Request to lift the censorship of Women on Web website in Spain

June 8th, 2020,

To whom it may concern:

We are contacting you concerning our recent revelation about the Women on Web website (from now on WOW) being blocked by all primary Spanish internet providers. A technical report prepared by independent experts on this blockade is attached as document. (non-technical summary can be read here)

This censorship was adopted without any prior formal notification that conforms to the minimum standards of due process. The only previous communication prior to the surprise block was an email from the Spanish Agency of Medicines and Healthcare Products (AEMPS) received on 29th May 2019, stating that Women on Web was operating without complying with the applicable regulations in Spain.

Accordingly, we would like to first of all stress that such email cannot be considered as an administrative notification that meets the applicable regulatory criteria. In this sense, this party reserves the right to appropriate legal actions once it has been duly notified of the full and reasoned resolution that justifies the motives why the website has been blocked and identifies the relevant appeals that may be filed.

In view of this and in response to the censorship and the blocking of the website, Women on Web would like to highlight the following information.

-       About Women on Web

Women on Web is a Canadian non-profit organization which aims at disseminating information on the human right to a safe medical abortion worldwide. We are a very well recognized woman’s right organization.

All of the information published on the Women on Web website is based on scientific information by the World Health Organization (hereinfter, WHO). In particular, the medicines used for a medical abortion, mifepristone and misoprostol, have been on the list of essential medicines of the WHO since 2005 and are available in almost all other European countries. WOW is sharing this scientific information and protocols on its website. Scientific research by the WHO has shown that medical abortion can safely be done by women themselves at home without supervision by health professionals. Medical abortion has the same health impact as a spontaneous miscarriage. There is enough scientific evidence of women themselves being able to handle a miscarriage without additional medical supervision. The risk of an abortion with medicines is similar to the risks of commonly prescribed medicines and over the counter medication, such as antibiotics and some painkillers.

However, in many countries access to abortion pills is extremely restricted and research showed that cost of the abortion, distance to the clinic, obligations from childcare, work and school, psychiatric illnesses, domestic violence and concerns about privacy cause severe obstacles to access abortion care. In Spain, women reach out to Women on Web when they have no access to safe abortion services because of these obstacles and because mifepristone and misoprostol are only available in hospitals and special clinics. The fact that many women in Spain are excluded from access to public health –such as undocumented migrant women–is also significant. It prevents them from accessing general health services and therefore, procedures of voluntary pregnancy termination.

-       On the need to ensure access to sexual and reproductive health services during the COVID-19 crisis and beyond:

We would like to emphasize that, given the security and isolation measures implemented to prevent the spread of COVID-19 in many countries, including Spain, access to contraceptives, emergency contraception and safe abortion care must be available in an appropriate, accessible, affordable and timely manner. We therefore understand that the medications referred to on the WOW page should be able to be taken after telematic consultation with a doctor, without the need to travel. Human rights organizations in the region have urged European countries to take measures to ensure timely access to safe abortion care during the crisis. They have stressed that restrictions on basic sexual and reproductive health services disproportionately affect women from excluded groups.

Most importantly, since the lockdown measures to control the spread of COVID-19 were implemented, the abortion pill should also be able without a physical visit to an abortion clinic but after a consultation with a doctor. It is currently unclear how long the restrictive measures to prevent the spread of the virus are needed. Many women are in a very unsafe home situation. Previously, an appointment could be made during working hours so that their abortion would remain secret. Because everyone now has to work at home, that is no longer possible. Other women are reluctant to take a long journey by public transport and visit a clinic with the chance of contracting a Covid-19 infection from contamination during transport there and back, by staff members or by fellow patients in a waiting room

Some countries, such as France or the UK, have already put in place concrete measures to ensure access to safe abortion by providing telematic assistance. The Royal College of Obstetricians and Gynecologists (RCOG) has created a basic guideline for abortion care in Corona times focusing on the safety and potential of using telemedicine without visiting a clinic. In Spain, Catalonia in particular has adopted measures to speed up the access to voluntary termination of pregnancy by reducing the number of visits and facilitating telematics follow-up while the COVID-19 alarm situation continues. Considering the permanent nature of the pandemic and the other barriers to access, these types of measures should be maintained in the long term.

-       On the States’ obligations in relation to sexual and reproductive health and access to information

Access to basic sexual and reproductive health services, commodities and information are essential and a key element in guaranteeing the human rights enshrined in many regional and international human rights instruments. These establish the right of all people to enjoy the highest attainable standard of physical and mental health, including sexual and reproductive health.

