AnnaCMumsnet (MNHQ) Fri 29-Jan-21 17:02:37

Guest Post: “Women should have access to medical abortion care at home, even after the pandemic”

Clare Murphy, Chief Executive of British Pregnancy Advisory Service (BPAS), says the changes made at the beginning of the pandemic - to give women access to telemedical abortion care at home - should be made permanent.

Clare Murphy

Chief Executive of British Pregnancy Advisory Service (BPAS)

Posted on: Fri 29-Jan-21 17:02:35

(103 comments )

Lead photo

“It’s women already in challenging circumstances who struggle the most," says Clare Murphy from BPAS

There have been few health silver linings of this pandemic. But a woman’s ability to access early medical abortion care at home is one of them. Make sure we don’t lose this by responding to the Government consultation by 26 February – it’s quick and will mean women across England and Wales can continue to access high-quality abortion home care at the earliest gestations, protecting their health, wellbeing and even their lives.

At the start of the pandemic, the Health Secretary Matt Hancock approved our request to enable women to receive the medication needed for an early abortion at home following a teleconsultation, removing the legal requirement for women to attend a clinic in person for termination under 10 weeks, and therefore the need to travel often considerable distances during a public health crisis.

Although this was clearly an evidence-based approach, the terms of the 1967 Abortion Act require specific authorisation from Government for changes to where abortion medication may be taken, rules which do not apply to any other comparable health procedure.

For instance, we have long been able to give women suffering from missed miscarriage the very same pills to use at home without political permission. Now the Government is consulting on whether it should retain or revoke this authorisation. It must stay and here’s why.

At BPAS, we didn’t need a pandemic to learn that some women really struggle to access in-clinic services. While COVID-19 exacerbated that problem, it didn’t create it. Every day prior to last year’s approval of home care our midwives spoke to women facing multiple barriers to accessing treatment.

Distance from clinics, reliance on public transport, juggling work, education and childcare, often meant women had later appointments than necessary so they could organise logistics – increasing the gestation at which the abortion was performed and sometimes tipping women over into a surgical procedure when they would have preferred medication.

It's a travesty that we needed a pandemic to provide a better service for women.


Abortion is safe, and considerably safer than continuing a pregnancy to term, but the earlier it’s performed, the better it is for a woman’s health.

It’s women already in challenging circumstances who struggle the most. Economic vulnerability and precarious employment, where taking a day off work could mean job loss as well as the loss of vital family income (well over half of women we see already have children to care for), can create serious disparities in access.

“I cannot access the NHS service as it means taking time off work and providing my employer with evidence of why I need time off work - plus losing wages.”

“I have no surplus income. I would not be able to feed my existing children.”

For women in coercive relationships, where pregnancy may be used to tie her to an abusive partner, finding reasons to leave home for the day to attend a clinic in secret was all but impossible during lockdown, but potentially life-threatening pre-pandemic too.

“I’m really struggling to access services as my violent partner won’t allow me to go anywhere on my own.”

“I can't go to an abortion clinic as I wouldn't be able to get there without my partner finding out. He's very abusive to me. If he ever found out I was pregnant I wouldn't be able to get away.”

Because we were not lawfully able to provide care to those who needed it at home, even for women with serious disabilities, it’s no surprise that they were left with little choice but to turn to online providers like Women on Web – set up to provide help to women in countries where abortion is unlawful, but which received regular requests from women in Britain. These requests have vanished since home care became lawful.

We knew that this service would meet women’s needs and that it was an extremely safe way to do so. The evidence gathered suggests it may be even more effective than in-clinic care.

Continuing pregnancy is a known risk of medication abortion, but it appears that home use reduces this by giving women greater control over the timing of when they use the pills, rather than leaving them dependent upon clinic opening times.

And it’s a service women value:

“It gave me the opportunity to have my home comforts around me. I was able to have my partner take care of my other two children with any stress. I was also able to wait until a time over the weekend that was right to start the treatment.”

“I had to have an abortion before COVID-19 when I had a small baby. It was difficult for childcare and I had to catch three trains to get there and three to get back. I was already cramping before I got home. I found it more discreet when it got posted.”

It’s a travesty that we needed a pandemic to achieve the legal change necessary to provide a better service for women. It will be a tragedy if we lose it once the pandemic has passed.

