Women in England should be allowed to take the second pill required for an early medical abortion at home, healthcare leaders have urged, saying “the time for action is now”.
The heads of the Royal College of Obstetricians and Gynaecologists, the Faculty of Sexual and Reproductive Healthcare and the British Society of Abortion Care Providers have called on the Health Secretary to follow the example of Scottish and Welsh governments and lift restrictions that require a second visit for a medical abortion to be carried out at a licensed clinic or hospital.
“There can be no justification not to act unless the aim is to punish women having a legal abortion,” write Professor Lesley Regan, Dr Asha Kasliwal, Dr Jonathan Lord, and colleagues in an editorial in the journal BMJ Sexual & Reproductive Health.
An estimated one in three women will have an abortion by the time they reach 45. Most will be early in the pregnancy when a medical abortion is most effective, the authors point out. The safest and most effective method for this is to take two drugs (mifepristone and misoprostol) 24 to 48 hours apart.
Because a medical abortion didn’t exist when the 1967 Abortion Act came into effect, the law has therefore been interpreted as requiring both drugs to be taken at a licensed premises, they argue. “This risks the distress of having the abortion while travelling back from the clinic, a trauma that would be entirely preventable if women were allowed to take the drugs at home.”
HuffPost UK has reported on the effect the current interpretation of the rules has on women. Claudia Craig, 23, from Edinburgh, explained that she had “no idea how quickly” the abortion pill she took would take effect after leaving the hospital. During her 15-minute taxi drive home from the clinic, she “turned pale green and could feel the process starting”.
“I collapsed almost as soon as I got inside and started vomiting and miscarrying on the bathroom floor,” she wrote in an open letter to health ministers. “I can’t imagine what it would have been like if we had been stuck in traffic for just two minutes longer. Or if, like many women, I couldn’t afford to take a taxi.”
Having access to an at-home abortion pill would have made a “huge difference”. “I could have gone through this process in my own time, without unnecessary distress, judgement and punishment for exercising my right to choose,” she wrote.
Prof Regan, Dr Kasliwal and Dr Lord, also argue that the obligation to return to the abortion service for a second visit impacts those who struggle with repeated time off work, childcare, transport difficulties or distance from the abortion service. “Furthermore, it selectively disadvantages the most vulnerable - those who are deprived, live in rural areas or have dependants,” they add, citing data on 28,000 women from one of the UK’s largest abortion providers.
This showed that most women (85%) opted to take both drugs at the same time rather than make a return visit to the abortion service, despite knowing that this method was less effective and associated with a higher complication rate. For every 38 women taking both drugs at once, one additional woman required surgery, compared with those opting for the two-step method, the data showed.
The World Health Organisation (WHO) recommends home use of both drugs for medical abortion. This would require no change in the law, the authors say. The government would need only to use its executive powers to approve the use of women’s homes as premises where early medical abortion could be carried out.
“I could have gone through this process in my own time, without unnecessary distress, judgement and punishment for exercising my right to choose."”
- Claudia Craig, who had to take abortion pills in the hospital.
In April 2018, women’s rights groups also called for a policy change on this issue. The British Pregnancy Advisory Service (BPAS) and the Fawcett Society wrote a letter to Jeremy Hunt, the former Health Secretary, calling for women to have the right to have an abortion at home.
In October 2017, Scotland became the first country in the UK to allow women to take their second abortion pill at home, meaning women won’t risk miscarrying in public. In April, Welsh ministers announced plans to follow suit.
In a separate editorial, editor in chief of BMJ Sexual & Reproductive Health, Sandy Goldbeck-Wood, has also called on Theresa May to decriminalise abortion in the UK.
Under the 1861 Offences Against the Person Act (OAPA), any woman who has an abortion could be given a life sentence in prison. However in 1967, an amendment to that law was passed, making abortion legal in Britain if a number of conditions were met, such as two doctors having to agree on each case.
Abortion should be decriminalised, rather than legalised as when the Abortion Act was passed, argues Goldbeck-Wood. “Future UK law could support conscientious reflection in abortion care more effectively by guaranteeing women access to the resources they need to make the ethical and practical choices which are theirs to make and live with.”
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