In April 2020, women across England, Wales and Scotland were able to access “pills by post”, while some abortion clinics closed or reduced services during lockdown.
Campaigners called for the system to continue beyond the pandemic and in England, we now have confirmation that it will.
On Wednesday, MPs supported retaining the service by 215 votes to 188, a majority of 27, following a free vote. The House of Commons heard since the change in the rules, 150,000 women have had abortions at home before they are 10 weeks pregnant, and face-to-face services will remain an option.
The deadline for the end of the service has been extended in Scotland while ministers gather further evidence and in Wales, women currently have access to at-home pills while a consultation is also underway.
Healthcare charities continue to call for improved abortion services in Northern Ireland, after abortion was decriminalised in 2019.
One in three women will have an abortion in their lifetime, yet due to the silence and stigma that often surrounds the procedure, you may not know what to expect when you book an appointment.
So, here’s a guide on what actually happens when you seek an abortion, whether you want to visit a clinic or access the at-home system.
When can you have an abortion?
In England, Scotland and Wales, you can legally have an abortion (sometimes called a termination) up to the 24th week of pregnancy, although abortions will be carried out in some circumstances after this – for example, if a mother’s life is at-risk. Abortions in England, Scotland and Wales are available for free at almost all clinics under the NHS.
In Northern Ireland, abortions are permitted up to 12 weeks gestation. Abortions beyond 12 weeks gestation are lawful in specified instances, including when severe foetal impairment and fatal foetal abnormalities are detected.
Who can you speak to about abortion?
The NHS warns women to beware of so-called “crisis pregnancy centres” that claim to provide impartial advice but often do not. There is a list of registered Pregnancy Advice Bureaux on the Department of Health’s website. These have all met the Department of Health’s required standards on accurate and balanced information-giving, because they refer for abortion.
The three largest NHS abortion providers you will find nationwide are the National Unplanned Pregnancy Advisory Service (NUPAS), British Pregnancy Advisory Service (BPAS), and MSI Reproductive Choices (previously named Marie Stopes).
Each of these providers has an advice line run by counsellors designed to help women make the decision that is right for them. Other well-known organisations that provide support and advice for women considering abortions include the FPA and Brook (for under-25s).
How do you access an abortion?
You can talk to your GP about abortion if you’d like to, but you don’t need a GP referral to access an abortion and can self-refer to an abortion clinic. You can do this by calling them for an appointment.
If you’re considering the pills by post option, you’ll need to schedule a phone consultation. You can also request a call back and you’ll be called by a withheld number. If you’re deaf or hard of hearing, you can call the Bpas textphone on 0345 365 1450. Your phone consultation will last around 40 minutes.
“During this, you need to be on your own, somewhere safe, where you can speak openly. Ideally you should also have access to the internet, to support a discussion about treatment,” Bpas Medical Director Patricia Lohr explained in a Twitter thread.
The consultation – whether at a clinic or on the phone – will follow the same structure: a clinician will go through your medical history, talk you through your consent and what treatment option you were hoping for. They will also discuss future contraception.
“If we have any concerns about your safety or wellbeing, we will arrange for a safeguarding assessment,” said Lohr. “This may take place over a video call, or in a clinic if you’re a young person, or over the phone.”
Your consultation will help you decide what type of treatment is right for you. There are two types of abortion: surgical and medical.
What is a medical abortion?
Medical abortions are available when the pregnancy is up to 10 weeks gestation (how many weeks pregnant you are).
This treatment option requires a woman to take two tablets 24 to 48 hours apart: mifepristone and misoprostol. The first ends the pregnancy and the second causes the body to pass the pregnancy, working in a similar way to a miscarriage.
Thanks to the recent policy change, women can now opt to take both of these pills at home.
After the phone consultation, the clinic will post the medication you need, with clear instructions and information on how to care for yourself. This will be sent in plain packaging and will not require a signature
“We will also include a pregnancy test to check the abortion has been successful, and a six-month supply of the progestegen-only contraceptive pill if needed,” Lohr added.
