Abortion is something that one in four women and people with wombs will experience in their lives because they need to end a pregnancy. It is an essential medical service yet something very weird has been going on in Westminster recently. And it has left women’s health experts like the British Pregnancy Advisory Service (BPAS) and the Royal College of Obstetricians and Gynaecologists (RCOG) frustrated and confused.
On 24th February the government announced that it would be scrapping at-home early medical abortions (also known as pills by post) after 29th August 2022. According to both BPAS and RCOG, this is a "serious step backwards" when it comes to abortion rights.
At-home early medical abortion allowed people to take mifepristone and misoprostol at home after a telephone consultation with a doctor (known as telemedicine) for the first time in English history. This was achieved through emergency coronavirus legislation, which was able to override previous laws (the 1967 Abortion Act) which required people to attend a clinic for an in-person consultation and to receive their second pill in the presence of a doctor.
When it was announced in 2020 that people would be allowed to take abortion medicine at home during the pandemic, experts celebrated. For years, RCOG and BPAS had been calling on politicians to make abortion more accessible. Doing so would make an enormous difference to all those seeking abortion but particularly those with childcare responsibilities, key workers and those on zero-hour contracts for whom it can be difficult to take time out to attend multiple appointments. The move, experts unanimously agreed, was a game-changer.
When it comes to the government’s latest u-turn, what makes matters even more confusing is that on 2nd February the government had appeared to say (via a leak to a Telegraph journalist) that at-home abortion would be made permanent.
The government’s mixed messaging about abortion could be easily overlooked given everything else that’s going on in the world – from the cost of living crisis to the invasion of Ukraine – but it is vital that this news doesn’t slip under the radar. Surely it is no coincidence that the government revealed its plans to scrap at-home abortion on the same day that Russia invaded Ukraine.
So what on Earth is going on and why does it matter so much?
In short, this is a story about anti-abortion sentiment in government, the enduring strength of anti-abortion campaigners in Britain and behind-the-scenes wrangling over the reproductive rights and autonomy that women and people with wombs ought to be able to take for granted.
This isn’t the first time that the government has been inconsistent on abortion in recent years.
The 2020 announcement was bungled. The government initially 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 to be allowed.
It then made a huge mistake, somehow managing to publish legislation which said that the pills required in early medical abortion would be available for pregnant people to take at home before mysteriously declaring that the legislation had been published in error and backtracking on the announcement. Health secretary at the time Matt Hancock said that there were "no changes to abortion law" before it was ultimately confirmed that at-home abortion was indeed being introduced in the first lockdown.
Are you keeping up? If it sounds confusing, that’s because it is. In 2020 the government made an announcement, retracted it and then made it again. Much like what has happened in 2022.
How can we explain this chaos? According to a Westminster source the explanation for all this back and forth is simple but shocking: there are anti-choice politicians at the Department of Health and anti-abortion campaigners are more vocal than people who are in favour of abortion.
"All you have to do is look at the voting record of the secretary of state for health (Sajid Javid) and the minister in charge of abortion (Maggie Throup) to understand what’s going on here," the source said.
"My understanding is that civil servants and even some Department of Health officials were supportive of at-home abortion staying because they’ve been in so many meetings with women’s health experts who say that it is safe and effective," the same source continued, "but we’ve just got two very anti-abortion, anti-choice ministers in charge who just don’t want to do anything to improve access to abortion."
Javid has abstained on crucial abortion votes in recent years, including a vote on the decriminalisation of abortion in 2017 and a vote to legalise abortion in Northern Ireland in 2018. He voted against the British government legislating to legalise abortion in Northern Ireland when Westminster MPs were asked to demand this (also 2018). As home secretary, Javid also declined to bring in buffer zones around abortion clinics across the country to stop anti-abortion 'protestors' accosting anyone accessing abortion.
There is another factor at play here, too. While deciding whether to allow at-home abortion to continue, the government opened a public consultation. We know that the anti-abortion lobby is strong and organised – that’s why it stages 'protests' outside abortion clinics. So perhaps it’s no surprise that of the 18,659 responses to the consultation, nearly half (9,109) were from individuals affiliated to campaigns and the majority of these (8,424) associated with one campaign in particular: Right to Life.
This group describes itself as "a charitable pro-life organisation" but it is an anti-abortion movement.
Ultimately it seems that on this occasion, the group's highly organised campaigning, coupled with the personal views of certain politicians, has dictated abortion policy in spite of the medical evidence.
At-home abortion has been proven to be safe and effective throughout the pandemic. 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 early medical abortions at home throughout the pandemic has provided a safe, effective and more accessible service. It has even reduced waiting times.
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, both before the telemedicine service was introduced and after. 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.
Other countries have listened to the evidence, as have other parts of the UK. In Wales, for instance, it was announced at the end of February 2022 that at-home abortion and telemedicine would be made permanent for those receiving early abortion care. In the United States, the Food and Drug Administration (FDA) confirmed that a similar service would be made permanent at the end of 2021.
In England, RCOG and BPAS are seriously concerned about the practical ramifications of the government’s decision to withdraw at-home abortion.
BPAS is the leading abortion provider in the UK. "During the pandemic we changed our service to accommodate telemedicine," associate director Katherine O’Brien told Refinery29. "That meant losing some clinics because we didn’t continue to rent or lease buildings that we weren’t using. So we don’t have as many physical clinics as we once had. This could make access to abortion even harder than it was pre-pandemic."
The success of at-home abortions during the pandemic showed us what modern abortion policy looks like and how successful it can be. But since Matt Hancock introduced permission for at-home abortion and then took it away, only to reintroduce it within 24 hours, the government’s approach to abortion rights has been nothing but shambolic. This latest move is a fitting bookend to the story – a story that neither centres the needs of women and people who have abortions nor takes on board expert opinion and research. Recent events appear to confirm instead that the anti-abortion lobby in Britain remains alive, well and influential.
Dr Edward Morris is the president of the Royal College of Obstetricians and Gynaecologists. He told Refinery29: "The decision not to make the telemedicine service for early medical abortion permanent is really disappointing and creates uncertainty."
"Telemedicine care for early medical abortion has been one of the few success stories of the pandemic, where barriers have been removed to allow women to access an essential form of healthcare," he added. "There is a wealth of evidence to show that telemedicine for early medical abortion is safe, has enabled women to access treatment sooner, and that the service is preferred by women. We consider the removal of this service an infringement on a woman’s right to access the healthcare she deserves."
The government has said that it will keep access to at-home abortion under review but that will provide little comfort for those who need an abortion. And for abortion service providers, it makes planning ahead almost impossible.
The Department of Health did not provide a comment when Refinery29 asked why it was not listening to medical experts. However, it did direct us to a press release which cites the end of coronavirus legislation for the decision to take at-home abortion away.
The Cabinet Office declined to comment.
Refinery29 has approached the prime minister’s office at Number 10 directly for a comment.