Abortion at Home Option to Become Permanent in England

Dr Sheena Meredith

April 01, 2022

MPs voted in the House of Commons Wednesday afternoon to make permanent the option for women in England to take the two pills needed for a medical abortion at home.

Under the scheme, originally put in place as a temporary arrangement at the start of pandemic measures in March 2020, women wanting to terminate pregnancies up to 10 weeks gestation could request both pills for home use following a telemedicine consultation with a doctor. Previously, the first drug, mifepristone, had to be taken at under medical supervision at a clinic or hospital and only the second, misoprostol, could be taken at home up to 48 hours later.

Public Health Minister Maggie Throup sparked an outcry from medical groups, pro-choice organisations, and abortion service providers when she announced last month that the 2-year trial of the so-called "pills by post" service would be extended by 6 months to the end of August, but then axed altogether.

In response, an amendment to the Health and Care Bill, tabled in the House of Lords by Conservative Peer Baroness Liz Sugg, sought to make it permanent. The amendment passed in the House of Lords 2 weeks ago. The Government then submitted a "motion to disagree" when it came back to the Commons, seeking to avoid being bound by it. However it was forced to abandon the plan Wednesday when the amendment passed by a clear majority. MPs voted 215 to 188 in favour of maintaining women's access to telemedicine and at-home early medical abortion care indefinitely.

The Baroness tweeted after the vote: "Delighted is an understatement. Thank you to all the MPs who voted in favour of supporting women to access their choice of healthcare in a safe and effective way."

By convention on moral matters, both Labour and Conservative MPs were given a free vote on the issue. The 72 Conservatives who voted in favour of the amendment included Maria Miller, former culture secretary, and Matt Warman. Labour MPs included Shadow Health Secretary Wes Streeting, Diana Johnson and Jess Phillips, shadow minister for domestic violence and safeguarding.

About 150,000 women have used the at-home service since it began in 2020. An online parliament petition urging the Government to maintain its provisions amassed more than 14,000 signatures, and research conducted by the British Medical Journal found that since it was introduced, requests for abortion pills from to illicit providers in the UK Britain had fallen by 88%.

Scheme Improved Safety and Reduced Waiting Times

Urging MPs to vote in favour, Dr Edward Morris, President of the Royal College of Obstetricians and Gynaecologists, said yesterday afternoon: "Telemedicine for early medical abortion has been a success story of the pandemic, and the removal of this service would be an infringement on women’s rights to access the healthcare they deserve.

"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. There is no logical or medical reason why the Government should not make telemedicine permanent."

He told Medscape UK after the verdict: "We are delighted that MPs have voted in favour of the amendment, which follows the Welsh Government’s decision to make telemedicine for early medical abortion a permanent feature of abortion care in England. 

"This is a vital decision that protects women’s rights to access the healthcare they deserve, and gives them the choice of accessing early abortion care at home.

"We would like to thank all the campaigners who have helped to make this possible as well as the MPs who voted yesterday to champion women’s rights."

Dr Zoe Greaves, BMA medical ethics committee chair, said last month that to end the option of telemedicine abortion would put the wellbeing and safety of women at risk and would be putting politics before women’s health.

"Even before the pandemic, the National Institute of Health and Care Excellence supported providing a telemedicine abortion service. Since the practice became legal during the pandemic, the largest-ever study of abortion care in the UK found that introducing a telemedicine service for abortion shortened waiting times for treatment and increased the safety of abortion services by allowing women to receive care much earlier in their pregnancy."

She told Medscape UK: "The BMA, along with other medical organisations, has been seeking to allow telemedicine abortion to become a permanent service for all those who wish it, including those who are most at risk such as women who are victims of domestic abuse. Our recent lobbying included a joint letter to the Prime Minister warning that removing access to this service would be ignoring the vast body of clinical evidence that demonstrates that it is a safe, effective and world-leading service. The BMA therefore welcomes the vote by MPs for the continuation of this service as we fervently believe that women should have a choice on health issues which affect them."

Mixed Reaction to the Decision

Commenting on the decision, Clare Murphy, chief executive of the British Pregnancy Advisory Service, said: "We are absolutely delighted that MPs followed the evidence and above all listened to women when they voted for the continuation of this service. Early abortion at home is safe, effective and an important option for women. We look forward to being able to provide this service into the future and are incredibly grateful to all the parliamentarians who championed it."

Anti-abortion groups however reacted with dismay to the vote. "This is a shameful day," said Alithea Williams, public policy manager at the Society for the Protection of Unborn Children. A spokesperson for Christian group CARE said: "This was a close vote and many MPs spoke out about the dangers of the at-home abortion scheme... We continue to believe that a better story for England and the rest of the UK involves respecting the value of life from conception through to natural end. Every abortion is a tragedy."

The vote will mean that the Abortion Act 1967 is amended and England will join the Welsh Government, which has taken the "progressive step" of making the temporary arrangements permanent. Scotland is planning to do likewise under the administration at Holyrood.

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