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Kate* began to suspect she might be pregnant a week before Boris Johnson’s lockdown order. At the time, she was also showing symptoms of Covid-19, so was self-isolating at home for 14 days.
She didn’t want to tell friends or family of her suspicions, so had an agonising wait until she could buy a pregnancy test herself. When she finally did – and her suspicions were confirmed – she knew she wanted an abortion.
The 40-year-old mum-of-three, from Melton Mowbray, had been in a casual relationship before lockdown that had since ended. She asked the man how she could’ve become pregnant when they’d been careful with condoms – he admitted to tampering with the contraception, in a bid to force her into a more serious relationship.
“I was furious, beyond furious. I felt violated,” she says. “I phoned my GP in a panic and he gave me the number for the British Pregnancy Advisory Service (BPAS). They were lovely and very understanding.”
Kate was anxious about accessing an abortion during lockdown, but BPAS told her about the “pills by post” system, which was introduced to help women like her during the pandemic.
The service enables women to receive two pills in the post – mifepristone and misoprostol – that induce a medical abortion, without the need to visit a clinic. Before lockdown, women in England, Scotland and Wales had to travel to a clinic to take the first pill, then take the second pill at home.
When using the “pills by post” system, women must first have a telephone consultation with a clinician, which covers the same questions usually asked at the clinic regarding their medical history, consent and the treatment itself.
Having the option to take both pills at home has helped many women like Kate, says BPAS, and the charity would like it to remain a choice post-lockdown.
“We know that even outside the pandemic, women struggle to access care in clinics due to childcare responsibilities and transport issues, for example,” says Katherine O’Brien, a spokesperson at BPAS. “Women in coercive or abusive relationships are at particular risk of being unable to attend clinic appointments without their abuser discovering their pregnancy.”
Some women have no choice but to turn to illegal methods, such as buying abortion medication online, risking up to life imprisonment under the current law, adds O’Brien. “To protect this group of extremely vulnerable women, the pills by post service must continue to be provided.”
So, will lockdown change abortion provision in the UK forever? The decision lies almost entirely with one man: Matt Hancock.
Under the 1967 Abortion Act, the Secretary of State for Health has the power to grant approval for where abortions can be carried out. The current approval for the pills by post service will last until the day the temporary provisions of the Coronavirus Act 2020 expire – or two years after the permission was granted.
“Just as the Health Secretary was able to grant permission for the new measures, they will be able to extend this permission beyond these dates,” O’Brien explains. “There’s no need for new legislation or parliamentary debate, it is entirely at the discretion of the Health Secretary.
“Women tell us they want to see pills by post to continue. It would make absolutely no sense for the Health Secretary to shut down the service.”
Kate, a key worker and a single mother, says it would’ve been “almost impossible” to access an abortion during lockdown without this system. “Due to Covid-19 there was a delay with the post,” she says. “I phoned the clinic a few times wracked with anxiety but every time, they put me at ease.”
When the pills eventually arrived, her eldest son, who is 16, received them for her as she was at work. The pills arrive in unmarked packaging to afford women confidentiality. “I told him they were my Lansoprozole [stomach acid] tablets from my GP,” she says. “I hated lying, but like I said, I haven’t told anyone.”
Kate says the instructions were very clear. “I took the first pill on a Thursday, and the next dose 48 hrs later on a Saturday,” she says. “It all went very smoothly.”
Critics of the pills by post system – largely anti-abortion groups – have raised concerns that women’s care will suffer without in-person appointments. Some claim the system has safeguarding issues, particularly regarding coerced abortions, at a time when domestic abuse is believed to have increased.
But BPAS says the service is “safe and effective” due to the extensive phone consultation required. If the clinician has any concerns about a woman’s safety or wellbeing, they will arrange for a safeguarding assessment, conducted in a clinic or over video call.
Anti-abortion groups also claim remote services increase the risk of ectopic pregnancies going undetected. However, as part of the telephone consultation, explains O’Brien, there’s a discussion about the signs and symptoms of this. “If an ectopic pregnancy is suspected, the client will need to attend a clinic for a scan,” she says. “The provision of early medical abortion without routine ultrasound scanning is recommended by NICE in their guidance issued in 2019, and our service is fully in line with the recommendation.”
Other expert bodies, including the Royal College of Obstetricians and Gynaecologists, also recommended telemedical abortion services before the current pandemic, BPAS adds.
“Women tell us they want to see pills by post to continue.”
Since the introduction of pills by post, waiting times have reduced significantly, says O’Brien, adding that the charity has received “overwhelmingly positive” feedback from women.
“Women tell us it gave them both privacy and dignity to take the medication in their own homes, enabling them to avoid long journeys to clinics – often on public transport,” she says. “It also meant their partner could be with them every step of the way if they wanted. Women can access our aftercare service at any time, and know we’re here for them if they have any concerns.”
For Kate, being able to access pills from home will have a significant impact on the rest of her life.
“Yes, I was in pain and uncomfortable, but the moment it was over I felt enormous relief,” she says. “I felt myself again. The sickness and exhaustion left. The anxiety left. I felt I have my life back.”
* Name has been changed