Women in England should be allowed to take misoprostol - the second drug used to effect an early medical abortion - just like their peers in Scotland and Wales, argue healthcare leaders, in an editorial published in BMJ Sexual & Reproductive Health today.
Professor Lesley Regan, President of the Royal College of Obstetricians and Gynaecologists, Dr Asha Kasliwal, President of the Faculty of Sexual and Reproductive Healthcare, and Drs Louise Massey, Jonathan Lord and Sharon Cameron from the British Society of Abortion Care Providers, call on the Secretary of State for Health and Social Care to follow the example of the Scottish and Welsh governments and lift restrictions that require medical abortion to be carried out as a two-step procedure at a licensed clinic or hospital.
“We urge the Secretary of State for Health and Social Care to use his powers to extend to women in England the same compassion, respect, and dignity that the Scottish and Welsh governments have announced, so that all women can access safe, effective abortion care,” they write.
“There can be no justification not to act unless the aim is to punish women having a legal abortion,” they insist. “The time for action is now.”
An estimated one in three women will have an abortion by the time they reach the age of 45. The majority of abortions take place early in the pregnancy when a medical procedure is most effective.
The safest and most effective method for early abortion is to take two drugs - mifepristone and misoprostol - 24 to 48 hours apart. But medical abortion didn’t exist when the 1967 Abortion Act came into effect, and the law has consequently been interpreted as requiring both drugs to be taken at a licensed premises. This risks the distress of having the abortion while travelling back from the clinic, a trauma that would be entirely preventable if women were allowed to take misoprostol at home.
“This obligation to return to the abortion service […] for a second visit impacts many women who struggle with repeated time off work, childcare, transport difficulties or distance from the abortion service,” they explain. “Furthermore, it selectively disadvantages the most vulnerable ─ those who are deprived, live in rural areas or have dependants.”
Data from 28,000 women from one of the UK's largest abortion providers showed that most women (85%) opted to take both drugs at the same time - rather than make a return visit to the abortion service. This is despite knowing that this method was less effective and associated with a higher complication rate. For every 38 women taking both drugs at once, one additional woman required surgery, compared with those opting for the two-step method.
“With only 15% choosing or able to return for a second visit, the implication is that many women required additional, preventable surgery and anaesthesia as a direct consequence of the government’s current interpretation of the Abortion Act,” they say.
Fewer clinic visits would not only be better for women’s dignity, privacy, and wellbeing, but this would also be a better use of resources for the NHS, they argue.
The World Health Organization recommends home use of misoprostol for medical abortion and no change in the law would be required in the UK. The government would need only to use its executive powers to approve the use of women’s homes as premises where early medical abortion could be carried out, as both the Scottish and Welsh governments have done.
In a separate editorial in The BMJ, the editor in chief of BMJ Sexual & Reproductive Health, Dr Sandy Goldbeck-Wood, calls on Theresa May to decriminalise abortion in the UK, following the recent decisions to liberalise abortion laws in the Republic of Ireland and the Isle of Man. The RCOG and the Faculty of Sexual and Reproductive Healthcare supports decriminalisation of abortion in the UK, and the RCOG backs abortion care reform in Northern Ireland and the Republic of Ireland.
Notes for editors
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BMJ Sexual and Reproductive Healthcare editorial: Early medical abortion: best practice now lawful in Scotland and Wales, but not available to women in England.
The BMJ editorial: Criminalised abortion in the UK obstructs reflective choice and best care.
In April 2018, the RCOG and FSRH signed a letter along with over twenty medical and women’s groups calling on the Secretary of State for Health and Social Care to allow women in England to take misoprostol in a setting of their own choice.
A recently published study found that over 500 women in Great Britain in a four month period in 2016/17 attempted to obtain medical abortion pills online due to inability to access services. Many of the women surveyed said they would like the option of self-administering abortion pills in the privacy and comfort of their own homes.
About the RCOG taskforce
The RCOG has identified the urgent need to ensure abortion services are safe, readily available and sustainable. Changes to the way abortion care is commissioned and delivered is having an impact on doctors’ access to training and women’s access to services. In order to address these issues, the RCOG has established an Abortion Task Force, led by President Professor Lesley Regan. The College has agreed to work collaboratively with the main independent-sector providers to seek system-wide solutions to ensure that women have access to safe, sustainable, high-quality care.
About the RCOG
The Royal College of Obstetricians and Gynaecologists is a medical charity that champions the provision of high quality women’s healthcare in the UK and beyond. It is dedicated to encouraging the study and advancing the science and practice of obstetrics and gynaecology. It does this through postgraduate medical education and training and the publication of clinical guidelines and reports on aspects of the specialty and service provision.
About the FSRH
The Faculty of Sexual and Reproductive Healthcare (FSRH) is the largest UK professional membership organisation working at the heart of sexual and reproductive health (SRH), supporting healthcare professionals to deliver high quality care. It works with its 15,000 members, to shape sexual reproductive health for all. It produces evidence-based clinical guidance, standards, training, qualifications and research into SRH. It also delivers conferences and publishes the journal BMJ Sexual & Reproductive Health in partnership with the BMJ.