Saverio Bellizzi1, Anna R Ronzoni2, Giuseppe Pichierri3, Luca Cegolon4, Paola Salaris5, Catello M Panu Napodano6, Maura Fiamma7. 1. Medical Epidemiologist, Independent Consultant, Geneva, Switzerland. 2. Eastern Mediterranean Region, World Health Organization, Cairo, Egypt. 3. Kingston Hospital NHS Foundation Trust, Microbiology Unit, Kingston upon Thames, UK. 4. Local Health Unit N.2 "Marca Trevigiana", Public Health Department, Treviso, Italy. 5. Endocrinologist, Independent Consultant, Olbia, Italy. 6. Infectious Diseases Department, AOU Sassari, University of Sassari, Italy. 7. Polo Ospedaliero San Francesco, ASSLL, Nuoro, Italy.
An estimated 56 million induced abortions occur globally every year, of which 54.9% are unsafe.
This is a major public health issue, especially where access to legal abortion is highly restricted, resulting in an estimated 7.9% of maternal deaths annually due to unsafe abortion.Italy passed the Legalization of Abortion: Law 194 in 1978 in which the country set forth the regulations governing the procedures for obtaining induced abortions,
which now account for a rate of approximately 10 per 1000 women, similar to the rates of other countries in northwestern Europe. As reported by the Istituto Superiore di Sanità, the reduction of induced abortion in past decades appears to be related to improved uptake of fertility control methods and the important role of maternal and child health clinics.Health emergencies such as the current COVID‐19 pandemic are considered in national legislations to enable response activities that go beyond routine health control measures, such as restrictive quarantine strategies, re‐allocation of health resources, and minimizing elective and non‐urgent health services. While the Italian Government rapidly enacted such measures in March, no details were provided on how to conserve access to voluntary interruption of pregnancy. Concurrently, some ultra‐conservative groups have initiated an online petition to block women’s abortion rights by claiming that abortion is not an essential service during the pandemic.In France, the National College of French Obstetricians and Gynecologists (CNGOF) has called for remote consultations and medical abortions at home to be made available during the pandemic; similarly, in the UK the government recently approved the use of abortion pills at home to avoid the risks of women attending clinics.Medical abortion accounts for less than one‐fifth of the total pregnancy interruption interventions performed in Italian public hospitals, and is only considered an outpatient procedure in five out of 20 Italian regions.
However, the World Health Organization welcomes self‐management using the abortion pill without direct supervision of a healthcare provider during the first trimester and under specific circumstances.Improvement of women’s access to abortion care is warranted in the current epidemic situation through continued access to key services, with early medical abortion pills delivered to homes protecting women and healthcare staff from unnecessary facility visits.
AUTHOR CONTRIBUTIONS
All authors equally contributed to the preparation of the manuscript. SB had primary responsibility for final content. All authors read and approved the final manuscript.