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Reflecting back on Sex, Drugs & Scotland’s Health Virtual and forward to 2022

As we head towards the end of 2021 we wanted to share some reflections on the Sex, Drugs and Scotland’s Health conference, and look ahead to plans for the Scottish Interdisciplinary Research in Sexual Health (IReSH) Network in 2022.

We recognise that 2021 has continued to be a challenging year across the sector, including for IReSH members and partners. While Scotland has moved into what has been described as a period of COVID recovery, and plans are set out to ‘reset and rebuild’ sexual health and blood borne virus services across the country, individuals, communities and organisations continue to navigate uncertainties that demand ongoing adaptations to ways of working and connecting with one another. Within the IReSH network we have continued to focus on our aim of bringing together people from academia, the third sector, health practitioners and communities to collaborate and coordinate research activities related to sexual health and blood-borne viruses. Much of the focus of IReSH members in 2021 has been on the Sex, Drugs and Scotland’s Health conference co-hosted by us and HIV Scotland.

Drawing on the aims of the IReSH network, the conference sought to bring together people across the sector to share research and practice, provide a space to listen and reflect on work done, and consider current and future challenges. The conference was originally scheduled to take place in Dundee in June 2020, but COVID-19 meant that the event had to be reimagined for a pandemic world. It was clear that the conference would need to bring the sector together virtually to share important learning, and lots of work focused on how to do this in a meaningful and inclusive way.  The ‘pause’ also provided a chance invite presentations on the rapid and far-reaching shifts in practice across NHS and community services, in response to the unfolding public health crisis, and their implications for sexual health and social justice beyond the pandemic.

We know that many of you reading this were able to join us for the conference, and we hope that you enjoyed it as much as we did. As much as we would have liked to attend everything, the sheer range of presentations and parallel sessions made that impossible (in a good way!). With that in mind we want to highlight that many of the recorded sessions are available through our conference co-hosts – HIV Scotland – YouTube Channel. This is an important IReSH and HIV Scotland resource, and we are delighted that it offers the opportunity to watch and learn from sessions you may have missed. We thought we would highlight just a few. The sessions included a diversity of topics and issues, including multiple presentations around sex and drugs (part 2), chemsex, innovations in HIV testing, Hep C eradication and prevention, the role of digital sexual health in delivering health services, sex and diversity in later life and learning from good practice in coproduction in peer support activities. There was a timely session focusing on developments in abortion care, considering what has changed in abortion care over time, and reflecting on future directions in Scotland. We had great presentations on diverse aspects of HIV including the experiences of people living with HIV, healthcare use and post-AIDS health promotion. We heard about the importance of public health and decriminalisation approach to sex work and drug use, learned about digital intimacies, smartphones and gay men’s sexual wellbeing, and focused on the value of partnership working in encouraging people to talk about sex! We hope that these resources may continue to spark conversations and interest in new collaborative research projects.

Another highlight of the conference were the roundtable discussions on trans health, racism and sexual health and wellbeing, the sexual health and wellbeing needs of migrant communities, asylum seekers and new entrants to Scotland, drug deaths in Scotland, chemsex, and intergenerational perspectives on consent. Roundtables offered a safe space to bring people together to engage in action oriented discussions, with a focus on advancing work in these areas – IReSH plans to take forward related workshops in 2022 and beyond.

The closing plenary brought together the Minister for Public Health, Women’s Health & Sport, Maree Todd MSP with partners from IReSH and HIV Scotland to highlight successes in the sector wide response to the pandemic, as well as reflections on future challenges.

We know that we face continued challenges in sexual health and blood borne virus sector and in our efforts to bring about social justice, and we must ensure that we can learn from and listen to each other and work together to support sexual health, wellbeing and social justice in Scotland. We trust that this conference has made an important contribution to these collective efforts, and IReSH looks forward to supporting collaborative work to build on and extend keys issues over the coming year. Look out for events, discussion groups and networking events throughout the course of 2022!

Wishing you all happy time over the holidays.

Discussion, collaboration & social justice: Looking forward to Sex, Drugs & Scotland’s Health

October is an exciting month for those working across the sector in sexual and reproductive health and blood borne viruses as it marks the start of the Sex, Drugs & Scotland’s Health Virtual Conference 2021, which will take place between the 19th October and 21st October.

