On Monday evening, the Department of Health announced landmark changes to abortion regulations in England. As a temporary measure during the coronavirus outbreak, women would now be allowed to take abortion pills at home and the procedure could be signed off by one nurse or midwife, instead of two doctors.
The measures, taken on advice from healthcare bodies including the Royal College of Obstetricians and Gynaecologists and the Royal College of Midwives, would ease pressure on the NHS, limit non-essential travel, and ensure continued access to early medical abortion services during this crisis.
But within hours, the statement on the Department of Health’s website was deleted, accompanied by a message that the guidance had been “published in error. There will be no changes to abortion regulations.” The U-turn has left medical professionals “staggered”.
Healthcare professionals today implored the Prime Minister to “listen and act on the scientific evidence” and reinstate the reforms, while abortion providers warned that services were “at risk of collapse” without urgent action.
“It is estimated that some 44,000 women will need abortion care in the next 13 weeks, meaning tens of thousands of women making a needless journey and exposing themselves and others to infection,” the British Pregnancy Advisory Service (BPAS) has warned.
BPAS, which cares for 100,000 women per year, said that a quarter of its abortion clinics were closed on Tuesday 24 March due to staff sickness and isolation, with further closures expected across NHS funded services today.
In a joint statement, Dr Edward Morris, President of the Royal College of Obstetricians and Gynaecologists, and Gill Walton, Chief Executive of the Royal College of Midwives said: “we are disappointed by the government’s decision not to allow home-use of Mifepristone, the first drug used for early medical abortion.
“This change in practice which the government announced and later revoked would have enabled women to access care remotely through video and teleconference, with treatment sent by post.
“This would have reduced pressure on an already overwhelmed health system, limited risk of coronavirus infection for women, their families and healthcare professionals, while ensuring safe and timely access to abortion care.
“The National Institute of Health and Care Excellence (NICE) recommends greater use of telemedicine to deliver services, and in these challenging circumstances this is a complete necessity.”
“Inaction is reckless and risks the health and wellbeing of women and frontline NHS workers.
“Abortion services take the safeguarding of women seriously, and if this care cannot be provided, women may be forced to seek an unregulated and illegal abortion.”
Asked if there are any risks associated with at-home early medical abortion pills, BPAS said there are “none at all”. The Royal College of Obstetricians and Gynaecologists similarly pointed to a review published on the World Health Organisation website “that concludes there is no evidence that home-based medical abortion is less effective, safe or acceptable than clinic-based medical abortion.”
“Matt Hancock [the Health Secretary] cannot possibly have a valid reason for permitting, and then withdrawing, permission for doctors working from home to prescribe medical abortion pills, and for women to be able to receive them in the mail to use at home,” said Dr Jayne Kavanagh, co-chair of Doctors for Choice.
Dr Laura McLaughlin, a consultant obstetrician and gynaecologist, told the New Statesman that a telemedicine abortion service is needed “urgently” and that requiring women to attend clinics in person puts them, their families and healthcare professionals in an “unsafe position”. “We are already seeing significant disruption to what are already overstretched services” as maternity units begin to face the reality of Covid-19, she said.
As well as strong support for the increased use of telemedicine in treating patients, there is also a longstanding consensus within the medical community that the requirement for two doctors’ signatures to approve an abortion procedure is a “clinically needless administrative burden”, as Dr Jayne Kavanagh describes it. As far back as 2007, a parliamentary committee could not find “any good evidence that, at least in the first trimester, the requirement of two doctors’ signatures serves to safeguard women or doctors in any meaningful way, or serves any other useful purpose”.
Women already in vulnerable situations have already begun to seek help outside of the regulated healthcare system, with Women on Web, an international organisation that provides abortion care online to women who live in countries where early medication abortion is not accessible, reporting an increase in Covid-related pleas from the UK for help.
An anonymous testimonial from a woman in this situation has been shared by BPAS: “This way of abortion is the only route I have as I am not allowed out due to the coronavirus… My parents would disown me and kick me out if they were to find out or they may even harm me and I have so much ahead of me. I cannot afford to have a child right now at such a young age with no financial help as the person whom I conceived the child with is no longer in my life. I beg you to please help me this is my only option. Please help me.”
Dr Kate Guthrie from Women on Web said: “We are being contacted by women who cannot leave their home due to the pandemic, despite taking such medication at home being illegal. They are desperate, and their emails are heartbreaking. We call on the Prime Minister to do the right thing by women in the most desperate of circumstances and approve telemedical abortion services as a matter of urgency.”
The Department of Health has declined to provide a reason for the abrupt change of policy and declined to comment on whether there were plans to reinstate these temporary reforms.