• Non-profit reproductive healthcare providers have written to warn the government that “abortion services will not cope if telemedical provision is withdrawn” in the coming weeks.
• Regulations which provide permission for at-home early medical abortion care are set to expire on 30 March. Around half of all abortions are currently provided by telemedicine, yet the government has yet to announce a decision on the future of the service.
• Revoking permission would lead to increased waiting times, a shortfall of appointments, and a 43% increase in terminations post-20 weeks. (Abortion is a safe, common procedure at any gestation, but the earlier it is carried out, the safer it is.)
• Services are experiencing a surge in demand for abortion care alongside unprecedented staff shortages due to Omicron. One provider reports a 700% increase in COVID-19 related absences in the first week of 2022 compared to the first week of December 2021.
• If everyone was again required to attend for face-to-face treatment, one provider alone would be able to provide 190 fewer abortions every week, pushing up gestations
• There is absolutely no reason to take a tablet that is safer than paracetamol, within a hospital or clinic. Forcing every single woman to attend a clinic in person, simply to take medicines which could safely be taken at home is a wasteful use of healthcare resources, especially at the current time.
• Women in the most challenging circumstances who may struggle to access in clinic care have benefited most from the ability to access care at home following a consultation with a healthcare professional. Since telemedicine was introduced, the numbers turning to unlawful means to end a pregnancy have reduced drastically.
• The charities have today written to the Minister for Public Health, Maggie Throup, stating that “time is now running out to protect a healthcare service that protects the health and wellbeing of women.”
Abortion care providers have today (Wednesday 26th January 2022) written to the Minister for Vaccines and Public Health, Maggie Throup, to warn of the “disastrous” consequences for access to abortion care if the current permission for at-home early medical abortion care is revoked. The non-profit providers have set out the potential for increased waiting times and shortages of appointments for treatment, which would mean a significant increase in the need for an abortion post-20 weeks’ gestation.
At the start of pandemic, the-then Health Secretary Matt Hancock granted permission for early medical abortion medication to be delivered by post and taken at home. The telemedicine service was available to all those who were clinically suitable following a telemedical consultation with a nurse, midwife, or doctor. In 2021, the government ran a consultation on whether to keep telemedicine as a permanent option. Multiple peer-reviewed studies have found that telemedicine is safe, effective, efficient, and preferred by a majority of women surveyed. There is no clinical need for everyone accessing an abortion to attend a clinic or to have an ultrasound scan. Forcing every single person to attend a clinic in person, simply to take medicines which could safely be taken at home is a wasteful use of healthcare resources, especially at the current time. Even before the pandemic, NICE (the National Institute for Health and Care Excellence) had recommended that the NHS should offer abortion assessments by phone or video call for women who preferred this as they recognised how it helps vulnerable patients.
As the regulations which provide permission for the service are set to expire on 30 March, the government must make a decision within weeks.
The three leading abortion care providers, BPAS, MSI Reproductive Choices, and NUPAS have today written to the Minister to share their concerns about the potential impact of revoking permission for the service, including the risks to women’s health and wellbeing, the sustainability of the reproductive healthcare sector and the safety of vulnerable women and girls.
Examples include women like Claire*, who disclosed to MSI that her ex-partner and father of her son had been abusive. Even though he was jailed in 2018, she has continued to be threatened by his family who live close to her nearest clinic. Claire didn’t feel safe going there in person. Thanks to telemedicine, MSI was able to carry out a thorough safeguarding assessment over the phone and support Claire to avoid a potentially dangerous face-to-face encounter by sending the pills, as well as a method of contraception, to her home. MSI’s safeguarding team were also able to ensure that she was in contact with a local Domestic Abuse Team and Police were aware of the harassment and threatening behaviour. The safeguarding team have found that many patients feel safer being able to talk about distressing and intimate details when they can ensure their privacy at home, than they would by having to explain to a coercive partner why they are having to travel to a clinic.
The letter states:
“Abortion services will not cope if telemedical provision is withdrawn and all women are forced to return to clinics or hospitals regardless of clinical necessity…. Without the option of telemedicine for those who need or prefer it… [there will be] a very serious escalation in waiting times and staffing pressures. To deliberately force services to run in a manner which is less efficient, when there is no clinical or ethical reason to do so, seems to us to be both indefensible and inexplicable.”
Abortion services across the sector are already under a significant strain due to unparalleled numbers of staff self-isolating or unwell with COVID-19.
Data from one provider, BPAS, indicates that from their service alone, the need for abortion care post-20 weeks would increase by 43% if telemedicine was removed. BPAS has also stated that if everyone was again required to attend for face-to-face treatment when it was not clinically necessary, the charity alone would be providing 190 fewer abortions every week.
Clare Murphy, Chief Executive, BPAS:
“We cannot be clearer – services will not cope if our ability to provide early abortion care for women at home is removed. Telemedical abortion care is safe, effective and preferred by many women. All NHS services are under huge strain as a result of the pandemic, and abortion care is no different – with unprecedented numbers of staff self-isolating or absent due to illness. Women will face significantly longer waits to treatment if their access to telemedical care is withdrawn by Government and will need later procedures as a result – and this when services are least able to provide them, pushing up gestations even further. While abortion is safe and considerably safer than carrying a pregnancy to term, the earlier it can be offered the better for women’s physical and mental health.
“The U.K. led the way in introducing telemedical abortion care at home at the start of the pandemic, and many countries – including the US – have followed suit. We should be proud of what we have been able to provide for women. It would be a travesty if it were withdrawn.”
Jonathan Lord, MSI Reproductive Choice’s UK Medical Director:
“Removing the option of early medical abortion at home would make accessing abortion care far more difficult, particularly for those experiencing domestic abuse who are often unable to safely attend a clinic in person. Forcing them to do so would mean more unregulated pills purchased online, more women and pregnant people forced into unnecessary surgical procedures or even into continuing unwanted pregnancies. It would also make the service less resilient and less efficient, wasting NHS resources – and ultimately taxpayers’ money.
“It makes no sense to insist that abortion medicines must always be taken in a hospital or clinic, especially at a time when health care services are under such pressure. It’s hard not to conclude that doing so would be a decision rooted, not in medicine, science, or compassion, but by a fundamental lack of trust in people, particularly women, to make their own reproductive choices.”
Letter from BPAS, MSI Reproductive Choices, and NUPAS to Maggie Throup, Minister for Vaccines and Public Health, is online here.
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BPAS is a charity that sees over 100,000 women a year for reproductive healthcare services including pregnancy counselling, abortion care, miscarriage management and contraception at clinics across Great Britain. 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: https://www.bpas.org/get-involved/centre-for-reproductive-research-communication/
In 2021, BPAS launched BPAS Fertility, England’s first not-for-profit fertility service, to provide ethical, evidence-based, person-centred care that supports patients. We provide a safe, high-quality, and accessible service, without profiteering from patients. Our service gives those ineligible for NHS funding an affordable option to access the care they need.