The conference is being co-hosted by us – the Scottish Interdisciplinary Research in Sexual Health (IReSH) Network – and HIV Scotland, and has been organised in collaboration with third sector, clinical and community partners, including Terrence Higgins Trust Scotland, Waverley Care, Scottish Drugs Forum, the Faculty of Sexual and Reproductive Health Scotland, NHS Lothian and the Universities of Edinburgh and Glasgow.

The conference is happening at an important time as Scotland moves into what has been described as a period of COVID recovery, and plans are set out to ‘reset and rebuild’ sexual health and blood borne virus services across the country. We see the conference as a timely intervention that will support a cross-sector, interdisciplinary space to support the development of the renewed Sexual Health and Blood Borne Virus Framework. We also hope that this conference can help highlight and support the revisions to the Sexual Health Standards due to be issued by Health Improvement Scotland in early 2022. The IReSH network is keen to promote and advance an intersectional and holistic approach to revising these key policies and service standards, and facilitate discussion about how to advance this work with colleagues across the sector in the coming months. In particular, we see the conference as way to energise conversations around, and take forward, work that seeks to respond to structural barriers to sexual and reproductive justice in Scotland.

The Sex, Drugs & Scotland’s Health Conference offers the opportunity for researchers, health practitioners, third sector and community organisations to come together to explore challenges around sexual health and blood borne viruses in Scotland, and work that seeks to address these. It’s going to be an exciting and energising space in which to engage with those working in this diverse interdisciplinary area. The three-day event aims to:

  • share research findings and examples of good practice
  • facilitate discussion and engagement with key issues
  • reflect on the developments made over the past 10 years, since the launch of the Scottish Government’s Sexual Health and Blood Borne Virus Framework
  • identify and respond to current and future challenges
  • develop and support collaborative partnerships to address contemporary health challenges

IReSH members have been working incredibly hard alongside the other conference organisers to put together an exciting programme that helps showcase the range and diversity of work that is happening across Scotland, and developing creative ways to engage virtually. The conference programme brings together a mix of presentations, panels and roundtable discussions that focus on research findings, reflections on service delivery, and facilitated discussion on critical issues in sexual and reproductive health and social justice. We encourage you to explore the programme to see the range and diversity of topics being addressed, including:

  • Work with key communities, including people who use drugs, trans communities, gay, bisexual and men who have sex with men, African communities and sex workers
  • Community outreach in sexual health and harm reduction
  • Roundtable discussions on trans health, race, racism and prejudice in sexual health, migration and asylum, drug deaths, chemsex, and consent
  • HIV prevention and testing, including PrEP, self-testing and service provision
  • Abortion access and care
  • Sexual health wellbeing and inequalities across multiple communities
  • Hep C eradication and prevention

The work of members of the IReSH network is showcased across the conference, so look out for (among others!) presentations, panels and workshops with Ingrid Young (Conference Co-Chair), Sally Brown and Nicola Boydell (IReSH co-chairs), Julie Riddell, Ruth Lewis and Jamie Frankis. Look out too for a visual timeline of HIV in Scotland, drawing on material from the Lothian Health Services Archive and being developed by the Centre for Biomedicine Self and Society.

The conference also offers the opportunity to visit virtual exhibition stalls – including our IReSH exhibition stall – that highlights work being undertaken by community organisations and academic institutions across Scotland.  As part of our virtual exhibition space we are keen to hear your thoughts on activities and events that you would like IReSH to take forward in the coming months, and your views on what would make it easier for you to be involved in IReSH. Look out for links to our interactive ideas board to share your thoughts on this! In the meantime, if you haven’t already signed up, we would encourage you to join the network.

If you know of people that haven’t yet heard about the conference, it’s not too late to register for the conference so do pass on the link. We are so looking forward to spending time with you during the conference – see you there!

Sex, Drugs & Scotland’s Health Conference: Programme Launched

We are pleased to announce that the programme for the Sex, Drugs & Scotland’s Health virtual conference is now live!

Running virtually from the 19th until the 21st of October, this cross-sector conference will ask the question ‘Where do we go next for Scotland’s Health?’ At its heart will be discussion and debate around sexual health, blood-borne viruses and sexual wellbeing in Scotland.

You can read the full programme here.

To register your interest for the conference and further information please visit the conference website:
https://www.conventiondundeeandangus.co.uk/attending/conferences/sex-drugs-and-scotlands-health-virtual-conference-2021/ 

Registration for the conference will open in the coming days. Keep an eye on this site or our twitter account @IReSH_Scot where we will be announcing when registration is open.

