ABORTION CARE DURING THE COVID-19 PANDEMIC
The current COVID-19 pandemic has made it plain: current UK abortion law is inflexible, impractical, and not fit for purpose. While other areas of healthcare have been able to adapt - via telemedicine and relaxation of some legal requirements - abortion providers have been hamstrung by regressive laws. The 1967 Abortion Act sets out the conditions under which a legal abortion can be performed in the UK – any abortion not fulfilling the conditions of the Act is illegal, carrying the risk of criminal sanctions for all involved. The Act controls where care can be delivered, how it’s delivered, and by whom, effectively preventing any kind of telemedicine or remote practice. Doctors for Choice UK are joining other medical and reproductive health organisations to urge the government to change UK legislation and regulation immediately, to ensure abortion care remains accessible throughout this pandemic.
We propose amending current legislation and regulation to:
Allow for abortion provision via telemedicine
Remove the gestational limit for home-use, allowing for clinical judgement
Allow a single registered medical practitioner, nurse, or midwife to certify an abortion
The 1967 Act restricts where an abortion can be carried out. The most common form of abortion in the UK is an early medical abortion, requiring a consultation and two medications taken between 24 and 48 hours apart. The second medication – misoprostol – can be taken at home, but the first – mifepristone – must be taken at a clinic. There’s no clinical reason for this: data from numerous studies shows that medical abortion is an extremely safe and effective procedure. We’re urging the government to permit home use of both mifepristone and misoprostol. We’re also asking for the law to be amended so clinicians can carry out consultations and prescribe abortion medication from their homes – via video link or telephone. The development of a telemedicine abortion service would mean self-isolating doctors could continue to work and ensure continued access to abortion, while also preventing unnecessary clinic visits and limiting the spread of COVID-19.
The gestational limit for home use of misoprostol is 9 weeks and 6 days, but this restriction is not based on clinical best practice. Medical bodies agree that if clinical judgement is exercised, a medical abortion at home is safe and effective up to 12 weeks. Bringing the law into line with the RCOG clinical best practice position, would enable more women to access care without unnecessary appointments – particularly relevant when women may have to delay attending services due to COVID-19.
Two doctors need to certify that an abortion fulfils the criteria laid out in the 1967 Act. No other medical procedure requires the permission of two doctors, nor the threat of criminal sanctions if this requirement isn’t met. Many abortion services will struggle to fulfil this requirement as more and more doctors have to self-isolate, and services are forced to close. In the face of COVID-19, it’s imperative that a single clinician is able to authorise the procedure, and that the definition of ‘clinician’ be expanded to include nurses and midwives. This would allow essential, time-critical abortion services to continue operating during this most challenging time.