Women’s health 女性健康

The pandemic shows a better way to handle abortion COVID-19大流行展示了处理堕胎问题的更好方法

It is safe and efficient for early terminations to take place at home 在家里提前终止妊娠是安全有效的

2020年9月19日

FOR MOST women deciding how or when to give birth, covid-19 has been a nightmare. Fertility treatments have paused, sexual-health clinics closed and partners been banned from delivery rooms. Yet the pandemic has brought one silver lining. It has shown a better way to carry out early-stage abortions. 对于大多数正在决定如何或何时分娩的女性来说，covid-19是一场噩梦。生育治疗暂停，性健康诊所关闭，伴侣被禁止进入产房。新冠肺炎疫情给企业带来了重大影响。它显示了进行早期堕胎的更好方法。

注： silver lining：(困境中的) 一线希望;

Abortion is legal in most of the world, and relatively straightforward in most rich countries. But obstacles remain. They include compulsory waiting times and mandatory counselling. Perhaps the most common obstacle is that the first step in medical abortions (which involve drugs rather than surgery) must take place in clinics. Yet temporary measures set up during the pandemic suggest this is often unnecessary. These temporary measures should now become permanent. 堕胎在世界上大多数国家都是合法的，而在大多数富裕国家则相对简单。但障碍依然存在。它们包括强制等待和强制咨询。也许最常见的障碍是医学堕胎的第一步（包括药物而不是手术）必须在诊所进行。然而，在大流行期间设立的临时措施表明，这通常是不必要的。这些临时措施现在应该成为永久性措施。

注： compulsory：MANDATORY, ENFORCED，强制性的 mandatory：required by a law or rule : OBLIGATORY，法律或规则要求的：强制性的 the mandatory retirement age：法定退休年龄

At-home procedures are available only to women in the first trimester of pregnancy—which includes most of those who have abortions today. Two medicines are needed: mifepristone (which blocks the effects of the pregnancy-enabling hormone progesterone) and misoprostol (which induces contractions). They are taken a couple of days apart, and the pregnancy normally ends four to six hours after the second one is administered. In most of Britain, before the pandemic, the drugs were handed out after an ultrasound and an in-person consultation at a clinic. The mifepristone had to be administered by a doctor; the misoprostol was taken at home. 在家终止妊娠只适用于怀孕前三个月的妇女，其中包括大多数现在需要堕胎的妇女。需要两种药物：米非司酮（阻止孕激素孕酮的作用）和米索前列醇（引起宫缩）。吃完一种药物后间隔几天吃另一种药物，服用第二种药后4到6小时终止妊娠。在新冠大流行之前，英国大部分地区的药品都是经过超声波检查和诊所的当面会诊后发放的。米非司酮必须遵医嘱服用，米索前列醇是在家中服用的。

注： an ultrasound：超声波

Covid-19 has changed that. In March Britain’s health secretary approved a rule change which, in effect, gave a woman’s home the same status as an abortion clinic. Instead of visiting a doctor, women could arrange an abortion by phone and have the pills delivered by post. Ireland introduced similar rules. France extended the limit for an at-home abortion from the seventh to the ninth week of pregnancy, though the pills must still be collected from a doctor or pharmacy. In July a federal judge in America lifted regulations that required women to collect abortion pills from a surgery, clinic or hospital, ruling that this was a “substantial obstacle in the path of women” during a pandemic. 新型冠状肺炎改变了它。今年3月，英国卫生大臣批准了一项规定的修改，实际上，这项规定赋予了妇女的家与堕胎诊所相同的地位。妇女们不用去看医生，而是通过电话安排堕胎，并通过邮递方式递送药物。爱尔兰也出台了类似的规定。法国将在家堕胎的限制从怀孕的第七周延长到第九周，尽管这些药片仍然必须从医生或药房领取。7月，美国一名联邦法官取消了“要求妇女从手术室、诊所或医院取得堕胎药”的规定，裁定这是大流行期间“妇女道路上的一个重大障碍”。

注： pharmacy：药房 a surgery：a room or area where surgery is performed，手术室

None of these countries have yet decided if these kinds of approaches will last. In America, the Trump administration has asked the Supreme Court to overturn it. A decision is expected soon (see article). In Britain the government has said that it will launch a public consultation on whether to keep the new approach. Ireland and France are also uncertain about whether to make the changes permanent. 这些国家还没有决定这种做法是否持续下去。在美国，特朗普政府已经要求最高法院推翻这一法案。预计很快就会做出决定。在英国，政府已经表示，将就是否保留新方法展开公众咨询。爱尔兰和法国也不确定是否将这些改变永久化。

Some people take a principled position that abortion at any time during pregnancy is wrong. For everyone else, however, the decision turns on two questions. Will removing medical supervision endanger women’s health? And will it lead to many more abortions? Take each in turn. 有些人持一种观点，认为怀孕期间任何时候堕胎都是错误的。对于其他人来说，这个决定涉及两个问题。取消医疗监管会危及妇女健康吗？它会导致更多的堕胎吗？接下来挨个讨论这2个问题。

There is no evidence that at-home terminations are dangerous, and plenty to suggest that they are not. The World Health Organisation has said that early-term abortions can be carried out safely outside a clinic. In Britain the British Medical Association and Royal College of Obstetricians and Gynaecologists have both called for the changes to be made permanent. Recent data there show that they have resulted in women having abortions earlier, and thus more safely. From January to June, 25% more than in the previous year were carried out at less than seven weeks’ gestation. 没有证据表明在家终止妊娠是危险的。世界卫生组织说，早期堕胎可以在诊所外安全进行。在英国，英国医学协会和皇家妇产学会都呼吁将改革永久化。最近的数据表明，这个规定让妇女更早堕胎，从而更安全。从1月到6月，怀孕不到7周的孕妇比去年增加了25%。

注： result in：导致 gestation：n. 怀孕

This increase is explained by a surge in early abortions not in the overall total. Britain has seen only a 4% rise in terminations carried out in the first half of the year. That could reflect a straitened economy, say, or stressed relationships in lockdown and less access to contraception as well as easier abortion. The Guttmacher Institute, a pro-choice research group, finds no link between abortion restrictions in American states and changes in their abortion rate—whether the states make abortion easier or harder. 这一增长的原因是早期流产人数激增，而不是总数。英国今年上半年实施的终止妊娠只增加了4%。这可能反映出经济拮据，居家隔离期在家啪啪啪，较少避孕而且堕胎更容易。Guttmacher 研究所，一个赞成堕胎合法化的研究组织，它发现美国各州的堕胎限制与堕胎率的变化之间没有联系，无论这些州让堕胎更容易还是更难。

注： as well as：不但…而且…

More important, if there ends up being an increase in the number of terminations that may be for a good reason. Some women are poor, live in regions with few clinics, or have a spouse or parent from whom they need to hide their abortion. For them the new rules have removed barriers that they might otherwise have found insurmountable. The changes to the abortion regime introduced as a result of the pandemic do not create new rights; they give a woman access to her existing rights more safely and efficiently. As with any citizen, that is welcome. 更重要的是，如果最终终止妊娠的数量增加，这可能是有原因的。有些妇女贫穷，生活在诊所很少的地区，或有配偶或父母，她们需要瞒着他们堕胎。对他们来说，新规则消除了原本认为无法克服的障碍。由于COVID-19大流行而对堕胎制度进行的改变并没有产生新的权利;它们让妇女更安全、更高效地获得现有权利。

注： insurmountable：无法克服的