UK Independent Article: Good Information About Having An Abortion At Home.
The case for ‘home abortions’
Early Medical Abortion (EMA aka the abortion pill) is a simple and safe procedure for abortion in the first nine weeks of pregnancy. The treatment involves taking two sets of pills, up to 48 hours apart, to induce a miscarriage. Its use has been encouraged by the Department of Health (DH) and the NHS because it is suitable for use as soon as a pregnancy is confirmed and, in their own words: ‘Department of Health policy is that women who are legally entitled to an abortion should have access to the procedure as soon as possible’.
Yet British Pregnancy Advisory Service (BPAS), a not- for-profit charity that works in partnership with the NHS, has found itself having to take the DH to court over its interpretation of the law surrounding the abortion pill. Why?
At issue is a clash between the phrasing of the Abortion Act and the way that medical practice has advanced since the Act became law in 1968. The Act (S1(3)) specifies that ‘any treatment for the termination of pregnancy’ must be carried out in a hospital or clinic. The DH insists that this means not only that the pills must be prescribed and given to the woman while she is in clinic premises, but that she must physically take them on-site.
So a woman needing to use Early Medical Abortion attends a clinic on one occasion to be given the first tablets of mifepristone, which block the pregnancy hormones and trigger the expulsion of the embryo. Then, usually a day or two later, she must return to the clinic to take the second tablets of misoprostol, which will cause uterine cramping and bleeding. Once the tablets are taken, the woman returns home where she will experience her miscarriage, coming back to the clinic in due course for a check up and confirmation that the abortion has worked. During the time she is at home, a woman has round-the-clock access to telephone advice from a nurse of doctor and clear instructions what to do if things don’t go to plan. It’s a protocol that works for more than 17,000 women each year who request EMA from BPAS clinics alone.
Our argument is that to require women to return to a clinic just to take a set of tablets on the spot, and then to travel while at risk of starting to miscarry, makes no sense. In Sweden, which has a law similar to ours, legislators got round the problem by deciding pragmatically that the abortion treatment should be defined as only the medication taken first, but UK officials rejected this solution. Three years ago, a report by the House of Commons Science and Technology Committee on developments relating to the Abortion Act noted that there was ‘no evidence relating to safety, effectiveness or patient acceptability’ that should stop legislation allowing the second stage to be taken at home: yet still no changes were made to the interpretation of the law.
And this is what women tell us they want. In effect, managing an early medical abortion at home is like managing a natural, miscarriage – except with EMA you know what’s coming and can prepare for it. Misoprostol isn’t dangerous: indeed women who have suffered an incomplete early miscarriage are given the same medication to take at home in recognition of the fact that at such a sensitive time it is preferable for a woman to be in the comfort and privacy of her own surroundings. If you could decide to start bleeding, not on your return from the clinic or while doing the school run, but when your partner is there to look after you and the kids are safely tucked up in bed, which option would seem most sensible to you?
BPAS has been advised the law could be interpreted differently to allow some of the abortion medication that has been prescribed and issued in a clinic to be administered by a woman at home. This would in keeping with almost every other area of medical practice. When a doctor treats you for high blood pressure, she prescribes the drugs that will alleviate your condition, and you take them as directed. So it should be with abortion. And so we are going to Court on 28 January, asking simply for a Court Declaration that, in Early Medical Abortion, treatment should be defined as the prescribing and issuing of the necessary drugs, but not necessarily administration. The first medication would still be taken in the clinic, but the second could be taken at home, just as it is in the USA, France and Sweden.
Abortion services must comply with the law: but they should also be shaped by best clinical practice. It is wrong to compromise women’s care through unnecessary restrictions imposed by officials who may fear criticism from those who oppose abortion in principle. Where abortion is legal, it is our job to make sure women do not suffer unnecessary anxiety or discomfort. No woman ever wants to have an abortion. It is the solution to a problem she wishes she didn’t have. No abortion provider wants to take officials to court – but there are some challenge.
Gayblackcanada 