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_

A miscarriage isn't something that takes 10 mins. It is a process whereby the woman's body ejects the contents of the universe, in the same way a period takes several days.

It's possible to lose most amniotic fluid and uterine lining but there still be a heart beat, the pregnancy cannot continue, in most countries drugs or even surgery can be used to speed things up.

Great letter OP.

I think there needs to be a clause in the Equality act so that employers cannot force pregnant women to visit those countries as part of their work.

Excellent thank you for doing this

Thanks very much - I will email my MP about this.

I never really considered these implications. I went to Poland (13 years ago) and Ireland whilst in early pregnancy. We just take it for granted that we'd get medical care if needed. But the sad fact is we won't.
It's hard to accept how many countries we are literally 2nd class citizens.

I think it has passed English women and their families by, just how vulnerable they could be in other countries, even those in the EU.

It's not simply a matter of religious preference as to the type of pregnancy care one might receive in another country - it can be a matter of law, and of life and death for the pregnant woman with her at the bottom of the pile.

Thanks for the reminder @BuanoKubiamVej
I've written to my MP too.

Most importantly I really want women in Britain to understand the risks of travelling to a place with strict abortion laws - it could be a matter of life or death. We need to make sure our daughters and their friends know. I hope people reading this thread spread the word.

Today at my work I plan to request the NHS Trust I work for our out a statement so that hopefully midwives and maternity staff can refer to it and give women some travel advice.

I think it's also important that people learn to look for the laws in the places they are visiting. not everyone checks (whether by FCDO travel advisories, or any other source) and every year there are people who end up in awful circumstances, whether by accident or by recklessness.

So as well as bumping this thread can I urge people to check before booking about laws and norms at their potential destinations?

There's an underlying point as well, if your travel is by choice (eg holiday) about whether you would want to support the economy of places with policies you deplore

@sashh makes an important point:

I think there needs to be a clause in the Equality act so that employers cannot force pregnant women to visit those countries as part of their work.

Very important letter OP.
Also what about women in other situations going to the US to try to get pregnant? Some people travel to the US for fertility treatment because some things are allowed there, which wouldn’t be allowed here, like IVF with sex selection? What if they needed an abortion for some reason while they were there?

Or what about people travelling to the US for surrogacy- like to be there when they try to get a US-resident woman pregnant under a surrogacy contract?

Or what if she was already pregnant as a surrogate before Roe v Wade fell on Friday? (Does the loss of the option of abortion render any existing or future surrogacy contract unfair depending on what state it’s in, or even in all of them because women can’t be required to not leave a pro-choice state for the entirety of the whole pregnancy- surely??)
What happens now if the woman who is pregnant as part of surrogacy needs an abortion?

And what about UK women who are travelling to the US to be a surrogate over there, maybe because there is no legal cap on the payment they can receive and there’s contractual non-motherhood from birth in some US states, or any other reason? Same issues will apply.

This is so awful and backward and so far-reaching into every choice that women of reproductive age can make. It’s not just about abortion, but also women being able to live our normal lives with the same choices we should be able to expect to have had before they took the right to abortion away. But I suppose that’s the very point of doing this. Stopping women in their tracks. It’s barbaric.

An adapted version of the OPs original letter appropriate for sending to MPs, with some additions from this thread:

Dear

I am writing as one if your constituents on a matter which could affect many of your female constituents.

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.

You may be aware of 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.

Miscarriage and ectopic pregnancy are talked about with a very different vocabulary than abortion. This is perhaps one of the reasons why many people 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. Equally, emergency contraception is sometimes also banned by anti-abortion laws.

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.

In 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.
Many women of childbearing age might regularly be required to travel to any of these unsafe countries as part of their employment, with no particular reason to suspect that they might be pregnant, and find themselves seriously ill and at risk with no access to appropriate healthcare.

For this reason I am writing to you to ask you to raise this issue with the Secretary of State for Foreign, Commonwealth and Development Affairs and Minister for Women and Equalities, that she should direct 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. Women need to be warned if they are about to go somewhere where they run a risk of being interrogated, potentially detained, and have their lives put at risk if they experience a health complication relating to a pregnancy, or a contraception failure.

I would also ask you to raise this issue with the Secretary of State for Business, Energy and Industrial Strategy to consider how Travel Insurance providers rules will need to be adapted to ensure that customers are appropriately advised and ensure that medical evacuation or repatriation is covered and can quickly be arranged if women need it. Also that UK employers who send employees to other countries as part of their employment must be required to hold insurance that explicitly guarantees access to all methods of healthcare that might be necessary while they are away, including emergency abortion and access to emergency contraception.

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

References:
aHR0cHM6Ly9lbGVhcm5pbmcucmNvZy5vcmcudWsvc2l0ZXMvZGVmYXVsdC9maWxlcy9FYXJseSUyMHByZWduYW5jeSUyMGxvc3MlMjAtJTIwbWFuYWdlbWVudC9zYWdpbGldXVtbelearning.rcog.org.uk/sites/default/files/Early%20pregnancy%20loss%20-%20management/sagili_tog_2007.pdf togg_2007.pdf
www.bbc.co.uk/news/uk-northern-ireland-203217411_
www.ekathimerini.com/nytimes/1186635/poland-shows-the-risks-for-women-when-abortion-is-banned/
www.theguardian.com/global-development/2022/jun/22/us-woman-left-traumatised-after-malta-hospital-refuses-life-saving-abortionn_

Wow. That is so good, much better than the original.

@BuanoKubiamVej
Thank you so much.

It's funny, I've written a (very) few pieces for a certain organisation and the woman who runs it is a brilliant editor and makes my poor scraps so much better than the original before posting on the website.

I have nothing but respect for all skilled editors.

but nb some the write to your mp website blocks the sending of multiple identical copy&paste letters so do adapt this a little.

Thank you @FannyCann and@BuanoKubiamVej for such a well written letter, I have contacted my MP this morning.

Thank you. This is an excellent idea and very important. I shall write to my MP.

This is worrying. I have had a 'missed miscarriage' at 13 weeks (although the consultant called it by the technically correct term of 'missed abortion', which was really upsetting for such a wanted pregnancy😥)

Women need to know that they will get appropriate medical care for early pregnancy complications, especially in the so-called 'enlightened western world'. The Malta story is horrific. 😡

Please can I just ask this, just for my understanding. Sorry if it says stupid question.

Is it then true that if I go to America and I’m pregnant and I need an abortion because my life is at risk, I won’t be allowed one?

I’m not planning on being pregnant or going to America, but the thought of this happening to another woman is terrifying.

It would now depend on the law in the state you were visiting.

@BuanoKubiamVej a minor correction, and perhaps you suffered from Autocorrect, but her name was Izabela, not Isabel. Don't anglicise her name just because it has a direct equivalent.

Yes in certain US states if you had e.g. an ectopic pregnancy doctors could not legally treat you, and if you couldn’t get to a different state / country your life would be at risk.

Apologies I didn't deliberately anglicise the name but copied and pasted without checking. No offense intended to Isabela.

Argh that second one was an autocorrect error

Izabela

Thank you OP it is an aspect I hadn't considered, but as the mother of daughters it is very pertinent.

I will write to my own MP as recommended by others and ask her to raise this with LT

Thanks so much for this OP. You’re a star.

I think the original Isabel/Izabela mistake was mine in my OP.
Apologies all, and also to Izabela herself.

Thank you so much everyone writing to your MPs.

Andrea Prudente was speaking about her - truly horrific - experience on woman's hour today. I think it is an issue WH will be coming back to. It was an excellent interview.