Sally-Ann Hart is the MP for Hastings and Rye and was a councillor in Rother.
The Department of Health and Social Care (DHSC) recently launched its public consultation on whether to make home use of both abortion pills a permanent measure in the UK.
‘At-home’ abortions – which the media and critics have termed ‘DIY’, or ‘do-it-yourself’ abortions – were introduced on 30th March 2020 in the most radical change to abortion law since 1967. After a phone call with an abortion provider, women can now be sent Mifepristone and Misoprostol pills to take at home without direct medical supervision in order to end their pregnancies.
Originally sanctioned as a temporary measure to reduce transmission of Covid-19 during the pandemic, abortion campaigners and providers are pushing to make ‘at-home’ abortions permanent.
But given the risk of serious complications, coercion from abusive partners, and inability to verify gestational age over the phone, the Government should immediately withdraw the temporary order. Should it and the consultation continue, however, I can only hope we see the concerns of those responding to the consultation taken seriously by our Government.
Before reviewing the serious complications that have occurred in relation to ‘DIY’ home abortion, it is prudent to refute recent claims in the New Statesman of a relative lack of medical complications for ‘DIY’ home abortion. Indeed, this article rather serves to highlight the serious problem of systemic underreporting of such issues.
DHSC data show only one complication following ‘DIY’ home abortion from April to June this year for the whole of England and Wales. Unbelievably, this would mean that the average rate of complication for medical abortions at a similar gestation over the past five years was over seventeen times higher than the complication rate for ‘DIY’ home abortions earlier this year. This is not only highly unlikely – that complications would radically reduce in a home setting versus a medical setting – but, some may say, ridiculous.
There is either a serious problem when medical abortions are provided in a clinical environment with direct medical supervision – leading to vastly more complications in clinics than in homes – or a substantial issue with the overall quality of reporting and recording the real impact of ‘at-home’ medical abortions on women’s health.
Serious complications can certainly arise when abortion is removed from a clinical environment. One Swedish study from 2018 of almost 5,000 induced abortions over eight years (from 2008 to 2015 inclusive) found that the complication rate for medical abortions before 12 weeks’ gestation almost doubled from 4.2 per cent in 2008 to 8.2 per cent in 2015, concluding that the significant surge in complications “may be associated with a shift from hospital to home medical abortions.”
Requiring the first pill to be administered in a clinic provided essential safeguards for women, not least as it allowed for an in-person examination or ultrasound to verify whether a woman was too far along in her pregnancy to be prescibed a medical abortion.
Tragically, we have already begun to see the effects of the absence of such safeguards. Police have been investigating the death of an unborn child who was aborted at 28 weeks – four weeks past the legal limit for surgical abortion and a shocking 18 weeks past the limit for abortions at home. Notably, abortion provider BPAS stated they were investigating the case along with eight other known incidents of babies who were aborted past the 10 week legal limit for ‘at-home’ abortions.
Only this year, a study (funded by NICE) found that for later gestational dates, greater dosage of misoprostol may be required to achieve a complete abortion. As such, there ‘may be more pain or bleeding associated with the expulsion of a larger/later pregnancy’. This clearly highlights a need for accuracy in determining gestational age, particularly if the woman expels the pregnancy at home.
Further concerns are highlighted by a leaked NHS email from a Regional Chief Midwife on the ‘escalating risk’ around the ‘pills by post’ service in May 2020, which revealed that a woman received abortion pills at 32 weeks of pregnancy. The email goes on to note that there were 13 incidents under investigation linked to ‘at-home’ abortions, and “3 police investigations”, one of which “is currently a murder investigation as there is a concern that the baby was live born.”
If such troubling incidents occurred within weeks of the ‘DIY’ home abortion ruling, making it a permanent feature of our healthcare system would clearly be a disservice to women in the UK.
In addition, many women in domestic abuse situations may be coerced by their partner into having an abortion. If we remove the requirement of a face-to-face consultation, there is no guarantee that a patient can speak freely without the coercive party listening in. Indeed, Health Minister Lord Bethell iterated these concerns on behalf of the Government when the Coronavirus Bill was brought to the House of Lords on 25 March, recognising that:
“If there is an abusive relationship and no legal requirement for a doctor’s involvement, it is far more likely that a vulnerable woman could be pressured into having an abortion by an abusive partner.”
Furthermore, if a woman is in a domestic abuse situation, leaving her to perform her own abortion at home only helps her abuser by enabling her to remain in an abusive situation.
Accounts from women of their experience of the ‘pills by post’ system should further compel the Government to immediately suspend this temporary order. For example, a nurse who suffered extreme complications from ‘DIY’ home abortion that left her needing life-changing surgery disclosed that she experienced ‘excruciating pain’, and heavy bleeding that continued for ten days after the abortion. Claiming Marie Stopes failed to provide follow up care, she also shares: “I’m actually quite shocked that the UK, with all of our research and expertise would approve this”.
In addition to physical complications, other women have expressed concern at the ease and speed with which they were able to acquire these life-changing pills. One woman describing her experience stated: “I wasn’t ready. It all seemed so fast. I was expecting to speak to lots of people, to be offered counselling.” Yet ‘greater capacity’ and ‘shorter waiting times’ have been lauded by proponents of ‘at-home’ abortion as prime reasons for extending the scheme, perhaps due to the notion that telemedical abortions free up NHS resources.
This is the kind of language used to discuss routine health appointments and hip replacements; that this narrative is currently being used to frame the life-changing decision to abort a child – the termination of a human life – is truly disturbing. Tragically, this same language is replicated in the newly launched UK public consultation, where participants are encouraged to reflect on ‘at-home’ abortion services in the context of ‘workforce flexibility, efficiency of service delivery’ and ‘value for money’.
Opposition to ‘DIY’ abortion schemes is widespread across the UK. Hundreds of healthcare professionals recently signed an open letter to the Health Minister of Northern Ireland to highlight the dangers of removing essential safeguards around abortion. Additionally following the launch of the Scottish Government consultation on ‘at-home’ abortion in October, Chairman of the Scottish Council on Bioethics Dr Antony Latham highlighted the increased health risk if ‘DIY’ home abortions are introduced on a permanent basis, stating ‘significant bleeding and sepsis are not uncommon.’ He further notes that the removal of in-person consultation opens the door for abortion coercion.
Finally, polling suggests that in-person assessment during the abortion process is highly valued by women in the UK; in one poll 77 per cent of women agreed that doctors should be legally required to verify in person that a patient seeking abortion is not being coerced, while another poll showed that 92 per cent of women agreed that a woman seeking an abortion should always be seen in person by a qualified doctor.
‘At-home’ abortions are not safe, and must not be euphemised as abortion ‘care’. Contrary to representation from abortion activists and providers, extending the ‘at-home’ abortion policy is not a given, and the public consultation has been launched with the option to ‘end immediately’.
Safe and effective healthcare is central to our British values: this irresponsible policy must be revoked before more lives are put at risk. I encourage all reading this to respond to the consultation – and select ‘end immediately.’