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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:
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Mammyofasuperbaby · 06/02/2021 09:09

Its tricky but I think that women should be watched incase of complications.
I had a medical managed miscarriage 18 months ago and while not an abortion the medicine is the same. If I had been at home I would have died as I had a massive haemorrhage. Thankfully I was in hospital.
I know this is rare but I would hate to see a woman die from something like this

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Meredithgrey1 · 06/02/2021 20:50

@Mammyofasuperbaby

Its tricky but I think that women should be watched incase of complications.
I had a medical managed miscarriage 18 months ago and while not an abortion the medicine is the same. If I had been at home I would have died as I had a massive haemorrhage. Thankfully I was in hospital.
I know this is rare but I would hate to see a woman die from something like this

But as people have said, women are not normally monitored. The pills are given, taken at the clinic, and the woman goes home, and that has been deemed safe. So apart from the very short period of time between the pills being given and the woman leaving the clinic, the amount of (post medication) monitoring is the same.
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Cribbles · 07/02/2021 01:09

I'm sad that people think abortion is the way out - pease don't get me wrong , I am not judging anyone but I have heard to many people regretting what they have done .
I feel in this day and age , there is no stigma to being pregnant or giving your baby a better life than what you think you can't proved . I think any woman who can do this unselfish act is a hero . X

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pointythings · 07/02/2021 11:06

@Cribbles

I'm sad that people think abortion is the way out - pease don't get me wrong , I am not judging anyone but I have heard to many people regretting what they have done .
I feel in this day and age , there is no stigma to being pregnant or giving your baby a better life than what you think you can't proved . I think any woman who can do this unselfish act is a hero . X

Cribbles, that isn't what this thread is about. If you're sad about abortion, start your own thread.

Your point on regrets is not borne out by research evidence, by the way.

And it isn't about the stigma of being pregnant. It is about not wanting a child. Something every woman should have the right to decide. You're clearly a pro-lifer - this thread is about managing medical abortions safely. Please don't derail.
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goldielockdown2 · 07/02/2021 16:36

Cribbles no one cares about your issues and why you think forced pregnancy is 'heroic' xxxxx

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Bramshott · 07/02/2021 17:03

I've completed the consultation. For anyone else considering it - it does NOT need to take 30-45 minutes unless you have a lot to say. I wondered if that had been added to put people off? Or is that quite standard for these kinds of things??

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HappyBluebird · 07/02/2021 17:05

Cribbles if you don't like abortions, ignore them. Like you ignore all the kids in foster care/children's homes/unsuitable situations with miserable lives.

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pointythings · 07/02/2021 17:25

Bramshott thanks for the reminder! I did all this talking on the thread and never completed the consultation! All done now.

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MaryMashedThem · 07/02/2021 18:07

I haven't RTFT but I've encountered two women whose situations make me wary of this. One was years ago - she went into the clinic thinking she was a few weeks along, took the tablets there and then went home, expecting to experience cramping, bleeding, and maybe passing some small clots / bits of tissue. At home she felt horrific pain, then passed a fully formed, live fetus about the size of her hand. It moved about in the toilet for a couple minutes, then went still. I met her on an inpatients mental health ward because she was so traumatised by her experience that she could no longer function in her day to day life.
The other is more recent. I met her in A&E after she had received a medical abortion pack in the post. She brought the dead baby in to A&E in a carrier bag where the paeds assessed it as being about 30 weeks gestation. Only she knows whether or not she knew how far along she was - the clinic said she had told them she was about 5 weeks along.
I know those aren't representative of most women's experiences, but that doesn't mean they can be dismissed. The scope for error or deliberate misuse, and the physical and mental stakes, are quite high.

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goldielockdown2 · 07/02/2021 18:24

Mary was this in the UK? Because your first example doesn't tally with what actually happens. During a visit to a clinic, a scan is performed to ensure the gestation and the first tablets ends the life of the foetus. The second lot of tablets bring on the end of the pregnancy.
As for your second...no words. The chances of you coming across these two experiences are almost unbelievably slim. In fact, they are the kind of anecdotes given on prolife forums.

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ThePriceIsNotRight · 07/02/2021 20:42

Neither story rings particularly true. Even so, in the spirit of hard cases make for bad law, it doesn’t take away from the vast majority of women who have, and will in future, benefit from being able to access this service.

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SinkGirl · 07/02/2021 22:02

@Rose87777

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.

To be clear, you think it’s different a woman being sent the pills and taking them at home than having to travel to a clinic, take the pills in front of a professional and then travel home while it’s taking effect?

What difference do you think this makes?

I have completed the consultation and hope that this option is available permanently for those who need it. The different rules for missed miscarriage and medical abortion are unjustifiable.
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AccidentallyOnPurpose · 07/02/2021 22:20

@SinkGirl because some people think women must be punished for sex. Since they can't do anything about abortions being legal, they at least hope it is as uncomfortable,difficult,laborious and hard to access as possible.

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Viviennemary · 07/02/2021 22:42

I think taking pills through the post and suffering horrific bleeding and cramps with often nobody there to help is no answer. Why isn't better contraception being promoted rather than this solution becoming the norm.

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FoxyTheFox · 07/02/2021 22:50

Why isn't better contraception being promoted rather than this solution becoming the norm.

