Following a poll of 8000 of you, we wrote to the Government urging it to retain telemedical abortion

[JuliaMumsnet]

Hi everyone

We thought you’d like to know that following a poll of 8000 of you (thanks everyone who voted!), Justine has written to the Parliamentary Under-Secretary of State for Vaccines and Public Health Maggie Throup urging the Government to retain telemedical abortions.

Here’s an extract: “The arrangements that were put in place during the pandemic have made us a world leader in the provision of telemedical abortion care for those seeking an early medical abortion. This means that women who struggle to attend an in-clinic appointment - because of a lack of childcare, transport issues, domestic abuse or any other reason - are able to obtain safe, timely and effective care.

I welcome reports that ministers are preparing to extend this provision, and would ask you to make the change permanent. As you may know, around 90% of Mumsnet’s 8 million users are women. When we polled them on this issue between the 28th and 31st of January, more than 8000 of them responded, with 77% of them in favour of retaining this provision permanently.

Telemedical abortion represents an important step forward for women’s health and reproductive choice. It must not be reversed.”

Full letter here. If you'd like to read more, Clare Murphy from the British Pregnancy Advisory Service (BPAS) wrote a guest post for us last year about telemedical abortion on which many of you shared your stories of abortion before this provision and since.

What you can do

1. If you’d like to take action on this, take two mins to write to Maggie Throup too here.
2. Retweet and/or share Justine's letter - it's on twitter here, on instagram here and on Facebook here.

Thanks!

MNHQ

Well done Justine & MNHQ.

I support this. Thanks MN!

Will do.

Fully support this. Thank you.

Thank you @JustineMumsnet @JuliaMumsnet and MNHQ

Excellent. Good work.

Thank you mumsnet. Good work.

This is a terrible idea. Apart from a poll on mumsnet, have you even looked at the research?
‘At-home’ abortion presents a high risk of coercion and abuse.
The ‘at-home’ abortion could be used by their abusers to disguise trafficking or abuse scandals. There is no way to verify who is consuming the medication and whether she is doing so willingly. Sex traffickers, incestuous abusers, and coercive boyfriends will all welcome more easily available medical abortion.

• Abortion providers cannot ensure that ‘at-home’ abortion pills are taken by the intended person in the intended circumstances within the intended time.

-A nationwide undercover investigation that concluded in early July 2020 found evidence of abortion providers putting women at significant risk, seemingly by not carrying out basic checks before sending abortion pills by post, showing that the scheme is open to abuse and facilitating abortions beyond the legal limit.

• In the investigation led by public health consultant Kevin Duffy, a former Global Director of Clinics Development at Marie Stopes International, all 26 requests by volunteers were successful in acquiring mifepristone and misoprostol using false names, dates of birth, and gestational dates.
• A second mystery client investigation conducted between November 2020 and January 2021 found that there had been no change in the behaviour of abortion providers despite assurances from the Care Quality Commission in November 2020.
• A leaked email from a Regional Chief Midwife at NHS England revealed that women had to attend Emergency Departments for a range of incidents including “significant pain and bleeding related to the process through to ruptured ectopics”, “major resuscitation for major haemorrhage”, and incidents involving the “delivery of infants who are up to 30 weeks gestation”.
• A recent Freedom of Information (FOI) request found that between 1 April and 30 November 2020, NHS England and Improvement had notified the Care Quality Commission of 32 “serious incidents” relating to early medical abortion, 29 of which saw the women suffer serious complications (the CQC notes that serious incidents are those requiring hospital treatment for complications ranging from “delivery of fetuses of unexpected gestation, incomplete abortion with retained products of conception, and ectopic pregnancies”). Of these 29 cases, 17 resulted from ‘at-home’ abortions.
• A recent study based on FOI requests to NHS Trusts found that more than 10,000 women who took at least one abortion pill at home provided by the NHS in 2020 needed hospital treatment for side-effects, equivalent to more than 1 in 17 women, or 20 women per day needing hospital treatment. Concerningly, the lack of a routine in-person consultation or follow-up in the case of ‘at-home’ abortion likely further adds to the significant risks that the use of medical abortion pills carry for the health and safety of women and girls across the country.
• Women face greater risk of complications from ‘at-home’ abortion than from other forms of medical and surgical abortion.
• Ultrasounds before abortion are not only used at times to determine accurate gestational dates but also for diagnosing ectopic pregnancies, which may be asymptomatic and can rupture if untreated. This is vital as mifepristone does not terminate pregnancies that are not implanted in the uterus, and undiagnosed ectopic pregnancies may rupture, resulting in serious bleeding and even death in extreme cases.
• Tragically, a 2005 study reviewing the deaths of five women after taking medical abortion pills found that four were specifically “due to endometritis and toxic shock syndrome associated with Clostridium sordellii” and one “whose death was attributed to a ruptured ectopic pregnancy”. This is especially concerning in relation to ‘at-home’ abortion, given that it is impossible to confirm ectopic pregnancies via a phone call.
• Studies also show more complications from medical than surgical abortions.
• A Finnish study of over 42,000 women receiving abortions up to 9 weeks’ gestation (63 days) found that the rate of complications was 4 times higher in medical than surgical abortions. Furthermore, the rate of haemorrhage was found to be over 7 times higher for medical than surgical abortions and the rate of surgical evacuation was over 3 times higher for medical than surgical abortions.
• A 2018 Swedish study of nearly 5,000 induced abortions over 8 years from 2008 to 2015 inclusive found that the complication rate for medical abortions before 12 weeks’ gestation (7.3%) was substantially higher than that for surgical abortions (5.2%).

