The current pandemic has forced a traditionally hands-off government to relax its abortion guidelines and make them appropriate for the 21st century.
In March 2020, the Department of Health (DoH) published measures to allow the two abortion pills that induce early medical abortions to be taken at home. Previously the guidelines required both pills to be taken in a clinical setting.
Abortion Rights has argued repeatedly for this – but told by successive governments that it required a change in the law. However, the dangers to patients and medical staff posed by Covid-19 prompted these sensible changes.
The current guidelines allow at-home abortions up to 10 weeks in England and Wales, up to 12 weeks in Scotland and while they are permitted up to 10 weeks in Northern Ireland since a 2019 amendment changed the law, in January a legal challenge was launched at the Northern Ireland Human Rights Commission because of the severe lack of access.
Below is an article by Kerry Abel, originally published here by Abortion Rights, that explains how the case for home use has been made by shorter waiting times and high patient satisfaction, but also breaks down other barriers.
The government is currently consulting the public about home use of the early medical abortion pills.
Taking abortion pills at home is exactly the same as going into the clinic and taking them. But if we keep the new regulations put in place over the pandemic it will ensure all kinds of women will have a better experience. Abortion Rights has argued for this for a long time. It is completely unnecessary to have to attend a clinic two days in a row to take a pill.
Aside from taking up medical professionals’ time and appointment admin, it means some women could have to give up a day or more of their work and in an era of zero hours contracts, not taking shifts could jeopardise their future earnings too. While most women who have abortions already have children, this also means securing childcare, another extra cost on top of travel – which for rural women is expensive and extremely time consuming.
And because of the travel, some women have been known to pass their abortions on the bus home rather than be in the comfort of their own home. In a 2017 study a woman gave her experience, “when I was on the bus I could feel that I was bleeding a lot […] I was really tired. I was just kind of, y’know: ‘I’ve spent 45 minutes on a bus for a two-minute appointment…?’
Traveling to clinics is not necessary. International scientific evidence and studies clearly demonstrate the safety and clinical appropriateness of women taking both of the abortion pills at home over and over again. Medical abortion is recommended by the World Health Organisation, with both abortion pills included within the World Health Organisation’s list of essential medicines and states that these lifesaving medicines should be available in every country.
Telemedicine works, women can take the pills after a consultation and with the simple instructions provided. Waiting times are down and figures produced by the Royal College of Obstetricians and Gynaecologists show that the average waiting time for an abortion has halved since home use was allowed, reducing to 4.5 days. Reducing waiting times makes the procedure safer and less complicated.
Patients have said they are happy with the current regulations. Data from MSI Reproductive Choices UK shows that overall 98.2% of those who responded to satisfaction surveys reported that their experience was either “very good” or “good”.
Any talk of women lying about their gestation times or trying to con doctors into allowing their abortions comes from a deeply misogynistic distrust of women.
Being able to have tele-consultations and to take the pills at home is even more important for those in domestic abuse situations. We know sexual violence is high for women suffering domestic violence and adding the pressure of attending multiple appointments outside of their regular routines makes the process even more difficult.
A 2018 study, which looked at barriers to abortion access highlighted women who couldn’t access abortion services for fear of the reprocussions. “Susan, who is 30 years old and lives in England, described her situation living with domestic violence and unable to seek care at a clinic or hospital for fear of partner intervention or retaliation: ‘I’m in a controlling relationship, he watches my every move, I’m so scared he will find out, I believe he’s trying to trap me and will hurt me. I can’t breathe. If he finds out, he wouldn’t let me go ahead, then I will be trapped forever. I cannot live my life like this.”
Abortion Rights believes that home administration of abortion medication puts women at the centre of their care, in clinically appropriate situations, will allow all women equal access to early medical abortion services, stripping away barriers for disabled women for whom public transport is still not perfect and costs that disproportionately affect poorer women.
In England and Wales in 2019, 82% of abortions were under 10 weeks. With this becoming increasingly preferred by patients, guidelines should catch up. The Royal College of Obstetricians and Gynaecologists have stated that, “This has significantly reduced the need for hospital admission and the risk of women suffering complications associated with surgical procedures. This simple adjustment to service delivery also means that precious NHS resources are saved by reducing the number of visits that a woman has to make to a clinic to obtain her medication”.
One in three women will have an abortion in her lifetime, if we can make the procedure easier and safer in a lot of situations, it’s our obligation to remove the barriers and post code lotteries.
We’ve learned a lot about healthcare since the pandemic, including ways to make the services more efficient and cost effective, this is the same with abortion care. A study into abortion provision in England and Wales concluded that the recent changes “further builds a strong case for changing policies to match the evidence base”, concluding that shifting early medical abortion services to GP clinics would increase the number of trained health professionals that perform simple abortion procedures, freeing up specialists for more urgent, complicated cases, such as those seeking abortion in later in pregnancy.
The changes are not just better and safer for women, they level the playing field and make our NHS more efficient.
The consultation closes on 26 February 2021.
Abortion Rights has produced guidelines to the consultation here.
Abortion Rights has an email your MP tool to let your MP know how you feel here.
A useful video is here.
Abortion Rights is the only member-led pro-choice campaign in the UK – Visit here.
You can take part in the public meeting ‘What has the pandemic taught us about abortion care’ on 27 March 2021 by signing up here
 Purcell, C. , Cameron, S., Lawton, J., Glasier, A. and Harden, J. (2017) Self-management of first trimester medical termination of pregnancy: a qualitative study of women’s experiences. BJOG: An International Journal of Obstetrics and Gynaecology, 124(13), pp. 2001-2008. (doi: 10.1111/1471- 0528.14690) (PMID:28421651) (PMCID:PMC5724679) http://eprints.gla.ac.uk/140042/
 Int J Gynaecol Obstet. 2016 Sep; 134(3):268-71. doi: 10.1016/j.ijgo.2016.02.018. Epub 2016 May 26. Prospective study of home use of mifepristone and misoprostol for medical abortion up to 10 weeks of pregnancy in Kazakhstan. Platais I, Tsereteli T, Grebennikova G, Lotarevich T, Winikoff B, and
Acta Obstet Gynecol Scand. 2014 Jul;93(7):647-53. doi: 10.1111/aogs.12398. Epub 2014 May 23. Medical abortion with mifepristone and home administration of misoprostol up to 63 days’ gestation. Løkeland M, Iversen OE, Engeland A, Økland I, Bjørge L. Free full text: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4670695/
 Aiken, A. R. A., Guthrie, K. A., Schellekens, M., Trussell, J., Gomperts, R. (2018). Barriers to accessing abortion services and perspectives on using mifepristone and misoprostol at home in Great Britain. Contraception, 97, 177-183
 RCOG Better for women – improving the health and wellbeing of girls and women – December 2019 https://www.rcog.org.uk/globalassets/documents/news/campaigns-andopinions/better-for-women/better-for-women-full-report.pdf
 Systematic review of early abortion services in low- and middle-income country primary care: potential for reverse innovation and application in the UK context Jacy Zhou, Rebecca Blaylock & Matthew Harris: Globalization and Health volume 16, Article number: 91 (2020) https://link.springer.com/article/10.1186/s12992-020-00613-z