"They tell you that the pill will set in quickly, but the urgency of how quickly you need to get home I don't think is emphasised enough," says Claudia Craig, 23, who nearly miscarried on the way home in a taxi after taking the medical abortion pill at a clinic last year.
"About 10 minutes into the journey home I started cramping and feeling really faint and queasy. Luckily I only lived a 15-minute drive away, but I was counting down the seconds until we got home. When we arrived back I almost collapsed in the kitchen. I made it to the bathroom but not to the toilet, and my abortion started on the bathroom floor."
In light of her experience, Claudia has started the #homeuse campaign with the Women’s Equality Party, urging health ministers Jeremy Hunt and Vaughan Gething to change the law to allow women to take the abortion pill at home.
A medical abortion is a non-surgical procedure typically carried out at up to nine weeks of pregnancy. It’s a combination of two pills – mifepristone and misoprostol – taken over the course of two days, which cause a breakdown of the uterus lining and contractions to expel the pregnancy.
Last year, Scotland changed its abortion legislation to allow women to take the second pill (misoprostol) at home. In England and Wales however, women are still required to take misoprostol at a surgery or clinic. Many now argue that this is simply an outdated hangover from the 1967 Abortion Act, when abortion was exclusively a surgical procedure.
"It is time that England and Wales caught up with other countries that have approved home use. These rules date back to the 1960s, and they do not reflect the medical advances that have happened in the last 50 years," a spokesperson from the Women’s Equality Party told Refinery29.
"Home use is recommended by the World Health Organization, and studies have found no evidence of adverse medical effects."
"This is important because these outdated rules are putting thousands of women, like Claudia and the others who spoke of their experiences, through a wholly unnecessary ordeal by making them travel after taking misoprostol. There is no good reason for it."
Statistics published by the Department of Health show that a medical abortion is the most common way for women in England and Wales to end a pregnancy, accounting for 62% of all abortions in 2016 (up from 30% in 2006).
Professor Wendy Savage, who is a member of Doctors for a Woman’s Choice on Abortion and a prominent campaigner for women’s reproductive rights, told Refinery29 that there were no medical benefits to the law remaining the way it is. "I’ve not done a survey but those doctors involved in abortion work are united in their desire to see women able to take the pill at home," she said. Other prominent British doctors such as Professor Lesley Regan, the president of the Royal College of Obstetricians and Gynaecologists, have also argued for women to be able to take the pill in the comfort of their own home.
Many women do not make it home, many women cannot afford a taxi, and many women start miscarrying on public transport. It's awful, yet could be changed overnight.
In 2016, the British Journal of Obstetrics and Gynaecology published the results of a study of women in the Republic and Northern Ireland who had used the services of Women on Web, a Dutch nonprofit which provides pills and advice to women seeking an abortion in countries where it’s illegal. Ninety-seven percent of the 1,023 respondents who successfully ended their pregnancy at home using the pills provided felt they had made the right choice.
The Women’s Equality Party says the Department of Health has acknowledged its campaign but urged it to do more. "The Department of Health has responded to the campaign by claiming that it will continue to ‘monitor the evidence’. If it was looking at the evidence, then it would see home use is safe, effective and will save women distress and discomfort. The sooner the health secretary recognises that these rules are nothing more than an anachronism, the sooner he can make the simple change needed."
Obstetrician and gynaecologist Clive Spence-Jones said that women should be placed at the centre of the debate but that there were reasons why they had previously been required to take the pill in-clinic. "It’s all about looking after someone in what is a very traumatic moment in their lives," he said. "I think what matters, however it’s done, is that we are looking after people, which is making sure they are taken care of and given pain relief and that they understand what is likely to happen next in terms of miscarriage."
The law surrounding reproductive health, particularly abortion, is under review in numerous parts of the UK. On the Isle of Man, where abortion is currently illegal in most circumstances, there are plans to review the law in light of a public consultation which found the majority of the population supported reform; meanwhile, Ireland's referendum on repealing the Eighth Amendment, which makes abortion illegal, will be held on 25th May.
"Forcing women to return sometimes repeatedly to the clinic for each separate dose can represent a real barrier to care," said a spokesperson from the British Pregnancy Advisory Service, "particularly for women in already challenging circumstances, and needlessly subjecting them to the risk of bleeding and miscarriage on the way home is quite simply wrong."
"Home use of misoprostol is safe, effective, and used extensively across the world."
The law in England and Wales permits women who are experiencing a miscarriage to administer misoprostol at home; but women who want an abortion will have to attend a clinic to take the same drug.
"As has been demonstrated by the likes of BPAS and other medical professionals, the evidence shows that home use is safe, effective and more comfortable than the current situation," Claudia told Refinery29. "I was lucky because many women do not make it home, many women cannot afford a taxi, and many women start miscarrying on public transport. It's awful, yet this could be changed overnight."
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