It also discovered that the complication rate for medical abortions before 12 weeks’ gestation almost doubled from 4.2% in 2008 to 8.2% in 2015, concluding that the significant surge in complications, while unknown, “may be associated with a shift from hospital to home medical abortions.”

• Polling of GPs showed that 86% surveyed across the UK were concerned about women having a medical abortion past the legal limit of ten weeks’ gestation. Concern was highest among female doctors (91%).
• 86% were concerned that women were at risk of being coerced into abortion by a family member or partner.
• 82% were concerned about the possibility of abortion pills being falsely obtained for another person, and 90% agreed it is concerning that callers giving false information can easily obtain abortion drugs.
• Polling of the general population in England has found that an overwhelming majority of the general public, especially women, are concerned about the safety, quality, and legal issues arising from ‘at-home’ abortion.

Previous polling undertaken in England, Scotland, and Wales has shown that: 92% of women agreed that a woman requesting an abortion should always be seen in person by a qualified doctor. 77% of women agreed that doctors should be required by law to verify in person that a patient seeking an abortion is not under pressure from a third party.

Really helpful post, TerribleIdea, lots to consider.

Can you give your references Terribleidea? They're not coming up on my searches where I'm finding a lot of support for extending a policy which began before Covid.

@PermanentTemporary

Can you give your references Terribleidea? They're not coming up on my searches where I'm finding a lot of support for extending a policy which began before Covid.

