If you Google “abortion in Georgia” you may see news about the State in the U.S – where there are often threats to provision of abortion care. Here in Georgia the country, there is also certainly a lot of abortion stigma. Thankfully the law protects the right to end a pregnancy. Abortion is available on demand up to 12 weeks, and on medical grounds after that. Despite the law granting rights to abortion, we know that in reality many face numerous hurdles to access the service. This access has been even harder during the COVID-19 pandemic.
Three Clinic Visits Are Needed
In Georgia, if a person decides to opt for medical abortion (taking pills to end the pregnancy) they are first required to have an ultrasound to confirm the pregnancy. This procedure is followed by a five day mandatory waiting period and the final decision is considered only after this. There is a second in-person visit to a clinic to receive the medications to be administered at home. After completion of medication, there is another consultation. Ultrasound examination is conducted at this third in-person visit, in order to confirm successful termination of pregnancy.
However, an alternative method, which requires fewer visits to a clinic, already exists in the world. It is a simplified and more comfortable process, especially from the patient’s perspective. Besides this, it can save doctors’ time and improve access to the abortion service in general.
Remote Access to Abortion Pills During COVID-19
Recognising the huge strain on health services during the pandemic, and the difficulty many face in getting to health centres, many countries have made changes to the way medical abortion can be provided. In Great Britain, those seeking early medical abortions are now able to access ‘pills by post’. These are sent following an online/phone consultation with a health professional, with no need for any face to face visits. People have been able to access abortions earlier, which likely offers relief and is safer.
The World Health Organisation has recommended that “ultrasound scanning is not routinely required for the provision of abortion”. WHO advises that early medical abortions can be self-managed without the need for a healthcare provider.
Knowing this, we are working to try to improve the process in Georgia. We want to reduce the barriers for the people we work with who are seeking abortion.
Pushing For Better Access to Abortion in Georgia
Our 2019 study on abortion stigma, funded by the Safe Abortion Action Fund, showed that follow-up visits after medical abortion create financial barriers for many. This is especially true for those living in rural areas. They need to leave their families and work to travel far distances to big cities where abortion services are provided. Additional in-person visits also increase the intensity of communication with medical personnel. This can increase abortion related stigma, especially for members of the community who are already marginalized. This includes those who use drugs, who are living with HIV and/or who belong to the LGBTQI community.
An Innovative Study to Change Healthcare
This innovative model to be trialed in Georgia involves the following steps. After completion of the first clinic visit and following the five day mandatory waiting period, the patient will call the doctor to announce their final decision about termination of pregnancy. The doctor will explain all the necessary information related to self-managed medical abortion which primarily should be given at the first in-person visit as well. After that, the doctor will mail study participants the medical abortion pills and two multi-level urine pregnancy tests. This is a highly sensitive test to confirm that the abortion is complete, never before used in Georgia.
Partner organizations are going to conduct complementary trainings to increase our network of “friendly doctors” who fully understand the simplified method of medical abortion and its benefits. In case of success of the trial, data, evidence and relevant recommendations will be sent to the Ministry of Health. We hope this evidence and the recommendations will be reflected in the national guidelines for abortion and of course, implemented into practice. This is especially important during the ongoing COVID-19 pandemic, where so many are experiencing blocks and delays.
Real People Real Vision is a SAAF grantee partner.