Photo by Olivier Douliery
Artillery Row

Time to close Pandora’s box

Authorising DIY abortion pills has devastated the safety of the most vulnerable women

After a series of rumours in both directions, the future of the government’s emergency DIY abortion scheme looks uncertain, with the government claiming it was “always intended to be a temporary measure”, but that they are still reviewing the evidence.

A quarter of abortions are coerced by men

This scheme, introduced out of desperation during COVID, allowed abortion vendors to place women’s safety at risk by sending abortion pills out in the mail to them (or potentially to their abusers). This required no face-to-face consultation, a critical safeguard against coerced abortion, life-threatening ruptured ectopic pregnancies and a litany of other possible risks. It was a devastating decision for the safety of the most vulnerable women.

Abortion providers used to reassure women at risk of coerced abortion — often domestic abuse or sex trafficking victims — that they would be seen in person to ensure they were not being forced into it. Some of them still do. But telemedicine cannot possibly provide the privacy necessary to ensure this, since someone else could easily be in the room dictating the woman’s answers. Since a quarter of abortions are coerced by men, the removal of this safeguard was brilliant news for abusers, traffickers and abortion providers. It was not so good news for vulnerable women.

In person examination and ultrasound were likewise critical safeguards against the risk of ruptured ectopic pregnancies. Ruptured ectopic pregnancies have life-threatening consequences, but because they produce symptoms similar to those of medical abortion, women having medical abortions are at risk of leaving a ruptured ectopic pregnancy undiagnosed. Most hospitals do not collect data on ruptured ectopic pregnancies, but recent Freedom of Information data from those Trusts which do are consistent with an increase in ruptured ectopic pregnancies since the telemedicine scheme began in March 2020.

DIY puts mothers at risk of late-term abortions with no medical supervision

Other alarming cases are well known from a leaked NHS email last year. This included more ruptured ectopic pregnancies and resuscitation for major haemorrhage. The lack of examination and ultrasound prior to abortion meant that babies could be aborted at any gestation at home, putting the mother at risk of dangerous late-term abortions with no medical supervision, and allowing the possibility of fully developed babies being born alive after attempted abortion. The e-mail noted cases of infants being born at up to 30 weeks’ gestation, and a murder investigation for a baby who was born alive and subsequently died. All of these were in one region alone.

This is not even to mention the lower rates of effective contraception and STI screening seen under the DIY scheme, because women were not given in-person contact with healthcare professionals.

Advocates of the scheme insist that complication rates are low in the DIY abortion scheme. But recent CQC reports from three BPAS facilities show that incidents were frequently unreported, and Freedom of Information data prove conclusively that complications from telemedicine abortion have been massively underreported. So the claims of these lobbyists cannot be trusted.

Claims that the scheme has led to earlier (and therefore safer) abortions are likewise not credible. The study allegedly showing this measured only when the pills were sent, but didn’t take into account the time it took for delivery, the fact that half of women did not take them the day they received them, and the fact that gestation estimates were unreliable in the first place because ultrasound was not performed.

Emergency ambulance call-outs have spiked since DIY abortion

It is better to stick to what we do know. This includes the fact that emergency ambulance call-outs have dramatically spiked since the DIY scheme was introduced, that women having medical abortions without an ultrasound are at risk of life-threatening ruptured ectopic pregnancies, and that the large number of women forced into having abortions by men, or others around them, are best protected by being seen confidentially. What may have seemed convenient to abortion providers is the devastating loss of a lifeline for victims of abuse and trafficking who desperately need to speak to someone in private. Abortion clinics are one of the most frequently visited public sites for victims of sex trafficking. Sending these women — or their pimps — abortion pills in the mail only keeps this horrific practice in the shadows, away from detection. And it potentially subjects them to forced abortion, an appalling human rights abuse that often leaves life-long trauma.

In desperate times at the very beginning of the pandemic, the government opened this Pandora’s box hesitantly in a series of dramatic U-turns. They were right to be hesitant. It was every bit as horrifying as some of the UK’s leading doctors warned. But while abortion advocates have been desperately trying to prop the box open, the evidence has only piled up more and more against it. Whatever the necessities of the early pandemic, the government must prioritise women’s safety above the interests of abortion providers by shutting the lid on it once and for all.

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