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Call to allow women in England to take abortion pills at home

Women in England should be allowed to take both the pills required for an early medical abortion at home, just like their peers in Scotland and now Wales, argue healthcare leaders, in an editorial published online in BMJ Sexual & Reproductive Health.

Currently in England, women who have an early medical abortion take one drug, mifepristone, in the clinic then need to return to take a second drug, misoprostol, 36-48 hours later.


In Scotland, and soon in Wales, misoprostol can be taken by the woman at home, but in England it must be administered within a licensed hospital or clinic.


Developed in 1973,  misoprostal is commonly used in labour induction and is regarded by the WHO as safe and effective.

Leading clinicians call for change in regulations

The heads of the Royal College of Obstetricians and Gynaecologists, the Faculty of Sexual and Reproductive Healthcare, and the British Society of Abortion Care Providers now call on health and social care secretary, Jeremy Hunt, to follow the example of the Scottish and Welsh governments, and lift restrictions that require the most effective method of medical abortion─a two-step procedure─to be carried out at a licensed clinic or hospital.

Evidence is strong that taking misoprostal at home is safe. It provides greater privacy, and is preferred by women.  There is no clear clinical imperative for it to be administered in a hospital setting.  Home use is the preferred option in most countries where abortion is legal, and there is no evidence that it increases the rate of abortion.

Give women in England same rights as in Scotland and Wales

The clinicians urge the Secretary of State to use his executive powers to extend the same rights to women in England as exist in Scotland and Wales. 

“Specifically, we urge the Secretary of State for Health to use his powers to extend to women in England the same compassion, respect, and dignity that the Scottish and Welsh governments have announced, so that all women can access safe, effective abortion care,” write Professor Lesley Regan, Dr Asha Kasliwal, Dr Jonathan Lord, and colleagues in their editorial.

Women should not be 'punished' for having a legal abortion

“There can be no justification not to act unless the aim is to punish women having a legal abortion,” they insist. “The time for action is now.”

An estimated one in three women will have an abortion by the time they reach the age of 45. Most of these will be early in the pregnancy when a medical abortion is most effective, the authors point out.

Safest and most effective method

The safest and most effective method for this is to take two drugs (mifepristone and misoprostol) 24 to 48 hours apart.

But medical abortion didn’t exist when the 1967 Abortion Act entered the statute books, and the law has consequently been interpreted as requiring both drugs to be taken at a licensed premises. This risks the distress of having the abortion while travelling back from the clinic, a trauma that would be entirely preventable if women were allowed to take the drugs at home, say the authors.

“This obligation to return to the abortion service…for a second visit impacts many women who struggle with repeated time off work, childcare, transport difficulties or distance from the abortion service,” they explain.

“Furthermore, it selectively disadvantages the most vulnerable─those who are deprived, live in rural areas or have dependants,” they add, citing data on 28,000 women from one of the UK’s largest abortion providers.

These showed that most women (85%) opted to take both drugs at the same time rather than make a return visit to the abortion service, despite knowing that this method was less effective and associated with a higher complication rate.

For every 38 women taking both drugs at once, one additional woman required surgery, compared with those opting for the two-step method, the data showed.

“With only 15% choosing or able to return for a second visit, the implication is that many women required additional, preventable surgery and anaesthesia as a direct consequence of the government’s current interpretation of the Abortion Act,” contend the authors.

Fewer clinic visits would not only be better for women’s dignity, privacy, and wellbeing, but this would also be a better use of resources for the NHS, they argue.

WHO guidelines

The World Health Organization and many other international guidelines recommend home use of both drugs for medical abortion, and no change in the law would be required, highlight the authors.

The government would need only to use its executive powers to approve the use of women’s homes as premises where early medical abortion could be carried out, as both the Scottish and Welsh governments have done.

“Contrary to fears which are sometimes expressed by those opposing abortion, rates do not increase in countries where effective medical regimens are approved,” write the authors.

“Rather, it is the proportion who opt for medical abortion over surgery that increases, with women in rural areas benefiting from improved access to abortion care.”

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