Indeed, under international law, the Spanish Government has a positive obligation to guarantee access to safe abortion services on equal terms and with dignity. The failure to provide this essential service constitutes a form of discrimination against women and girls, as it puts their lives, health, and physical and psychological integrity at risk. If the Government fails to comply with their due diligence obligations in the matter, women have the human right to do what is needed to protect their health and lives. Violation of the rights to life and health, including women’s sexual and reproductive rights, is a form of gender-based violence that, in some cases, can constitute torture or cruel, inhuman or degrading treatment.

The Committee on the Rights of the Child has urged States parties to decriminalize abortion to ensure that girls have access to safe abortion and post-abortion services, to review legislation to ensure the best interests of pregnant adolescents and make sure that their views and decisions regarding abortion are always heard and respected. In its General Comment No. 4, the Committee stressed the best interests of the child in having access to appropriate health information.

For his part, the Report of the Special Rapporteur on the right of everyone to the enjoyment of the highest attainable standard of physical and mental health has urged States to “(…) adopt measures to guarantee access to legal and safe abortion services without risk. In addition, information about abortion and access to the corresponding services should be available and accessible, of good quality and non-discriminatory. In particular, those regarding planning, counseling, pre- conception care, maternal care, sexually transmitted infections, diagnosis and treatment, as well as modern forms of contraception, including emergency contraception, and safe abortion and post-abortion services.”

Access to information, meaning the right to seek, receive and impart information on health issues – is a key determinant of access to health care. This is especially true respecting access to abortion services. States must also ensure that third parties to do not limit people’s access to health-related information and services.

By blocking a website such as WOW’s which provides comprehensive and timely information to protect women’s health, integrity and lives, not only puts women’s health and risk, but also violates their fundamental right to access information, recognized and protected in international instruments and national standards. Specifically, the right of access to information is set out as an independent right in Article 19 of the International Covenant on Civil and Political Rights and Article 10 of the European Convention on Human Rights, which derives from the right to freedom of expression. In this regard, the European Court of Human Rights has underscored the right to impart and receive information about available abortion services as essential to ensuring women’s health and well-being (Open Door and Dublin Well Woman v. Ireland, Judgement 14234/88, 29 October 1992).

The United Nations Human Rights Council has recognized the right of women and girls to enjoy the highest attainable standard of physical and mental health, including access to information, education and the means to exercise that right, both in the virtual environment and beyond. The promotion, protection and enjoyment of human rights on the Internet is also referred to in Human Rights Council Resolution 23/13, which unequivocally condemns measures aimed at preventing or intentionally disrupting access to online information or the dissemination of information on international human rights law and calls upon all States to refrain from taking such measures and to abandon them.

In the same strain, the recent Report of the Special Rapporteur on the promotion and protection of the right to freedom of opinion and expression has highlighted that freedom of expression applies online. It also emphasizes the role of private actors in safeguarding freedom of speech and states that although it is the duty of States to respect and protect freedom of expression, the private actors that establish, operate and maintain digital access also play a critical role. The Guiding Principles on Business and Human Rights adopted by the Human Rights Council in June 2011 (also known as the "Guiding Principles") recognize the responsibility of business enterprises to protect human rights. Within this context, States should take appropriate measures to investigate, sanction and redress abuses of individuals' rights by companies in their territory and/or jurisdiction. They also recognize the responsibility of business enterprises to respect human rights, independent of State obligations or the implementation of those obligations.

In Spain, the Spanish Constitution recognizes the freedom of expression and freedom of information in its article 20.1.d). Likewise, Article 4.2 of the Law on Patient Autonomy and Article 10 of the General Health Law establish that clinical information must be provided in  a manner that is understandable to the patient and adapted to his or her condition as a nonmedical professional, thus allowing him or her to make a decision. Article 17 of the Organic Law 2/2010 on sexual and reproductive health and the termination of pregnancy establishes, among other things, that all women who express their intention to undergo a voluntary termination of pregnancy "shall receive information about the different methods of terminating the pregnancy, the conditions for the termination provided for in this Law, the public and accredited centres to which it may be directed and the procedures for accessing the service, as well as the conditions for coverage by the corresponding public health service".

The restrictions on information published by WOW and obtained from the WHO on safe access to abortion are a restriction on freedom of expression and also on the freedom to receive scientific information on safe health services from Spanish women. The Human Rights Committee highlighted the need to strengthen the Spanish Government’s commitment to guarantee the fundamental rights of freedom of expression during its sixth periodic Report of Spain in 2015.

