To ask Liz Truss to require Foreign Office Travel advice to include advice regarding countries that ban abortion where women may not receive appropriate treatment for miscarriage

[FannyCann]

Now that Roe v Wade has been overturned many of the states in the USA are likely to enact abortion bans. These laws may be so draconian that women are not offered appropriate care for pregnancy problems such as miscarriage and ectopic pregnancy and their lives may be put at risk. There have been recent cases of women dying or being put at risk in Poland and Malta.

People think the abortion debate is all about terminating an unwanted pregnancy but the scope of laws banning abortion impacts the practice of safe obstetric and gynaecology care that could be needed by any pregnant woman, including those who may be vehemently opposed to abortion themselves. It also means that practitioners who want to be able to offer women an up to date, fully evidenced service encompassing the full range of treatments that may be needed are likely to choose not to practice in states with draconian abortion laws. This further impacts women by reducing availability of qualified practitioners and treatment choices.

The fact is that women who travel to these countries could find themselves in a dangerous situation where they will not be given the appropriate treatment they could expect in the U.K.

It is really important that all women of childbearing age understand this. If you could be pregnant, or your daughter or friend is pregnant and they travel to one of these countries and develop early pregnancy problems or miscarry they could actually die.

So I have written to Liz Truss to ask that all foreign office travel advice is updated to include advice regarding those countries and states in the USA that ban abortion.

Here is my letter. Perhaps not one of my best but I've added some references and please copy and paste or improve it and also write to Liz Truss and anyone else you feel appropriate.

The Right Hon Elizabeth Truss MP
Secretary of State for Foreign, Commonwealth and Development Affairs and
Minister for Women and Equalities
House of Commons
London
SW1A 0AA

26 June 2022

Dear Ms Truss

On Friday the Supreme Court in USA struck down Roe v Wade, overturning the constitutional right to an abortion for millions of women in USA. Thirteen states had “trigger” laws ready to ban abortion within 30 days of the ruling and others will follow.

For women in the United Kingdom who have grown up with the knowledge that safe access to abortion is legal and free, it is hard to understand the extent of the implications of this ruling. Many of the laws that ban abortion, both in USA and in other countries which ban abortion such as Poland and Malta, are so restrictive that safe and appropriate management of common pregnancy related problems such as ectopic pregnancy and miscarriage is hampered by abortion laws.

I did not understand this myself until the 2012 case of Savita Halappanavar, who died of sepsis after she contracted infection during a miscarriage. The pregnancy could not be terminated as there was still a foetal heartbeat and in Ireland she was denied appropriate treatment that would have been given if she had been living in the UK.

I work in the NHS and am a qualified midwife albeit not working in maternity currently. I can remember much of the lecture on abortion that we received as students from one of the hospital consultants. Miscarriage and ectopic pregnancy were not mentioned during this lecture, they were topics for another day. This is perhaps one of the reasons why I, and many other women and health professionals do not understand that treatment for these conditions can be impacted by strict abortion laws. Previously the terms used for miscarriage included the word “abortion”, such as “threatened abortion”, “septic abortion” or “incomplete abortion”. These days, out of respect for mothers who are likely to be upset at the loss of a pregnancy, language has been updated so that the word “miscarriage” is used instead of “abortion”, eg “threatened miscarriage” or “inevitable miscarriage”. It is easy to fail to understand that treatment of these events may fall within the remit of laws that ban abortion.

People think the abortion debate is all about terminating an unwanted pregnancy but the scope of laws banning abortion impacts the practice of safe obstetric and gynaecology care that could be needed by any pregnant woman, including those who may be vehemently opposed to abortion themselves. It also means that practitioners who want to be able to offer women an up to date, fully evidenced service encompassing the full range of treatments that may be needed are likely to choose not to practice in states with draconian abortion laws. This further impacts women by reducing availability of qualified practitioners and treatment choices.

More recent cases that have occurred in other countries include that of Isabel Sajbor who died last September in Poland, after her waters broke at 22 weeks gestation, but doctors would not induce delivery of the foetus despite the pregnancy not being viable so long as the foetus still had a heartbeat. When they were able to treat her surgically it was too late and infection and sepsis were advanced such that she died soon after.