 

IReSH calls for an intersectional and wholistic approach to revising the Healthcare Improvement Standards for Sexual Health

A working group comprised of members of the IReSH network operations group developed a response to the consultation on the Healthcare Improvement Scotland Standards for Sexual Health in July 2021.

Given the cross-sector and interdisciplinary nature of IRESH, our aim was to avoid duplicating responses from clinical services and third sector organisations that have specific expertise relevant to individual Standards. We sought to complement this by sharing overarching comments on the draft Standards as a whole. Our main comments on the Standards highlight the need to centre an intersectional approach to sexual health and justice, and to be explicit in naming and responding to the structural inequalities that currently affect sexual health, wellbeing, and justice in Scotland.

We suggest that there is a need to explicitly acknowledge the increasingly hostile environment (exacerbated by the COVID-19 pandemic) in relation to sexual and gender rights, racism, immigration, ableism and increased socio-economic inequalities. These factors directly impact the availability of, and access to, sexual and reproductive health services. This is important because it affects the sexual health and wellbeing of individuals and communities across Scotland, and beyond.

We commend the importance of championing human rights and taking a rights-based approach in the Standards. However, we suggest that this should be expanded beyond the current focus only on young people and emphasised across all the Standards with concrete acknowledgement of, and suggested responses to, the structural barriers to sexual and reproductive justice in other areas of service provision.

We recognise the limits of the Standards in tackling structural social inequalities. However, we suggest that they do not go far enough; neither naming such issues, nor in providing further guidance on addressing inequalities and ongoing discrimination. In our response, we draw attention to examples of where there is an absence of this approach, and where this has potential material consequences for the sexual and reproductive health and wellbeing of communities

In line with participatory engagement principles, we strongly support the need for involvement of key stakeholders (community, third sector, research, clinical) in determining the implementation and monitoring of Standards at a local level. Given the strong emphasis on ‘engagement’, and recognising the diverse ways in which this term is used and applied, we suggest that more explicit reference is made to using local data to inform meaningful engagement work (and links to guidance on community engagement), so that such work does not inadvertently replicate the inequalities that boards seek to address.

We recognise the challenges associated with drafting the updated Sexual Health Standards at a time when there are rapid and ongoing changes in local and national policy and current clinical best practice in the context of COVID-19. We suggest that it may be worth revisiting the current structure of the Standards, which represents a mix of broad areas for improvement (leadership and governance, sexual wellbeing, access etc.), service delivery (STI prevention, detection and management, abortion care etc.) and key populations (young people, GBMSM). In particular, we note that this ‘siloed’ approach, with explicit sections focused on the needs of some key populations (young people and GBMSM), but not others (communities of colour, disabled people, including people with learning difficulties, LGBTQ+ people etc.) could inadvertently lead to further exacerbating inequalities. As such, we suggest that there may be benefits to reframing using an intersectional approach that acknowledges overlapping identities, and intersectional issues that shape availability, access, and experiences of sexual and reproductive healthcare.

As an interdisciplinary network of researchers, health practitioners, third sector organisations and community stakeholders, we welcome the chance to respond to sexual health Standards, and encourage further discussion on how sexual health provision can be central to acknowledging and addressing entrenched structural inequalities that affect us all.

Click here to download the full IReSH response

Save the Date! 19-21 October: Sex, Drugs & Scotland’s Health

IReSH, HIV Scotland and our partners are delighted to announce that our Sex, Drugs and Scotland’s Health Conference will be held on 19-21 October 2021. Originally planned to take place in Dundee, our conference will take place online, providing our attendees with a virtual slice of the city!

Where do we go next for sexual health in Scotland? Organised by a cross-sector partnership, this brand new biennial conference will be used to highlight new and emerging issues and research, support workforce development and connect communities and those working within the SHBBV field in Scotland, the UK and internationally. At its heart will be discussion and debate around sexual health and blood-borne viruses in Scotland.

Further information about our exciting new conference is available now at this link.

The conference will bring together third sector organisations, academics, researchers and healthcare professionals who are committed to making Scotland a healthier country.

The time is now to share amongst your peers and colleagues before the abstract submission process goes live. More information on our submission guidelines are available here.

