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

104 replies

AnnaCMumsnet · 29/01/2021 17:02

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.

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.

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ArabellaScott · 01/02/2021 11:12

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.