At-Home Abortion Care Has Been A Lifeline In The Pandemic. Let’s Keep It

There aren’t many ways healthcare has improved during this crisis. But helping women access safe, effective abortion care from the safety of their home is one, writes BPAS' Clare Murphy.

A new study shows that enabling women to have early abortions at home during the pandemic is safe and effective – and meets women’s needs. There have not been many ways in which healthcare has improved during the pandemic, but this is one of them. It absolutely needs to stay.

At the start of the coronavirus crisis last year, the health secretary, Matt Hancock, granted legal permission for women to receive and use both sets of medication for an early abortion (under 10 weeks) at home.

Why we need government permission rather than the common sense and clinical best practice that governs all other healthcare procedures is another story, and a sad hangover from our out of date abortion laws – but let’s leave that for now. The amended rules meant women did not have to travel considerable distances in a public health emergency to access care they could safely receive in the comfort and privacy of their own homes.

But the permission has an expiry date, and the government is currently consulting on whether to keep this framework in place. Every voice matters, and here’s why you should tell them they should.

In the biggest ever study of UK abortion care, researchers looked at more than 50,000 early medical abortions in England and Wales, of which more than half were conducted following the changes in the rules. Waiting times fell steeply because staff and women’s times was not wasted in a clinic, and with that of course so did gestations – with more than 40% conducted at six weeks or less compared to just a quarter in the old, in-clinic group. Abortion is extremely safe, and considerably safer than continuing a pregnancy to term, but the earlier it can be performed the better for women’s health.

“Our doctors, nurses and midwives say women find it easier to confide from the comfort of their own home than when anxious in a clinical consulting room.”

That doesn’t of course mean it is risk-free – once a woman is pregnant, every outcome has possible clinical implications for the woman – whether her pregnancy ends in birth, miscarriage or abortion, whether at home or in a hospital or clinic. But what’s crucial is that the already extremely low incidence of serious adverse events – for example, haemorrhage requiring transfusion or infection needing hospitalisation – remained the same (and indeed fell from 0.04% to 0.02%). We can safely say therefore that this is a very safe service.

But women’s experience is also key – 96% of women were satisfied, and none reported that they were not able to consult in private. This is important, because questions were raised as to whether a model without in-person care can effectively address the needs of very vulnerable clients who may have safeguarding needs.

In fact, the experience of our doctors, nurses and midwives in providing this service suggests women may find it easier to confide from the comfort of their own home than when anxious in a clinical consulting room, however welcoming and supportive our staff. And, of course, where we feel we need to see a woman in person, or she prefers face-to-face advice, this will always be available.

My organisation did not need a pandemic to teach us that some women struggle to access in-clinic abortion care. Even outside of a public health crisis, women in challenging circumstances like coercive and abusive relationships, where pregnancy is used to tie her to controlling partner, found confidentially accessing a clinic sometimes considerable distances from where they live all but impossible when their every move was watched.

“We shouldn’t have to fight to retain the gains we have made in this period, when they are already so few and far between. But this is one of them.”

The law gave us no discretion to care for these women at home, in secrecy, and so they were left to decide between continuing a pregnancy they did not want or taking their chances ordering pills online, an act which carries a punishment of life in prison under our 19th Century abortion laws. It is no surprise to hear from our colleagues at wonderful organisations like Women on Web, which provides early medical abortion to countries where abortions is unlawful, that requests from Great Britain have dried up since legal telemedical abortion services were introduced.

Caring for existing children (more than half of the women we see are already mothers), work commitments – and particularly for those in precarious financial circumstances where a day off work to attend a clinic may mean the loss of much needed wages to feed her family or even job loss, all create barriers to care. It is women in these most difficult circumstances, alongside those with physical disability, mental health conditions or illness, including serious pregnancy related conditions like hyperemesis, who suffer the most and who have benefitted the most from the new model of care.

Early medical abortion at home is safe, effective, and a lifeline for women everywhere. We shouldn’t have to fight to retain the gains we have made in this period, when they are already so few and far between. But this is one of them. Make your voice heard in the government consultation here.

Clare Murphy is chief executive of the British Pregnancy Advisory Service (BPAS). Follow her on Twitter at @clareemurph


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