‘Harm reduction’ – a catchy slogan, but illegal

Kevin Duffy, independent public health consultant and former Marie Stopes director, ­­­comments on the international abortion industry’s attempts to justify its actions.

When your global strategy is to promote and enable self-managed medical abortion, even in places in which the national laws prohibit this, then you need catchy slogans to justify your actions to your supporter base.

How about these two:

• ‘Harm reduction’
• ‘Conscientious provision’

In most countries, even in those in which the abortion law is relatively permissive, there remains a legal prohibition on over-the-counter sale of abortion treatments, mifepristone and misoprostol, by pharmacies to women and the subsequent self-management of their own abortions by women away from approved healthcare facilities.

On International Safe Abortion Day, 28 September, Marie Stopes International held a public webinar to share data and learnings on how best to support self-managed medical abortion. MSI invited Dr Suchitra Dalvie, Gynaecologist & Coordinator of the Asia Safe Abortion Partnership, to present on the rights-based case for this.

Harm Reduction

In this clip, Dr Dalvie describes a harm reduction strategy to be one in which doctors and healthcare providers give information to women about how they can use misoprostol to self-manage their abortion, with instruction to come to the healthcare sector when they have any complications, where they will then be treated as though presenting with a spontaneous miscarriage.

The Guttmacher Institute when presenting its recommendations for the provision of induced abortion in countries in which it is highly restricted by law, says on page 43 of its report Abortion Worldwide 2017:

Consider whether it is feasible to implement harm-reduction strategies that have worked, such as giving women correct information about misoprostol but not the drug itself.

It is interesting to note that Marie Stopes International has gone beyond the initial recommended step of providing information, to also enabling the provision of the drug itself. In its 2019 annual report, MSI says that a target within its five-year strategy is to double the provision of medical abortion. It describes how its commercial sales channel is used to distribute products through local pharmacies and community-based distributors. In 2015, MSI reported that 80% of all abortion services it provided were through the sale of medical abortion treatments to local pharmacies and community-based distributors.

Harm reduction might sound nice as a public health slogan but in this context, it is being used to help make abortion providers feel better about themselves when breaking national laws.

Conscientious Provision.

Dr Dalvie reminds us that even if the law of the country permits abortion, a doctor can say “I will not provide an abortion because my conscience or my religious beliefs do not allow it.” This is conscientious objection, and it is legally accepted in most countries with permissive abortion laws.

She then turns this on its head and says that conscientious provision should also be allowed. This would mean that in countries like hers, where abortion is legally restricted, that doctors like her who think that women should be allowed abortion on-demand, should be able to act on their conscience and provide such a service.

The problem with this is that in the first case, conscientious objection is enshrined within the national law, whereas in her proposed case the doctor would be breaking the national law.

Conscientious provision is nothing more than a slogan, it has no legal footing.

The full webinar and slides presented are available online from Marie Stopes International.

All data sources used in this article were in the public domain and available online on the day of posting, 6 November 2020.