38390i1l7ec447lcrc1wgzfr-wpengine.netdna-ssl.com/wp-content/uploads/2021/11/Gregory-Gardner-Witness-Statement-Abortion-200420.pdf hansard.parliament.uk/Lords/2020-03-25/debates/3C266E78-4BB7-4330-9199-D361CDBAE2AD/CoronavirusBill?highlight=abusive%20relationship#contribution-462597AA-5446-4EA3-B13B-77B1A83D14A0 committees.parliament.uk/writtenevidence/4457/pdf/ www.jpands.org/vol24no4/skop.pdf christianconcern.com/ccpressreleases/undercover-investigation-exposes-diy-abortion-service-as-unsafe-and-crossing-legal-boundaries/ percuity.files.wordpress.com/2021/01/cc-resource-abortion-at-home-a-mystery-client-investigation-201210.pdf percuity.files.wordpress.com/2021/01/cc-resource-abortion-at-home-a-mystery-client-investigation-201210.pdf percuity.files.wordpress.com/2021/02/complications-from-ema-kd210211.pdf www.dailymail.co.uk/news/article-8349739/Police-investigate-death-unborn-baby-woman-took-abortion-drugs-home-28-weeks-pregnant.html www.thesun.co.uk/news/11690506/police-probe-death-of-unborn-baby-after-woman-has-illegal-abortion-by-post-at-28-weeks-four-weeks-past-limit/ www.gov.uk/government/statistics/abortion-statistics-during-the-coronavirus-pandemic-january-to-june-2020 38390i1l7ec447lcrc1wgzfr-wpengine.netdna-ssl.com/wp-content/uploads/2020/09/Abortion-200729-NHS-email.pdf percuity.files.wordpress.com/2021/02/complications-from-ema-kd210211.pdf percuity.files.wordpress.com/2021/10/foi-ma-treatment-failure-211027.pdf www.express.co.uk/life-style/health/1527888/Abortion-pill-diy-nhs-warning www.medicines.org.uk/emc/product/3380/smpc docetp.mpa.se/LMF/Mifepristone%20Linepharma%20tablet%20ENG%20SmPC_09001be6802ba369.pdf www.ncbi.nlm.nih.gov/pmc/articles/PMC6305792/ www.nejm.org/doi/10.1056/NEJMoa051620?url_ver=Z39.88-2003&rfr_id=ori%3Arid%3Acrossref.org&rfr_dat=cr_pub++0pubmed www.nhs.uk/conditions/ectopic-pregnancy/diagnosis/ www.ncbi.nlm.nih.gov/pmc/articles/PMC7968738/ pubmed.ncbi.nlm.nih.gov/19888037/ www.ncbi.nlm.nih.gov/pmc/articles/PMC6156848/ GP Polling: bit.ly/SavantaComResPolling General public polling: bit.ly/SavantaComResPolling

Just to say that a big motivator for me in voting in the poll to keep the current arrangements is that there's evidence women are able to have abortions earlier in their pregnancies with this system, which I think is very positive (I haven't got the reference myself...)

And here are some first-hand testimonies:
www.dailymail.co.uk/femail/article-8367467/Abortions-post-got-rushed-approval-lockdown-troubling-stories-emerging.html
www.telegraph.co.uk/news/2020/10/13/nurse-criticises-judges-diy-abortion-ruling-excruciating-pain/

Right @TerribleIdea I have engaged with your Gish Gallop and have a list of comments. Those who don't want to bother reading my comments may wish to note the very few actual papers listed. There is definitely a higher risk of complications from medical abortion than from surgical abortion and all women and medical professionals should definitely be aware of this. It is very important to distinguish between telemedicine and alleged DIY medicine which are not at all the same things.

Oh and @TerribleIdea's numbering has got a little muddled so mine is my own. My comments relate to the list of links in the post from 17.28.

1. Dr Gregory Gardner’s evidence submission re the Coronavirus Bill – please note that Dr Garder provides no evidence for his statements that it is not possible to get enough information during telemedicine appointments as opposed to face to face appointments. I question why coercion on a woman to have an abortion is more difficult to manage when a woman is speaking from a place of her own choosing such as her home, and he does not mention coercion on women not to have an abortion which I’d think would be equally relevant. He also brings up supposed link between incidence of breast cancer and abortion, which has no particular relevance to this issue. Large studies suggest no such link so I question why he brings it up. He confirms that telemedicine is not the same as unsupervised abortion, which I welcome.
2. Christian Concern press release about ‘DIY’ abortion – those speech marks exist because ‘DIY’ abortion is what happens when there is no healthcare available. Telemedicine is not ‘DIY’ medicine. The press release indicates that 8 people prepared to lie to health care professionals got abortion pills in a way that breached guidelines. Christian Concern’s application for Judicial Review failed.
3. Daily Mail article about a very worrying case where a woman had a medical abortion at home at 28 weeks pregnant, long past the legal deadline for abortion. Very concerning case and I hope is being investigated.
4. Sun article about the same case
5. Government statistics about abortion during Covid – not sure what this is intended to say? Would you like to point to any particular issues?
6. Percuity Ltd (trading name for Kevin Duffy ‘s consultancy) briefing paper about complications from early medical abortion – this is about a higher rate of complications post early medical abortions. It is insisting that it is ‘non-negotiable’ that women have a follow-up face to face visit post medical abortion. I don’t think the many women who have a medical abortion with no further symptoms or complications should be forced to make an additional appointment – why? And what is the improvement in complication rates based on women accessing abortion earlier in pregnancy – I would imagine that has an impact?
7. Daily Express story about Percuity’s briefing
8. Clinical characteristics of Mifepristone, i.e. one of the drugs used in medical abortion. Clearly added to pad out the list.
9. 2005 American study on toxic shock after medical abortion. Lucky we have legal abortion and the NHS here so people are more likely to access healthcare with symptoms.

