There is no reason to deny women the option of taking abortion pills at home
In March 2020 the government granted permission to allow early medical abortion to be carried out at home. The at-home service, known as telemedicine, gave clinically eligible women the option of taking both abortion pills - instead of only the second pill - in the privacy and comfort of their own home instead of at an abortion clinic.
Aware that there was a case to be made for offering this option regardless of the pandemic, the government held a public consultation on whether to make it permanently available. The evidence submitted from clinical bodies was overwhelmingly supportive.
Last month, a year after the public consultation had closed, the Public Health Minister issued a written statement to Parliament to say that the service would be extended for a further six months, but for no longer. The removal of this service would be a step back for women’s reproductive rights, and we are pleased that the government committed to keeping the decision under review.
But this week the House of Commons has the opportunity to listen to the clinical evidence and keep the option open to women to take early medical abortion medication at home. Last week the House of Lords voted in favour of an amendment to the Health and Care Bill which, if passed by the Commons, would make telemedicine abortion available permanently.
Telemedicine has been a success by any reasonable measure. It has reduced waiting times, improved access for women in the most vulnerable circumstances, and it has been safe. There is no clinical reason why every woman using this service should attend a clinic in person to take a pill which can be taken safely at home. In one peer-reviewed study, 83% of women said they preferred home use.
Some critics argue the service was never meant to be permanent. But offering telemedicine is well-established as recommended best practice in abortion care.
The National Institute for Clinical Excellence (NICE), the Royal College of Obstetricians and Gynaecologists, the Royal College of Midwives, the World Health Organisation (the WHO), and the British Medical Association all endorse telemedicine, regardless of Covid-19.
In Wales, the government recently announced that telemedicine will be offered permanently, and Scotland still offer the service, with a recommendation included in their Women’s Health Strategy that this should continue. Even the US Food and Drug Administration, hardly a radical institution, made postal delivery for abortion medication permanently available at the end of last year.
The FDA’s decision was made with reference to world-leading evidence from the UK. If this can be offered in America, where abortion is a wildly divisive issue, it can surely be offered to women in England, where the vast majority of people are pro-choice.
Studies have found that telemedicine has no higher complication rate than taking abortion pills in a clinic, which women have been doing legally and safely since the early 1990s. In fact, the largest ever study of abortion care of over 52,000 women found a small reduction in some complications, and no increase in any. Some of those campaigning against this issue have ignored these studies and attempted to monitor complications themselves. The only way to measure cause and effect, especially with a service delivered during such an unusual period in time, is through formal research, conducted using transparent methods, and subject to peer-review and scrutiny.
The anti-choice groups desperately trying to find evidence of links between telemedicine and health complications should save themselves the time - a global body of peer-reviewed, credible evidence already exists. It shows that telemedicine is safe.
It is not only clinical bodies that support telemedicine. Women’s Aid, Rape Crisis, and the End Violence Against Women Coalition are all very clear that telemedicine is a lifeline for many women.
Pregnancy is one of the most dangerous times for women with abusive partners, and it can be impossible to safely attend a clinic in person without an abusive partner finding out. Removing the option of legal, regulated abortion at home forces women to make the unbearable choice between risking their personal safety and risking criminalisation in order to end a pregnancy.
It was no surprise that the sale of abortion pills from unregulated online providers fell since home access was made legally available.
Anti-choice campaigners claim their fight to deny everyone access to telemedicine is rooted in concerns for vulnerable women. It is more common to be forced into keeping a pregnancy than ending one. Anybody who understands gender-based violence, coercion and abuse will tell you that the solution to reproductive coercion is stronger reproductive rights. Making abortion access more difficult does not prevent coercion. It does the opposite.
Everyone’s personal circumstances are different. Some women will prefer face-to-face care; others prefer collecting their pills or receiving a discrete postal package. Some women who choose telemedicine may still want counselling; others won’t. Women are perfectly capable of making these decisions for ourselves, together with clinicians and safeguarding leads where needed.
Rather than asking whether it was right for the government to permit home use of abortion pills in 2020, perhaps we should ask why it was ever unlawful in the first place. When the Abortion Act 1967 was passed, abortion care looked very different than it does today. There were no pills; all abortion was surgical. The stipulation that abortion always take place in a clinical setting was written into law decades before medical abortion was even a possibility.
It is right to put women’s safety first. Those of us who believe that abortion, like all medical care, should be delivered in line with the best clinical standards are alarmed by the government’s disregard for clinical opinion on this. For a government proud of its global clinical leadership and its record on gender equality, removing the option of telemedicine is a grave misjudgement.
This amendment gives Parliament the chance to listen to women about their own healthcare. We encourage all MPs who believe in evidence-based policymaking and women’s reproductive rights to vote in support of the amendment, so that doctors and nurses can continue offering this safe, effective, and compassionate form of abortion care for all who choose it.
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