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15 December 2020

How the pandemic revolutionised abortion access in the UK

Since patients have been allowed to take pills at home to terminate pregnancies, major medical complications have dropped by two-thirds.

By Katharine Swindells

When national lockdown was imposed at the end of March, and in-person access to healthcare was limited, the government initially flip-flopped over temporary changes to abortion laws.

Yet from the beginning of April, it approved measures to allow patients within the first ten weeks of pregnancy to take abortion pills at home after a telephone call or e-consultation with a clinician. Previously, these would have been face-to-face appointments.

If the healthcare professional indicates any potential risk factors, if the patient doesn’t know how far along they are, or if there are any other concerns over the patient’s welfare, they are brought into the clinic for an ultrasound. But if there are no such concerns, patients can now access an abortion without having to leave the house.

A consultation is under way over whether to keep these changes in place. Abortion providers argue they have revolutionised abortion provision, expanding and improving access and also allowing patients greater control and dignity in the process. They say it has also resulted in more abortions taking place earlier in the pregnancy.

The same changes were made in Scotland, which is now also holding a consultation on at-home abortions, and providers have also expanded the telemedicine abortion service to Northern Ireland so that patients don’t have to travel to England to access care.

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The data shows that, as soon as it was possible, many patients took the option of an at-home medical abortion, with a rise in non-surgical abortions in April, which providers say may have been the result of economic uncertainty in the early days of the pandemic.

By June, more than half of all abortions took place at home.

Once the law was changed, patients increasingly opted for at-home abortions
Abortions by method in England and Wales, 2020

Advocates and service providers say they have been pushing for this change for a long time. Previously, many patients had to travel long distances to a clinic – a journey made more difficult and more dangerous during the pandemic – meaning a pregnancy could pass on the way home.

Aaron Flaherty, the head of clinical services at the National Unplanned Pregnancy Advisory Service (NUPAS), said reducing the number of journeys has itself been beneficial. 

“Sometimes it [the result of an abortion] is happening on public transport, particularly in cities like London,” Flaherty said. “Where they’d have to come to the clinic, take the tablet and then face a two-hour journey home on public transport, by which time miscarriage could have started.”

By receiving the pills at home, patients also don’t have to take time off work or find childcare while they attend their appointment. They can have the abortion when it is most convenient, and they can have someone with them for support during the procedure who, due to Covid-19 restrictions, wouldn’t have been able to attend a clinic appointment with them.

Aside from improved access, the temporary change to the law has also brought health benefits. Data provided by the British Pregnancy Advisory Service (BPAS) shows a reduction in the risk of medical abortions across the board, with the risk of major complications dropping by two-thirds, and the risk of continuing pregnancy, which would require further treatment, down by almost three-quarters.

Risks decreased across the board with the introduction of at-home abortions
Risk of complications for Early Medical Abortions provided by BPAS

Katherine O’Brien, the associate director of communications and campaigns at BPAS, said having the option of taking pills at home means patients are more likely to take the two courses of pills at the correct interval, because they can plan it around their work and childcare schedules, rather than being constrained by clinic appointments.

Reduced waiting times mean abortions are occurring earlier, with patients receiving pills within days instead of having to wait weeks for an appointment that fits their schedule. This, in turn, reduces the chances of medical complications.

Abortions happened earlier in the pregnancy
Gestation of pregnancy at termination, England and Wales, 2020

The risks of abortion are lowest prior to eight weeks of gestation, and BPAS says there is evidence that in June 2020, 79 per cent of abortions had occurred by this time, compared with just under 60 per cent in June 2019.

“I find it personally very frustrating that it’s taken a pandemic for us to re-evaluate how these services should be provided,” O’Brien said. “At a time when we look around and no one can get an appointment at their dentist and waiting times for everything else have increased massively, waiting times for abortions have more than halved because of telemedicine.”

Offering pills by post through official abortion clinics has also effectively curbed the trade of unlicensed abortion pills online, a trade that also meant healthcare professionals were unable to talk to the patient and offer medical and pastoral advice.

Providers say at-home medical abortions are also likely to cut costs for the NHS, as telephone and video chat appointments in some cases replace face-to-face meetings and the need for brick-and mortar-clinics, while any reduced risk of complications means fewer follow-up treatments.

O’Brien said this evidence should act in advocates’ favour during the consultation, and she is optimistic the law change will be made permanent.

“All the evidence suggests that it’s actually safer for women than the previous system was,” she said. “Obviously, there’ll be opposition from those who are opposed in general terms to access to abortion, but I think it’s going to be incredibly difficult for the government to revoke telemedicine, because all the medical evidence will be in support of it.”

A Freedom of Information request filed to the Department of Health and Social Care (DHSC) found that after the 23,061 abortions performed between April and June where both pills were taken at home, only one complication has been reported.

O’Brien said the law change has not only made the process easier for those who might struggle to access abortion, but has also improved the way patients perceive the procedure too. In a BPAS feedback survey of more than 100 women, O’Brien added she was struck by how many patients included words such as “dignity” in their responses.

[see also: How Poland’s abortion protests became a fight for democracy]

She hopes this will not only improve the abortion experience for patients, but will also change the country’s attitude towards abortion more generally.

“I think we’ve always almost punished women who have an abortion, because we’ve made a decision that it shouldn’t be easy, which seems insane because it’s a medical procedure. Why wouldn’t you want to make access to clinical procedure as easy as possible? 

“There is such a paternalistic view around abortion which is that these are inherently vulnerable women and abortion is a sign that something’s gone wrong in their life,” she said. “And I think telemedicine has really challenged that view of women in need of abortion care.”

Kath Swindells is a data reporter at the New Statesman Media Group