A Gynae's Perspective on Abortion Post Roe V Wade

TW: please be aware we’ll be discussing pregnancy, abortion rights, rape and adult/child death in this piece.

Post the repealing of Roe V Wade in the US, our Co-Founder Dr Sarah Welsh shares an expert perspective on the essential need for universal reproductive rights and reflects on her experience working in the NHS.

"Before launching HANX with my Co-Founder Farah, I worked in NHS gynaecology and obstetrics. During medical school, I realised how much I wanted to help and support women through key points in their life, such as problems with periods, during pregnancy, childbirth, fertility problems, menopause and much more so I went into this as my speciality. It was something I really enjoyed. I felt a great deal of empathy for my patients and it was extremely rewarding to make a difference in what could be such significant times in their lives. There’s a wonderful mix of medicine and surgery in O&G and the work is very varied. That being said, it can be extremely emotionally (and physically, at times) challenging, and is not a career for the faint hearted!

Why do people have abortions?

The United States Supreme Court’s landmark abortion ruling is atrocious. Repealing Roe v Wade will massively impact reproductive rights and women’s health - and is already. So many of us are horrified by the news of the 10 year old child who became pregnant after being raped and had to leave her home state of Ohio to access a safe and legal abortion. If we are unable to even have the autonomy to decide what happens to our bodies, what is the purpose of all other human rights?

I see so many hot takes on social media or in the news which carry a very narrow understanding of the motivations of people seeking abortions. “Unwanted pregnancy” is the reason we speak about the most, however, this can cover many different situations. Here in the UK at abortion clinics, we would ascertain whether the pregnancy would fall into any of the below categories:

 -   if it continued (and was less than 24 weeks in gestation), it would involve risk to the physical or mental health of the pregnant patient or any existing children of their family

-   the abortion is necessary to prevent grave permanent injury to the physical or mental health of the pregnant patient

-   if continued, and a child was born, there is substantial risk that the child would suffer from physical or mental abnormalities to be seriously handicapped.

Abortions can be carried out for multiple reasons, including the patient not being able to properly care for a child, to prevent the negative mental health impact from having a child, preventing severe health issues for the patient (such as high risk of stroke when pregnant) or the potential baby (such as severe genetic abnormalities). Working in abortion clinics, you see a vast variety of circumstances: pregnancy as a result of rape, being under 15 years old, not being ready for a family or the opposite - already completed their family, and many simply accidentally got pregnant. I would occasionally see patients who had just found out their unborn baby would be very unlikely to be born alive, or if it was, then it would likely die within hours or days. These patients opted for an abortion before the pregnancy got to that stage, for understandable reasons. Others had been advised by their doctor to have an abortion because the risk of the pregnancy posed significant health risks to themselves.

As doctors, we consider the patient’s wider social physical and mental health circumstances when assessing their will for an abortion. Put simply, the patient in front of us comes first. 

How do I get an abortion in the UK?

Abortions are accessible in the UK, but unfortunately there are still barriers, mainly due to the taboos around abortion. For some it is a straight forward decision, others less so. Many people feel that they will be judged when accessing care, are worried about seeking help or keep their own abortion private if they do have one due to persistent stigma. However, there are a lot of resources out there to support you, if you need an abortion here in the UK, and the staff in clinics staff treat patients with care and compassion. 

You are able to self-refer directly to an abortion care provider (such as BPAS or Marie Stopes), or you can see your GP who can refer you onto an abortion clinic. This is all free healthcare on the NHS. At the clinic, you will be seen by a healthcare practitioner who will ask you a few questions about your circumstances and medical history, then run through your options. You will be treated with respect and care and are able to change your mind at any point. 

You will be supported, physically, emotionally and psychologically. Remember, you’re not alone, and you always have options.

Learn more about what to expect here. 

Why is abortion still taboo?

Although we are seeing progress in breaking down stigmas around women’s bodies, abortion is still hugely stigmatised. Terminating a pregnancy can be a difficult topic, especially when the conversation involves circumstances such as rape, incest, maternal health complications, child abnormalities, the death of a child and beyond. Some who oppose abortion do so from religious, cultural or moral grounds, and actively campaign to make abortion illegal or use intimidation tactics, which can further put people off speaking about or seeking treatment. Those seeking abortion deserve the right to essential healthcare, without experiencing harassment at clinics, and equally medical staff deserve the right to support patients without harassment. 

It’s important that as a society, we speak more openly about abortion. The emotional impact that may accompany considering and going through with an abortion, as well as potential physical effect and mental health implications, mean that abortion care should not be something patients go through alone. However, the societal norm is to ignore that abortions happen, and deny open conversation about the realities and practicalities.

Abortion should be something we educate about as part of sex education, and speak more openly about in popular culture. A judgement-free perspective would not only help support those who have abortions, but also improve the accessibility of sexual, contraception and essential healthcare. Celebrities who have publicly speaken about their abortions help normalise the topic, and include Phoebe Bridgers, Keke Palmer, Lil Kim, Steve Nicks, Busy Phillips, Whoopi Goldberg and Susan Sarandon.

Similarly, opening up the conversation is important so as not to further stigmatise communities, or create disparity in healthcare access and care. This includes the language we use around reproduction, pregnancy and abortion care. With the repealing of Roe V Wade, there increased focus on its impact on the LGBTQ+ community, which has historically experienced discrimination and prejudice in a healthcare setting. Anyone who can get pregnant needs access to safe, legal abortion and that includes LGBTQ+ people, including queer women, transgender men and non-binary people.

Why is access to safe abortion is so important?  

You can’t ban abortion, only safe abortions. Abortions can be dangerous if not done properly with expert supervision. When there is no safe, legal medical care available, people will and do opt for so-called ‘backstreet abortions’ - and people all over the world die due to unsafe abortion attempts. Nearly every death and injury that results from unsafe abortion is entirely preventable. It is crucial that we have universal access to safe abortion care and support. We started HANX with the belief that it’s time the world stopped being weird about our sex lives. Championing sexual and reproductive rights is still central to our mission. We stand with all those whose access to abortion is restricted - and will continue to push for change, open conversation and the end of stigma around reproductive rights."

• Find out more about the practicalities of abortion from Dr HANX
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