Early at-home abortions are now a reality in England
After political resistance, we’re now seeing a win for reproductive freedom in some parts of the UK
image Oleg Rebrik/Getty
words Megan Wallace
Women, and other people with uteruses, will now have permanent access at-home, early abortions in England from 30 August.
After an initial tele-consultation, people who are up to nine weeks and six days pregnant will have the option of having abortion pills sent out to them via post for use at home.
The move is a continuation of pandemic-era “telemedicine” measures, which allowed individuals to be provided with early medical abortion care after a telephone or video call consultation with a health professional to determine whether they were eligible and safe to do so.
Resistance from pro-life organisations
Medical (ie non-surgical) abortions require the ingestion of two pills: a tablet called mifepristone which blocks the pregnancy hormone and, one to two days later, a tablet called misoprostol, a prostaglandin medication which within four to six hours causes the womb lining to break down. Up until the pandemic, the first of these was traditionally administered in a clinic or hospital before a patient would be sent home to take the second pill.
However, during the pandemic, when the government was trying to stop the spread of Coronavirus by keeping as many people away from hospital as possible, it was made possible to have both pills delivered to be taken at home.
Though this was initially intended as a temporary measure, a public consultation was launched in November 2020 to February 2021 to determine whether these pandemic abortion services should be made permanent. However, 70% of respondents indicated that they believed that telemedicine should be stopped immediately - likely informing a later announcement by the The Department of Health and Social Care that they would be ending the scheme in August 2022, making taking both pills at home an illegal act.
The results of the consultation were likely skewed by anti-abortion groups: out of 18,659 responses, 8424 of them were affiliated to a campaign by pro-life organisation Right to Life. The guidance notes to the consultation outcomes also recognise this flaw in methodology, saying; “It is important to note that views gathered through a public consultation should not necessarily be considered as representative of the views of the wider population. Rather, they are the views of a self-selecting group of people who were aware of the consultation, have an interest in the subject matter, and chose to take part.”
As the situation progressed, there was strong evidence that the results of the consultation really weren’t indicative of the wider population’s beliefs. Over 150,000 women and people with uteruses used the telemedicine service during the pandemic and in December 2021 an independent poll by market research company Savanta Com-Res found that 65% of women were in support of extending telemedicine with only 15% against it.
With mounting pressure from feminist advocacy groups, and public outcry when the news broke that the scheme would be scrapped, a movement to permanently extend telemedicine gained traction. Conservative MP Baroness Liz Sugg helped bring in this change by tabling an amendment to the Health and Social care bill and, in March 2022, this passed in the House of Commons with 215 for and 188 against.
Why is the pills by post service so important?
In 2019, 82% of abortions in England and Wales were performed on a patient who was under 10 weeks pregnant – making it clear that a large proportion of people experiencing an unwanted pregnancy would be able to benefit from a telemedicine service.
Among the supporters of the amendment posed by Liz Sugg was Labour Cabinet Shadow Minister Dr Rosena Allin-Khan, who argued in parliament that at-home early medical abortions are “crucial for women’s healthcare” and enable “thousands of women to gain access to urgently needed care more quickly, more safely and more effectively” before pointing to the likelihood that scrapping the service would have led to more later-term abortions.
Now, people in England, Scotland and Wales will have the option to go to a clinic or hospital if necessary but will also have the option of at-home treatment. This will save patients who wish to use the service from the added stress of attending a clinic – whether it is arranging time off from work to go to an appointment, arranging childcare, or travelling far. There is also the psychological burden of potentially being obstructed and harassed on the way into the clinic by pro-life protesters, who have been known to protest outside of abortion clinics.
With telemedicine now being made permanent in the majority of countries in the UK, women and people with uteruses have more choices to end unwanted pregnancies on their own terms – a decisive step forward for reproductive freedom and bodily autonomy.
What has the reaction been?
While the news may not have been warmly received by anti-abortion groups, the move to make telemedicine permanent in England has been celebrated by reproductive services and many members of the public.
In a statement, Dr Edward Morris, President of the Royal College of Obstetricians and Gynaecologists, said; “We are delighted that telemedicine for early medical abortions will continue in England and Wales. The permanent provision of telemedicine is a huge win for women, girls and people accessing abortion care.
Over email, Louise McCudden, Advocacy and Public Affairs Advisor at MSI Reproductive Choices told Woo that; “We were delighted that the Government voted earlier this year to permanently keep the option of at-home abortion care, supporting the continuation of this essential service.”
“Making this safe and popular service a permanent option will particularly benefit those who struggle to attend face-to-face appointments, including those in abusive relationships, those with caring responsibilities, and those without transport,” she added.
Kerry Abel, Chair of Abortion Rights also spoke to Woo, sharing her thoughts that the move is important but should not have been delayed to begin with. "Abortion is healthcare and it’s high time it was treated like any other medical procedure," she said. "The government’s initial decision to scrap telemedicine flew in face of solid medical evidence and survey data showing that telemedicine for early medical abortion is safe, effective and preferred by women. The case has been made for telemedicine."
What about abortion in Northern Ireland?
Now, England, Wales and Scotland will all have permanent access to abortion pills by post. However, there are still discrepancies across the UK: notably, Northern Ireland has not permitted access at any point during the pandemic.
"However we know abortion is still subject to a post-code lottery with choice varying according to area and some areas still under-funding abortion," says Abel. "161 people from Northern Ireland travelled to England for abortions in 2021, a significant decrease from previous years, but in most cases this is unnecessary travel."
While the World Health Organisation has deemed early medical abortion medication to be safe (even taken out of a clinical setting) there are issues associated with taking pills bought from an unreliable source.
The British Pregnancy Advisory Service and activist groups such as Alliance for Choice Derry recommend Women on Web as a resource that provides genuine early medical abortion medication and trusted advice on reproductive health to those who cannot access it through legal means.
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