Clinics call for at-home abortions to continue

Women and girls in England should be able to access early medical abortions by phone or video call, clinics say.

Remote appointments began at the start of the pandemic and MPs are set to vote on making the service permanent.

However, some senior safeguarding doctors say under-18s should be seen face to face and examined to make sure they are less than 10 weeks pregnant.

They cite a small number of cases where a mix-up over dates led to women having later abortions than expected.

The at-home abortion arrangements are due to end in August - but Conservative peer Baroness Sugg has tabled an amendment to the Health and Care Bill, seeking to make them permanent.

On Wednesday, MPs will be given a free vote on the issue.

Medical abortions involve taking two pills.

Before the pandemic, women seeking an abortion of a pregnancy under 10 weeks needed a face-to-face consultation in a clinic and were routinely scanned.

They would take the first pill there and be given a second to take at home within 48 hours.

But when lockdown hit, the government changed the regulations so treatment could be accessed and taken at home after a telephone or online consultation.

If concerns were identified, such as not being sure of the date of their last period, a scan was provided.

According to clinics, the number of abortions provided via telemedicine since the pandemic began is in the region of 150,000 in England.

This remote care has been revolutionary for women's health, the British Pregnancy Advisory Service (BPAS), one of three main clinics operating in England, said.

Chief executive Clare Murphy said: "We've long known there are women who really struggle to access clinic services.

"They are sometimes women in very complex situations, very vulnerable women."

Women in coercive relationships, for example, found it difficult to access clinics without their partner knowing.

"These women either turn to illegal methods or they present to us very late," Ms Murphy said.

A Royal College of Obstetricians and Gynaecologists representative said: "There is a wealth of evidence to show that telemedicine for early medical abortion is safe, has enabled women to access treatment sooner and that the service is preferred by women."

The largest study of UK abortion care, published by the British Journal of Obstetrics and Gynaecology in 2021, analysed the outcomes of more than 50,000 early medical abortions.

It found low rates of significant complications but said there was a potential gap in the consistency of reporting of incidents.

The National Network of Designated Health Care Professionals (NNDHP), which represents senior NHS doctors and nurses who fulfil child-safeguarding roles in England, has recorded 47 cases of early medical abortions that actually resulted in mid- to late-pregnancy terminations, across all ages, since the start of the pandemic, in March 2020.

Six involved girls and in half of those cases - and 12 instances in total - there had been signs of life.

NNDHP early medical abortions lead Dr Helen Daley, a consultant paediatrician, said: "We've had young people say they are depressed, anxious, afraid to go out, months after the event.

"We've also had staff being hugely traumatised."

But BPAS said there had been fewer than one in 2,000 cases where the gestation was more advanced than expected, without a case of this type in girls since 2020, and it saw all under-16s and most under-18s face to face.

About 7,500 girls seek medical abortions each year in England and Wales, according to the Royal College of Obstetricians and Gynaecologists.

The NNDHP said it supported ready access to safe and effective abortions but called for all girls to be seen face to face, as well as vulnerable care leavers under 25, to ensure they could be clinically examined to make sure they were less than 10 weeks pregnant and to prevent coercion and exploitation.

The Royal College of Paediatrics and Child Health said the same groups "must be offered and actively encouraged to take up a face-to-face appointment to assess gestation, support their holistic needs and assess any safeguarding issues as part of the pathway for early medical abortions".

But Dr Jonathan Lord, who co-chairs the British Society for Abortion Care Providers, said reverting to compulsory in-person consultations for young people "will force abortion providers to go against all current guidance and evidence, make it more likely to miss cases of child sexual exploitation and abuse and increase the risk of a return to the worst of all outcomes - concealed pregnancy with unattended birth at home".

Sixteen-year-old Savannah, not her real name, said the clinic she had approached on the phone had calculated she had been less than eight weeks pregnant.

She was seen - and collected her medication from a BPAS clinic - but not scanned or examined.

She took both pills at home but after the second felt "really bad" pain.

"My relative called another ambulance because when I was pushing, my boyfriend could see feet," Savannah said.

The baby had been born with a heartbeat and they had both been taken to hospital. It was concluded she had been between 20 and 21 weeks pregnant.

Savannah said she had been left traumatised.

"If they scanned me and I knew that I was that far gone, then I would have had him," she said.

BPAS said it could not comment on individual cases.

The Welsh government has already acted to make the continuation of at home abortions law, while Scotland is holding a consultation.

The Department of Health and Social Care said: "The wellbeing and safety of women and girls requiring access to abortion services is a priority.

"Safeguarding is an essential component of abortion services and it is vital that women and girls who are at risk of harm are identified and supported appropriately, including through referrals to other agencies.

"The department is working closely with the royal colleges and safeguarding leads, including the NNDHP, to review all safeguarding policies within abortion services."