Calls for abstracts and general registration for the conference will open shortly, details will be posted to the Conference Information Page.

Follow Sex, Drugs and Scotland’s Health 2021 on Twitter via @HIVScotland and @IReSH_Scot, and join the online conversation using our official event hashtag #shbbvscot

 

Sharing abortion experiences online: how my research is being shaped by the global pandemic

I know that I am not the only researcher whose project has been impacted by the recent COVID-19 pandemic. But, in an unexpected twist, my research might become ultimately more relevant in the long run. You see, I am a PhD student looking into how women talk about their abortion experiences, and interact with the experiences of others, in online spaces. One in three women will have an abortion in their lifetime, making it the most common gynaecological procedure worldwide. And yet, many women choose not to talk publicly about their abortion experiences because it remains a stigmatised procedure, criminalised in many countries, and highly regulated in others. Whilst choosing to remain silent about their abortion may protect them from the stigmatising reactions of others, this also prevents women from accessing social support, and further perpetuates the silence and stigma around abortion more generally.

Why research online abortion disclosures?

My Masters research (conducted in 2018) looked at who women chose to talk to about their abortion with friends, family, and conception partners. But several women described sharing their abortion experiences online. For some, they looked online because they didn’t know of anyone in their life who had previously had an abortion, and were looking for some direct experience to comfort them. For others, posting about aspects of their experience was their way of fighting abortion stigma and normalising the procedure. However, little research to date has focused on how women use the Internet to share their abortion experience, despite the existence of many designated online spaces in which to do so (shoutyourabortion.com, womenonweb.org, etc).

We know that individuals with other healthcare needs and conditions have utilised online chat rooms, support groups, and message boards, and benefit from disclosing their experiences through computer-mediated communication. Online, people can connect with others without geographical boundaries, when it is convenient for them, and from the comfort of their own home. The anonymity provided by Internet communication has been demonstrated to encourage those living with stigmatised conditions, such as HIV to speak with others in a similar situation. The support provided in such contexts is sometimes perceived to be more valuable than that provided by those without that shared experience. These online spaces may foster empowerment by offering experiential knowledge of, for example, what a medical procedure will be like, knowledge that is often not provided by healthcare professionals.

Abortion online and COVID-19

My study explores how and why women use these online spaces in the context of their abortion experience, in the hopes that with this knowledge, I can contribute to better support for women and reducing abortion stigma. But with current government guidelines about social distancing and the importance of staying at home, these online resources might become even more vital for women in the UK (and globally). We all have to be more creative with communicating with those outside our household at the minute. But there is a particular question around how women can access abortion services safely, without exposing them to unnecessary risk by requiring them leaving their homes during this pandemic (for further information regarding this topic read Carrie Purcell and Nicola Boydell’s blog post here)

This unprecedented time could be a chance to utilise existing online resources for women during and after their abortion. For instance, womenonweb.org provides abortion pills and telemedicine for women where abortion is illegal. They have demonstrated the safety and utility of women accessing abortion services online. Initially the UK governments refused to embrace this option, however, they have since changed their guidance. Women in Scotland, England, Wales, and Northern Ireland (with the help of British Pregnancy Advisory Service) can now have the consultation using telephone or video calls, and can take both early medical abortion medications (mifepristone and misoprostol) at home during the first 10 weeks of pregnancy.

With these movements towards telemedicine abortion care, and in this time of heightened computer-mediated communication and uncertainty, it is crucial to understand how and why women are using online spaces to post about their abortions and interact with other women’s stories. Are they receiving the healthcare and social support they need? Are they experiencing abortion stigma either on or offline? This study seeks to answers these questions by interviewing women and speaking to them about their personal experiences with talking and reading about abortion online.

Want to contribute your story/experience?

I have recently requested an amendment to my study’s ethical approval, adapting my research methodology to allow for interviews via Zoom or telephone. I want to hear from women about why they have used online resources and spaces before, during, and after their abortion. If you would like to participate in this study or just find out more,
Check out my study’s Facebook page
Please follow me on Twitter for more updates: @Rwilsonlowe

Working together to understand condom and contraception use among young people in Scotland

We are now about half way through the CONUNDRUM project – a research study aiming to understand the social context shaping use and non-use of condoms and contraception for penetrative sex among young people in Scotland.

