Elizabeth Chloe Romanis, Jordan Parsons and Nathan Hodson
Today, the Department of Health and Social Care announced that a temporary change in the law allowing women in England to access abortion entirely remotely during the COVID-19 pandemic.
The approval order allows women to be prescribed abortion medications remotely and take both early medical abortion medications (mifepristone and misoprostol) at home. Before this order was issued it was unlawful under the Abortion Act 1967 for women to be prescribed abortion medication anywhere except in a licenced clinic and women were required to swallow the first abortion pill in the clinic, though they were permitted to take the second pill home.
Under the approval order it is now temporarily lawful for a woman to take both abortion medications at home provided that:
- They have consulted with a clinic via video link, telephone conference or other electronic means;
- They have consulted with a registered medical practitioner via video link, telephone conference or other electronic means; and
- They are prescribed the abortion medications to be taken to induce miscarriage
While this approval order only applies to England, it is hoped that similar orders covering Scotland and Wales will follow shortly, and that similar provision for women in Northern Ireland can be made.
Why is this so important?
The provision of abortion is closely regulated in England, Wales, and Scotland by the Abortion Act 1967. Before the recent change in the law strict regulations required a woman to visit an abortion clinic in order to receive the medications for earlier medical abortion. In a blogfor BMJ Sexual and Reproductive Health we raised our concerns about limited access to abortion during this crisis. With the rules in place at the time, there were grounds to believe that many women would be unable to access the treatment they need because social distancing, social isolation (in cases where women or their families are unwell), and reduced transport provisions make accessing an abortion clinic much harder for pregnant women.
The change in the law should be welcomed as it permits abortion providers to ensure that a safe, effective, and essential service is available to women throughout the duration of the COVID-19 pandemic. The importance of access at this came cannot be understated. We estimate, based on Department of Health statistics on abortion care from 2018, that around 14,000 women in England are already pregnant but will need early medical abortion services now or in the next 12 weeks. This is even before any new conceptions occur, and some experts have proposed that ‘isolation sex’ will lead to a over the next year as a result of more people staying home.
Moreover, if women struggle to access birth control from their usual providers or access condoms, then unwanted conception will increase during social distancing and more women will need access to abortion care.
Reproductive and Sexual Health are easily forgotten in the midst of emergencies of the scale we now face, but access to this healthcare remains important for individuals, as Nabaasa Innocent explains, their need is an ‘emergency to them.’ The concerns we raise about access to healthcare in the UK in this post are applicable to all sorts of services within this arena – from barrier forms of contraception intended to prevent the spread of STIs to forms of birth control and abortion medication.
Now that it is legally permissible for services to be provided remotely, we need to start to consider how an effective process for service provision can be appropriately implemented. It may be a challenge for some service providers to quickly institute methods of remote working and of organising medication provision. Services are well established and pivoting to provide services under these new policies will be a difficult challenge – especially in making sure this is available to women across the country. Organisations such as the British Pregnancy Advisory Service will also have to make sure that women know about the change in service provision and support women in receiving treatment at home in whatever way is deemed necessary.
There also remain some issues with the wording of the order – it still requires that women receive and take the medication at their permanent address or where they are usually resident. This wording technically excludes some groups of women who may be particularly vulnerable, such as those without homes or those who need access to treatment but are unable to be at their permanent address for complicated reasons resulting from the current emergency. While we do not believe that such technicalities , there may be some concerned about technically breaking the law. The wording of any future order should consider the impact of placing this requirement on women.
After the Pandemic
This temporary order paves the way for a more permanent change to the law across the UK following the pandemic. Early medical abortion is safe and effective and is practiced at home by women across the world through services provided nationally in the US and Australia, and globally by Women on Web. Telemedical abortion is important to address access issues that were evident before this pandemic. Women need to live near clinics to be able to easily access them, which presents an issue for those who are reliant on public transport, live in rural areas, or areas where there have been lots of clinic closures. It is also much harder for women who already have dependants or who need to arrange time off work to attend clinics in person. Remote provision could improve the situation, and we hope that after the current emergency that measures are permanently put in place that allow women to access treatment remotely.