10. NHS page about ectopic pregnancy, a potentially very dangerous condition for women. It usually has symptoms although they can be hard to diagnose. 11. 2009 Finnish study about complications compared between medical and surgical abortion. No differences seen in psychiatric morbidity, death, infections or circulatory events. 4 x more adverse events overall in medical abortion vs surgical abortion, particularly haemorrhage and incomplete abortion. Both methods generally safe. Useful information for those working with and following up women post medical abortion. 12 and 13. Don’t seem to be any different. Savanta Comres poll report commissioned by SPUC about how ‘concerned’ people are about women undergoing an abortion at home. Sample question: ‘With a telemedicine abortion appointment, the doctor never sees the woman in person. How concerned, if at all, are you about each of the following considerations…?’ Poll also talks about ‘disposing of the terminated pregnancy into the toilet or sanitary pads’. Highly biased and useless poll which gives no basis for the current issue.

Thanks @PermanentTemporary.

@TerribleIdea

This is a terrible idea. Apart from a poll on mumsnet, have you even looked at the research? ‘At-home’ abortion presents a high risk of coercion and abuse. The ‘at-home’ abortion could be used by their abusers to disguise trafficking or abuse scandals. There is no way to verify who is consuming the medication and whether she is doing so willingly. Sex traffickers, incestuous abusers, and coercive boyfriends will all welcome more easily available medical abortion.

• Abortion providers cannot ensure that ‘at-home’ abortion pills are taken by the intended person in the intended circumstances within the intended time.

-A nationwide undercover investigation that concluded in early July 2020 found evidence of abortion providers putting women at significant risk, seemingly by not carrying out basic checks before sending abortion pills by post, showing that the scheme is open to abuse and facilitating abortions beyond the legal limit.

• In the investigation led by public health consultant Kevin Duffy, a former Global Director of Clinics Development at Marie Stopes International, all 26 requests by volunteers were successful in acquiring mifepristone and misoprostol using false names, dates of birth, and gestational dates.
• A second mystery client investigation conducted between November 2020 and January 2021 found that there had been no change in the behaviour of abortion providers despite assurances from the Care Quality Commission in November 2020.
• A leaked email from a Regional Chief Midwife at NHS England revealed that women had to attend Emergency Departments for a range of incidents including “significant pain and bleeding related to the process through to ruptured ectopics”, “major resuscitation for major haemorrhage”, and incidents involving the “delivery of infants who are up to 30 weeks gestation”.
• A recent Freedom of Information (FOI) request found that between 1 April and 30 November 2020, NHS England and Improvement had notified the Care Quality Commission of 32 “serious incidents” relating to early medical abortion, 29 of which saw the women suffer serious complications (the CQC notes that serious incidents are those requiring hospital treatment for complications ranging from “delivery of fetuses of unexpected gestation, incomplete abortion with retained products of conception, and ectopic pregnancies”). Of these 29 cases, 17 resulted from ‘at-home’ abortions.
• A recent study based on FOI requests to NHS Trusts found that more than 10,000 women who took at least one abortion pill at home provided by the NHS in 2020 needed hospital treatment for side-effects, equivalent to more than 1 in 17 women, or 20 women per day needing hospital treatment. Concerningly, the lack of a routine in-person consultation or follow-up in the case of ‘at-home’ abortion likely further adds to the significant risks that the use of medical abortion pills carry for the health and safety of women and girls across the country.
• Women face greater risk of complications from ‘at-home’ abortion than from other forms of medical and surgical abortion.
• Ultrasounds before abortion are not only used at times to determine accurate gestational dates but also for diagnosing ectopic pregnancies, which may be asymptomatic and can rupture if untreated. This is vital as mifepristone does not terminate pregnancies that are not implanted in the uterus, and undiagnosed ectopic pregnancies may rupture, resulting in serious bleeding and even death in extreme cases.
• Tragically, a 2005 study reviewing the deaths of five women after taking medical abortion pills found that four were specifically “due to endometritis and toxic shock syndrome associated with Clostridium sordellii” and one “whose death was attributed to a ruptured ectopic pregnancy”. This is especially concerning in relation to ‘at-home’ abortion, given that it is impossible to confirm ectopic pregnancies via a phone call.
• Studies also show more complications from medical than surgical abortions.
• A Finnish study of over 42,000 women receiving abortions up to 9 weeks’ gestation (63 days) found that the rate of complications was 4 times higher in medical than surgical abortions. Furthermore, the rate of haemorrhage was found to be over 7 times higher for medical than surgical abortions and the rate of surgical evacuation was over 3 times higher for medical than surgical abortions.
• A 2018 Swedish study of nearly 5,000 induced abortions over 8 years from 2008 to 2015 inclusive found that the complication rate for medical abortions before 12 weeks’ gestation (7.3%) was substantially higher than that for surgical abortions (5.2%).

