Implications for the continuation of DIY abortions (taking both pills at home)
The Governments of England, Wales and Scotland have launched consultations on making permanent, the relaxation of rules to allow for both abortion pills to be taken at home. Here we outline our concerns which we have raised in the consultations.
The England consultation can be accessed here. Closing date is 26 February 2021
The Wales consultation can be accessed here. Closing date is 23 February 2021
Safety risks in speed and ease of access to abortion
We are concerned about the following issues around safety:
- It cannot be guaranteed without seeing the woman, what gestation her pregnancy is. She could be taking the pills for a pregnancy that is further along than the legal time limit. This could be due to:
- She may have irregular cycles
- Not be knowledgeable about how to monitor her cycle
- Lack of compliance in contraceptive use
- Intentionally misleading the abortion provider e.g. not disclosing the correct gestational age of the pregnancy.
In England, the abortion provider, BPAS was reported earlier this year to be investigating 9 cases where women have taken the pills after the 10 week limit with one of those identified as being 28 weeks. If this happens it could have grave health implications for women. Police are currently investigating a case of woman who took pills at home and aborted a 28 week baby (https://www.dailymail.co.uk/news/article-8349739/Police-investigate-death-unborn-baby-woman-took-abortion-drugs-home-28-weeks-pregnant.html ) At 28 weeks the baby would have had over 90 percent chance of surviving. Research shows that there can be serious complications arising from taking abortion pills and risks escalate with the gestational age of the baby. The potential inaccuracy of the gestational age and the greater emphasis on a private experience raises the possibility that women, especially vulnerable women, will be at a greater risk of experiencing these complications.
- There is a risk of haemorrhage in medically induced abortion. The NHS in describing the risk of bleeding in medical abortions says “serious complications such as heavy bleeding, damage to the womb, or sepsis: this happens to about 1 out of 1,000 women” (https://www.nhs.uk/conditions/abortion/risks/). We would point out that if women are bleeding excessively and do not receive urgent medical intervention, this can put their lives at risk.
- The NHS says 7 out of every 100 medical abortions up to 14 weeks require further procedures to remove “parts of the pregnancy” that have stayed in the womb. The abortion provider BPAS says between 3-7 out of every 100 women between 9-10 weeks experience continuing pregnancy, retained pregnancy tissue or need surgery to complete their abortion. For the first three months of the lockdown this year 3% of the medical abortions which took place at home would account for 690 women who were at risk of needing follow up surgical procedures after a medical abortion.
- There may be situations where teenagers are having the abortions secretly and having to deal with the trauma of seeing the result of the abortion. As a charity which supports thousands of women every year, we hear client stories about the mental harm caused by medical abortion.
- Last year we had a teenage client who said she felt rushed into the decision and had the medical abortion at home on her own. She later experienced feelings of tremendous guilt and sadness.
- Another client said how she regretted taking the pills and now feels ashamed. She was struggling and felt unsupported.
- A third client felt emotionally pressured by her partner into having the medical abortion. She had not wanted the abortion but felt like she had no option. She was still trying to cope after two months and found herself breaking down and crying.
We know of the emotional impact abortion has on women because of the fact that we deal with them every year. During the first five months of the first lockdown last year when home abortions (with both pills taken at home) were approved, Life saw a 44% increase in clients accessing our post abortion support services. During a time when people’s mental health was more fragile, faster and easier access to home abortions put vulnerable women at greater risk by reducing their access to medical professionals. It appears that faster and easier access to abortion was to the detriment of women’s mental health.
One of our biggest concerns has to do with safeguarding. We are worried about women and young girls in abusive relationships being coerced into taking these pills by abusers and groomers to hide their crimes. When abortions are procured without the physical input of doctors we cannot ascertain for sure if the pills are to be used by the caller or if she’s obtaining them for someone else. The Life website has an article titled “The common factor in the grooming and abuse of children” which shows 12 instances where abortion has been used as a tool to hide the crimes of paedophiles.
Benefits for abortion providers
Less staff would be required for video appointments as opposed to the physical presence of staff for face to face appointments. This could be seen as a money saving measure to the detriment of women’s health care.
The lax arrangements could allow for some abortion providers to more easily circumvent existing laws regarding the legal conditions required for abortions and gestational time limits for abortion.
Risk of trivialising pregnancy
The new arrangements lead to a trivialising of the value and worth of pregnancy and subsequently of abortion – At least by keeping abortion medicalised it can be viewed as more than just a couple of pills. Women will find themselves able to dismiss the emotional and physical impact of a pregnancy and potentially devalue their ability to reproduce. This might mean that some women may not seek medical help following an abortion because they were under the impression that abortion is not “serious”.
Impact on people with disability
There are greater risks involved in faster and easier access to abortion for some people who have disabilities; in particular women with learning disabilities may not fully understand the full implications of taking these pills after a telemedical consultation with a medical professional. They may also be less able to explore how their disability may affect decisions about their pregnancy.
Impact on people in rural or island communities
The risks which we have outlined above in terms of women experiencing complications who need emergency interventions are likely to be far greater if in rural communities people are not close enough to emergency services.
Recommendation for the future
We do not believe abortion is the solution to an unplanned pregnancy. However, if medical abortions are to be carried out we should prioritise safety for women which includes doctors being able to correctly ascertain gestational age, carry out pregnancy/health tests and assess the impact of these decisions on women’s mental health. There should also be strict adherence to the current laws, in particular, the rule for abortions to be approved by two doctors rather than one health professional.
It should be noted that in telemedical consultations there is an assumption made that a woman may or may not have an STI, based on her history and not on testing. If it is assumed she has STI she is then sent antibiotics. Assumption is not good health practice and misuse of antibiotics leads to antibiotic resistance. Alternatively if the assumption of the likelihood of an STI is missed then the woman is exposed to an infection which can have long term effects on her health and fertility.