The pandemic brought very few gains for women, but one of them was access to telemedicine abortion. In March 2020, protecting NHS resources and reducing Covid-19 transmission was the catalyst for the necessary legal orders to be agreed – on a temporary basis – to allow early medical abortion (EMA) drugs to be taken at home. Over the last two years, the success of that policy has been unprecedented. Yet despite the clear benefits, last month the Government announced the policy would be repealed, citing the ‘wellbeing and safety of women’.
It’s worth stressing how successful the change has been. By July of 2020, the average waiting time for treatment was halved, resulting in the gestation at the time of the procedure falling by more than a week. That in turns meant a reduced rate of complications, which increase incrementally with each passing week of pregnancy. Together these factors have meant that the need for late gestational abortions has fallen and removed additional strain on surgical services during the pandemic, with a 20% decline in women presenting to hospital with complications. The overall rate of abortion success has increased to 99.2%.
Most importantly, the implications for women themselves have been significant, and patient satisfaction rates exceed 96%. Women can receive this basic healthcare from the comfort of their own homes, without the fear of being heckled by anti-abortion activists outside a clinic or having to bleed on the bus on the way home. For women in vulnerable situations, telemedicine abortion has been a lifeline, because forced pregnancy is far more common than forced abortion. Implementing clinically unnecessary barriers to abortion only helps abusers, not survivors. Since telemedicine abortion was introduced, the illicit sourcing of abortion drugs from the internet has also melted away.
The World Health Organisation’s newly published abortion care guidelines are very clear about the safety and efficacy of telemedicine. What’s more, there is a growing body of global evidence showing that early medical abortion at home is safe, effective and preferred by both women and providers. Much of this evidence originates from research conducted within the UK. Allowing early medical abortion at home has made Britain a pioneer of medical progress within reproductive rights.
While it was previously announced that the legislation would be repealed after August of this year, MPs can vote on whether to keep the provision as part of a new amendment to the Health and Care Bill. If it passes, the amendment will mark the single most progressive change to abortion care since abortion was legalised in 1967.
A key point to understand here is that restricting access to abortion does not stop women from having them. At the very least, it makes women’s lives more difficult, and at the very worst, it pushes the problem underground. It will be the most vulnerable women in the UK who are forced to go to backstreet clinics and risk life-altering morbidities, or even death.
To even suggest repealing the legislation in the face of such overwhelming medical evidence – and the recommendation of not just the WHO, but the National Institute for Health and Care Excellence, the Royal College of Obstetricians and Gynaecologists, and the Faculty of Sexual and Reproductive Healthcare – is tantamount to saying not everyone has the same right to good health. It infantilises women, implying they cannot be trusted to swallow a pill without a clinician watching over them. To this day, abortion remains the only procedure in UK medicine requiring two medical doctors’ signatures on the consent form – and failure to do so is a criminal offence.
It is ironic that the legislation up for debate is not in and of itself significant. Women will still be required to have a video consultation, an ultrasound scan, and follow up aftercare. The issue is simply where the woman chooses to take the medication that is at stake. But that stake is high, because it will symbolise how far attitudes to women’s health have come.
Today, MPs must vote to keep the option to have an early medical abortion at home. It took a pandemic for the limited procedures that prevented women from having autonomy to be appropriately modernised. Removing this right against all the medical evidence would be little short of a national scandal.
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