In March 2020, as the reality of the coronavirus pandemic set in both for politicians and the population as a whole, the government changed its mind. As political commentators say, it did a U-turn on abortion.
Initially, the government refused to take the advice of scientific experts and professional bodies specialising in abortion which were calling in unison for at-home early medical abortions (also known as telemedicine) to be allowed.
It then made a colossal blunder, somehow managing to publish legislation which said that the pills required in early medical abortion (mifepristone and misoprostol) would be available for women and pregnant people to take at home before mysteriously declaring that it had been published in error and backtracking on the announcement. Then health secretary Matt Hancock said that there were "no changes to abortion law" before it was ultimately confirmed that women and pregnant people would be able to access at-home early medical abortion after all.
There is currently a spotlight on access to abortion so it’s worth revisiting this particular British debacle.
In recent weeks punitive new anti-abortion laws known mendaciously as a 'heartbeat ban' have come into force in the US state of Texas. Under these laws, abortion providers are prohibited from performing abortions once a foetal heartbeat is detected – which can occur as early as six weeks into a pregnancy – with no exception for cases of rape or incest. For so many reasons, this is cruel, inhumane and draconian; not least because at six weeks, it’s perfectly plausible that a person may not know that they are pregnant.
What has this got to do with at-home abortion in Britain? As people rightly focus on the abhorrent news coming out of America and Mexico’s landmark ruling, the fact that abortion is still more restricted than it should be in the UK cannot and should not be glossed over.
Firstly, abortion is still technically a criminal offence in England and Wales. This is because the 1967 Abortion Act, which legalised abortion for the first time, did not get rid of a Victorian law known as the Offences Against The Person Act. Experts have long been calling for this to change and the Royal College of Obstetricians and Gynaecologists (RCOG) is just one of many organisations which back full decriminalisation of abortion. It is because abortion is still technically a criminal offence that you have to have two doctors sign off on a procedure and that at-home abortion was not previously allowed because, under the 1967 Act, it must be carried out in certain places e.g. a licensed clinic.
Secondly, it took a global pandemic for women to be granted at-home early medical abortion in Britain. This was also something that experts had long argued should be allowed. It was hard-won and it almost didn’t happen, even as the world grappled with a huge public health crisis.
As we emerge from – or, rather, learn to live with – the pandemic and ease back into a new semblance of normality, uncertainty hangs over whether this change will remain.
In effect, what this means is that while Mexico has effectively decriminalised abortion, the British government is currently considering whether or not to reimpose criminal sanctions for women who use abortion pills at home.
Just sit with that for a moment.
Over a year since it was finally implemented, the consensus from experts – from RCOG to the British Pregnancy Advisory Service (BPAS) to domestic abuse support organisations – is that at-home abortion improves care.
While Mexico has effectively decriminalised abortion, the British government is currently considering whether or not to reimpose criminal sanctions for women who use abortion pills at home.
According to the largest ever study of UK abortion care, carried out by researchers at the University of Texas at Austin, BPAS, MSI Reproductive Choices and the National Unplanned Pregnancy Advisory Service, allowing women to have abortions at home throughout the pandemic has provided a safe, effective and more accessible service. It has even reduced waiting times which, as Freedom of Information requests submitted by Refinery29 prior to the pandemic showed, were rising.
The study analysed the outcomes of more than 50,000 early medical abortions that took place in England, Scotland and Wales between January and June 2020, before and after the telemedicine service was introduced. The aim was to compare data and see how the telemedicine service compares to the service before.
It found that:
- The effectiveness of the treatment remained the same for abortions carried out through the traditional service and the telemedicine service.
- There were no cases of significant infection requiring hospital admission or major surgery. Contrary to misleading claims, no person died from having an early medical abortion at home.
- Eighty percent of women said telemedicine was their preferred option and they would choose it in the future.
Experts agree there’s no clinical argument for reinstating previous restrictions and it’s vital that access to telemedical abortion continues after the pandemic. So why are women and pregnant people in Britain still waiting for a decision on whether at-home abortion can continue? The UK, Scottish and Welsh governments have all held public consultations on whether to keep it but no decisions have yet been made.
Clare Murphy, chief executive of BPAS, told Refinery29:
"When we look at what’s happened in Texas, it should make us think about how we fight for women’s reproductive freedoms wherever we are. Abortion needs to be firmly embedded alongside all other aspects of women’s healthcare – it’s not an exception, it’s a normal part of women’s reproductive lives."
"We must also remain focused on our own challenges at home and ensure that while reproductive rights are being rolled back elsewhere, the UK is a beacon for the rest of the world. If the government removes permission for telemedical abortions, any woman who uses pills at home could be imprisoned for life for an abortion at any gestation under the 1861 Offences Against the Person Act. Even the Texas law doesn’t threaten women with that."
Dr Edward Morris, president of the Royal College of Obstetricians and Gynaecologists, said:
"We would welcome the extension of the telemedicine service for medical abortions in the first 10 weeks of pregnancy, as it has proven to be a preference for many who are seeking access to an abortion. Many users feel more comfortable accessing this service while remaining in the comfort of their own home, and have cited a positive patient experience."
"Though face-to-face consultations should always be offered as a choice to anyone who would prefer one, the option of an at-home abortion is an important initiative in making safe abortion care more accessible, and removing barriers to essential healthcare."
A Department of Health and Social Care Spokesperson said:
“Safe and continued access to key services has been and remains our priority during this unprecedented period. The current temporary measures allow eligible women to take both pills for early medical abortion up to ten weeks’ gestation at home, following a telephone or e-consultation with a clinician."
“The government’s consultation on whether to make the current measure permanent has now closed. We will carefully consider all of the responses received, and plan to publish the our response later this year.”
This article was updated on September 16th 2021 to include a response from the Department of Health and Social Care.