Melody Redman: Abortions at home must only be a temporary measure

17 Jul

Dr Melody Redman is a clinical genetics registrar, with a background in academic paediatrics.

In March 2020, temporary provisions were introduced to permit women in the first 9 weeks and 6 days of pregnancy to take both medical abortion pills at home. The pills are sent through the post, after a remote consultation with an abortion provider. Prior to this, the administering of the first of the two required pills for medical abortions could only take place in approved hospitals or abortion clinics.

This emergency ‘at-home’ abortion scheme was introduced because of fears about limited in-person access to clinics during the coronavirus pandemic, with the mantra at the time being ‘Stay Home and Protect the NHS’. The UK, Welsh, and Scottish Governments have recently undertaken consultations on whether to end these measures or make them permanent, and the publication of their respective decisions is imminent.

Unsurprisingly, this push to permanently permit ‘at-home’ abortion has been spearheaded by the UK’s two largest abortion providers: MSI Reproductive Choices (formerly Marie Stopes) and the British Pregnancy Advisory Service, who are lobbying for the scheme to be made permanent. Given that 59.3% of UK abortion clinics are rated by the Care Quality Commission as ‘Requires Improvement for Safety’, how then can we trust them to ensure the safety of women ‘at-home’?

Last month, I along with over 600 other medics signed an open letter demanding an end to the scheme. Our letter expressed grave concerns over examples of the pills being used beyond the 10-week limit for home medical abortions, and in some cases after the 24-week legal limit for surgical terminations. The letter also highlighted a string of other safety and safeguarding issues related to issuing abortion pills without a face-to-face consultation.

Indeed, ‘at-home’ abortions rely on women accurately remembering the first day of their last period, which only around 50% of us do. This date is then used to estimate how far through the pregnancy the woman is. The Department of Health & Social Care has confirmed that pregnancies beyond the legal limit for ‘at-home’ abortions are being terminated at home, putting women at higher risk of complications.

It appears that data on the effects of ‘at-home’ abortions is being significantly and systemically under-reported. A Freedom of Information (FOI) request to the Care Quality Commission revealed that between April and November 2020, 11 women using the scheme, who had a gestational date beyond the legal limit for early medical abortion, required hospital treatment for complications. FOI requests have similarly since shown women suffering from serious issues (including sepsis, haemorrhage, and trauma to pelvic organs) after taking the pills.

Worryingly, an undercover investigation (led by a former director of MSI Reproductive Choices) revealed the lack of basic checks carried out by abortion providers before issuing pills-by-post. The investigation saw volunteer clients being sent abortion pills despite using false identities and gestational dates, including a date that could only have led to an abortion beyond the legal limit for ‘at-home’ abortions.

The removal of a mandatory in-person consultation also hinders clinicians’ abilities to flag up signs of coercion and abuse. An alarming seven per cent of British women have been pressured into an abortion by their partner or husband, a figure that likely increased under lockdown, during which there was a 49% increase in calls to domestic abuse services.  This is a serious concern; 87% of GPs are worried about ‘unwanted abortion arising from domestic abuse’ when no in-person consultation is required.

As a doctor, I know that telephone consultations can work well for some things, but there are huge limitations. I cannot control the environment on the other side of the phone, unlike in a safe clinic space. I cannot tell if my patient is next to an intimidating partner. I cannot ‘eyeball’ them to see if they appear frightened, have a black eye, or are heavily pregnant. Abortion consultations are not as simple as phoning your GP for advice on your reflux. They are intimate and challenging discussions, with life-changing physical and psychological ramifications.

Savanta ComRes polling of the general public reveals a high number of serious concerns. We are so often told to simply ‘trust women’ when it comes to liberalising abortion laws. Why then should we ignore the 92% of women who agreed that a woman seeking an abortion should always be seen in person by a qualified doctor?

‘At-home’ abortions were a hasty, temporary measure, introduced at a time when it was feared women should not attend an abortion clinic. This should not be a permanent solution. When making the difficult decision to pursue an abortion, we must be sure that women get a face-to-face consultation. Let us give women the space, the safety and the specialist assessment they deserve. I therefore implore the Government to bring this temporary policy to an end with immediate effect.