England is set to end temporary pandemic arrangements permitting women to take both pills for early medical abortion at home, but Wales is to make the change permanent

A temporary measure allowing women and girls to complete early medical abortion at home during the pandemic will end this summer in England, but remain in place in Wales.

The arrangement permitted women to take both pills for the procedure up until 9 weeks and 6 days of gestation in their own homes if they chose to do so. Although they needed to have a telephone or e-consultation with a clinician, the change meant that the first pill could be taken at home without visiting a clinic.

The measure came into force alongside COVID-19 lockdown restrictions in early 2020, and was due to expire in March 2022.

On 24 February, England announced a return to pre-pandemic arrangements, although the move will be delayed by 5 months until 29 August.

Wales takes ‘progressive step’

However, the Welsh Government has said that it will be taking the ‘progressive step’ of making the temporary arrangements a permanent fixture.

Eluned Morgan, Wales’ Minister for Health and Social Services, said: ‘I am satisfied that the arrangements are safe and bring significant benefits to women and girls who wish to access abortion services, with reduced waiting times enabling them to access the help they need more quickly than would have been possible under the previous arrangements.’

The announcement ‘demonstrates the Welsh Government’s commitment to supporting women’, she said. 

The decision met with approval from the British Pregnancy Advisory Service (BPAS), which said that the authorities in Wales had listened to medical professionals and others who were convinced the ‘at-home’ arrangements were safe and effective.

Clare Murphy, BPAS Chief Executive, said that the announcement ‘should be a source of shame to the Government in Westminster, who continue to play politics with women’s health.’

NHS pressures

Also on 24 February, Maggie Throup, England’s Minister for Vaccines and Public Health, announced in a parliamentary written statement: ‘After careful consideration, the Government’s view is that the provision of early medical abortion should return to pre-COVID arrangements.’

However, explaining the decision to delay, she added: ‘Thanks to the success and impact of the national vaccination and booster programme, we are in a very different position compared to the beginning of the pandemic.

‘However, health services and the workforce have been under increased pressure in recent months. A short-term extension of the temporary approval will be made to enable a safe and reliable return to pre-pandemic arrangements and continued access to services.’

‘Disastrous for women’

Although the Government promised to keep the issue under review, BPAS said its decision was ‘devoid of both evidence or justice.’

Ending telemedical abortion care will increase the risk of women resorting to illegal methods of abortion that could see the most vulnerable facing criminal penalties, it said.

Ms Murphy commented: ‘Over the next 6 months, we will continue, along with medical experts including the Royal College of Obstetricians and Gynaecologists, the Royal College of General Practitioners, the BMA, and the Royal College of Midwives, to reiterate to the Government that removing access to at-home early medical abortion care would be disastrous for women, and that to do so would be to wilfully ignore the vast body of clinical evidence that demonstrates that this is a safe, effective, and world-leading service.’

Since the beginning of the pandemic, over 100,000 women in England and Wales have had an early medical abortion at home. The Royal College of Obstetricians and Gynaecologists (RCOG) said that data show that complications related to abortion had decreased since the pre-pandemic rules were suspended.

It pointed to a study, published in February 2021 in BJOG: An International Journal of Obstetrics and Gynaecology, which suggested that allowing women to use the two pills required for an early medical abortion at home ‘is safe, effective, and improves access to care.’

Dr Edward Morris, RCOG President, warned last month: ‘Withdrawing the service will lead to increased costs, wasting NHS resources, and ultimately increased waiting times for women, which will lead to later abortions and the known risks associated with this.

‘The decision to force women to go into clinics to have a face-to-face consultation, when the NHS is already struggling to cope with patient demand, will only exacerbate this further.’

Anti-abortionists expressed disappointment over the delay in ending the temporary arrangement in England. Pressure group Right To Life UK said that it was concerned that some abortions could have been taking place later than the 9-week-and-6-days legal limit because in-person medical supervision had been suspended.

It also expressed alarm that some women and girls could be coerced into having an abortion against their will under the current arrangement.

This article originally appeared on Medscape, part of the Medscape Professional Network.

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