- Charities and medical bodies working across sexual and reproductive health, human rights, and gender equality and liberation have signed an open letter to Health Secretary Matt Hancock MP and Minister Helen Whately calling for temporary measures made during the pandemic to allow for telemedical abortions to be made permanent.
- The coalition letter states that “revoking telemedical abortion care would… make access to abortion more difficult and distressing – for entirely political purposes.”
- New research published in Contraception Journal adds to the significant body of evidence in favour of telemedicine, concluding that it was the preferred method of treatment for 80% of BPAS clients.
- Prior to the introduction of telemedical abortion care, vulnerable women sought illegal abortion medication online. Charities are warning that revoking telemedical care would effectively recriminalise vulnerable women who cannot access in-clinic care.
- Announcements from the governments of England, Scotland, and Wales are expected in the coming weeks.
Today a coalition of charities and organisations have published a letter to the Health Secretary Matt Hancock MP demanding the continuation of telemedicine for early medical abortion beyond the pandemic.
Signatories include the British Pregnancy Advisory Service (BPAS), the Royal College of Obstetricians and Gynaecologists (RCOG), the Royal College of Midwives, Women’s Aid, Rape Crisis, Amnesty International, MSI Reproductive Choices UK, and Stonewall.
At the start of the pandemic, Ministers in England, Scotland, and Wales granted temporary permission for early medical abortion treatment to be received by post following a telemedical consultation to reduce the transmission of COVID-19. This move has allowed more than 100,000 women to end pregnancies from the comfort and privacy of their own homes. Following public consultations, the governments in England, Wales, and Scotland are currently considering whether or not to make telemedicine a permanent option for women, and announcements are expected in the coming weeks.
The coalition wrote to explain the significant and overwhelmingly positive impact it has had, including shorter waiting times, greater efficacy due to earlier gestation, and increased access especially for vulnerable groups such as victim-survivors of domestic abuse, migrants, teens, those on low incomes and insecure work, and members of other minority demographics.
Research published in Contraception Journal this week adds to the body of evidence in favour of telemedicine, concluding that it was the preferred method of treatment for 80% of BPAS clients with 97% reporting they were satisfied or very satisfied¹. Since its introduction in April 2020, almost 80,000 BPAS clients across Britain² have had safe early medical abortions following telemedical consultations. A further study by the Royal College of Obstetricians and Gynaecologists found telemedical abortion to be ‘effective, safe, acceptable, and improves access to care’.³
However, permission is set to expire when we emerge from the Covid pandemic, which would force all women to attend a clinic for in-person care. Charities are warning that revoking telemedicine would effectively re-criminalise early medical abortion at home, and that women unable to attend a clinic for treatment would once again be forced to turn to online pills – risking up to life imprisonment.
Prior to the introduction of telemedicine, on average two women a day⁴ sought online abortion medication due to barriers accessing in-clinic care. Since abortion remains in criminal law, ending a pregnancy using pills purchased online remains a crime carrying a sentence of up to life imprisonment. Since the introduction of telemedicine, research shows that requests for pills from women in Great Britain has fallen by 88%⁵, meaning that vulnerable women who may have previously used illegal pills have instead been able to access legal care, and in doing so have not risked criminalisation. If the government were to revoke permission for telemedicine, women would once again turn to illegal online pills.
Clare Murphy, Chief Executive of BPAS, said: “There is no clinical argument for reinstating previous restrictions, and it is imperative that these new measures continue after the pandemic to avoid re-criminalising at-home abortions. The UK is in a bizarre situation in which abortion has been decriminalised in Northern Ireland yet is still unavailable for many; while abortion remains in criminal law in Britain, yet more women than ever have been able to access the care they need, thanks to these temporary changes made during the pandemic.
“We hope that the Government will ensure the experiences of all who need abortion care are kept at the heart of decision-making.”
Dr Edward Morris, President at the Royal College of Obstetricians and Gynaecologists, said:
“There is irrefutable evidence to show the telemedicine abortion service is safe and there is no medical reason not to make it permanent in the UK.
“We know that during the pandemic thousands of women have accessed this service and when asked the majority said they preferred it. At-home early medical abortions are more accessible and highly valued by women, and that is why this service should remain.”
Ros Bragg, Director of Maternity Action said:
“We strongly support the call to permanently legalise at-home early abortions. We know that it is the most vulnerable women who struggle to access basic healthcare, often because of language, financial and logistical barriers. By making early abortion available over the phone, many more women will be able to access the healthcare that they need."
