The UK Government has decided to change the rules on abortion in England by legalising the home-use of early medical abortion pills. Medical abortions involve taking two drugs in oral form – mifepristone and misoprostol. The other form of abortion legal in the UK is a surgical abortion, which involves having a procedure under anaesthetic.
According to the UK’s Department of Health and Social Care, roughly 180,000 women in England have an abortion and approximately four out of five of those have medical abortions before nine weeks of gestation every year.
Mifepristone is a synthetic steroid analogue that antagonistically stops hormones, such as progesterone, which encourage pregnancy, from working. The second drug, misoprostol, is a synthetic prostaglandin analogue, which works by encouraging the lining of the womb to break down.
Under the change in legislation, women will be able to choose whether to take the second of the two abortion pills, misoprostol, in the clinic or ‘in the safe and familiar surroundings of their own home’; previously they had to return to the clinic to complete their medical abortion. However, women will still have to go to the clinic initially in order to obtain the two drugs, and undergo checks necessary under the Abortion Act (1967).
Understanding the change to medical abortion in England
According to the government ruling, ‘the 2 visits can be difficult to organise and often uncomfortable or traumatic, and in some cases women can begin to miscarry before they have reached their home.’ This follows a similar announcement from the World Health Organisation, which has concluded that home-use of abortion pills is safe based on findings from to various studies.
The decision followed a campaign led by Claudia Craig in collaboration with the UK’s Women’s Equality Party, titled #homeuse. The campaign was initiated after Craig miscarried in a taxi on her way home after taking misoprostol at an abortion clinic.
It is hoped that the legislative change regarding abortion in England will come into effect by the end of 2018. The government plans to discuss this new approach with important actors in the healthcare system in order to create clinical guidance for healthcare professionals providing medical abortion pills to patients.
This move brings regulation of abortion in England in line with that of Scotland and Wales. In October 2017, the Scottish Government recognised that misoprostol could be safely taken outside of a clinical setting and claimed a legislative change did not need to occur because it came within its power under the Abortion Act. The Welsh Government followed suit in June this year.
Northern Ireland remains an exception on abortion
In the fourth remaining country in the UK, Northern Ireland, abortion remains highly restricted. It is only legal in three cases: to preserve the life of the mother, if the adverse effect on the woman’s mental or physical health is deemed to be ‘real and serious’ and ‘permanent or long-term’ and if the pregnancy is under nine weeks and four days of gestation. This means abortion is legal in cases of rape, incest, foetal abnormalities or still births. However, it is legal for Northern Irish women to travel to another country to access safe and legal abortion care.
As a result of the legislative change to medical abortion in England, Labour’s Shadow Secretary of State for Northern Ireland Tony Lloyd, accompanied by various pro-life campaign groups, has called on the UK Government to bring Northern Ireland’s laws on abortion in line with the rest of the UK. These pleas also occur in the context of the historic abortion referendum in the Ireland in May this year that overturned the country’s abortion ban.
Responses to changes to medical abortion in England
The British Pregnancy Advisory Service (BPAS) has been lobbying to change the law on home medical abortion for many years. Its CEO Ann Furedi responded to the legislative change regarding medical abortions in England by saying: “We are delighted by this decision, which represents an outbreak of common sense. It will dramatically improve the experience of the more than 100,000 women in England who undergo Early Medical Abortion every year.
“Enabling women to use this medication at home rather than being forced to take it in a clinic means women will no longer risk pain and bleeding as they travel home after taking it, and means they can use it at the time that is right for them, when they are safe and comfortable in the privacy of their own homes.
Royal College of Obstetricians and Gynaecologists president Professor Lesley Regan said:
“Today’s announcement that use of misoprostol at home will be allowed in England is hugely welcomed and a major step forward for women’s healthcare.
“This simple and practical measure will provide women with significantly more choice and is the most compassionate care we can give them.
“It will allow women to avoid distress and embarrassment of bleeding and pain during their journey home from an unnecessary second visit to a clinic or hospital. It will also improve access to safe and regulated abortion care and take pressure off NHS services.”
However, the Society for the Protection of Unborn Children, which recently filed an ultimately unsuccessful legal challenge against the change of law in Scotland, said the move in England “further trivialises abortion”.
“The abortion pill puts women through a terrible emotional and physical ordeal. The determination of the abortion industry to push women to undergo this in their own home with no real medical supervision illustrates their cavalier attitude when it comes to the well-being of women.”
Life issues campaign group Right to Life also disagreed with the legalisation of at home medical abortion in England. The organisation’s spokesperson Clare McCarthy said: “Self-administering these strong drugs is not to be taken lightly and the utmost quality of care should be provided to these women – especially those who suffer from complications afterwards.
“The ‘home’ abortion is not a safe or sensible solution for women. It will significantly reduce the supervision and care that is provided to women during a medical abortion.
“Taking the abortion pill away from medical supervision totally avoids dealing with the real issues facing women in that situation. It makes no provision for real, affirmative aftercare for these women potentially leading to further emotional and medical risk.
“Women’s safety or health should never be compromised for the sake of convenience or profit.”