Meanwhile just last week in Malta, Andrea Prudente an American tourist who was miscarrying at 16 weeks was also denied appropriate treatment as the foetus still had a heartbeat. Terrified she might succumb to infection she had to battle with doctors to share her medical records with her insurance company so that she could be transferred to another country for treatment. Thankfully she has been medically evacuated to Spain and I believe has now had appropriate treatment.

I have checked RCOG guidelines for treatment for these sorts of cases in the UK and there is no reference to abortion law. All treatment is guided by medical need on an individual basis. However, if British women, who are pregnant (they could be in very early pregnancy and quite unaware) travel to any of these countries or states in USA with abortion bans, their lives could be put at risk if they develop an ectopic pregnancy or if they miscarry.

For this reason I am writing to you to ask, as Secretary of State for Foreign, Commonwealth and Development Affairs and Minister for Women and Equalities, that you require the Foreign, Commonwealth and Development Office to update all Foreign Travel Advice to include advice regarding abortion and women’s health so that British women of childbearing age can make an informed choice when travelling to these countries, and consider avoiding travel to them if they are pregnant or there is a possibility that they may be.

I would also ask you to raise this issue with Travel Insurance providers, so that they can give customers appropriate advice and ensure that medical evacuation or repatriation is covered and can quickly be arranged if women need it.

I hope you will recognise the importance of this demands whilst deploring the treatment of women in these countries.

Yours sincerely

References:

https://elearning.rcog.org.uk/sites/default/files/Early%20pregnancy%20loss%20-%20management/sagilitogg_2007.pdf

https://www.bbc.co.uk/news/uk-northern-ireland-203217411_

https://www.ekathimerini.com/nytimes/1186635/poland-shows-the-risks-for-women-when-abortion-is-banned/

https://www.theguardian.com/global-development/2022/jun/22/us-woman-left-traumatised-after-malta-hospital-refuses-life-saving-abortionn_

Here is a thread with further discussion and information regarding the problem.

When abortion is banned www.mumsnet.com/Talk/womens_rights/4572700-when-abortion-is-banned

Here are her contact details:

[email protected]

[email protected]

Thank you for raising this very valid concern and sharing your letter. It's a very important point.

Excellent letter.

That horrible situation in Malta should be enough of a warning

You absolute star OP ❤

If is a very valid point.

Female travellers need to know in which countries (and US states) they will or will not receive adequate medical care if they have a miscarriage, ectopic pregnancy or other unforseen gynaecological or contraceptive emergencies, and are in need of immediate urgent care.

And where they will not end up being interrogated, potentially detained, and have their lives put at risk.

This situation with the US has really brought it home to me how vulnerable women can be outside of GB. (Sorry, NI health service still needs to sort its shit out.) Guidance is needed.

The EU is a patchwork mess, too.

I’m a situation like the woman in Malta or Savita, could the mother be given antibiotics to protect from an infection taking hold as a precaution?

can I also ask why there was still a heartbeat if the she had a miscarriage?

I think your letter is a good idea. Well written, too. Thanks, OP.

I think this is a good idea. I remember the case of Savita Halappanavar. It made me wary of travel to Ireland in pregnancy and I missed an event because of it. That case terrified me.

This would be relevant travel information needed to make informed decisions about going abroad. It might also help women who need to travel for work, to say no.

Thank you OP. Although you are not currently working in maternity you are truly “with women”.

Women should have information on where they will and won’t be safe and well cared for in the event of an obstetric emergency when making travel plans.

Thank you @StridTheKiller and other kind posters.

