Research shows obstacles to abortion access in the Netherlands

Abortion services in the Netherlands seems well organised, but its accessibility is insufficient. Abortions can only take place in clinics in large cities and there are no clinic in 3 large provinces ( Friesland, Drenthe and Zeeland). The abortion pill has been registered in the Netherlands since 2001 but are only available in abortion clinics and hospitals to women who are insured and / or registered in the Netherlands.  Women who are not insured or who have a foreign health insurance policy such as foreign students and undocumented women, have to pay the costs for an abortion, at least 500 euros, themselves.

The telemedical abortion service Women on Web supports women who have no access to safe abortions. During a 9 months period 172 women living in the Netherlands completed the online consultation. The consultations were in Dutch (16%), English (37%), Polish (35%) and other languages (12%). The data showed that 10 women (17%) lived more than an hour traveling from a hospital or abortion clinic; 38 (22%) women were undocumented, uninsured or had foreign health insurance and could not afford to pay for an abortion. Contraception had failed in 64 women (37%) and 7 women were pregnant as the result of rape (4%).

The main obstacles to access to abortion care mentioned: having to keep the abortion a secret for partner or family (33%), too high costs (22%), stigma (11%), protests at abortion clinics (11%), not being able to babysit arranging for children (10%), distance to clinic (9%) and domestic violence (5%).

In addition, more than 40 percent of women emphasized the importance of privacy in desiring to do the abortion at home.

Some emails for illustration: 

I need certain documents when I do visit a clinic, which my mom has, and I can’t ask for without her getting suspicious. I really need your help. (teenager living in small village)   

Please I can’t go to any clinics ... I have already troubles with government... And the clinics will inform other instances then the government will pickup my child and I don’t want that. They will escalate. I don’t want to become in troubles. Its complicated.

Unfortunately I am undocumented and I don't have Dutch insurance to take care of my bills.

I have contacted some clinics for help about this but all came back to huge amount of money (one asks 700 Euro for example). I don't have the money to raise a child so to pay 700 Euro is also not a solution.

I cannot go to a clinic as this is not allowed by Muslims. I have to do this without anyone knowing.

I flee from the war in my country and I’m in procedure in the Netherlands. I have a friend and got unplanned pregnant. I’m 3 days over time.

The total cost of an abortion is 665 euros. I am a non working student and this is very very hard for me to fund myself and would require months of saving. I just need help. This is very difficult for me and I have had to deal with this without the knowledge my family. I feel lost and alone and all I want is my life back. ... I am really not ready to have a child. I’m only 19 and still a child myself. … I have had to keep this a secret from my entire family because this is not accepted at all. Not only would I receive backlash but I would also be forced to keep a child I am not ready for a consequence of a broken condom. 

I have a family and no one around me who knows about this situation. I don't have a babysitter and can't leave my children alone. The clinic is much more than two hours away by public transport. Including treatment, I can not be away from home that long.

It is impossible for me to go to a clinic because of possible retaliation when my friend finds out. I can't just 'disappear' for an hour or two. Would you please help me? I'm so desperate and scared.

Other research in England and the US also showed that distance to the clinic, problems with childcare, obligations from work and school, psychiatric illnesses, domestic violence and concerns about privacy caused obstacles to access abortion care. The above small analysis shows that various groups of women are also experiencing problems in the Netherlands. 

By making abortion pills available  by general practitioners, many of the obstacles to access abortion services found in the research can be solved (this has already been suggested since the pill became available in 1898). The costs of the medication are low. Supervision of an abortion with medicines does not differ medically from a spontaneous miscarriage. The World Health Organization recommends low-threshold access. Other countries, such as Ireland that recently legalized abortion, France and Canada abortion pills are already available on the prescription of general practitioners.

The article is published in Dutch and can be read here in full https://www.medischcontact.nl/nieuws/laatste-nieuws/nieuwsartikel/abortushulp-kent-te-veel-barrieres.htm

For more information: 

Dr. Rebecca Gomperts

+31652052561

References

1. Aiken ARA, Guthrie KA, Schellekens M, Trussell J, Gomperts R.Barriers to accessing abortion services and perspectives on using mifepristone and misoprostol at home in Great Britain. Contraception. 2018 Feb; 97(2):177-183.
2. Demand for Self-Managed Medication Abortion Through an Online Telemedicine Service in the United States
3. Endler M, Telemedicine for medical abortion: a systematic review. BJOG. 2019 Aug;126(9):1094-1102. 
4. https://doktersvandewereld.org/barrieres-voor-ongedocumenteerden-in-toegang-tot-anticonceptie-en-abortus/
5. WHO, Medical Management of Abortion, 2018. https://www.who.int/reproductivehealth/publications/medical-management-abortion/en/