-       On the impact of Censorship on Women’s Rights

We are concerned about the adverse effect that the censorship of the WOW webpage web could have on those women seeking safe and legal abortion services. This censorship does not only involve a violation of the aforementioned national regulations but also ignores the consequences for those seeking scientific information to terminate their pregnancy safely.  The lack of access to this information could contribute to unsafe procedures that put women’s life and integrity at risk, as well as violate women’s human rights.

The restrictions to access information on legal and safe abortion contribute to unsafe abortion in a manner inconsistent with human rights under international law. It is well known that unsafe abortion is a significant cause of maternal mortality and morbidity worldwide.^[2] Every year an estimated twenty-eight thousand women die and millions more suffer with complications from unsafe abortion. Women resort to unsafe abortion because they cannot access safe services on equal terms and with dignity because of the various barriers that they face, including lack of access to information.

Notwithstanding, scientific research by the WHO has shown that medical abortion can safely be done by women themselves at home without supervision by health professionals. A medical abortion has the same health impact as a spontaneous miscarriage. Usually, women themselves handle a miscarriage without additional medical supervision. As a non-invasive alternative to surgical abortion, medication abortion is widely regarded as having significantly improved access to safe abortion. It is safe and effective, with few serious complications.^[3] In addition, medical abortion is now widely practiced worldwide, combining effectiveness with task shifting. It involves the possibility of being performed by a more diverse set of providers in healthcare.^[4]

By censoring the WOW website and restricting information about safe abortion procedures, the impact of this is gender-differentiated, negative and disproportionate. The consequences of censoring information about a procedure needed exclusively by women at any stage of their lives is also a form of discrimination and violence against women. The Internet is one of the primary sources of health information. Therefore, the information provided is of particular importance, especially to those who lack access to traditional health service information, as well as for those who require confidential, secure and timely information and seek services outside of their communities.

Similarly, the stigmatization of abortion, attributable in part to its criminal regulation in some parts of the world, including Spain (Article 144 of the Criminal Code) or the fact that it is conditioned to, as anticipated, the fulfilment of discriminatory requirements when it comes to migrant women, also deters women from inquiring about the availability of these services. Women may be reluctant to request services for fear of health provider judgment or refusal, and public disclosure and retribution from families and communities. Many women for this reason do not consult their regular health providers and seek care outside their communities. They are without traditional sources of health information.

In short, the availability of scientific information on health services on known and accessible platforms to which pregnant women and adolescents can have access is fundamental for them to be able to make autonomous and informed decisions to which they are entitled. Restricting the right to access information on safe and legal abortion contributes to creating conditions for unsafe and unsafe abortions to take place, as well as increasing barriers to access to sexual and reproductive health services in Spain. All of which, as noted above, constitutes a violation of women's human rights and of the norms that prohibit discrimination and violence against women based on gender.

By way of conclusion, we would like to emphasize once again the lack of transparency displayed by the AEMPS throughout this process and the limitations imposed to WOW’s right of defence, given the automatic censorship of the site, without the possibility of contradiction. As previously mentioned, we want to reiterate that we are a women’s rights organization and our main aim is to broadcast information on the human right to safe medical abortion and to make them accessible.

Without prejudice to the fact that we reserve the right to initiate legal action in this regard, we understand that the AEMPS could have taken a series of other less drastic measures instead of blocking all the content of the website. The serious consequence of which is to prevent women in Spain from having access to scientific and objective information on safe abortion. This is especially true in the context of the COVID-19 pandemic, during which States have an urgent obligation to ensure access to health care services, including sexual and reproductive health care, following the principles of dignity, equality and non-discrimination recognized in the Spanish Constitution and taking into account the various vulnerabilities and risk situations that women, girls and others who may become pregnant during and beyond the period of quarantine and isolation measures are subject to

Therefore, we hereby kindly request you to lift the censorship and allow women in Spain to access the Women on Web website.

Sincerely,

Rebecca Gomperts, MD, MPP, Phd CEO Women on Web

[2] Safe abortion: technical and policy guidance for health systems. 2^nd edition. World Health Organization, Department of Reproductive Health and Research.

[3] Self‐administered versus provider‐administered medical abortion Cochrane Systematic Review - Intervention Version published: 09 March 2020, https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD013181.pub2/full

and 

https://www.nap.edu/read/24950/chapter/4#58

[4] Safe abortion: technical and policy guidance for health systems. 2^nd edition. World Health Organization, Department of Reproductive Health and Research.