About one in four pregnancies worldwide end in an abortion every year. In England, Scotland and Wales, women have had a right to this crucial form of healthcare since 1967 – but such a right is meaningless if it cannot be exercised.
This fact is well understood by anti-abortion groups and legislators in the US, who, while awaiting permission from the supreme court to bring in an outright ban, are seeking to make it as difficult as possible for women to use abortion services. Now, here in the UK, women’s access to abortion is also being undermined.
At the start of the first lockdown, the government approved the use of both pills in England for early medical abortions (EMA) at home. This meant that care could be delivered entirely remotely, through a virtual consultation with a qualified nurse or midwife, while the patient took the two pills involved in the procedure. The government recently announced their intention to reverse this approval.
Prior to the introduction of this pathway, anyone seeking a medical abortion in the first 10 weeks of pregnancy would be required to attend an in-person appointment to receive an ultrasound scan and take the first of the two pills (mifepristone) within a clinic, with the second (misoprostol) being taken at home.
The decision not to make these measures permanent goes against a wealth of robust and widely accepted, peer-reviewed evidence from medical professionals – including World Health Organization guidelines published this month – showing telemedicine to be both safe and effective. In fact, since telemedicine was introduced, the risk of complications related to abortion has reduced as women have been able to access abortion services much earlier in their pregnancy. Telemedicine has the support of organisations such as Rape Crisis and Women’s Aid.
It is a disappointing change of heart from a government that said time and time again during the Covid-19 pandemic that it was committed to “following the science”.
But there is now an opportunity to set this right through an amendment to the health and care bill – put forward by Liz Sugg – which would put this telemedicine pathway into legislation.
Concerns have been raised as to the ability of doctors to ensure the safeguarding of patients, particularly of young people and women in abusive relationships, during remote consultations. Yet MSI Reproductive Choices UK reported a 20% increase in the number of safeguarding disclosures, including of domestic abuse and sexual violence, following the introduction of telemedicine services. As organisations such as Brook and the NSPCC have pointed out, providing remote support in a familiar environment may help service users feel more able to open up about their emotions, experiences and situations.
Women have already expressed a preference for telemedicine for EMA to be available beyond the pandemic. In one study, 89% of respondents stated that they would choose this pathway again if they needed another abortion. The failure to listen to what women are asking for from abortion services greatly undermines the government’s commitment to putting women at the centre of their own healthcare as it develops a national Women’s Health Strategy.
This decision is also out of step with the health secretary’s recent pledge to drive greater personalised care, set out in his speech on healthcare reform at the Royal College of Physicians. He spoke about the need to “empower patients and fulfil the promise of the technological leaps we’ve seen throughout the pandemic” – but ending access to EMA via telemedicine does anything but this.
Furthermore, given that analysis has shown that the telemedicine pathway could result in savings of £3m a year for the NHS it is difficult to see how this is a decision that benefits our healthcare system.
The Welsh government has decided to make telemedicine for EMA permanent in Wales. This sends a clear message that, while women in Wales can be trusted to use a healthcare service in a way that meets their needs, women in England cannot.
The government has said it will review telemedicine for EMA measures in England but is unwilling to allow it to continue after August. If it is committed to enabling women to have greater control and choice over their health, we must see a detailed plan for this review – including the steps that will be taken, from whom input will be sought and anticipated timescales.
Telemedicine for EMA presents an opportunity for the government to be seen as a shining light for women’s reproductive rights around the world, at a time when rights are being rolled back elsewhere. As we await the publication of the women’s health and the sexual and reproductive health strategies, I call on MPs to recognise the weight of the evidence and ensure that access to this essential form of healthcare is not restricted for women in England.
Dame Diana Johnson is the Labour MP for Kingston upon Hull North and chair of the all-party parliamentary group on sexual and reproductive health in the UK
