International Campaign for Women's Right to Safe Abortion, London, United Kingdom.
Best Pract Res Clin Obstet Gynaecol. 2020 Feb;63:45-55. doi: 10.1016/j.bpobgyn.2019.07.012. Epub 2019 Aug 6.
At the conference "Developing an Advocacy Agenda for Abortion in the 21st Century and Making Change Happen" held on 5-7 September 2018, Lisbon, Portugal, organized by the International Campaign for Women's Right to Safe Abortion, it was argued that abortion services not only need to be treated as a bona fide form of health care but also completely reconceptualized, particularly because of the influence of medical abortion pills. It emerged, however, that there is no consensus on how this reconceptualization should be configured. Indeed, substantial differences arose, or so it appeared, complicated not only by different exigencies in national settings but also reflecting differing perspectives, specifically, those held primarily by health professionals compared to those held by advocates who felt they spoke for women needing abortions. In the course of these discussions, questions emerged on how much women should be able to do on their own, whether and why services were necessary in every case, where services should be located, what they should offer, who should provide them, and who should be in charge of the process. The biggest discussion was over the extent to which women can safely self-manage use of medical abortion pills for abortion in both the first and second trimester, and to what extent health professional control should be relinquished. Regardless of these arguments, however, since 1988 with the discovery in Brazil that misoprostol is an abortifacient, over-the-counter access to medical abortion (MA) pills began to put self-management of abortion on the map. Today, self-management is happening in almost every country, and we have no idea how many abortions are taking place anymore. Moreover, because of the work of safe abortion information hotlines, there is a growing body of evidence that self-management of abortion by women is safe - or at least far less unsafe than what prevailed in the past. Looking beyond the abortion rights movement, the crux of the issue is whether the state should continue to control abortion, with power over individual decisions delegated to the medical profession - or whether, as has been happening at a snail's pace for the last half century, and as with contraception and emergency contraception too - control can and should be more and more in women's hands. This paper examines these perspectives and attempts to describe what a consensus might look like. It concludes that convincing governments and conservative health professionals to accept a large dose of self-management will not be easy.
在 2018 年 9 月 5 日至 7 日于葡萄牙里斯本举行的题为“为 21 世纪的堕胎倡导议程而努力并促成变革”的会议上，国际争取妇女安全堕胎权利运动组织表示，堕胎服务不仅需要被视为一种真正的医疗保健形式，而且还需要对其进行全面重新构想，尤其是因为药物流产的影响。然而，人们认为，对于如何进行这种重新构想，并没有达成共识。事实上，似乎出现了重大分歧，这不仅因各国国情的不同而变得复杂，还反映出不同的观点，特别是医疗专业人员的观点与那些认为自己代表需要堕胎的妇女的倡导者的观点不同。在这些讨论中，出现了一些问题，例如妇女应该能够在多大程度上自行完成、是否以及为何在每种情况下都需要服务、服务应设在何处、应提供哪些服务、应由谁提供服务以及应由谁负责这一过程。最大的讨论是，妇女在第一和第二孕期内安全地自行管理使用药物流产的程度，以及应在多大程度上放弃卫生专业人员的控制。然而，无论存在这些争论，自 1988 年巴西发现米索前列醇具有堕胎作用以来，非处方获得药物流产（MA）药片已开始使自行堕胎成为可能。如今，几乎每个国家都在自行堕胎，我们已经不知道有多少堕胎了。此外，由于安全堕胎信息热线的工作，越来越多的证据表明，妇女自行堕胎是安全的——或者至少比过去安全得多。超越堕胎权利运动，问题的核心是国家是否应继续控制堕胎，将个人决定的权力下放给医疗行业——或者，是否像过去半个世纪以来缓慢发展的那样，也像避孕和紧急避孕一样，控制可以而且应该越来越多地掌握在妇女手中。本文探讨了这些观点，并试图描述可能达成的共识。本文得出的结论是，说服政府和保守的卫生专业人员接受大量的自我管理将不容易。
