By Kylie Kiunguyu.
More often than not we discuss the illegality of abortion as the main limitation towards receiving comprehensive reproductive health care, but there are other obstacles that limit abortion access, for example, what is observed in countries such as Cambodia. Although it has one of the more liberal abortion laws, women on the ground still struggle to access abortions; highlighting the way in which abortion access is limited for women across the globe.
According to Articles 5 ,6, 8, and 12 in Cambodian Law , women may obtain an abortion, on request, during the first 12 weeks of pregnancy. After this point in the pregnancy, abortions are allowed only under the following circumstances
- if there is a possibility of the pregnancy developing abnormally or if the pregnancy poses a danger to the woman’s life;
- if the foetus has an “ incurable disease”; or
- if the pregnancy is caused by rape.
In these cases, the abortion must be approved by a group of “two or three medical personnel.”
Only medical doctors, medical assistants, or midwives are authorized to perform abortions, and they must obtain the consent of the pregnant woman after explaining the possible complications from the abortion and the advantages of birth spacing .
Abortions must be performed in hospitals, health centers, clinics, and public or private obstetric centers authorized by the Ministry of Health. These facilities must have the technical ability to manage emergencies due to the complications of abortions and must be able to transfer patients to a hospital if necessary .
People who violate the provisions of the law are subject to warnings, fines, or imprisonment depending on the violation, with the most severe fines imposed when an illegally performed abortion causes chronic illness, disability, or death.
What legal, structural, and institutional limitations mean for abortion access
From the above set of laws, some issues can already be identified. Even where abortion is legal, structural and institutional barriers, and stipulations that call upon women to have access to a myriad of resources, can deter or delay women from accessing abortion care. Additionally, state restrictions result in limited service providers, travel-related logistical issues, limited clinic options, and financial implications.
Research shows that young, poor, and unmarried women who live outside prioritized areas (where abortion providers are) are more likely to experience delays in accessing abortion care, fear judgement, and have difficulty in making a decision, a lack of autonomy, and difficulty paying for and traveling to abortion services .
For women who need to travel, there are other invisible barriers, including long wait times for appointments, lost wages, and expenses for childcare and accommodation. It takes time to make all of these arrangements and raise the money, but this only increases the overall cost for this subset of women because as a pregnancy advances, the health-care costs increase and the number of available providers decreases.
How barriers to legal abortion affect womxn in Cambodia
Reports indicate that Cambodia has one of the more desperate maternal health situations in Asia. Since the early 1990s, the country has scrambled to rebuild its public health infrastructure, train new health personnel, and restore the people’s confidence in government health services that were destroyed by years of war and genocide .
Despite abortion being legal, reluctance by providers to begin termination services in public facilities, slow adoption of technical guidance, and unregulated and erratic fees for termination, alongside inadequate training in high-quality termination services, continue to create barriers to safe terminations. These gaps and public mistrust have triggered Cambodian women to seek abortions from unskilled health-care providers, herbalists, drug sellers, and all types of traditional medical practitioners. Many of them go on to experience complications that necessitate further post-abortion care (PAC). These unsafe abortions are known to be a major contributor to maternal mortality and poor maternal health in Cambodia .
Given the above, it is crucial that trustworthy, reliable, and quality abortion services are brought to the communities where women live.
The importance of telemedicine in abortion access
The most viable way to address some of the issues countries like Cambodia face is through telemedicine,which fittingly originated from a shortage of credible and qualified clinicians as well as limited resources outside central areas. It began as a way of catering to the disenfranchised and people in rural or remote areas, thus playing a very important role in the delivery and access to equitable and quality health care for more people.
Telemedicine is beneficial in general  because
- Remote analysis and monitoring services and electronic data storage significantly reduces health-care service costs;
- Expenses, such as transport, admission, etc. are drastically reduced for vulnerable patients or those affected by socioeconomic barriers; and
- It offers faster and more convenient access to specialized care and patient-centered approaches, including referrals, regardless of location.
In the same effective and convenient way, telemedicine for abortions combines medical abortion care and videoconferencing or telephone consultations. Medical abortion care is the management of different clinical conditions, including viable and non-viable pregnancies, incomplete abortion, and post-abortion contraception. It reduces the need for surgical abortion providers by offering non-invasive but safe options to women .
Medical abortions are the preferred option of many women seeking abortion services because it is less invasive and more private than surgical options. In fact, the World Health Organisation (WHO) has approved the use of certain abortion pills without the supervision of a clinician for up to the eleventh week of gestation.
In a nutshell, telemedicine provided by platforms such as safe2choose is beneficial in abortion access because
- It helps avoid delays in care, negative psychological impact, and misguided self-induction;
- It provides support for women along every step of the process, including but not limited to check-ins during the process, emotional support, reminders, and follow-ups;
- Telemedicine abortions have identical outcomes to standard medication abortions conducted by an on-site clinician; and
- Telemedicine isn’t hinged on as many factors as in-person care and is, therefore, more reliable even in extreme conditions, such as during a global pandemic.
For safe, confidential, and reliable abortion access that is tailored around legislation in your country, contact safe2choose and go here for more information.
 “The Law on Abortion.” Kingdom of Cambodia, Nation Religion King, 1997, moh.gov.kh/content/uploads/Laws_and_Regulations/Law/Law%20on%20Abortion%20Eng.pdf. Accessed January 2021.
 Gerdts, C, et al. “Second-trimester medication abortion outside the clinic setting: an analysis of electronic client records from a safe abortion hotline in Indonesia.” BMJ Sexual and Reproductive Health, 2018, srh.bmj.com/content/44/4/286. Accessed January 2021.
 “Abortion-related complications in Cambodia.” BJOG An International Journal of Obstetrics & Gynaecology, 2008, www.researchgate.net/publication/51425381_Abortion-related_complications_in_Cambodia. Accessed January 2021.
 “Medical management of abortion.” World Health Organisation, 2018, www.who.int/reproductivehealth/publications/medical-management-abortion/en/. Accessed January 2021.
 “The Importance and Value of Telemedicine.” Electronic Health Reporter, 2017, electronichealthreporter.com/importance-value-telemedicine/. Accessed January 2021.