Women support home use of abortion pills and telemedicine model of care

According to a new study published in BMJ Sexual and Reproductive Health.

The governments of Wales and England have made these permissions permanent, with the Scottish government yet to announce its decision.

This new research is part of the SACHA study, the largest abortion research project to date in the UK, funded by the NIHR and led by researchers from the London School of Hygiene & Tropical Medicine. (LSHTM) in collaboration with a consortium of researchers from various institutions, including the BPAS Center for Reproductive Research and Communication. The goal of the project is to gather information that will have a direct impact on clinical policy and practice and help shape abortion care for the future.

Researchers interviewed 30 women who accessed abortions in Scotland, Wales and England between July and December 2021 while COVID-specific abortion permits were in place allowing the use of both pills for medical abortion at home. This marked the introduction of a fully telemedical model of abortion care with consultations taking place over the phone or video call and medication delivered to women’s homes.

In interviews, researchers specifically asked whether women thought home abortion permits should be made permanent based on their own experiences. Participants overwhelmingly supported the continuation of telemedicine abortion and felt lucky to have had access to home abortion. The women responded, “Without a doubt, that’s the way to go” and “I really don’t think that should change.”

The women interviewed favored telemedical abortion because it is convenient and allows them to plan their treatment around work and childcare. One participant commented: “It meant I didn’t have to take days off. I had nothing to say at work, and that was fine with me…it worked really well, and I was able to l ‘adapt to my life.’ Participants who had previously had an abortion felt that telemedicine was more efficient and saved them time and travel costs compared to their previous experience. Many women have recognized the particular advantage of home abortion for those who are less advantaged.

Kaye Wellings, Professor of Sexual and Reproductive Health at LSHTM, principal investigator of the SACHA study and lead author of the study, said: “This study shows that women are supportive of the home management option of medical abortion, adding to growing evidence from other studies on its safety and effectiveness.

“It also aligns with current changes in healthcare more broadly, towards greater patient autonomy and increased use of digital assistance. This has been further proven by the positive response from MPs to indefinitely extend the ‘pills in the mail’ approach, which is a fantastic outcome for safe and appropriate access to abortion services for women in England and Wales.

Home use of abortion drugs was preferred by participants because it offered the comfort and privacy of being in their own space. Women also reported that home management reduced stigma, with one participant expressing, “There’s this fear of being judged, of being ashamed. Not having to see someone face to face, it was really awesome actually.”

The women felt that the pills in the mail led to greater autonomy and control over their bodies and their decisions. Another important theme that emerged from the interviews was the importance of choice of model of care. Overall, participants felt that pills in the mail should continue, but that women should also have the option of accessing clinic-based care. A woman said

“I personally think having options is great. So if someone wants to do it at home, they should be allowed to do it. If they want to do it at the clinic, they should also be allowed to because everyone, everyone is I think giving people a choice is probably the […] ideal location.”

Highlighting the voices of women who have had abortions during the pandemic, these findings make it clear that this model of care is acceptable, often preferred by women, and should be made permanent by all UK governments.

The evidence supporting the use of both home abortion pills and for telemedicine predates the approvals granted in Britain in March 2020. This study amplifies the voices of women who have had abortions during the pandemic and who overwhelmingly endorse this model of care. We are delighted to be able to continue this service for women in England and Wales.”

Dr Patricia Lohr, Study First Author and Medical Director of BPAS, Director of the Center for Reproductive Research & Communication, London School of Hygiene & Tropical Medicine


London School of Hygiene and Tropical Medicine (LSHTM)

Journal reference:

Lohr, Pennsylvania, et al. (2022) Should COVID-specific Abortion Provisions Continue? The perspective of women who have had abortions in Britain during the pandemic. BMJ Sexual and Reproductive Health. doi.org/10.1136/bmjsrh-2022-201502

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