England 'Out of Step on Home Abortion Pills'

Nicky Broyd

July 10, 2018

An early medical abortion (EMA), involves taking two drugs (mifepristone and misoprostol) usually 24 to 48 hours apart.

In October 2017 the Scottish Government gave approval for the second drug, misoprostol, to be taken at home and Wales is following suit. Now England is being urged to do the same.

Lift Restrictions

The Royal College of Obstetricians and Gynaecologists, the Faculty of Sexual and Reproductive Health, and the British Society of Abortion Care Providers have all called on the Health and Social Care Secretary, to lift the restrictions that only allow medical abortion pills in England be taken at a licensed clinic or hospital.

In an editorial published online in BMJ Sexual & Reproductive Health, Professor Lesley Regan, Dr Asha Kasliwal, Dr Jonathan Lord, and colleagues said: "We urge the Secretary of State for Health [and Social Care] to use his powers to extend to women in England the same compassion, respect, and dignity that the Scottish and Welsh governments have announced, so that all women can access safe, effective abortion care."

Current Law

Abortions are currently legal under the 1967 Abortion Act, which requires that they should take place on licensed premises. For medical abortions, which didn't exist when the law was written, this has been interpreted as meaning the two pills should be taken at a hospital or clinic.

This can be difficult and expensive for women. In some areas of England it means long journeys and the second visit risks the distress of cramps and bleeding while travelling home, a trauma the authors argue is entirely preventable if women were allowed to take the drugs at home. "This obligation to return to the abortion service…for a second visit impacts many women who struggle with repeated time off work, childcare, transport difficulties or distance from the abortion service."

They said allowing the medication at home wouldn't require a change in the law because the Government in England would only need to use its executive powers to approve the use of women’s homes as premises where early medical abortion could be carried out.

The Department of Health in England has asked the National Institute for Health and Care Excellence (NICE) to develop a new guideline on termination of pregnancy. It's expected to be published in September 2019.

A Department of Health and Social Care spokesperson said: "Around 180,000 women have an abortion each year in England - our priority is always to ensure that care is safe and high quality.

"We will continue to monitor the evidence surrounding home use and will await the outcome of the judicial review in Scotland."

Better Outcomes

It's estimated 1 in 3 women have an abortion by the time they're 45 and most of these are early in the pregnancy when a medical abortion is most effective.

Although it is associated with a higher complication rate, most women (85%) now opt to take the two drugs, mifepristone and misoprostol, together during the same clinic visit rather than make the return trip.

The BMJ editorial said data showed that for every 38 women taking both drugs at once, one additional woman required surgery, compared with those opting for the two-step method. The authors said "the implication is that many women required additional, preventable surgery and anaesthesia as a direct consequence of the government’s current interpretation of the Abortion Act."

They argue allowing home abortion would not only be better for women’s dignity, privacy, and wellbeing, but would also be a better use of NHS resources.

Lord J, Regan L, Kasliwal A, et al. BMJ Sexual & Reproductive Healthcare

Published Online First: 9th July 2018. doi:10.1136/bmjsrh-2018-200134. Article.

Editorials. Criminalised abortion in UK obstructs reflective choice

and best care. BMJ 2018;362:k2928 doi: 10.1136/bmj.k2928. Article.