Abigail Smith, a clinical nurse manager from the British Pregnancy Advisory Service (BPAS), tells HuffPost UK most women do not feel any symptoms after taking the first mifepristone pill, but the body reacts unpredictably to misoprostol and every woman is different.
“The most common side effects of those tablets are sickness and diarrhoea. Some people get a headache, some people get a rash and some people get light-headed,” she says.
Passing the pregnancy is rarely sudden, Smith explains. “It doesn’t usually start with a big bang. It usually starts as a bit of spotting, a bit of cramping which builds up, which is why I always liken it to climbing a hill,” she says. “At the top of the hill, which is usually about four to six hours after inserting the tablet, that’s when you can expect to pass the pregnancy.”
When you pass the pregnancy you’ll know, she says. “That’s not necessarily because you’ll be able to see anything, although that is a possibility. But actually, as soon as the tablets have done their job you start to feel much better very quickly.”
A lot of people go back to work the following day after a medical abortion, but if you do a very physical job, or if you’re going to be on your feet all day, it can increase blood loss. “It’s normal and not a big problem, but it is something to be aware of,” she says.
What is a surgical abortion?
A surgical abortion is usually given to women wishing to access treatment between 10 and 24 weeks gestation, but women can also choose to access this option under 10 weeks. Some women may choose a surgical procedure over a medical one because it is very quick when completed early into the pregnancy (taking 5-10 minutes).
“Some people could even come on their lunch break,” says Smith. “Although we do say you need to give yourself plenty of time to be here for the day, theoretically it can be a very quick procedure and it can fit into somebody’s day quite simply if that’s what they need to do.”
Depending on your medical history and how many weeks pregnant you are, you might require pre-medication before surgery can take place, Smith explains. This consists of two tablets that prepare your cervix for the procedure.
“You might be asked to take those if you’ve got previous obstetric history like multiple cesarean sections, or once the gestation is over a certain limit,” she explains, adding that pre-medication may also be necessary if you have had surgery on your cervix or have a raised BMI.
The surgery itself is a minor procedure where the pregnancy is removed through the vagina using a suction method. Other slim instruments may also be used.
The procedure is completed under local anaesthetic, conscious sedation or general anaesthetic, depending on your gestation. If you receive local anaesthetic, you’ll be able to attend the appointment alone and can drive straight afterwards. For sedation and general anaesthetic, you will not be able to drive afterwards and you will need to be accompanied by someone at your discharge whether you plan to travel home by car or public transport, due to the affects of medication.
“The medication we give can alter your decision-making ability and it can alter your memory slightly, not forever, but it works for a couple of hours,” Smith explains, which is why you must have someone with you when you’re being discharged. “They don’t have to stay in clinic the whole day, but you need someone to come and pick up and sit with you when you’re being discharged, basically so there’s someone there to absorb the information you’re probably going to forget.”
What happens next?
Physically, a woman’s body recovers from a medical or surgical abortion very quickly, Smith says. However, women can have different emotional experiences related to the procedure.
“For some people who come here, they are completely 200% sure of what they are doing, they’re at peace with what they’re doing and they’ve got a plan,” she explains. “But for other people they really need a lot more support and a lot more time, so they get that. For some people it’s a much more difficult and complicated journey.”
Most treatment providers will offer a counselling service to women who wish to receive further support after an abortion. BPAS clinics, for example, offer up to three free counselling sessions. After this, the counsellor can direct women how to access further counselling via their GP, should they need it.
It is recommended that women do not have sex for at least a week post-treatment to protect against infection.
Does abortion affect fertility?
The idea that abortion might impact a woman’s fertility in the future is one of the most common misconceptions about the procedure, Smith says.
She explains that no medical procedure is “risk-free” of complications, but complications after medical or surgical abortion are extremely rare.
“They’re very simple treatment options physiologically,” she says. “As long as everything goes according to the plan, and nothing is untoward as far as surgery goes – ie. there’s no emergency – there’s absolutely no evidence of any future effect on your fertility.”
There are also no “rules” about how many abortions a woman can have, which Smith says often gives rise to concern and confusion for some women.