We will not be silent: Safe abortion care is health care

Doctors Without Borders
6 min readJan 23, 2020


On the anniversary of the Global Gag Rule, we’re launching a free, open-source, evidence-based online course on medication abortion. An abortion with pills is simple, safe, and effective — even for those in the hardest to reach places.

Dr. Manisha Kumar MD, MPH is a family medicine doctor and Head of the Task Force on Safe Abortion Care at Doctors Without Borders/Médecins Sans Frontières (MSF).

Talking about abortion is not a crime.

These days, however, health care providers and humanitarian workers who receive US funding overseas risk being shut down if they do just that.

The Global Gag Rule — which President Donald Trump reinstated and expanded on January 23, 2017 — prohibits doctors, nurses, and other health workers around the world from even speaking about abortion. If they do, they could lose their US government funding. Health workers are relied upon to provide thorough, evidence-based medical information, and now they’ve been silenced in the places where that information is needed the most.

I’m a doctor and, for the past three years, I’ve travelled the world talking about abortion. Almost everywhere I go, it’s not a topic that is openly discussed — even with other health care workers. Many of them tell me they didn’t learn about abortion during their training. Abortion wasn’t even mentioned, despite how common it is.

The fact is that one in four pregnancies ends in induced abortion. That means that, chances are, someone you know has had an abortion. But because there is so much stigma and shame around abortion, it can be difficult for people to talk about freely, let alone share their experiences and learn from each other.

Despite the stigma, abortion is a part of people’s lives and a key component of reproductive health care. It’s essential that health care workers, humanitarian workers — and everyone for that matter — know the basics about abortion.

Go to the online course Medication Abortion in Humanitarian Settings:

That’s why Doctors Without Borders/Médecins Sans Frontières (MSF) has teamed up with HowToUseAbortionPill.org to create a free, open-source, evidence-based online course on medication abortion, or abortion with pills. Our goal is to ensure that everyone has access to factual, scientifically accurate information about abortion — no matter who you are, where you are, or where you are going.

The online training consists of five animated videos that provide a solid foundation in how to safely administer an abortion with pills and support women through the process. The online training also provides important facts about abortion, such as:

· Unsafe abortion is one of the main causes of maternal death — and the only one that is almost entirely preventable.

According to the Guttmacher Institute, at least 22,800 women die every year from complications from unsafe abortion. And the World Health Organization reports that around 7 million women are admitted to hospitals every year as a result of unsafe abortion.

· 97 percent of unsafe abortions take place in the Global South.

Unequal access to abortion highlights broader social injustices: poor women, women of color, and women living in rural areas are disproportionately cut off from safe abortion services. They are the ones whose lives and dignity are most at risk.

Women and girls trapped in war, crisis, and conflicts often face additional barriers to accessing safe abortion care. That’s why we’ve included specific considerations for humanitarian settings in this online course.

· A safe, effective abortion can be done with pills.

Having an abortion doesn’t necessarily mean going through a surgery or a medical procedure anymore. An abortion can be provided safely with pills, also known as a medication abortion; a combination of pills is taken that causes the uterus to contract and push out the pregnancy in a process that is similar to miscarriage. Abortion with pills will successfully work more than 9 times out of 10. The chance of severe complication from a medication abortion is less than 1 percent. An abortion with pills is so safe that, most of the time, women can take the medications at home — they only need to go to a hospital or clinic if they have a question or a problem. Contrary to rumors, a medication abortion does not cause infertility, mental health problems, or problems with future pregnancies.

An abortion with pills is relatively simple to provide — even in the most remote and low-resource settings

· You don’t need any advanced technology or specialized medical interventions in order to provide medication abortion safely.

According to the World Health Organization, blood tests, ultrasound, and follow-up are not required. All you need to provide a medication abortion are: 1) accurate information, 2) quality medications, and 3) mutual respect and trust. Because of this, medication abortion has increased access to safe abortion care for millions of women and girls around the world — and especially in low-resource and humanitarian settings.

If everyone knew these basic facts about abortion, it would go a long way to combating stigma and increasing access to safe abortion care. Unfortunately, those who need this information the most often do not have it. People living in crisis and conflict situations don’t commonly have access to computers, smartphones, or the Internet. That’s why it’s essential for humanitarian workers to learn about medication abortion and spread the information.

The more you know, the more you can help others.

After I gave a training on medication abortion in one of our field projects, a local doctor working with MSF came up to me to share her experience. “Last year, when we did an emergency intervention in a refugee camp, women came to me asking for help with abortions. They really needed our help, but we didn’t know about this, so we turned them away,” she said. She didn’t know what happened to those women afterward, she didn’t see them again. “But now,” she said, “with what we have just learned, I see how easy it is. I think we can do more.”

I asked her if she thought that during the next emergency intervention, with the information she has now, it would be possible to provide safe abortion care. She nodded her head, “Yes, I think we can. In fact, we must.”

From everything I’ve experienced, I know that talking about abortion is the only way to break the cycle of stigma, shame, and misinformation that marginalizes people and puts their lives in danger.

As humanitarian workers, as doctors, midwives, and advocates, as sisters and brothers, and as friends, it is our duty to educate ourselves so we can educate others.

Both MSF and HowToUseAbortionPill.org do not take funding from the US government and are not directly affected by the Global Gag Rule. This means we have an even greater obligation to speak out about safe abortion care and stand in solidarity with people by providing accurate sexual and reproductive health information around the world.

We will not be silent. We will speak the truth. An abortion with pills is simple, safe, and effective — even for those in the hardest to reach places.



Doctors Without Borders

Medical aid org working globally to assist people whose survival is threatened by violence, neglect, or catastrophe. http://www.doctorswithoutborders.org