UNITED KINGDOM – Government threatens to withdraw support for telemedical abortion care as an essential health service: letter to the Prime Minister 

Prime Minister’s Office, 10 Downing Street London, SW1A 2AA

Dear Prime Minister,
We write to you with deep and urgent concern about the delay in announcing the permanent approval of telemedical abortion care. The current approval is used by 2000 women a week who require an early medical abortion, and the ongoing uncertainty presents a clear and present danger to their access to, and confidence in, their abortion care. Moreover, the delay is increasingly leading to a perception of the UK Government as willing to ignore the medical evidence on a key issue affecting women’s health, undermining their right to make decisions about their health and future. In March 2020, the then-Secretary of State for Health and Social Care gave permission for the first medication in an Early Medical Abortion (mifepristone) to be taken at home. Abortion providers rapidly reconfigured services to provide the option of telemedical care and made sure women and other people needing an abortion were able to continue to access abortion care throughout the pandemic. As you know, the NHS continues to be tested to its limits and clinicians have adapted swiftly to ensure that patients continue to be provided with the highest quality care. The pandemic has been a tremendously difficult experience for the country, but we should be proud of the way health services responded to the situation, in particular, the rapid innovation of vital health services such as telemedical abortion. It is estimated that between April 2020 and February 2022, more than 125,000 women have made the choice to access fully telemedical rather than face-to-face abortion services. Multiple studies have shown that this service is safe effective, accessible, and is often preferred by women – including the largest study of telemedical abortion care in the world. Offering of telemedical services as a permanent option is supported by clinicians, women’s rights groups, and regulators including NICE, the Royal College of Obstetricians and Gynaecologists, the Royal College of Midwives and the Academy of Medical Royal Colleges. The services that have been developed here in the UK are world-leading. We have set a global example with our leadership in and commitment to women’s healthcare and choice. Recently, the United States Food and Drug Administration, based on research conducted in England and Scotland, made telemedical abortion care permanently legal. The only places in the USA which now outlaw the use of mifepristone outside a designated clinic, as a removal of the current English approval would do, are virulently anti-abortion States including those seeking to ban abortion from six weeks’ gestation like Texas. Meanwhile, telemedicine has created a more equitable service which has enabled thousands of people to access the care they need more quickly, and just as safely, while also being a more efficient use of NHS resources. Even before the pandemic, attending a clinic in person was prohibitively difficult for many women for a variety of reasons, including those living with an abusive or coercive partner, those with a disability or those who couldn’t afford childcare or time off work. Removing telemedicine would result in the UK Government re-criminalising hundreds of vulnerable women each year under the Offences Against the Person Act 1861, who will be forced to turn to unregulated abortion pill providers. The most recent British Social Attitudes study on abortion found that more than 90% of the public believe a woman should be able to end a pregnancy in certain circumstances, and 70% support the right to have an abortion if a woman does not want a child (a more liberal position than the current law). These figures do not vary by party affiliation or vote. Private YouGov polling of MPs in early 2020 found that 78% of MPs describe themselves as ‘pro-choice’, including 70% of Conservative MPs and 94% of the 2019 intake. And 2021 Savanta Com-Res polling from the Faculty of Sexual and Reproductive Healthcare found that only 15% of women do not support the permanent approval of telemedical abortion care. We trust that your Government will continue this safe, effective service, and to offer women choice about their healthcare, in line with best clinical practice. To remove this service, despite the scientific and medical support it carries, would indicate a deep mistrust of women and an institutional disregard for their reproductive rights. At a time when women’s reproductive rights and choices are being rolled back elsewhere in the world, we call for leadership in asking the Secretary of State for Health and Social Care to make this essential service permanent by the end of March.

Signatures: 33 organisations, see https://www.rcog.org.uk/globalassets/documents/news/position-statements/rcog-joint-letter-on-telemedicine.pdf

According to an Upday news report published 1 March 2022, the decision was based on the numbers of people who responded to a government consultation on the subject earlier this year, but not taking account of who they were or what they said – let alone on the basis of the substantial evidence that the services and women’s experiences of them have been overwhelmingly positive. Some 70% of respondents to the consultation said they were in favour of ending the scheme. However, of the more than 18,000 total responses, 8,811 were members of anti-abortion groups, of whom 8,424 were from just one anti-abortion group, Right to Life (sic). That is, the members of that group all wrote individually, a bad habit they have developed and practised for many years now. One would expect the government to recognise this for what it is, and discount it as the main source of a policy decision in a country where support for abortion rights is very high. It is a sign of incompetence on the part of the UK’s Secretary of State for Health and his deputy the Public Health Minister.

In fact, data from the main abortion clinics and a study by the Royal College of Obstetricians and Gynaecologists have all found that allowing women to have abortions at home has provided a “safe, effective, and more accessible service.” The RCOG study analysed the outcomes of more than 50,000 early medical abortions in England, Scotland and Wales between January and June 2020, both before the telemedicine service was introduced and after. It found that 98.8% of women were able to end their pregnancies with pills at home, without any further intervention, and less than 0.05% experienced a serious complication. There were no cases of significant infection requiring hospital admission or major surgery. And, contrary to misleading claims, no one died from having an early medical abortion at home. If these aren’t a reason to maintain the service, nothing is!

PLEASE NOTE the national campaign in the UK to convince the government to reverse this decision, will continue up to the deadline in September 2022.