model for international feminist action and solidarity on sexual and reproductive health, rights, and justice. Led by Global South feminists, we collaborate with more than 220 partners in 40+ countries in every region of the world. Our partners are leading national providers of sexual and reproductive health services and community-based caregivers; advocates for sexual and reproductive rights at the subnational, national, and/or international levels and are grassroots groups working with marginalized populations. For decades Fòs Feminista has been supporting different self-care models for abortion practice through local partners worldwide who are working in diverse legal contexts. These models include: 1) legal abortion provision in clinics with medication techniques; 2) legal abortion provision of medication abortion through telemedicine; 3) harm reduction counseling in legally restricted contexts by health care teams, community health promoters, and feminist accompaniers, either in person on through digital platforms; and 4) orientation on safe abortion and access outside formal health systems by trained accompaniers who are part of feminist groups where abortion is hard to access or services are of poor quality. This work has shown that self-managed abortion is safe, can be applied in different models and contexts, and should be considered an essential part of health care to achieve universal health coverage for all.
At Fòs Feminista, we use the term abortion ‘care’ en lieu of abortion ‘services’ because care is focused on comprehensively and continuously ensuring the health and wellbeing of a person, placing them at the center of our work. Meanwhile, services are often a one-off measure of provider productivity, which does not fully reflect the fulfillment of a person’s specific needs across the care continuum and their desired health outcomes. In addition, we conceive abortion safety in a holistic sense for all people involved, including their physical and emotional wellbeing, as well as their social and legal safety.
Our work focuses on decriminalizing, destigmatizing, and demedicalizing abortion. Abortion seen from the self-care perspective is empowering and rooted in feminist practices of women supporting and accompanying women outside of the formal health system. It values the role of mid-level providers such as midwives, lay health professionals and community agents. It is also a path toward universal health coverage because it expands access to the most vulnerable populations, including those in legally restricted contexts as well as those who, despite more progressive legislation, still face obstacles in accessing quality abortion care, for example, conscientious objection by health care professionals. Without the ability to choose how one would like to handle a pregnancy, universal health coverage cannot be achieved as lack of access to abortion care limits individuals from taking control of their health.
Today, grassroots feminist organizations creatively leverage a variety of channels to share accurate, scientific information about abortion self-care with individuals. This information both contributes to the social decriminalization of abortion and also reinforces the safety of medical abortion.
We have made enormous progress in increasing access to and awareness of self-managed abortion, but we still face major hurdles in changing restrictive legal frameworks, making quality medication abortion widely available, guaranteeing the safety of abortion activists and accompaniers, engaging medical professionals in harm reduction counseling, expanding telemedicine, and reaching populations with limited or no Internet access. In the face of these challenges, we must continue to work collectively to find solutions both within and outside of the formal health system to legalize self-managed abortion and achieve UHC for all.
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A lo largo de las últimas dos décadas, la introducción del aborto con medicamentos ha revolucionado para la práctica de aborto, ofreciendo una vía para mejorar el acceso a la atención en salud poniendo el poder para terminar un embarazo, y los medios para hacerlo de manera segura, en las manos de quienes necesitan un aborto.
El aborto autogestionado es el uso de medicamentos (mifepristona y misoprostol o misoprostol solo) para interrumpir un embarazo sin la necesidad de un proveedor que realice la práctica. El aborto autogestionado es una vía para que las personas puedan interrumpir su embarazo fuera de un ambiente médico formal. Para que el aborto con medicamentos sea seguro y efectivo, las personas que lo requieren deben tener información sobre cómo usar el medicamento correctamente, qué esperar y las precauciones que deberían de tener, incluyendo cuándo buscar atención médica. El acceso a los medicamentos de calidad es crucial. Cuando se cumplen estos requisitos el aborto con medicamentos es una forma extremadamente segura para interrumpir un embarazo. De hecho, la Organización Mundial de Salud contempla los cuidados integrales para el aborto, incluyendo prácticas de autocuidado, en su lista de servicios esenciales de salud que deberían de formar parte de los planes universales de atención a la salud de todos los países.
El aborto autogestionado con medicamentos ha desbaratado la idea de que los proveedores médicos son los únicos agentes legítimos para la prestación de servicios de aborto y contribuye a una tendencia creciente hacia la desmedicalización en la que las mujeres y otras personas con capacidad de gestar tienen un papel central en el control de sus procesos de aborto. Además, las nuevas Directrices sobre la atención para el aborto de la OMS, proporcionan un fuerte apoyo científico y político a las prácticas de autocuidado del aborto.
