In October 2017, Scotland became the only part of the UK where women are given the choice to take abortion medication at home.
The decision by the Scottish government means women seeking “early abortion” in the first nine weeks of pregnancy can take the second of two necessary medications at home, rather than in an NHS outpatient clinic. Mifepristone and misoprostol have to be taken one to two days apart which, until now, saw women attending the clinic for two separate appointments.
The move was welcomed by medical experts and women’s rights campaigners. It makes access to abortion more straightforward, and means women can complete the process in the comfort and privacy of their own homes.
The issue returned to the frontline again recently when anti-abortion pressure group, the Society for the Protection of Unborn Children Scotland, tried to block this new option. SPUC wrote to the Scottish government to express its view that allowing women to take this medication themselves at home was “unlawful”, “dangerous”, and marked a return to “DIY abortions” on the “backstreets”. The group is now pursuing a judicial review.
Challenging ‘DIY abortion’ claims
It is important to pick apart these SPUC claims, particularly when it comes to the inflammatory rhetoric of “DIY abortions”; what the evidence says on the safety and acceptability to women of home abortion; and the 50-year-old abortion law itself.
Using the phrase “DIY abortions” suggests a lack of understanding of contemporary methods of abortion. The vast majority of early abortions in Scotland – and increasingly in England and Wales – are carried out using medication rather than surgery. Abortion these days is much less something that is done to women by a doctor using instruments, and more commonly something similar to early miscarriage, which women manage themselves once provided with the medication they need.
Another issue that the use of the “DIY” rhetoric raises, is that it is not the widening of access to abortion, but a combination of restrictions on provision and the stigma surrounding it which push women to seek unsafe alternatives. Research suggests that, when women feel uncomfortable about seeking an abortion or are unsure if it is freely available to them, then they will they seek other methods online.
What should alarm anyone concerned about the safety of pregnant women is that despite abortion having been safely provided within the law for more than half a century, women may feel the need to seek dangerous and illegal alternatives.
Safety and privacy
Most people are unaware that in Britain, misoprostol is given to women to take at home if they have had an early miscarriage where the pregnancy has not been expelled spontaneously. And while the physical experience a woman undergoes is essentially the same as an early abortion, miscarriage is not regulated by law, so there are no restrictions about where women can take this same medication.
It is established practice for women having an early medical abortion – where there are no additional concerns such as medical complications or an unsafe home environment – to return home after taking the second medication. But the necessity of taking the medication on NHS premises means that some women, for whom the medication takes effect quickly, experience bleeding and cramping on the way home.
This can be a unpleasant and distressing experience, though research suggests that women who preferred to go home accepted it as a necessary evil. Allowing women to wait to take the medication at home is a simple way to avoid this anxiety and discomfort. The benefits were acknowledged in a House of Commons Science and Technology Committee report over a decade ago.
Research has found that women valued the option to complete the process at home, and were glad of the opportunity to complete a typically painful and messy process in the privacy of their own space, with a partner or friend (often not possible in a hospital setting).
Providing they were adequately prepared by their health professionals, these women felt well-equipped to manage the process. The small proportion of women who could not return home said they valued the alternative of hospital care, which continues to be offered.
Regulation of abortion in Britain
Objections to home use of misoprostol also make clear that the 1967 Abortion Act has not kept up with medical advances over the last 50 years. When the legislation was drafted, abortion by medication did not exist. Lawmakers aimed only to prevent women dying from unsafe abortions – and were hugely successful – but they did not imagine the flexibility that safe medical alternatives might bring.
That we can be in a situation where women in one set of pregnancy circumstances (miscarriage) can, but those in another (abortion) cannot, use the very same drug for essentially the same medical purpose, underscores that it is not the safety of the medication, but judgements of those circumstance that prevail.
This is just one of the reasons that experts including the Royal College of Obstetricians and Gynaecologists and the British Medical Association are in favour of decriminalisation; it is time to replace the out-of-date law with regulation in line with any other form of medical care.
Attempts to challenge home misoprostol use are less about concerns for women’s safety and more about exercising a socially conservative view of the world in which women should not be allowed to make decisions about their own bodies.
With the Republic of Ireland on the verge of a referendum to reform its highly restrictive abortion law, it is hoped that Scotland – and the rest of Britain – will reject any attempts to return women to the “backstreets” and continue development of safe, legal abortion in the 21st century.