Accessing healthcare has been difficult throughout the pandemic – waiting lists have skyrocketed, face-to-face appointments have been limited, and attending hospital remains mired in covid-related risks. For women who needed to access abortion services, this made an already tough period even more difficult.

Abortions during Covid-19

In March of last year, the Department of Health introduced the option of home abortions. This meant that women who needed an abortion up to ten weeks and couldn’t access a clinic could take two pills at home. Before the pandemic, the first pill had to be taken in a clinic, but this initial consultation can now take place remotely rather than face-to-face. These teleconsults not only make appointments easier to access, but also mean that women can have these consultations in a familiar and comforting environment.

Policy on home abortions changed several times throughout the pandemic as the government struggled to settle on the best course of action – in one case, a total U-turn took place in a matter of hours. It was ultimately decided that they would be offered to ensure continued access to this vital health service.

Thanks to a 6-month extension issued in February, home abortions are currently set to be available until August – after which services are set to return to the old rules. However, many have campaigned for the option of home abortions to remain indefinitely.

Three Tory MPs are now calling for at-home abortions to remain a permanent option for women in England, with MPs set to vote on the proposal on Wednesday. Tory MPs Sir Peter Bottomley, Caroline Nokes and Crispin Blunt commented that removing the option of telemedicine would be a grave misjudgement:

‘This amendment gives Parliament the chance to listen to women about their own healthcare. We encourage all MPs who believe in evidence-based policymaking and women’s reproductive rights to vote in support of the amendment, so that doctors and nurses can continue offering this safe, effective, and compassionate form of abortion care for all who choose it.’

BPAS (British Pregnancy Advisory Service) offers a ‘Pills by Post’ service that comes with comprehensive support and information at every step of the process. BPAS also provide free post-abortion counselling to anyone who has accessed their service. This service is free for 97% of patients as they can receive funding from the NHS or other government bodies. BPAS provides care for everyone, no matter their gender identity, and works to support trans, non-binary and intersex people through the very challenging and dysphoric experience of unwanted pregnancy. Clinic attendance is very challenging for transgender people, so home treatment options can massively benefit this demographic.

Concerns

While the option to have an abortion at home is hugely beneficial for many, there are some concerns surrounding it. Home environments are not safe spaces for everyone, so some MPs are worried that women with coercive partners may be forced to take their tablets against their will, which is precisely the kind of thing initial in-person consultations seek to prevent.

On the flip side, telemedicine is a lifeline for many women in abusive relationships. For people with controlling partners, attending a clinic without their knowledge may be completely impossible. In such instances, they could be forced to carry an unwanted pregnancy to term – something that could have been avoided had they had unhindered access to a medical abortion at home.

There are also some medical safety concerns surrounding home abortions. Without an ultrasound scan to date the pregnancy, people may misjudge how far along they are in their pregnancy, potentially resulting in the treatment failing. Misoprostol may cause serious birth defects if the pregnancy continues, so it is vital that people accessing this service take a pregnancy test 3 weeks after their home abortion. Online suppliers such as BPAS do not contact patients to check if the treatment has worked, so it is vital that patients remember to do this for themselves.

As the medication is prescription only, it is illegal to give the medication to anyone else – while this is an unlikely occurrence in the case of in-person appointments (the first pills are taken in the appointment) there is a risk of people giving pills they receive in the mail to others. Not only is this illegal, it also poses health risks if the recipient is not aware of potential side effects or misjudges their conception date.

While there are medical safety concerns around home abortions, ending regulated access will not end demand. Sales of abortion pills from unregulated online providers dropped since home access was made legal, making it clear that the new regulations were actually providing a safer option for women who were previously having to rely on these unregulated sources.

A personal choice

As is the case with almost all discussion around abortions, the home abortion debate comes down to the right to choose. Women deserve the right to freely select the option that is right for them and their situation, and the move to instate home abortions as a permanently available option is a fantastic step towards this.

Everyone’s circumstances and preferences for treatment types will vary, so providing people with a variety of options that enable them to make the best choice for their own health is absolutely vital.

Note: the use of the word ‘women’ in this piece is for the sake of clarity, and does not intend to exclude people assigned female at birth who do not identify as female and may still need to access these services.