Threads

See more results

Topics

Usernames

Mumsnet Logo
Please
or
to access all these features

Guest Post: “Women should have access to medical abortion care at home, even after the pandemic”
104

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.

OP's posts:
Please
or
to access all these features

AllCatsAreBeautiful · 04/02/2021 17:03

@HappyBluebird

I hope things have changed, I had this in 1999 and the pain was indescribable. Having said that, even in a (private) hospital I wasn't given any pain relief. I passed out several times and definitely needed someone with me. I also defecated and weed myself and was violently sick. Is the pill better now does anyone know?

@HappyBluebird I'm sorry to hear you went through that! I'm not sure what's changed but my experience with the medical abortion (circa 18 months ago, NHS) was not like what you're describing – I had cramps that felt a bit like period cramps and heavy bleeding (of course) and that was it. They gave me a couple of dihydrocodeine pills for the pain and either they worked perfectly or the pain wasn't too bad to begin with. They gave me some anti-nausea drugs too, so I wasn't sick or anything. It sounds like maybe they're better at giving out painkillers etc these days.
Please
or
to access all these features

PearlclutchersInc · 04/02/2021 17:56

This is even a question? Of course I agree and the proper support should be given, no if, buts or discussion.

Please
or
to access all these features

HappyBluebird · 04/02/2021 20:07

That is good to know allcatsarebeautiful ! Honestly it was horrendous. I was in pure agony for hours, contractions and was so open (dilated)? That my whole hand slipped up when I wiped myself. Glad things seem to have improved-orperhaps my body just had a bad reaction?

Please
or
to access all these features

hibbledibble · 04/02/2021 21:00

If this is done entirely remotely, how is gestation, or an intrauterine (not ectopic) pregnancy confirmed? Without an ultrasound, dispensing medication to procure a termination of pregnancy, is dangerous.

There is also the risk of the tablets being intercepted, and misused, for example given to another person.

This proposal is not safe for women.

Please
or
to access all these features

pointythings · 04/02/2021 21:24

hibbledibble I would imagine that if there is any doubt about gestation, the woman will be called in to an actual clinic.

The process of providing medical terminations at home has been in place for some time now - if there had been masses of adverse outcomes, we would have heard about it.

As for medicines being intercepted - hosts of people have their prescriptions delivered. Again, there aren't masses of reports of medication being intercepted and given to the wrong person.

This proposal is safe. It's just that like any other medical procedure or treatment, it isn't 100% safe. Because no such thing is possible.

Please
or
to access all these features

hibbledibble · 05/02/2021 00:44

pointy this is exactly my point, that it is impossible to be confident about gestation without an ultrasound. Dating by last menstrual period is not accurate. Nor is it possible to know if a woman has an ectopic pregnancy without an ultrasound.

I am a doctor, and have seen a lot of women coming into hospital with complications following 'home abortions'. My colleagues and I are concerned.

Please
or
to access all these features

Shedbuilder · 05/02/2021 09:11

@hibbledibble

If this is done entirely remotely, how is gestation, or an intrauterine (not ectopic) pregnancy confirmed? Without an ultrasound, dispensing medication to procure a termination of pregnancy, is dangerous.

There is also the risk of the tablets being intercepted, and misused, for example given to another person.

This proposal is not safe for women.

This process is safe for the vast majority of women.

You'll need to provide some form of data, rather than anecdata, if you're going to argue that this is unsafe for 'lots of women'. Gather your data and submit your evidenced dissent.
Please
or
to access all these features

highame · 05/02/2021 09:39

I have completed the consultation and I think the questions I would ask are well covered.

Please
or
to access all these features

hibbledibble · 05/02/2021 09:56

There is no data to back the claim that this is safe. Shed you are claiming something that has no data to back it up. The studies that refer to telemedicine abortion include an ultrasound, and often bloods, as part of their care. To carry out an abortion without these is not safe. Why are we not providing women with the best possible care?

Please
or
to access all these features

DaisiesandButtercups · 05/02/2021 10:20

Daniel Grossman et al. Oct 2017

Published data about the safety of medical abortion at home with telemedicine.

The conclusion was that it is safe.

Please
or
to access all these features

hibbledibble · 05/02/2021 12:10

daisies I suggest reading the full text, rather than only the abstract. This study is very clear that telemedicine abortions included an in person visit where the woman had an ultrasound and blood tests.