Fòs Feminista es un modelo de acción y solidaridad feminista internacional en materia de salud, derechos y justicia sexual y reproductiva. Bajo el liderazgo de feministas del Sur Global, colaboramos con más de 220 organizaciones socias en más de 40 países de todas las regiones del mundo. Nuestras socias l son líderes nacionales en la prestación de servicios de salud sexual y reproductiva en la salud comunitaria. Son defensoras de los derechos sexuales y reproductivos a nivel subnacional, nacional y/o internacional y muchas son grupos de base que trabajan con poblaciones marginadas.
Durante décadas Fòs Feminista ha apoyado diferentes modelos de autocuidado para la práctica del aborto a través de socias locales en todo el mundo que trabajan en diversos contextos legales. Estos modelos incluyen: 1) Provisión de aborto legal en clínicas con técnicas medicamentosas; 2) Provisión de aborto legal con medicación a través de telemedicina; 3) Consejería en reducción de riesgos y daños en contextos legalmente restringidos por parte de equipos de salud, promotoras de salud comunitarias y acompañantes feministas, ya sea de manera presencial o a través de plataformas digitales; y 4) Orientación sobre aborto seguro y acceso fuera de los sistemas formales de salud por parte de acompañantes capacitadas que forman parte de grupos feministas donde el aborto es de difícil acceso o los servicios son de mala calidad. Este trabajo ha demostrado que el aborto autogestionado es seguro, puede aplicarse en diferentes modelos y contextos, y debe considerarse una parte esencial de la atención sanitaria para lograr la cobertura sanitaria universal.
En Fòs Feminista, utilizamos el término “atención” del aborto en lugar de “servicios” de aborto porque la atención se centra en garantizar de forma integral y continua la salud y el bienestar de las personas, colocándolas al centro de nuestro trabajo. Mientras tanto, los servicios son a menudo una medida puntual de la productividad, que no refleja plenamente la satisfacción de las necesidades específicas de la persona a lo largo del proceso asistencial y sus resultados de salud deseados. Además, concebimos la seguridad del aborto en un sentido holístico para todas las personas implicadas, incluido su bienestar físico y emocional, así como su seguridad social y legal.
Nuestro trabajo se centra en despenalizar, desestigmatizar y desmedicalizar el aborto. El aborto visto desde la perspectiva del autocuidado es empoderador y está arraigado en las prácticas feministas de mujeres que apoyan y acompañan a otras mujeres fuera del sistema sanitario formal. Este enfoque valora el papel de los proveedores de nivel medio, como las parteras, agentes de salud no especializados y promotorxs comunitarixs.
También es un camino hacia la cobertura sanitaria universal porque amplía el acceso a las poblaciones más vulnerables, tanto para quienes se encuentran en contextos con restricciones legales, así como para quienes, a pesar de una legislación más progresista, siguen encontrando obstáculos para acceder a una atención del aborto de calidad, como la objeción de conciencia de profesionales de la salud, por ejemplo. Esto evidencia que, sin la capacidad de elegir respecto de continuar o no un embarazo, no se puede lograr la cobertura sanitaria universal, ya que la falta de acceso a los servicios de aborto limita a las personas a poder ejercer el control de su salud.
Hoy en día, organizaciones de base feminista aprovechan de forma creativa diversos canales para compartir información precisa y científica sobre el autocuidado del aborto. Esta información contribuye tanto a la despenalización social del aborto como a reforzar la seguridad del aborto con medicamentos.
Hemos logrado enormes avances en el aumento del acceso y la concientización sobre el aborto autogestionado. Sin embargo, aún nos enfrentamos a grandes obstáculos para cambiar los marcos jurídicos restrictivos, lograr que el aborto con medicamentos de calidad esté ampliamente disponible, garantizar la seguridad de activistas y acompañantes en aborto seguro, involucrar a profesionales de la salud en el asesoramiento para la reducción de daños, ampliar la telemedicina y llegar a las poblaciones con acceso limitado o sin acceso a Internet.
Frente a estos desafíos, debemos seguir trabajando colectivamente para encontrar soluciones tanto dentro como fuera del sistema de salud formal para legalizar el aborto autogestionado y lograr la cobertura sanitaria universal para todes.
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