Dr. Melody Redman is a Clinical Genetics Registrar with a background in academic pediatrics.
On March 2020, temporary provisions were introduced to allow women in the first 9 weeks and 6 days of pregnancy to take both medical abortion pills at home. The pills are sent by mail, after a remote consultation with an abortion provider. Prior to this, the administration of the first of the two pills required for medical abortions could only be done at approved abortion clinics or hospitals.
This ‘at home’ emergency abortion scheme was introduced due to fears about limited in-person access to clinics during the coronavirus pandemic, with the mantra at the time ‘Stay home and protect the NHS’. The UK, Welsh, Y Scottish Governments have recently consulted on whether to end these measures or make them permanent, and the publication of their respective decisions is imminent.
Unsurprisingly, this push to permanently allow abortion ‘at home’ has been spearheaded by the UK’s two largest abortion providers – MSI Reproductive Choices (formerly Marie Stopes) and the British Pregnancy Counseling Service, Who lobbying so that the scheme is permanent. Given the 59.3% of UK abortion clinics are rated by the Quality of Care Commission as ‘Requires Safety Improvements’, how then can we trust them to ensure women’s safety ‘at home’?
Last month, along with more than 600 other doctors signed an open letter demanding the end of the plan. Our letter expressed serious concerns about examples of pill use beyond the 10-week limit for home medical abortions and, in some cases, after the legal 24-week limit for surgical interruptions. The letter also highlighted a number of other safety and security concerns related to issuing abortion pills without a face-to-face consultation.
In fact, ‘at home’ abortions are based on women accurately remembering the first day of their last period, which only about fifty% of us do. This date is then used to estimate how far along the woman’s pregnancy is. The Department of Health and Social Assistance has confirmed that pregnancies that exceed the legal limit for abortions “at home” are interrupted at home, putting women at higher risk of complications.
It appears that data on the effects of abortions “at home” are not reported in a meaningful and systematic way. A Freedom of Information (FOI) request to the Quality of Care Commission revealed that between April and November 2020, 11 women Using the scheme, which had a gestation date beyond the legal limit for early medical abortion, required hospital treatment for complications. FOI Similarly, applications have since shown women suffering serious problems (including sepsis, bleeding, and trauma to the pelvic organs) after taking the pills.
It is concerning that an undercover investigation (led by a former director of MSI Reproductive Choices) revealed the lack of basic controls carried out by abortion providers before the pills are issued by mail. The investigation saw volunteer clients receiving abortion pills despite using false identities and gestation dates, including a date that could only have led to an abortion beyond the legal limit for abortions “at home.”
Eliminating a mandatory face-to-face consultation also hampers the ability of clinicians to point out signs of coercion and abuse. In alarming seven percent of British women have been pressured to have an abortion by their partner or husband, a figure that likely increased under confinement, during which there was a 49% increased calls to domestic abuse services. This is a serious concern; 87% of GPs are concerned about “unwanted abortion stemming from domestic abuse” when an in-person consultation is not required.
As a doctor, I know that telephone consultations can work well for some things, but there are huge limitations. I cannot control the environment on the other end of the phone, unlike in a safe clinical space. I can’t tell if my patient is around an intimidating partner. I can’t ‘look’ at them to see if they seem scared, have a black eye, or are very pregnant. Consultations about abortion are not as simple as calling your GP for advice on your reflux. They are intimate and challenging discussions, with life-changing physical and psychological ramifications.
Savanta ComRes vote of the general public reveals a large number of serious concerns. We are often told that simply ‘trust women‘when it comes to liberalizing abortion laws. So why should we ignore the 92% of women who agreed that a woman seeking an abortion should always be seen in person by a qualified physician?
Abortions “at home” were a hasty temporary measure, introduced at a time when it was feared that women should not go to an abortion clinic. This should not be a permanent solution. When making the difficult decision to perform an abortion, we must ensure that women receive a face-to-face consultation. Let’s give women the space, security and specialized appreciation they deserve. Therefore, I implore the government to end this temporary policy with immediate effect.