DIY abortion: one year on

On this day last year, the UK Government, after a bizarre double-u-turn, made the home an approved ‘class of place’ for early medical abortion up to ten weeks.

Women could now obtain both mifepristone and misoprostol after just a phone or video consultation with an abortion provider. The pills would be sent to the woman’s home with instructions on how to take them, and then she was on her own.

CMF has worked with a number of organisations throughout the year, seeking to answer questions about the process and practice, helping to build the case for why we want to see this ‘DIY abortion’ provision withdrawn as soon as possible.

We have looked at issues of women’s safety, the rate of complications – leading to pain, distress and the need for medical attention, the risk of coercion by abusive partners, and the incidence of the pills being taken at later than the 9-weeks-6-days legal limit. All this and more was covered in our response to the Government’s consultation on whether to end or extend this emergency provision.

For me, though, one of the biggest issues is that of principle.

One of the key drivers for the legalisation of abortion in 1967 was that women were finding ways to terminate unwanted pregnancies anyway; they were just risking their lives going to ‘backstreet’ abortion providers. Any attempts to restrict abortion further now – such as calls to lower the legal time limit, based on ever-improving survival rates for babies at 21+ weeks’ gestation – are criticised on the grounds that they will drive women back to backstreet abortionists.

Abortion providers have repeatedly raised concerns that women may resort to ordering abortion pills online, and in 2017 the Daily Mail revealed – with horror – that some women had been able to obtain abortion approval after only a phone consultation. And this was when the abortion itself would take place in an actual clinic.

Later that year, Professor Lesley Regan, campaigning to end the requirement for two doctors to sign-off on abortion requests, famously likened abortion to bunion-removal, saying, ‘If you go and get your bunions sorted … you would go to a consultation … then you take a decision and the doctor who was competent to undertake the procedure would sign the form too, and that would go forward.‘

Abortion, she implied, should be the same.

Of course, she was arguing that abortion should be no harder than this. But it should certainly not be easier – or subject to less bureaucracy and fewer safeguards.

If you were going to get your bunions sorted, you would have an in-person consultation, so the doctor could adequately assess the state of your feet and your health in general and make sure there were no other issues that might cause problems for or be affected by the operation. He or she would record the consultation and its outcome on your medical notes – against your NHS number, to ensure the information was available for reference by any future medical practitioners. He or she would then see you in person again and carry out the procedure for you in a scrupulously clean clinical environment. You would be signed off once the medical team were sure that the procedure was complete and that it was safe for you to leave, and an appointment would be made for you to receive a follow-up examination and any further care.

Regan’s phrase ‘the doctor who was competent to undertake the procedure‘ rings particularly false in the context of a DIY abortion since no doctor will be carrying out the procedure or will even be in the vicinity when it is carried out. This ‘standard part of medicine’ is being entrusted to non-medics, in avenues, closes and backstreets up and down the UK.

A study published in the BMJ Sexual and Reproductive Health journal online in April 2020, argued for the need to ‘normalise‘ and ‘increase the cultural legitimacy‘ of abortion.

The paper (which was written just before the temporary provision for DIY abortions was announced), stated: ‘The current Covid-19 pandemic has again foregrounded the exceptionalisation of abortion within the healthcare system, as women in England, Wales and Scotland continue to be required to attend clinics for treatment that could easily be delivered by telemedicine, putting both women and providers at medically unnecessary risk.‘ Yet surely the ‘exceptional’ thing is to provide the means to kill and evacuate living, growing tissue from an organ without any medical examination, supervision or help.

Nor do abortion providers help their own ‘normalisation’ cause if they continue to argue that the woman’s NHS number shouldn’t be required for an abortion. If it is the standard healthcare procedure they like to claim and nothing to be ashamed of, why not treat it just like bunion removal, with the provision for anonymity in exceptional cases? That way, it is on the woman’s record like every other medical procedure she has ever undergone and every other drug she has been prescribed.

CMF is supporting an open letter from medical professionals to the Prime Minister, First Minister of Scotland, and First Minister of Wales, asking them to bring an immediate end to the ‘at home’ abortion schemes in their nations. The letter was organised by our friends at Right to Life, and they have a tool on their website enabling you to sign it, too.

Please join us in bringing pressure on the British Governments to end this unsafe and unnecessary practice of legalised backstreet abortions.