It also discovered that the complication rate for medical abortions before 12 weeks’ gestation almost doubled from 4.2% in 2008 to 8.2% in 2015, concluding that the significant surge in complications, while unknown, “may be associated with a shift from hospital to home medical abortions.”

• Polling of GPs showed that 86% surveyed across the UK were concerned about women having a medical abortion past the legal limit of ten weeks’ gestation. Concern was highest among female doctors (91%).
• 86% were concerned that women were at risk of being coerced into abortion by a family member or partner.
• 82% were concerned about the possibility of abortion pills being falsely obtained for another person, and 90% agreed it is concerning that callers giving false information can easily obtain abortion drugs.
• Polling of the general population in England has found that an overwhelming majority of the general public, especially women, are concerned about the safety, quality, and legal issues arising from ‘at-home’ abortion.

Previous polling undertaken in England, Scotland, and Wales has shown that: 92% of women agreed that a woman requesting an abortion should always be seen in person by a qualified doctor. 77% of women agreed that doctors should be required by law to verify in person that a patient seeking an abortion is not under pressure from a third party.

I agree with some of this

I think it should be available BUT only after an in person appt to make sure the patient is at the correct gestation and not over , and there’s not an ectopic or coercion

Thank you MN.

I’m assuming that anyone who objects to telemedical abortions for the reasons mention by Terribleidea - the lack of physical checks and actually placing the tablets into a woman’s hand - is very keen for extra government funding to reopen sexual health clinics and provide swift access to abortion services in person.

Obviously these concerned citizens aren’t just anti abortion activists, using potential ’risks’ to women’s health to restrict access to abortion.

@Ncwinc

Thank you MN.

I’m assuming that anyone who objects to telemedical abortions for the reasons mention by Terribleidea - the lack of physical checks and actually placing the tablets into a woman’s hand - is very keen for extra government funding to reopen sexual health clinics and provide swift access to abortion services in person.

Obviously these concerned citizens aren’t just anti abortion activists, using potential ’risks’ to women’s health to restrict access to abortion.

Exactly this

I think a purely telemedicine system is wrong due to potential risks and I absolutely would welcome increased funding to facilitate women having a quickly arranged and in person appt

Pre Covid, the woman was handed the tablets and a glass of water and then kicked out the door. They weren’t routinely scanned. They weren’t kept under supervision while the tablets worked.

While awaiting a perfect system, I'm glad that we are supporting a practical route that is working to make safe abortion more accessible, ie telemedicine. Both medical and surgical abortion are safe, as TerribleIdea's links show.

@Ncwinc

Pre Covid, the woman was handed the tablets and a glass of water and then kicked out the door. They weren’t routinely scanned. They weren’t kept under supervision while the tablets worked.

I think that is wrong then. I think if this is a medication for under a certain gestation only then all efforts need to be made to ascertain dates. Also it could identify early some ectopics (although would the tablets actually be a treatment for ectopic - I’m unsure )

So you want women routinely scanned before they take the medication?

Just a reminder that complication rates for pregnancy (never mind birth) are higher than for either medical or surgical abortion.