Please
or
to access all these features

hibbledibble · 05/02/2021 12:13

I think the confusion here is that lay people don't understand the difference between what is currently being offered, and the telemedicine abortions reported in the literature, and are therefore coming to a false conclusion that this is a safe provision, when it is not.

The situation is also clouded by people who are vehemently pro-choice, and willing to prioritise access over safety.

Please
or
to access all these features

DaisiesandButtercups · 05/02/2021 12:33

So hibbledibble what has been happening during the pandemic and where is the data we can look at to see the results? It would help if you gave more information about the adverse outcomes and how frequent they are.

How do you think that medical abortion can be made easier for women to access as early as possible?

Isn’t part of the problem the legal barriers make it difficult for a single doctor to prescribe the medication and for any blood tests and/or scans to be done more locally to where women live?

Mainly though the point is that once prescribed the woman should be able to take the medication somewhere where she feels safe and comfortable and not have to be watched by a clinician or return to a far off clinic for the second dose.

Please
or
to access all these features

NessieM · 05/02/2021 13:39

Does anybody know of a forum / app / website that I can join that will answer any homework question (on any topic) that my son (GCSE Year 10) gets? It’s all getting too difficult for me now! Sometimes we just can’t find the answer we need ourselves.

Please
or
to access all these features

NessieM · 05/02/2021 14:00

Sorry I think I’ve posted this question in wrong place. Apologies...I’m new to Mumsnet & never used it before so have no idea where to post a random question? Or where to see replies? Can somebody give me some advise / help??

Please
or
to access all these features

DaisiesandButtercups · 05/02/2021 14:10

Welcome NessieM you will find a secondary school area in the education section of talk. Click on talk at the top of this thread to find the other sections.

Please
or
to access all these features

catgirl1976 · 05/02/2021 14:29

I absolutely agree with this.

As a PP said pre Covid you were given the pills the sent home, then back again a day or two later, given the second set and sent off again. This creates all sorts of difficulties for women.

Provided there is proper supporting place then abortion via telemedicine must continue post Covid.

Please
or
to access all these features

SnuggyBuggy · 05/02/2021 14:30

It's surely going to be less safe than an abortion with a check up but more safe than buying who knows what from the Internet. At least its known what's in the tablets.

Please
or
to access all these features

catgirl1976 · 05/02/2021 14:31

Sorry I’ve just seen telemedicine is perhaps the wrong phrasing. But abortion without the need to visit a clinic and to take the pills at home is what I mean. I’d also like to see the removal of the need for two doctors to agree but one battle at a time I suppose.

Please
or
to access all these features

NessieM · 05/02/2021 15:09

Thank you DaisiesandButtercups! Your help is much appreciated. X

Please
or
to access all these features

Dancingbea · 05/02/2021 16:46

There’s a new study here on safety and acceptability of telemedicine abortion
srh.bmj.com/content/early/2021/02/04/bmjsrh-2020-200976

Please
or
to access all these features

pointythings · 05/02/2021 18:46

Dancingbea that's a really interesting study and at least gives an indication that outcomes are very similar even with last menstrual period used for dating.

Please
or
to access all these features

hibbledibble · 05/02/2021 19:03

daisies I don't see that having a second doctors signature plays any role, no. Contrary to popular belief, this isn't always required, as under emergency circumstances an abortion can be carried out with the consent of one doctor.

What has been happening during the pandemic is that medication to induce an abortion is dispensed without any ultrasound on a pregnant women.

I cannot give details of complications due to patient confidentiality, but in broad terms we have seen complications related to women with an undiagnosed ectopic, and advanced gestational age. There have also been issues with the pills getting lost in the post, and women having complications later on as a result of having an abortion at a late gestation, which is riskier.

Please
or
to access all these features

AubergineDream · 05/02/2021 23:09

As a PP said I'd be worried about complications and ectopic pregnancies.

Also, I would be worried about abusive situations and coerced abortions.

Please
or
to access all these features

AubergineDream · 05/02/2021 23:11

For me I made the decision to keep my child after a pre abortion scan. A friend of mine discovered she was further ahead than she thought and had to go through with a different procedure. Those scans are important.

Please
or
to access all these features
Please create an account

To comment on this thread you need to create a Mumsnet account.