Q&A: How MSF provides abortion care now

Medication abortion pills in Haiti

Haiti 2013 © Patrick Farrell/MSF

Doctors Without Borders/Médecins Sans Frontières (MSF) provides safe abortion care at many of its projects around the world and is working to expand access to these services to more people. While the legal and cultural landscape around safe abortion care continues to change, the clear medical need for it does not. As we mark International Safe Abortion Day on September 28, here is an update on our work and perspective on abortion care now. 

What are the medical impacts of criminalizing abortion, based on MSF's experience around the world? 

MSF has seen that regardless of legal restrictions, when safe abortion care is not accessible, women and girls* will often turn to dangerous methods to end an unwanted pregnancy. There is clear evidence that making abortion illegal does not reduce the number of abortions, it makes unsafe abortions—one of the top causes of global maternal mortality—much more likely. 

At MSF we see the complications from unsafe abortion on a daily basis when women and girls arrive at our medical projects needing emergency care after consuming poisonous herbs, chemicals, or medications without correct information; or with severe internal injuries from sharp objects. Some women die before arriving at a hospital; others need major surgery to survive, and some are left permanently disabled. In 2021, MSF cared for more than 18,339 patients with complications from unsafe abortions. 

As the link between restricting access to safe abortion care and higher rates of unsafe abortion has become better understood, more and more countries have liberalized their abortion laws or legalized abortion. The United States is an outlier in this global trend, moving backwards by imposing new restrictions on access to abortion while much of the world is moving forward. 

While few nations have complete bans on abortion, many countries, including many of those where MSF works, limit abortion while allowing it in cases where it will save the life of the woman or preserve her health. These exceptions can be challenging for patients and care providers to navigate and, as a result, it remains difficult for many people to access abortion services.   

How to ensure a safe abortion with pills

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Does MSF provide safe abortion care in the United States? 

MSF does not provide safe abortion or any medical services in the US at this time. Based on our medical expertise and experience treating the devastating consequences of unsafe abortion worldwide, we have raised concerns about the impact of US policies. We issued a statement when the US Supreme Court overturned Roe v. Wade, which had protected the constitutional right to abortion. MSF also spoke out repeatedly about the harmful effects of the Global Gag Rule, a US policy that forced health providers overseas to choose between providing information on abortion to their patients or receiving US funding.  

MSF is concerned that the loss of the constitutional right to abortion in the US will lead to terrible health outcomes for women and girls, particularly women and girls of color and those with limited resources to access care in states where abortion is not restricted. There is no reason to think that what holds true for the rest of the world will be any different in the US: Legal restrictions on safe abortion do not lower the number of abortions, they make unsafe abortions more likely. 

What does abortion care look like in MSF projects around the world? 

Working alongside national ministries of health or other non-governmental organizations, MSF aims to provide comprehensive reproductive health care, including contraception care, safe abortion care, prenatal care, deliveries, and postnatal care. Lifesaving treatment for unsafe abortions is also a critical part of reproductive care in the places where MSF works.  

Over the last several years, MSF has made a concerted effort to increase our provision of safe abortion. In 2021, MSF provided around 35,000 safe abortions in 33 countries. Most women choose to have an abortion with pills, an extremely safe method that can be done on an outpatient basis, does not usually require blood tests or ultrasounds, and can be administered by nurses or midwives. Guidance and information is provided before, during, and after the abortion so patients know what to expect and have the information they need to make a plan and identify any needs for support.  

We know that many people are not ready to make decisions regarding contraception when they have abortions, so the decision is up to them about when and if they would like to use a form of birth control. Psychological counseling is also an option. We know that there are often serious and detrimental consequences on people’s lives when they are denied access to abortion. Supporting abortion as health care is a powerful way to prevent poor outcomes and support the well-being of women. 

How do people find out about MSF’s safe abortion care services? 

Talking about abortion can be sensitive or difficult in many parts of the world, including most of the places where MSF works. Social stigma can prevent people from seeking care and talking about abortion openly. However, once abortion services have been established and MSF has gained the trust of women in the community, word often travels quickly from woman to woman.  

Community and peer workers can be essential for connecting hard-to-reach groups such as sex workers with MSF's services. These people are often reluctant to come for health services because of stigma and mistreatment they might have experienced before. If they learn about MSF's services from a trusted source, they are more likely to come for care. 

Why does MSF offer safe abortion care? 

For many years, MSF did not have a policy to provide safe abortion care. As a result, our staff witnessed the preventable deaths of women and girls in our projects around the world with no power to help. In 2004, MSF agreed for the first time that it was our duty to help reduce maternal death and suffering by providing safe abortion care where it is needed. We know without a doubt from our experiences that safe abortion care is health care. Today, MSF is striving to increase our provision of this care, to reach the people who need access to it, and continue to reduce maternal death and suffering. 

*While this article focuses on MSF’s experience treating women and girls at our medical projects, we recognize that all people who can become pregnant deserve access to safe abortion care–including people who identify as trans, nonbinary, and intersex.