Progress on abortion is hanging in the balance as the government decides whether to make ‘abortion at home’ permanent

Early Medical Abortion at home, or ‘telemedicine’, was introduced on 30 March 2020, as a temporary measure until the pandemic ended, or a maximum of two years, whichever came first. Now as we approach the two-year deadline, the government faces a decision about whether it stays or goes. 

The global body of clinical and patient experience evidence is so strong, that it’s hard to see how removing this pathway could be justified either now, as Omicron takes its toll, or in the future. No matter what happens with Omicron, it’s clear long-term resilience must be built into essential services like abortion. Telemedicine cannot be introduced and removed as and when pandemics (or indeed other crises) hit.

Case studies: how telemedicine keeps women safe 

MSI Reproductive Choices UK’s peer-reviewed research, published in the BMJ Sexual and Reproductive Health journal, has shown at-home abortion is a valued, private, convenient and more accessible option, especially for those who find in-clinic visits logistically or emotionally challenging, including those experiencing domestic abuse.

When Claire* found out she was pregnant she contacted the MSI UK call centre, disclosing that her ex-partner and father of her son had been abusive. He had been jailed in 2018, but his family and friends who live close to her nearest clinic continued to threaten her and Claire told us she didn’t feel safe going there in person. Thanks to telemedicine, MSI was able to carry out a thorough safeguarding assessment over the phone, giving Claire complete privacy and control, and supported her to avoid a potentially dangerous face-to-face encounter by sending the pills as well as a method of contraception to her home. Claire felt more comfortable discussing distressing and intimate details over the phone than she would have done if she was forced to come into a clinic. 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. With Claire’s consent, MSI also connected her with a Family Support Worker to ensure she and her son were appropriately safeguarded. 

Amy* had previously self-harmed and suffered anxiety and panic attacks after giving birth aged 16. The impact of lockdown and lack of sleep was then exacerbated by an unintended pregnancy nine months later. But despite the challenges of the global pandemic, thanks to telemedicine, Amy was able to easily access the care she needed. MSI’s safeguarding team were also able to ensure she was safe and supported at every step of the journey, arranging counselling, putting her in contact with a health visitor to support her with her baby as well as booking an appointment for her with a nurse specialising in mental health. 

The impact of Omicron on service delivery and waiting times 

At a time when Covid cases are at an unprecedented level due to Omicron, MSI UK is experiencing the same staffing pressures as the whole of the health and care sector, with absences spiking in January. In the first week of 2022 alone, MSI UK saw a 700% increase in COVID-19-related absences compared to the first week of December. Thanks to telemedicine, many of its clinical and call centre staff who have needed to self-isolate have been able to continue working from home. If this had not been possible the impact on waiting times would have been disastrous, particularly given the time-sensitive nature of abortion.

Jonathan Lord, MSI Reproductive Choice’s UK medical director said:

“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.”

A fact box about telemedicine

Since its introduction in April 2020, over 35,000 MSI clients across Britain have had safe early medical abortions following telemedical consultations.

The UK’s largest study in abortion care of 52,142 women, representing 85% of all medical abortions performed nationally in the study period, found that waiting times from when the woman has her consultation to treatment improved from 10.7 days to 6.5 days and was “effective, safe, acceptable, and improves access to care”

  • An MSI study into the acceptability of telemedicine in 1,243 patients found it highly rated, with 8 out of 10 (83%) MSI clients reporting preferring telemedicine during the pandemic and two thirds (66%) reporting they would choose telemedicine again if Covid-19 were no longer an issue.
  • Since the introduction of telemedicine, research shows that requests to illicit providers for pills from women in Great Britain has fallen by 88%, meaning that vulnerable women who may have previously used illegal pills have instead been able to access legal care, and in doing so have not risked criminalisation