Jonathan Lord is a consultant gynaecologist in the NHS and Medical Director of MSI Reproductive Choices UK, and Louise McCudden is an Advocacy and Public Affairs Adviser at MSI Reproductive Choices UK.
In March 2020, with Covid-19 limiting health service access, the Government made a bold but sensible decision: across England, Scotland, and Wales. It was agreed that both mifepristone and misoprostol, instead of only the latter, would be approved for home use.
These are the two medicines used in abortion care. In other words, early medical abortion could now be completed at home, following a telephone consultation with a clinician. This service, known as telemedicine, has now been running smoothly for over a year. hail it as a success.
This week, Dr Melody Redman made a series of claims about the service on ConservativeHome: that clinicians oppose the service, that women don’t want it, and, perhaps most egregiously of all, that abortion providers are relaxed about offering a service which jeopardises safety. In all these assertions, Dr Redman is mistaken.
First of all, telemedicine wasn’t suggested by the sector merely as a response to Covid-19. This has long been the direction of travel in abortion care. Dr Redman cites 600 medics expressing concerns about telemedicine. But conspicuous by their absence from her article are the official views of bodies like the National Institute for Clinical Excellence (NICE), the Royal College of Obstetrics and Gynaecology,) and the Royal College of Midwives. These bodies recommend telemedicine. NICE calls it “an improvement” in abortion care.
that telemedicine is safe, effective, and often preferred. As far as complications go, studies suggest that telemedicine, if anything, results in a small drop in complications. This could be because telemedicine reduces waiting times, so more treatments happen at an earlier gestation. Abortion is a common, safe procedure with a low complication rate in general, but it’s still true that the earlier the gestation, the safer it is.
It’s not only clinical bodies that back telemedicine. Dr Redman may well be sincere in her safeguarding concerns. But it’s no surprise to us, seeing the service operate up close, that End Violence Against Women Coalition, Rape Crisis England and Wales, and the Women’s Aid Federation of England telemedicine should stay.
Many vulnerable clients benefit from the option of telemedicine. For instance, there are women in abusive households who can safely receive discretely packaged abortion medicine at home but can’t safely attend a clinic. As predicted by safeguarding experts, the availability of telemedicine coincided with a drop in online pill sales from informal, unregulated providers – and during the pandemic, countries with no regulated “at home“ option saw a rise in these sales. Being forced to buy pills from these sources can mean abortion with no safeguarding, no counselling and no aftercare at all – and, shockingly, a risk of life imprisonment.
MSI UK’s safeguarding team members are deeply conscientious, highly skilled professionals. We would never support telemedicine if it hindered our ability to protect vulnerable clients. Dr Redman implies, by reminding readers that we are a “leading abortion provider”, that MSI isn’t an impartial voice in this debate. It’s true that as a provider, we’re not impartial on the question of abortion rights. We are unapologetically pro-choice, and we are proud to be a leading abortion provider. That doesn’t make us biased; it means we know what we are talking about.
Dr Redman is right to say that domestic abuse, including reproductive coercion, has risen during the pandemic. But she only mentions the dangers of forced abortion. It is more common to be coerced into keeping a pregnancy than ending one. As an unapologetically pro-choice organisation, we fight all reproductive coercion. No credible analysis of reproductive coercion or any other form of domestic abuse concludes that a sensible solution would be greater barriers to reproductive healthcare. The best way to fight reproductive coercion is more choice, more autonomy, more privacy, and more flexibility in access, not less.
As for the claim that 92 per cent of women want to be seen in person, this is not what show, and nor is it what we hear from our clients. When those using the service were surveyed, , regardless of Covid-19 (when we factor in Covid-19, that rises to 80 per cent). But in any case, even if the figure were true, why remove the option? With nine in 10 adults , this is, or should be, a clinical decision, not a political one. We don’t say telemedicine is right for everyone. We simply want to offer choice.
The truth is, there’s . It’s more efficient for the health system as a whole, despite providers still offering a full pathway that includes safeguarding, counselling, and aftercare. No matter the obfuscations and rhetorical insinuations of those who disapprove of at home abortion, there are simply no clinical or safeguarding justifications for taking the choice away.