Jhe English and Welsh governments are consulting the public on whether to revoke the temporary rules that allow women to end early pregnancies at home with the use of two pills. The rules were introduced to reduce the need for face-to-face meetings as Covid-19 swept through the population.
It is essential that women continue to have access to these home-use medications for early medical abortions. This method of pregnancy termination is safe and allows women to manage their reproductive health privately and respectfully. Despite concerns raised by anti-choice activists that allowing women to obtain early abortions at home will result in the misuse of medications, the evidence to date does not support these claims.
A small number of cases have been reported in the media of women accessing medication from abortion providers, such as the British Pregnancy Advisory Service and MSI Reproductive Choices, when they were more than 10 weeks pregnant. This included one reported case of a woman who was 28 weeks pregnant when she took the drug.
In England, Wales and Scotland, it is illegal to terminate a pregnancy at any time unless the abortion is performed by a licensed doctor. The only circumstances in which it is legal to terminate a pregnancy that has reached the 24th week of gestation are if there is a serious threat to the physical or mental health of the woman or due to fetal abnormalities.
The temporary law allows the abortion drug – mifepristone and misoprostol – to be sent to a woman’s home after a phone or video consultation with a medical professional. If a woman deliberately misleads abortion providers about the gestational stage of her pregnancy to get medication, she could theoretically be jailed for life, thanks to Victorian legislation that still applies.
Less than one percent over 10 weeks
But before people jump to the conclusion that home use equals misuse, there are other important things to consider. These cases are just a handful of early medical abortions that have taken place at home in England and Wales. Between April and June 2020, 23,061 abortions took place at home, representing 43% of all legal abortions that took place.
A study showed that drugs sent to women more than 10 weeks pregnant represented only 0.04% of the drugs requested.
The fact is that 86% of pregnancy terminations reported in the 2020 data took place before the 10th week of pregnancy, including 50% before seven weeks of gestation. With easier access to drugs, it is likely that this percentage of “early” discontinuations will remain higher than before.
It is also unclear whether women who requested the drug when more than 10 weeks pregnant knew the stage of development of their pregnancy. Women can continue to bleed during pregnancy. This is called “spotting” and it can be interpreted as a period. It therefore takes longer for some women who experience this to realize that they are pregnant.
Whether home use continues or not, a very small number of women will continue to illegally access drugs to terminate the pregnancy of a viable fetus. It is relatively easy to obtain abortion drugs illegally through the Internet. In 2015 and 2016, 645 abortion pills were seized en route to addresses across Britain. It is likely that many more arrived at their destination.
Home use will reduce some women’s desperate need for this illegal trade.
Women who are in desperate circumstances are distinct from the vast majority of abortion cases that occur. And those in the position of having to terminate a late pregnancy are incredibly vulnerable. My research shows that women in this situation experience what is called a “crisis” pregnancy. An unwanted pregnancy is not necessarily a crisis pregnancy, if a woman has access to safe and legal abortion services.
The crisis arises because of the difficult life circumstances these women endure, such as living in violent and abusive relationships or living in poverty with limited social support.
Given the stage of pregnancy, the dire context surrounding them, and the steps women take to terminate them, these crisis cases should be considered distinct from “regular” abortions, which typically occur very early in pregnancy – with only 0.1 percent. 100 occurring at or after 24 weeks, according to 2019 national data. Most of these terminations after 24 weeks will be for wanted pregnancies following a diagnosis of fetal abnormalities.
My research has shown that cases of crisis pregnancy are, in fact, closer to newborn infanticide. It’s when a newborn baby is killed, with the child’s mother being the most likely suspect. In these cases, the woman often acts out of fear, shame and conviction that her pregnancy cannot exist. There needs to be a debate about whether it is right to criminalize these women, given their level of vulnerability. I do not believe that.
Whether home use for early medical abortion is legally permitted or not, women in crisis will find ways to end their pregnancies – they have done so in the past and they will again.
Governments don’t ban alcohol because some people drink and drive. Why should they ban abortion pills for home use because a very small number of women will knowingly be more than 10 weeks pregnant when they ask for the drug?
These vulnerable women need support. And they should not be used to prevent all women from easily accessing safe and compassionate abortion care at home.
Emma Milne is an assistant professor of criminal law and criminal justice at Durham University. This article first appeared on The conversation.