This isn't about contraception or changes to the provision of contraception. This is about abortion provision and changes to that. If you want to campaign for increased promotion of contraception then crack on with yourself and go start one.

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Pbur · 07/02/2021 23:04

You already have to go through the abortion at home alone, you only need to go to the clinic to be assessed and then take one of the pills in front of the nurse. It was a massive headache, a long wait, they did a scan and gave me a print out (totally unnecessary for me to see) then a GIANT pad that I had to wear on the tube home worrying that it would suddenly start (actually took hours). Much better to just have the pills at home - not really sure what the clinic visit added except them being sure I was under 10 weeks? Which I suppose is important if you’ve got your dates wrong.

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AccidentallyOnPurpose · 07/02/2021 23:07

@Viviennemary

I think taking pills through the post and suffering horrific bleeding and cramps with often nobody there to help is no answer. Why isn't better contraception being promoted rather than this solution becoming the norm.

Abortion is not contraception. Abortion is a solution for someone who is already pregnant. Mixing up the two is disingenuous. However, feel free to campaign or start a new thread about contraception if you feel so strongly.
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Stingebag100 · 07/02/2021 23:14

Absolutely. I had a termination myself a few years ago and it was so much more traumatic to have to go into the clinic. The worry leading up to it - who would watch my DD, making excuses for where I was so no one would know etc - as well as the horrible clinical environment. I think it would be a benefit for women in abusive relationships or women who are simply scared of actually going to an unfamiliar place where they would have an abortion surrounded by medical staff they do not know.

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MaryMashedThem · 08/02/2021 22:03

@goldielockdown2 I can assure you I'm not part of any pro-life forums/groups! But I should clarify that I work in women's health, so my chances of encountering these two women are perhaps higher than the average person's. I'm aware that their experiences are unusual. But I doubt they're unique; it's not vanishingly rare for the first set of tablets not to end the life of the fetus.
Both the women I referred to had their abortions in the UK.

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goldielockdown2 · 09/02/2021 14:06

Mary how odd, because your posting really doesn't make you sound like you work in 'women's health' at all. Your first story in particular doesn't add up.
You should maybe have pointed out you 'met' these women in a professional capacity as it reads like you just happened upon these extremely rare cases as you found yourself on a mental health ward and then in A&E. If you truly do work in women's healthcare then shame on you for sharing such graphic horror stories when you know they are very much the exception (if true).
You could maybe link your point to the guest post and state why you think women shouldn't have easier access to abortion and your concerns around remote terminations as opposed to all terminations, because your post gave the impression you aren't prochoice at all.

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MaryMashedThem · 10/02/2021 14:48

@goldielockdown2 Yes - perhaps I should have mentioned that I met these women in a professional capacity. Apologies for not making that clear. I've occasionally posted about my work before under this username - I suspect you have better things to do than look through all my other posts but you're certainly welcome to.
I did state in both my posts that these women's experiences were atypical. But that doesn't mean they should be dismissed or not talked about.
I am vehemently pro-choice. But my concern is that the system is a) not set up to facilitate women's choices and b) already failing to safeguard some women's health, and postal abortions allow further erosion of the existing safeguards.
By point a) I mean that women already aren't counselled properly about the short- and long-term effects of medical abortion, as illustrated by the many on this thread who found the experience much more painful or traumatic than they had expected, despite a face-to-face discussion with a healthcare practitioner. Supporting choice means (amongst other things) giving full and accurate information, and allowing time to digest this. Reducing the pre-procedure consultation to a quick phone call does not facilitate informed choice. By point b) I mean that some women are already experiencing poor health outcomes following medical abortion (the examples I gave were at the very extreme end of the scale but other less "graphic" examples include heavy blood loss, anaemia, pain, or low mood) and taking away the dating ultrasound - even though it's an imperfect technique - will mean that more women end up either knowingly or unknowingly undergoing medical abortions at later gestations, which entails a greater risk of physical and mental health complications.
I hope that answers some of your concerns about my post.

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freyahenry · 10/02/2021 14:51

Message deleted by MNHQ. Here's a link to our Talk Guidelines.

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MaryMashedThem · 10/02/2021 15:04

Oh - and regarding the first woman I mentioned, I wasn't involved in her abortion care so I only heard her account of it. But I have no reason to doubt her. Ultrasound dating technology is very good, but it's not perfect, and it also relies on the skill of the sonographer - who's human, and makes mistakes. So it's not vanishingly rare for pregnancies to be dated incorrectly. And if a fetus is more advanced than was thought, there's a greater chance that it will survive the abortion process and be born alive.

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goldielockdown2 · 10/02/2021 15:30

Nah.
Anyway, it's time we started trusting women to make their own decisions and not reduce them to infantile beings who make flippant choices based on a 'quick phone call'. As if no agonising or at least prior thought has gone into how to proceed with their pregnancy.
No woman I've ever met has had a termination for the shits and giggles. It's not a walk in the park (for some it is) for most. I imagine being made to go ahead with an unwanted or unworkable pregnancy and have a child which cannot be provided for is even more traumatic, physically and emotionally.

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goldielockdown2 · 10/02/2021 15:32

For those who are unable for whatever reason to work out their dates, there is always the possibility of on site care, and/or surgical abortion.

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