Medication abortion at home: why people should have the option

Studies have shown that individuals can have a strong preference for the method of their abortion. While some people may prefer the clinic setting and opt for surgical abortion, others may feel more comfortable experiencing a medical abortion in the comfort of their own home. The medical abortion procedure consists of two pills: mifepristone, which stops the pregnancy by blocking the hormone progesterone; and misoprostol, which causes the uterus to contract and expel the pregnancy tissue. Currently country protocols differ on whether these pills are given the same time, and/or the number of clinic visits required for a medical abortion.

Debate over the proper protocol for medical abortion has gained traction in Great Britain. Back in October, Scotland became the first part of Great Britain to change their clinical procedures for medical abortion. Previously, individuals were required to have two clinic visits – one to take mifepristone, and the other to take misoprostol. However given that misoprostol can cause contractions soon after it is taken, it increased the risk that individuals experienced symptoms on their way home. This protocol consequently caused individuals to potentially experience physical distress, discomfort and associated difficulties of these symptoms in an inopportune environment. Considering that individuals are not required to stay at the clinic for the duration of the medical abortion, and that medical abortion is a safe procedure, it was argued that this was an unnecessary risk for abortion patients. As a result, the protocol was changed in October to allow patients to take misoprostol at home, after receiving mifepristone at the clinic.

With this development in Scotland, advocates in England are pushing for a similar change. Building on the We Trust Women campaign, which works towards decriminalizing abortion across the United Kingdom, the Women’s Equality Party has published an open letter to the Health & Social Care Secretary. This letter recounts the experience of Claudia, who began to miscarry in a taxi on her way home from the clinic. Since medical abortion is safe and effective, advocates argue that current laws only cause unnecessary distress and discomfort for individuals at a time when they need the best medical support.

While it remains to be seen what will happen in England, these examples are a reminder of the need for laws and policies that adapt to changing medical technologies and protocols. The law in England was written in the 1960s, and since then the provision of medical abortion, and the known safety of the procedure has changed immensely. With evolving knowledge on the safety of medical abortion at home, as well as the preferences of individuals for medical abortion, countries must continue to update their laws and policies to ensure individuals have access to the safest and most appropriate abortion care.