I forgot to say but if copying the letter please could you edit out this paragraph:

work in the NHS and am a qualified midwife albeit not working in maternity currently. I can remember much of the lecture on abortion that we received as students from one of the hospital consultants. Miscarriage and ectopic pregnancy were not mentioned during this lecture, they were topics for another day. This is perhaps one of the reasons why I, and many other women and health professionals do not understand that treatment for these conditions can be impacted by strict abortion laws. Previously the terms used for miscarriage included the word “abortion”, such as “threatened abortion”, “septic abortion” or “incomplete abortion”. These days, out of respect for mothers who are likely to be upset at the loss of a pregnancy, language has been updated so that the word “miscarriage” is used instead of “abortion”, eg “threatened miscarriage” or “inevitable miscarriage”. It is easy to fail to understand that treatment of these events may fall within the remit of laws that ban abortion.

I had no idea about this. How worrying for women who may travel to these countries. Thanks OP for raising this.

What an excellent letter. Thank you for sharing it.

@Nolongerteaching I would hope that a woman in that situation would be being dosed to the eyeballs with IV antibiotics but without removal of the source of the infection that may not be enough. It is also possible that antibiotic regimes may be influenced by the abortion laws and the fact the foetus was still alive. I wouldn't know but I suppose it might be a factor.

The heartbeat may still be present and the baby could be born alive in a miscarriage but at 16 weeks as in the case in Malta of course survival is not possible. Some of the RCOG material I looked at gave advice about this - of course I can't find the relevant paper now .

Thanks Fanny, this is a really important point and needs to be explored further

It is a really important issue- thank you for raising. I travelled for work a couple of times when I was around 18 weeks and was thorough in checking what would happen if I needed anti d (I’m rhesus negative) and whether I’d be able to come back easily if I miscarried but I never really considered that I wouldn’t be able to access appropriate care if need be to save my own life. It’s a horrifying thought.

From the paper I linked, some explanation regarding updated language.

Looking at twitter and some of the conversation about Roe v Wade it appears the outdated terminology around miscarriage using the word "abortion" as in "incomplete abortion" is still in use in the USA or maybe that is intentional from some of the pro-life lobby, with a view to muddying the water and contributing to general misunderstanding of the issues around miscarriage and early pregnancy problems.

That was good planning @Bunnycat101

I must say, from my midwifery days I was sometimes amazed how some women didn't seem to have any appreciation of the risks of travel to some destinations. I recall one woman who was high up with an international high profile charity and was planning a tour of their African projects in various countries on the continent. There was much discussion about the risks of anti-malarials and which were safest to use in pregnancy. My first thought about these places would be "How good is the blood transfusion service, what if I need a blood transfusion?" I wouldn't have dreamt of doing the travelling she did during pregnancy.

It had never occurred to me until recently that one needs to consider abortion laws in some countries if one is pregnant.

Good letter. But Liz Truss is unlikely ever to see it.

The better option tactically is to write to your MP and ask him/her to raise it with Liz Truss.

That way, both your MP and Liz Truss or one of the junior Foreign Office ministers will see it.

Good point @Fifthtimelucky thank you. Will do.

Hmm. I’m going to write to my MP but I’m going to need to edit that information down a LOT. He doesn’t strike me as being a man with a very long attention span.

Good luck Jelly!

A thread from twitter of a woman who needed a 24 week abortion due to pregnancy problems. I don't know why she couldn't get the treatment she needed in New York, I suppose she must have gone beyond the term legally allowed there so despite being ill she had to fly to Kansas for treatment. The doctor who treated was shot sometime later. It's a horrendous thread. And again, a woman having difficulty obtaining the treatment she needed to save her life - in the U.K. this would have been done as a matter of course, giving safe obstetric management of a complicated pregnancy.

The situation for women in the USA is really horrendous.

twitter.com/sjohnsdottire/status/1540797614945439744?s=21

Great letter. I was taking to DH about Andrea Prudente and saying it’s not the sort of thing I would ever have thought to check when I travelled in the early stages of pregnancy

It's a brilliant lettee but ministers of state aren't obliged to pay any attention to letters from random members of the public. Everyone on this thread needs to write to their own MP with the text of this letter and aaking your MP to call on Liz Truss to do this. That's the proper procedure.

There are websites to help you write to your mp which can be found with a quick Google I think one is called writetothem and one is theyworkforyou

I'll be writing to my MP once I'm home about this, it's not something I'd considered. Thank you x