Should women continue to be allowed to have at-home abortions after Covid?

Should women continue to be allowed to have at-home abortions after Covid?

By Harriet Argent

Due to lockdown, people up to 10 weeks pregnant have been allowed to take abortion pills at home, and many are calling for this to be made a permanent change.

Organisations such as Abortion rights UK and MSI Reproductive Choices are calling for at-home abortions, temporarily introduced for those up to 10 weeks pregnant, to be made permanent in the UK after the pandemic.

Due to lockdown restrictions, women are now allowed to consult a health care professional over the phone and take the two abortion pills, previously administered at a clinic, in the comfort of their own home.

The Government is currently in talks to decide whether this should be made a permanent change to the law. Consultations on the matter closed in late February, and we are still waiting for the outcome; if it were to go ahead, it would be the biggest change to abortion law since the 60s.

A valued and safe option

A recent study by MSI Reproductive Choices UK on over 1,200 women found 83% preferred the telemedicine approach to abortions during the pandemic, and a further 66% said they would choose this approach again if Covid-19 were no longer an issue. 

The medical director of the organisation and co-author of the report, Jonathan Lord, said in a statement that this research proved at-home abortions were valued and a more accessible option, especially for those who found in-clinic visits logistically and emotionally challenging.

“Removing the possibility of choosing telemedicine now would be to outright ignore those patient’s voices,” he said, “We hope the government decides that it can continue to trust women to make their own decisions about what is best for their reproductive health.”

Not only is this approach more valued by the people it affects, but it has also been proven to be a safe and, in fact, more effective option.

In a study carried out by the Department of Health and Social Care (DHSC) of over 50,000 medical abortions, it was found that the mean waiting time from referral to treatment declined from 10.7 days in the traditional pathway to 6.5 days in the telemedicine pathway. Because of this, the gestational age at the time of the abortion was reduced significantly too.

The study also found there was no evidence of a lower success rate at home and all cases were treated and completed safely.

Room for error?

There are, of course, concerns about this proposed change.

Right to Life, a pro-life organisation in the UK, has been scrutinizing the data released by the DHSC and claims it is seriously obscured.

In a webinar hosted by the group in March, Kevin Duffy, former Global Director of Clinics Development at MSI Reproductive Choices, pointed out the data proposes at-home abortions are 17 times safer than ones in a clinical setting, which he said was ridiculous.

Another concern from both sides of the debate was the increased opportunity for survivors of domestic abuse to be coerced into having an abortion they did not want.

Dr. Callum Miller, an NHS doctor and research associate at the University of Oxford, also present at the Right To Life webinar, stated that the lack of direct medical supervision when it comes to telemedicine was a threat to vulnerable women.

“There is often no background relationship with the patient or available notes to identify risk factors,” he said, “with telemedicine, you only get one person’s perspective which can often be limited.” [29:40]

The right to choose

Anoushka, a 24-year-old student from Cardiff, was faced with the at-home option when she was seeking an abortion last year.

Because she was at such an early stage and at risk of having an ectopic pregnancy, she was allowed to go to the clinic and have a scan beforehand, but still had to take the pills at home.

“It’s not something I have done before, so I don’t know if I can compare the two options,” she said, “but in my experience, it meant I got to be at home in my own comfort with my own bathroom and my own bed, and I had my boyfriend there with me. I felt safe and comfortable.”

However, Anoushka said there were some downsides, and she valued being able to see a professional face to face beforehand because it made her feel less alone. Furthermore, after taking the second pill, she faced some complications which could have been dealt with more easily if she had been able to see a professional at the time.

“I’m pro-choice, but I do think it would be a mistake to get rid of the face-to-face appointments completely,” she said.

Anoushka also said she thought that if someone was healthy and with a strong support system at home, there is no reason why they shouldn’t be allowed to have their abortion it in the comfort of their own home.

“There are always two sides to these things, and it is genuinely dependent on your situation,” she said, “at the end of the day, you can’t tell someone what is right for them.”

Accessible to everyone

The proposed change to the law does not mean women would be blocked from going to a clinic if they needed to. That option would still be open to them, but for women who live far away or are not able to attend to multiple doctor appointments for various reasons, this is a far more accessible option.

In their statement about at-home abortions, Abortion rights UK said they have been arguing for a long time it was unnecessary for a woman to have to attend a clinic two days in a row to take a pill.

In response to concerns about coerced abortions, the organisation also said they believed teleconsultations were even more important for those in domestic abuse situations: “We know sexual violence is high for women suffering domestic violence and adding the pressure of attending multiple appointments outside of their regular routines makes the process even more difficult”.

“One in three women will have an abortion in her lifetime. If we can make the procedure easier and safer in a lot of situations, it is our obligation to remove the barriers and postcode lotteries.”

All abortions come with risks, whether the pill is administered in a clinic or taken at home. This proposed change to the law would allow women at least a choice in the type of health care they received and make it more accessible to everyone.

Graphic courtesy of Alice Eaves.