Monday, 31 August 2020

At-home abortions before 10 weeks could become a permanent option on the NHS as ministers consider continuing temporary rule allowing women to take pills alone during Covid-19 lockdown

  • Women up to 10 weeks pregnant can get abortion pills with a phone consultation
  • The temporary measure allowed women to get abortion care during lockdown 
  • But now ministers are holding a consultation on whether to keep it in place
  • Contraception services and doctors are in favour as it cuts waiting times
  • But critics say lack of supervision could allow 'unlawful' or 'dangerous' abortions
Taking abortion pills at home could become a permanent option in parts of Britain after being temporarily allowed during the Covid-19 pandemic.
Women up to 10 weeks pregnant have been able to get the necessary pills by only having a phone consultation, rather than attending a clinic, since March.
The temporary measure was set up to allow for women to still get the care they needed despite the lockdown, and it has reportedly been used almost 100,000 times.
Ministers are now set to hold a public consultation on whether to keep the new system in place in England, Wales and Scotland before the provision ends in 18 months' time, The Times reports.
Lord James Bethell, a member of the House of Lords and undersecretary at the Department of Health, said that there would be a public consultation 'on permanent home use of both pills for early medical abortion'.  
Contraception clinics and doctors are in favour of the move and say it would greatly benefit those with childcare or work responsibilities, disabilities or women in domestic violence situations whose pregnancy could leave them in danger. 
The easy access to the pills has slashed waiting times, allowing for abortions to take place earlier in the pregnancy, which is the safest way.
The pills in question are suitable for abortions up to 10 weeks into a pregnancy. The legal limit is 24 weeks and the procedure is different for late-stage terminations. 
But there are concerns about the new rule and the possibility for people to pass the pills on to other people who haven't had a medical consultation, who may put their health in danger by taking pills prescribed for someone else. 
Abortion pills taken at home may become permanent after being temporarily allowed during the Covid-19 pandemic (stock image)
Abortion pills taken at home may become permanent after being temporarily allowed during the Covid-19 pandemic (stock image)
The Government approved the use of phone consultations for early medical abortion care in the first trimester in March.
The Department of Health had already back-tracked on the policy once before, causing Health Secretary Matt Hancock to come under increasing pressure to continue with the published plans. 
The British Pregnancy Advisory Service (BPAS), The Royal College of Midwives and the Royal College of Obstetricians were among the 13 organisations that convinced  the Health Secretary to amend the law during the pandemic. 
Clare Murphy, of the BPAS, said: 'All the evidence supports the continuation of this service as in the best interests of women. 
'Women’s ability to access early abortion care at home during lockdown has been one of the few healthcare success stories of the pandemic, and it’s clear it should continue after we emerge from it. 
'This service has cut waiting times significantly and with it the average gestation at which an abortion takes place – while abortion is an extremely safe procedure the earlier it can be performed the better for women’s physical and mental health.'
Under the temporary service, eligible patients are able to take both pills for medical abortion up to 10 weeks in their own homes, without attending a clinic. It relies on the honesty of women's self reports.
Normally, women wanting to end a pregnancy had to go to a registered clinic where they have a face-to-face consultation. 
They then take the first pill there and the second one at home 24 to 48 hours later.
The first pill, mifepristone, stops the hormone that allows the pregnancy to continue. 
The second, misoprostol, causes the body to expel the pregnancy from the womb by breaking down the lining and softening and opening of the cervix.
The Sunday Mirror reported that the at-home abortion service has been used around 90,000 times since it was set up.
BPAS says that the first visit is not necessary at all, and Ms Murphy said wait times had been reduced by as much as two weeks since appointments were done away with. 
She said: 'Even before lockdown, there were many women who struggled to access in clinic care because of their own health problems, work or childcare commitments, and sometimes living considerable distances from a clinic which they relied on public transport to access. 
'Women in abusive or coercive relationships can find travelling to a clinic particularly difficult when their every move is watched, and pregnancy is often used by abusive partners to tie a woman to him. This service has enabled women in these circumstances to access our help safely and discretely.'
She said women who had praised the service included an NHS worker on the frontline, a women in the process of leaving an abusive marriage whose every move is followed by her husband, and women who are cannot drive but struggle to afford extra public transport.    
But the service will be challenged in a judicial review by evangelical advocacy group Christian Concern, which says that the change to policy is 'unlawful' and 'dangerous'.
The case argued that the government's 'DIY home abortion policy' goes against the purpose of the Abortion Act - to ensure abortions are safe and prevent backstreet procedures. 
At the judicial review hearing, lawyers argued Mr Hancock had no power under the 1967 Abortion Act to authorise home abortions - only Parliament should be allowed.
The religious non-profit organisation submitted a witness statement from Kevin Duffy, former global clinics director at Marie Stopes International.
His statement included contents of an 'urgent' email sent by a chief midwife at NHS England and NHS Improvement to NHS staff said there was 'escalating risks' of the 'pills by post' service.
It claimed that 13 incidents were under investigation, including abortion pills being delivered to a woman 22 weeks over the limit for home abortion.
It also claimed there had been two deaths of women linked to the home pills. But it is not clear if the deaths are specifically caused by the pills and how they took them.
But last month a judge ruled that a witness statement could not be considered as part of the case. 
Andrea Williams, chief executive of Christian Concern, said: 'The leaked email is a sickening admission that those running abortion services in England have elevated ideology over women's safety.
'The email appears to suggest that pregnant women who have used the telemedicine service during UK lockdown have died or experienced serious life-changing complications.
'This further confirms the inherent danger of DIY abortions and shows how ideologues who show little concern for women – and no concern for babies – have captured NHS England as well as the providers and professional bodies.' 
An investigation by Christian Concern also claims abortion clinics sent pills out to women on the phone, posing as pregnant patients, despite them giving fake names, dates of birth, GP registers and conception dates.
It raised fears the service could be used illegitimately by third parties such as for underage sexual abuse victim without any investigation.
But contraception and pregnancy services providers dispute claims the service is dangerous for women. 
Jonathan Lord, medical director of abortion provider Marie Stopes, said: 'Thanks to telemedicine women have been able to access the timely high-quality care they deserve. Had this not been available the consequences could have been catastrophic.'
Lisa Hallgarten, of the sexual health charity Brook, added: 'Many will benefit from this permanent option, including those with childcare responsibilities, disabilities, who cannot travel or are in domestic violence situations.'
Last month the Labour MP Dame Diana Johnson tabled an amendment to the Domestic Abuse Bill to provide women in abusive relationships with the ability to access 'safe, legal' abortion care without going to a clinic.
She said that if a doctor determined that a woman was in an abusive relationship and unable to attend a clinic she could obtain the care required.
The amendment was not selected by Sir Lindsay Hoyle, the Speaker, however, after criticism from Maria Miller, a former minister for women, who said that the 'rushed nature' of the amendment had resulted in 'a clause which is open to a great deal of misinterpretation'.

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