Please respond to the consultation before it closes on 26 February, using our handy guide if you need. We’re so grateful for your support.

By Clare Murphy

Twitter: @bpas1968

ArabellaScott Mon 01-Feb-21 11:12:43

Was there not concern that women needed to have medical supervision in case there were complications? A bit unsure how this will impact on potential risks.

Is there a risk/benefit analysis somewhere that goes into more detail than 'abortion is safe'? 'The evidence gathered suggests it may be even more effective than in-clinic care' - could you possibly point me in the direction of this evidence, please?

All for the safest and best quality care for women, but always cautious about these things in case there may be unforeseen consequences.

Many thanks.

Viviennemary Mon 01-Feb-21 11:29:39

I disagree. There was a post not long ago from somebody very worried. She had taken the tablets and was in horrific pain. There was little or no support from the helpline she rang.

missrm Mon 01-Feb-21 11:31:33

I had a nurse who made me come into the hospital, instead of allowing me to use the pills at home, because I was "crying too much"

I was absolutely terrified of abusive eXDP finding out. She still made me come in. I'll never forget her. Pure evil.

I had to construct various lies about where I was that day and why I had to have DC watched. Absolute nightmare. The relief when it was all over was relief I'll never forget. I've never been more traumatised in my whole life.

DaisiesandButtercups Mon 01-Feb-21 11:35:09

I agree that women should be able to take the pills for a medical abortion at home.

JaimeLeeCurtains Mon 01-Feb-21 11:42:48

DaisiesandButtercups

I agree that women should be able to take the pills for a medical abortion at home.

Me too.

Squarepigeon Mon 01-Feb-21 11:46:35

The change is about having a telephone appointment rather than an appointment in person. Pre COVID the women weren’t medically supervised while the pills worked. They were sent home while the pills started working.

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highame Mon 01-Feb-21 11:58:42

So long as everything is fully explained (including how much pain) and there is good help if needed, I'm all for it.

pointythings Mon 01-Feb-21 12:02:36

As long as there is good support via telephone or video consultation, I'm in favour. More women will be able to access the service they need, and they won't need to run the gauntlet of so-called 'pro-life' demonstrators outside clinics.

Shedbuilder Mon 01-Feb-21 12:05:45

As long as there is good back-up in those few cases where women experience pain or other issues then I am fully behind this.

DaisiesandButtercups Mon 01-Feb-21 12:06:07

SquarePigeon what you say is true.

Just to clarify, I agree with the guest post that women should not have to get to a distant clinic, a clinic which may have awkward opening times, and necessitate arranging transport plus a chaperone plus childcare in order to access a medical abortion.

The risks of a medical abortion are not significant enough to warrant putting up so many barriers and as Square said it is merely that a woman must take the pills in front of the health care professional, she then goes home, with a companion and mustn’t drive herself, children cannot attend the clinic. It all feels like jumping through hoops and just making things difficult for women seeking abortion for the sake of it.

Taking the pills in her own home a woman has privacy and dignity. She won’t be delayed by clinic opening times, can take the pill when it suits her and doesn’t need to organise transport or childcare.

AllCatsAreBeautiful Mon 01-Feb-21 12:24:23

DaisiesandButtercups

I agree that women should be able to take the pills for a medical abortion at home.

I agree too.

Obviously I don't think women/people who need abortions should have to take the pills at home - I think everyone should have the option to either take them at home or in a medical setting. Different people will have different situations and want different things.

FWIW I had a medical abortion at home about 18 months ago as part of a trial for how it worked/how patients felt about it. I felt it was over-all a good experience (or, as good as such an experience could be!) and afterwards I told researchers that I felt the option should stay.

I think abortion should be decriminalised and these extremely safe pills should become easier to access – although of course women/people seeking abortion should always have access to medical info and medical support should they want or need it.

OvaHere Mon 01-Feb-21 16:23:12

I supported a young friend a few years ago in getting an appointment and taking the pills. The travel made it far more difficult than it needed to be.

We had to travel to another town (it needs to be by car really and to have someone to drive you) and be there for about 8am. I had to sort out childcare and take time off work to help my friend.

You then have to return something like 6 hrs later for the 2nd pill again which is incredibly difficult without support because the advice is you can't be alone for that appt and need a driver.