Nancy Kelley (she/her), CEO at Stonewall, said:
“Making abortion services available outside of clinic environments has been revolutionary. High-quality, safe and effective abortion services should be available to everyone who needs them. But, in reality, going to a clinic can cause barriers, particularly for LGBT women and people assigned female at birth who may fear discrimination at abortion clinics and a lack of understanding about their needs. Making the system more flexible has meant that abortion services can be accessed more easily by everyone who needs them, and we urge the UK Government to make these vital services permanent.”
Felicia Willow, Interim CEO, The Fawcett Society, said:
“During the pandemic telemedicine has provided accessible, safe, and effective abortion care – enabling women, including those in abusive relationships or struggling to access in-person clinics, to make the right choices for them. Telemedicine must become a permanent option for women, and this progress which has been made during the pandemic must not be lost.”
Jonathan Lord, Medical Director for MSI Reproductive Choices UK said:
“Definitive studies have shown that telemedicine has improved access to abortion care and is safe, effective and preferred by patients. It is one of the few positive outcomes of the pandemic, with waiting times – and therefore also the distress that can be awful for women faced with an unwanted pregnancy – considerably reduced. Given the compelling evidence that shows how much kinder and better this care is, there would be no justification to remove the approval unless there was a political desire to cause more distress and difficulty for women needing this essential healthcare.”
Amy Gibbs, Chief Executive at Birthrights, said:
"Early medical abortion care at home is not only safe, it has also made abortion more accessible to a wider range of women/people, it means more abortions are happening earlier in pregnancy, and satisfaction levels are sky high. This is surely a great example of the innovative and person-centred care we want to see in every area of the NHS."
Dr Jayne Kavanagh at Doctors for Choice said:
“Telemedical abortion care is so clearly good clinical practice. Revoking permission for it would put clinicians in the impossible professional and ethical position of having to offer substandard clinical care for no good reason other than political expediency. That’s not good medicine!”
Florence Schechter, Director of the Vagina Museum said:
“Telemedical care has removed many barriers standing in the way of accessing abortion. Everyone deserves the right to access safe and legal medical care to end a pregnancy if they choose. While born of necessity, over a year of telemedical care for early medical abortion has demonstrated what is possible - the question remains whether decision makers will choose to accept the overwhelming evidence in favour of telemedicine."
Humanists UK said:
“The success of telemedicine has been one of the shining lights that has emerged from the darkness of the pandemic. The evidence that this change in regulation has benefitted women and girls by making abortion safer and more accessible is very compelling. It would seem illogical, given the proven benefits of telemedicine, to return to mandated face-to-face clinic appointments after the period of the pandemic.”
Safe Abortion Action Fund (SAAF) said:
“Let's remove harmful barriers to safe abortion access by ensuring telemedicine is an option not just now, but in the future.
“As a global funder of abortion we see the ongoing barriers so many are facing in trying to access safe abortion care. Abortion by telemedicine is one way to improve safety and access, which is unfortunately not being implemented in many countries. With reliable evidence about the efficacy of telemedicine as well as patients' satisfaction we are now, in the UK, afforded with a perfect moment to extend remote abortion provision to all who may need it.”
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Notes to Editors
- Client satisfaction and experience of telemedicine and home use of mifepristone and misoprostol for abortion up to 10 weeks’ gestation at British Pregnancy Advisory Service: a cross-sectional evaluation
- BPAS figures from 8th April 2020 - 7th May 2021
- Aiken, ARA, Lohr, PA, Lord, J, Ghosh, N, Starling, J. Effectiveness, safety and acceptability of no‐test medical abortion (termination of pregnancy) provided via telemedicine: a national cohort study. BJOG 2021; https://doi.org/10.1111/1471‐0528.16668. 00: 1– 11.
- Figures from the study “Demand for self-managed online telemedicine abortion in eight European countries during the COVID-19 pandemic: a regression discontinuity analysis” https://srh.bmj.com/content/early/2021/01/11/bmjsrh-2020-200880
BPAS is a UK charity that provides reproductive healthcare services including pregnancy counselling, abortion care, miscarriage management and contraception, for 100,000 women a year. It supports and advocates for reproductive choice.
BPAS also runs the Centre for Reproductive Research and Communication, which seeks to develop and deliver a research agenda that furthers women’s access to evidence-based reproductive healthcare, driven by an understanding of women’s perspectives and needs. You can find out more here.
BPAS intends to launch a not-for-profit fertility service in Autumn 2021, to provide ethical, evidence-based, person-centred care that supports patients. We intend to only charge what it costs to provide a safe, high-quality, and accessible service to patients who may be unable to access NHS-funded care.