Dr Elizabeth Chloe Romanis, from our Durham Law School, Jordan Parsons, PhD candidate from University of Bristol and Thomas Hampton, Wellcome Trust Clinical Research Fellow from University of Liverpool, comment on the changes to abortion laws during the pandemic.
As a result of the pandemic, the governments in England, Scotland and Wales temporarily relaxed abortion rules in March 2020. This means that, in every part of the UK except for Northern Ireland, people early in pregnancy can to take abortion pills at home following a telephone consultation. But with COVID restrictions largely eased across the UK, there’s uncertainty over whether this will still be allowed.
Before the pandemic, for an early medical abortion to be legal in Great Britain people had to go to a clinic where they were given two drugs – mifepristone and misoprostol. The first pill had to be taken under supervision, while misoprostol was taken later at home.
Being allowed to take abortion pills at home can make abortion more accessible, more comfortable for the person involved, and less expensive. But some anti-abortion groups argue that it’s unsafe and that it could increase the risk of vulnerable people being coerced to have an abortion.
In a short review article in The Lancet, we recently looked into the ethics of the use of at-home abortion drugs during the pandemic. We found clear evidence that “telemedical abortions” – as they are called – are safe and don’t put people at greater risk of physical or mental-health complications. As such, we believe that telemedical abortion should remain an option.
Even before the pandemic, a substantial body of evidence showed home use of abortion drugs after a telephone or online consultation was safe and effective. People who used this service also found remote care met their needs.
Because of changes to the law during the pandemic, this body of evidence has grown significantly. Data collected from recently established telemedical abortion services in Great Britain show them to be as safe as in-person services, with similarly low rates of adverse outcomes.
Telemedical abortion provided with the safety protocols already in place – such as requiring an ultrasound scan or in-person examination in some instances – is just as safe as abortion pills being provided in clinics. Telemedical abortion may also improve safety for patients by allowing people to access abortion pills through formal channels – rather than buying abortion pills unlawfully online.
One argument sometimes made against telemedical abortion is that consultations may not be able to provide vulnerable people with the proper help they need when seeking an abortion. The problem with this objection, however, is that it doesn’t recognise that many vulnerable people don’t access abortion clinics when there are requirements that consultations take place in-person, for many reasons.
Many victims of abuse report being unable to attend abortion clinics. This is either because they can’t leave home or they’re afraid of their abuser’s reaction if they did attend a clinic.
Changes to abortion laws during the pandemic now mean that these people have access to clinical support during abortion that they otherwise would not have had. Vulnerable people could find it much easier to access treatment when they can have their consultation in a place where an abusive partner would not question where they were – such as from their own home or a relative’s house.
Some groups have suggested that for vulnerable people, such as victims of domestic violence, remote consultation is inadequate as it may be easier for abusive partners or families to pressure people into having abortions. This argument assumes abuse victims would be likely to disclose abuse or coercion if the consultation took place in person.
In many instances, abusive partners attempt to attend appointments with their victims, and victims report not feeling safe disclosing abuse – even if abusers aren’t in the room. As such, in-person consultations do not automatically increase the likelihood of a victim speaking to someone.
Many people may even feel more comfortable discussing sensitive or difficult things over the phone, as they can be somewhere they feel safe or in control. We suggest that telephone consultations can also be less intimidating than clinical environments.
With proper training, healthcare professionals can identify signs of a person being potentially coerced during remote consultation – such as listening to the tone of their voice, listening to background voices, or recognising signs of hesitation. As remote care is becoming more common, this training is increasingly important, so that healthcare professionals of all kinds can identify signs of abuse.
Many of the concerns about safety play into the idea that people seeking an abortion are inherently vulnerable. This perpetuates abortion stigma, seeing it as a welfare issue instead of a routine, essential medical procedure that people need to access for a variety of reasons.
Statistics show that one in three women in England and Wales will have an abortion in their lifetime. Remote consultation is unlikely to lessen the quality of care for some and there are substantial benefits for the majority.