Women have right to choose abortion at home
When visiting a clinic remains such a tough experience for so many, removing the option of telemedicine, without a clinical basis for doing so, would be indefensible.
In March 2020, as part of its Covid-19 response, the UK government temporarily allowed early medical abortion to be carried out at home. Previously, only the second of the two pills used to terminate a pregnancy, misoprostol, could be taken at home; mifepristone had to be taken in a clinic. Now, if the pregnancy is under 10 weeks’ gestation and a remote consultation gives the go-ahead for abortion at home (known as “telemedicine”), there is no need to visit a clinic at all. Both pills can either be collected in person or posted directly to a home address.
Through delivering the telemedicine service, abortion providers can now evidence what we’ve long argued: there is no medical reason why every abortion must be carried out in a clinical setting. With the medicine and technology available to us in 2021, this outdated restriction makes no sense. It is right, therefore, that the UK, Scottish and Welsh governments decided to hold public consultations, asking whether telemedicine should be made available permanently. They are now in the process of considering all the evidence before making a decision.
Telemedicine is a long overdue step forward. The National Institute for Clinical Excellence (NICE) and the Royal College of Obstetricians and Gynaecologists (RCOG) both view telemedicine as an improvement in abortion care. Peer-reviewed research found that two thirds of those treated through the remote service said they would choose telemedicine regardless of the pandemic. With Covid-19 factored in, that figure rises to 80%.
Telemedicine has improved abortion access while improving safety
The highly pressurised health and social care sector has benefitted, too. Telemedicine is efficient, with waiting times falling by over four days on average. Allowing clinicians to work flexibly and from home has been positive for the overstretched medical workforce.
Telemedicine isn’t right for everyone; we still need clinics. But for many of our most vulnerable clients, telemedicine has proved invaluable. For example, some women living with abusive partners tell us they can’t visit a clinic. Some are dependent on their partner for transport, or unable to leave the house at all. Many of them tell us that having the option of discretely packaged medicines delivered by post is vital.
And while our team members at MSI Reproductive Choices take great pride in creating a welcoming, non-judgmental space, visiting a clinic can still be stressful. There are often anti-abortion groups outside, harassing people (mainly women and girls), and distributing medical misinformation. In smaller communities, it can be difficult to attend an abortion clinic and be certain you won’t run into someone you know.
Of course, avoiding in-person services should never be necessary in order to feel safe; everyone who chooses abortion deserves dignity. We continue to advocate for national legislation which would protect our clinics. But when visiting a clinic remains such a tough experience for so many, removing the option of telemedicine, without a clinical basis for doing so, would be indefensible.
Telemedicine has improved abortion access while improving safety. It is both more compassionate and more efficient. It is preferred by the majority of those who choose abortion, and it disproportionately benefits our most vulnerable clients. It is recommended by doctors, nurses, and public bodies. We understand that some people have strong ideological feelings about the idea of telemedicine. But now that telemedicine has been successfully delivered for over a year, it is difficult to imagine what clinical, ethical, or logical justification could be made for removing it.
Louise McCudden is the advocacy and public affairs advisor for MSI Reproductive Choices UK.