COVID-19: Abortion Provision During the Coronavirus Crisis

Edna Astbury-Ward

March 25, 2020

Editor's note, 31st March 2020: The Governnment has now said home abortion pills will be available via telemedicine. The official announcement is on the Department of Health website.

The Government issued new guidance to make access to abortion simpler during the COVID-19 pandemic but then withdrew the changes in what one senior consultant told Medscape UK was a 'backward step'.

The British Pregnancy Advisory Service has estimated that over the next 13 weeks 44,000 women in England and Wales will need access to an early medical abortion (before 9 weeks gestation).

Organisations - including the Royal College of Obstetricians & Gynaecologists (RCOG), the Royal College of Midwives (RCM), and the British Pregnancy Advisory Service (BPAS) - have called for more flexible arrangements in the face of the COVID-19 pandemic.

Disappearing New Guidance

The Department of Health and Social Care responded by hurriedly issuing new guidance on its official website (now removed).  On Monday 23rd March the UK Government announced via email that women and girls who were seeking abortion during the COVID-19 crisis would have the opportunity to take the two abortion pills at home instead of travelling to a clinic to take them.  However, the advice was withdrawn hours later on Monday without explanation.

New guidance (Coronavirus (COVID-19) infection and abortion care) from the Royal College of Obstetricians & Gynaecologists published 21st March 2020 gives advice to health care professionals during the coronavirus crisis. It was made clear that the guidance "is a living document that may be updated if or when new information becomes available…it will be kept under regular review as new evidence emerges".  

The guidance states that, "during the COVID-19 pandemic access to normal healthcare processes will be disrupted. To ensure safe and effective abortion care, greater use of remote consultations and medical abortion at home may be necessary, especially where women and staff may be self-isolating or acute hospital facilities are unavailable". It also added the caveat that: "Current law does not permit an early medical abortion service which could be completely provided through remote assessment and mail delivery."

The RCOG took the opportunity in the document to suggest that "change to allow such remote assessment and mail delivery would align with the Government’s advice to limit social interaction and travel". Clearly this advice was not heeded and indeed very hastily retracted by Government, so what has happened?

Commons Questions

Matt Hancock was asked several times during Commons questions on Tuesday 24th March about this. He responded clearly that: "We have no proposals to change any abortion rules as part of the COVID-19 response."

Ruth Cadbury, Labour MP for Brentford & Isleworth asked him again whether "he could commit to not oppose moves to enable individual healthcare practitioners to certify abortions and reinstate the regulations that were put up for a short while on the Government website last night, so that we can have use of medical abortion medication, and one practitioner being able to prescribe on the phone"? His answer remained the same; pushed a third time to explain "why the Government is not listening to the royal colleges" and why it is "making it more difficult for women to get access to an essential procedure during this time of crisis" he gave the same response.

Finally, Matt Hancock was asked by DUP MP Jim Shannon if the Government could give assurances that "legislation which regulates life and death will not be made in this way through stealth and opportunity"? Mr Hancock responded as before.

Today (25th March) BPAS has issued a press release calling on Boris Johnson to heed expert advice. It said it is a "reckless failure not to listen to scientific advice and is putting vulnerable women at severe risk".​ A quarter (23%) of abortion clinics run by BPAS were closed on Tuesday due to staff sickness and isolation, with further closures expected across NHS funded services today. BPAS and other independent abortion providers such as Marie Stopes provide 72% of all NHS funded abortions.

Backward Step

Medscape UK interviewed a senior consultant and clinical lead in sexual & reproductive healthcare in the North West of England, who has provided abortion care in the NHS for more than 20 years, about their views on the controversy. The consultant, who did not wish to be identified due to their employer's strict media policy, said "this is a shocking backward step for women seeking to access abortion in unprecedented times".

When asked why they thought this had happened? They responded, "I cannot understand why, when something so important for women’s reproductive health and welfare, has not been given the go ahead". They added that, "it is even more important now during CORONA-19 outbreak when even essential healthcare may have to be rationed that it has been rescinded".

Asked whether the public were aware of this sudden U-turn? The consultant said that, "unfortunately breaking any form of bad news at the moment was likely to be lost amidst the Corona pandemic, so it was doubtful that the general public were aware".

When asked why this had happened now, they replied that "all health care is limited at the moment so it is especially difficult to ensure women’s health and reproductive care right now. It is limited at the best of times and is especially challenging now, and the Government reversal [of the plan] allowing greater access to remote telemedicine is going to make it even more challenging."

When asked why it was that women still have to wait for two medically qualified doctors’ signatures before abortion is given the go ahead? The response from the consultant was unequivocal "there is NO other medical or surgical procedure that requires two doctors to sign the form in good faith on the woman’s behalf".

We asked what this will mean for women. It was the view of the consultant that "it was a retrograde old-fashioned step that will harm women’s reproductive health, as it will mean further delays to accessing services and the longer the delay the longer the gestation and therefore the greater the risk".

One effect of this about-turn was that according to our source "the Genie is well and truly out of the bottle now and there is no way they [the Government] can put it back!"

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