We must safeguard access to both medical and surgical abortion methods

The right to have an abortion continues to be denied, fought against, and rolled back in nations across the world. In the lead up to the first election since the right to the procedure was overturned, abortion in the US has been politicised to a frightening degree. This common and lifesaving form of healthcare is stigmatised, and we continue to see widening gaps in abortion access worldwide.

A new MSI report on abortion care1 sets out global trends. It shows stark numbers of unsafe abortions and increasing threats and abuse faced by abortion providers. Access continues to be restricted and denied in different ways—including, and needing more attention, a risk to the continued provision of surgical abortion. Giving women a choice of how they access abortion, wherever possible, is a crucial component of quality and person centred abortion care, and one we must safeguard.

Increased access to medical abortion has been transformative, cost effective, and, in many contexts, lifesaving. Its convenience is appealing given the simplicity of taking tablets to safely end a pregnancy. With the growth of telemedicine, the full abortion care pathway—including consultations, counselling, and prescriptions—can be given over the phone and pills can be delivered to your home. Medical abortion can be safely and effectively self-managed at home and can be a preferred option. Our research revealed that 66% of medical abortion patients in the UK2 and 84% in Ghana3 who used telemedicine during covid-19 would choose this pathway again if needed.

But research is largely focused on high income countries and investment and attention are increasingly directed towards medical abortion access. This means that insufficient resources are being put into maintaining surgical abortion services. Our report highlights the growing challenge of loss of access to surgical abortion, with less investment and fewer healthcare workers being trained in surgical methods.1 To better understand this problem we need to look at how the situation is unfolding globally.

Comprehensive abortion care, including surgical services, saves lives. This encompasses post-abortion care which is critical to treat women who experience a miscarriage or complications from an unsafe abortion. Low and middle income countries see 97% of unsafe abortions globally,4 with women resorting to methods like ingesting bleach or broken glass to end their pregnancies. There are at least nine million complications from unsafe abortions each year,5 and in many of these cases surgical abortion can be the difference between life or death.

A lack of surgical abortion services will limit access to abortion, as it remains the only legal method for ending pregnancies beyond the first trimester in many countries. Abortion rights are backsliding globally and unnecessary clinical and policy restrictions already block access in many countries. This means that women must overcome hurdles for safe abortion care including long waiting lists or the need to travel across states or internationally. Maintaining access to abortion beyond the first trimester is essential for many reasons—among them is to allow adequate time to seek care, as well as in cases of miscarriage or fetal abnormality.

Beyond medical reasons, some women simply prefer surgical abortion and taking that choice away is neglecting their right to make informed decisions about their own healthcare. Some opt for surgical abortion because it’s directly dealt with by a healthcare professional, it can be faster, and in some cases is more discreet. MSI reports an almost 50/50 split in people choosing surgical or medical abortion when both methods are available, showing the continued global demand for both methods.6 If someone is medically eligible for both—which the majority are—they should have the right to make a choice.

Expanding access to both abortion methods requires us to look across health systems. We must train healthcare providers across the public and private sectors, including on surgical methods and procedures for later term abortions. Health financing must support facilities with the supplies and skills needed to continue providing surgical care.

But it’s not just the infrastructure we need to embed—it’s also a commitment to give women choice. Providing regular psychosocial support and mentoring for abortion providers, using stigma breaking training tools, and fostering a non-judgmental, pro-choice experience for clients is paramount. It means providing accurate information about abortion methods and giving women the respect to make their own decisions about their body and healthcare.

Medical abortion continues to positively change the landscape of abortion care, greatly expanding access. But it’s a mistake to lose sight of the importance of maintaining surgical abortion alongside it—one that will cost lives. We must safeguard both methods as we continue to expand comprehensive and person centred abortion care to everyone who needs and wants it.