Rather than rush headfirst into “collecting” data, we’ve spent the past six months working with young people and a range of professionals involved in supporting young people’s sexual health to better understand what they think this study needs to focus on. At the midpoint of the project, now seems like a good time to pause and reflect on what we’ve been doing so far.

How did the CONUNDRUM project come about?

CONUNDRUM emerged from conversations between people involved in the design and delivery of services providing free condoms and contraception. They perceived changes in uptake among young people over recent years and wanted to find out what was going on. While condoms remain a commonly used form of protection against sexually transmitted infections and (where relevant) unintended conceptions, over the last five years, there have been strong indications in some areas of Scotland that fewer young people than before are accessing free condom services, such as c:card schemes. National data also suggest a decline in use of some forms of Long Acting Reversible Contraception (LARC), such as the implant, IUD and IUS, among women under 20.

Among those working to improve young people’s sexual health, these changes raise important questions – have young people’s attitudes towards using condoms and contraception changed in recent years? What matters most for young people in accessing free condoms and contraception, and are these priorities being met? And how do young people navigate the complex array of information and messages about sexual health in general, and condoms and contraception in particular?

To investigate this situation, three NHS health boards (Greater Glasgow and Clyde, Lanarkshire, Lothian) in partnership with Scottish Government, asked us (a team of researchers at University of Glasgow) to explore the multi-level and complex factors shaping young people’s use and non-use of condoms and contraception for penetrative sex in Scotland. In particular, the study commissioners wished to understand the contemporary social context in which young people are making decisions about condoms and contraception. Our aim is to work with young people to shape the study throughout, including to co-produce recommendations for future sexual health policy and service provision. We were asked to provide a broad picture of the social context, and to ensure multiple experiences and perspectives are represented in the research. This includes working with young people living in a range of locations and circumstances, and with a range of gender and sexual identities.

What have we been doing so far?

The first phase of CONUNDRUM involved 7 interactive workshops – six with young people (38 total), and one with 22 professionals involved in supporting young people’s health and wellbeing (e.g. health promotion workers, youth workers, school and family nurses, pharmacists).

We designed these sessions to help us understand young people’s and professionals’ views on what topic areas to explore with young people in the next phase of the study, which will involve small group discussions and an online survey. We used systems thinking tools, including a technique called rich picture, to open up conversations about the numerous factors shaping young people’s use and non-use of condoms and contraception.

images from workshops with young people, including rich pictures and study priority setting activities

These discussions underlined a basic, yet crucial point: no one factor ‘causes’ young people to use or not use condoms or contraception. Rather, young people’s experiences in relation to condoms and contraception are dynamically shaped through their interactions with many different actors and contexts within a complex system that involves sexual partners, friends, families, education systems, health services, community and faith groups, mainstream and social media, porn, and so on. Not only does this complex social system have many interrelated parts, it is also continuously evolving – whether that be due to social changes (e.g. changing norms regarding roles and responsibilities for sexual health), technological changes (e.g. development of new prevention technologies, growth of digital health services, proliferation of apps offering new ways to sexually connect with others), political changes (e.g. cuts to funding for sexual health), and so on.

Building cross-sector partnerships and ways of working that allow us to engage with this complexity matter because “solutions” to improving sexual health are unlikely to be simple or located just in one part of the system. Improving sex education in schools, or innovating sexual health services, would – on their own – not be enough. Rather, assessing and rethinking the system in a way that better protects and promotes young people’s sexual health requires the action and collaboration of many different partners, and young people must be at the heart of these efforts.

images from workshop with multi-sector stakeholders

What’s next for CONUNDRUM?

Building from the discussions we’ve had with young people and multisector stakeholders, our next steps are to further explore the priority topics identified in our first phase. As with everyone, we have had to adapt our plans in the context of the COVID-19 pandemic, meaning all of the remaining study activities will now be conducted virtually. This includes:

    • Small group discussions with young people living in three health boards (Greater Glasgow and Clyde, Lanarkshire, and Lothian);
    • An online survey which will go live in June 2020 and will be open to any young person aged 16-24 who lives in Scotland;
    • Collaboration with young people to co-develop policy and practice recommendations for the NHS and Scottish Government.

Thanks to everyone who has participated in CONUNDRUM so far! If you would like to get involved, be added to the mailing list for the final report, or if you have any comments or feedback, please get in touch with us at sphsu-conundrum@glasgow.ac.uk

You can also find project updates on twitter at #ProjectCONUNDRUM.