Really it all just adds to maelstrom of feelings for many women choosing to terminate. We don't need to make it harder.

I agree easy access to support should be there on the rare chance complications arise but otherwise I support a home based service option.

Shedbuilder Mon 01-Feb-21 16:28:38

I think abortion should be decriminalised

Where are you living, AllCatsAreBeautiful? Obviously not in the UK.

ArabellaScott Mon 01-Feb-21 16:37:27

No, I think AllCats is right, abortion is still criminal in the UK, with exceptions:

www.fpa.org.uk/sexual-and-reproductive-rights/abortion-rights/abortion-law

I dont' fully understand it - complex legal issue, as far as I can tell.

pointythings Mon 01-Feb-21 16:39:06

Shedbuilder abortion is technically still a crime. The 1861 Offences Against the Person Act was abolished in NI in 2019, but that event did not cover the rest of the UK. The 1967 Abortion Act doesn't repeal the 1861 act, it only offers exemptions to it. The fact that in practice women aren't sent to prison for procuring an abortion does not change that.

So yes, abortion should be decriminalised fully everywhere in the UK, and the law changed so that the woman no longer needs the say-so of two doctors. It's an archaic law that basically assumed the little woman doesn't know her own mind.

AllCatsAreBeautiful Mon 01-Feb-21 17:31:31

Shedbuilder

*I think abortion should be decriminalised*

Where are you living, AllCatsAreBeautiful? Obviously not in the UK.

I'm in the UK. Abortion is not decriminalised in England, Scotland or Wales (I know Northern Ireland recently changed it's laws around abortion so I'm not sure if they decriminalised? But there is still no access there). In England, Scotland & Wales it is criminalised under the 1861 Offences Against the Person Act, and women are still occasionally prosecuted – eg: www.mirror.co.uk/news/uk-news/mum-jailed-after-performing-diy-7031761

Decriminalising abortion is a feminist campaign/demand in the UK: wetrustwomen.org.uk/5-reasons-to-decriminalise-abortion/

Serenschintte Mon 01-Feb-21 17:43:54

Somethings to consider,
What if there is a coercive partner sitting next to the woman. She doesn’t want an abortion. Her partner does. He prompts her to give answers. It wouldn’t be hard to do.
What if she was over 10 weeks - she didn’t realize or was in a coercive situation where the partner didn’t care. The risks to the pregnant woman are much greater for every day over ten weeks.
I’d question BPAS statement that abortion is safer than pregnancy - they provide no evidence to back this statement up and this is not what the government is asking. It’s not safer for women when they are over 10 weeks.
Women that have dangerous medical complications (or who think they have) then have to go to the NHS - at no cost to BPAS. This is an additional burden on the NHS
Telemed is no substitute for an in person appointment- it is much more likely to be abused than when someone sits in a room with another person.

DaisiesandButtercups Mon 01-Feb-21 18:02:13

BPAS are correct a medical abortion is safer than pregnancy and birth. The medication should still be prescribed by a doctor and obviously the woman should still be able to access medical care.

In the situation of a coercive relationship it is better to make it easier for the woman herself to be free to choose how when and where the medication is taken. Removing obstacles makes it easier for a woman keep her medical choices secret if she needs to.

Women should absolutely have the choice and control in this situation.

HannaWeb Mon 01-Feb-21 19:49:18

I agree. But different cases are possible...

ChattyLion Mon 01-Feb-21 20:18:28

Women absolutely should have choice and control. Abortion laws were drawn up to reflect hospital based surgical abortions which predate early medical abortion methods by decades. With telephone back up this will be a preferred option for a lot of women.

BoobsOnTheMoon Mon 01-Feb-21 20:20:05

Why is this only stickied in the feminism section? Abortion is essential health care, this post should be out there pinned to the top of active convos because many women who aren't interested in the feminist section would still want to respond to the consultation.

ChattyLion Mon 01-Feb-21 20:49:22

That’s a very good point BoobsontheMoon

ChattyLion Mon 01-Feb-21 20:50:16

It’s stickied in Active smile

Rose87777 Tue 02-Feb-21 09:00:57

Decriminalisation of abortion paves the way for abortion up to birth for any reason. Just want to add my voice to this to say that I don’t think medical abortion pills should be allowed to be taken at home. It essentially makes abortion a form of contraception.

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