VIDEO: Keynote by Dr Peter Keogh (Apr 2019)

In April 2019, we ran our IReSH Spring Conference in Edinburgh, entitled Doing sexual health research in Scotland: collaboration, innovation & community participation? At this conference, we were pleased to feature a keynote lecture by Dr Peter Keogh, Lead for the Reproduction, Sexualities and Sexual Health Research Group at the Open University. Peter’s talk – The knowledge problem in reproductive and sexual health: filling the pedagogic space – explored the potential usefulness of an approach that blurs the lines between research and practice, problematises the notions of ‘evidence for’ or ‘evaluation of’ and thinks instead about ‘communities of knowledge production’ and ‘praxis’. Peter suggested that this approach has the potential to strike a better balance between the political and the technical dimensions of our work. We are now able to share this keynote by Dr Peter Keogh, and follow up discussion and welcome your comments and engagement with these ideas below this post, on YouTube and Twitter

Supporting safe, self managed abortion during COVID-19

It was a relief to many last week when the Scottish Chief Medical Officer wrote to NHS Health Boards to advise that mifepristone can now legally be taken at home by women seeking early abortions. Mifepristone and misoprostol are the two drugs used in medical abortions in the first 10-12 weeks of pregnancy and, in 2018, home use of misoprostol became legal in Scotland (and shortly after in Wales and England).

However, until last week, women were still required to visit clinics to be given mifepristone, despite evidence that this is safe for home use. Given the current COVID-19 pandemic, and ‘lockdown’ conditions in the UK, this put women seeking abortion and health professionals providing care at unnecessary risk, and directly contradicted government advice against all but essential travel. This is indicative of an exceptionalism with which abortion is often marked in health services, with it also being, for example, the only routine gynaecological treatment that requires permission from two doctors for women to undergo. Conversely, the normalisation of abortion, and some of the ways in which it might be achieved, is the subject of two recent papers from the SASS project (Purcell et al 2020; Maxwell et al 2020).

Our research from 2017 found that women in Scotland were happy to have the option to return home to complete the early abortion process in the privacy and comfort of their own home, and more recent research has been exploring the shift to home self-administration of misoprostol (Harden, Boydell, et al forthcoming).

Safe self-managed abortion has long been offered to women in countries where access is restricted, by organisations such as Women on Web. For many women in Scotland, abortion care via telemedicine (phone or online consultation) and having the necessary medication posted to them will be a welcome option at this time. In particular this would improve access for women living in remote and rural areas, for whom attending a clinic is particularly difficult. It is also crucial to note that, for some women, home is not a safe or appropriate space for them to undergo an abortion, for example in cases of domestic abuse. Hence, alternatives to home self-management must continue to be provided.

Similarly, the letter from the CMO advocates that in the current context of COVID-19, women should be provided with later abortion care as close to home as possible. At present, women requiring abortion after around 18-20 weeks have to travel to clinics in England for treatment, and no later abortion service is provided north of the border, except in the case of fetal anomaly (and even then, only if the woman is willing to undergo early induction of labour). This seems in part to be down to a difficulty or lack of will to establish a service in any one NHS Health Board area, and the reluctance of some individual health professionals to be involved in abortion care as a pregnancy progresses and the fetus becomes more developed. It also relates to the different surgical techniques required (dilation and evacuation rather that the vacuum aspiration used at earlier stages, or medical induction), as well as the need for an injection to stop the fetal heartbeat prior to these.

But what will happen when the pandemic subsides and normal life begins to return (whatever that may look like)? Will the option of safe home self-management of abortion be withdrawn? Or can there be some hope that this small amendment to abortion regulation in Scotland might remain, relieving pressure on over-stretched sexual and reproductive health services, and potentially offering women more control over ending a pregnancy which they do not feel able or want to continue? It is likewise too early to speculate whether the current shift might enable a shift toward longer-term provision of later abortions in Scotland, regardless of the reason the procedure is needed. However, it could certainly set a precedent that this provision is possible for the small proportion of women who present later in pregnancy, often for complex reasons outwith their control. In doing so, it would remove the additional stress and stigma, and in some cases cost, created by the need for travel (Purcell et al 2014).

As they relate to both early and later abortion, the changes brought about by the COVID-19 pandemic will be worth monitoring for their longer-term implications for the equitable provision of abortion care in Scotland.