Bioethics Forum Essay

England’s Abortion Law Catches Up

Last month, England announced that it would allow women to take the second pill required for a medical abortion–misoprostol–at home, rather than requiring them to travel to a clinic. The policy brings England in line with Scotland and Wales, as well as many other countries, and it eliminates significant obstacles to legal abortion for many women. The Society for the Protection of Unborn Children, a pro-life group, intends to fight the policy in court.

A medical abortion requires the use of two drugs–mifepristone and misoprostol–usually taken between 24 and 72 hours apart. It has long been regarded as a safe and effective method, and accounts for a greater percentage of abortions in the U.K. (excluding Northern Ireland, where abortion is illegal) every year.

The requirement to take both drugs in a clinic was difficult for many women. Taking time off work, arranging child care, and covering the cost of travel were among the obstacles. Particularly for women living in rural areas where the nearest clinic is hours away, access to a legal medical treatment was nearly impossible.

While the difficulty and inconvenience of attending a clinic twice was itself cause to reconsider the law, of greater concern was the nature of many women’s journeys home after taking misoprostol. Its side effects, which include cramping, dizziness, and heavy bleeding, often started on the way home. There have been harrowing accounts of women bleeding heavily on buses and being forced to check into hotels at the last minute to deal with the effects of the drug. Women living in rural areas, where the journey home can take hours, had no hope of getting home before the side effects began.

Home use of misoprostol for medical abortion has been common practice in many countries for decades. Even in America, a country known for being polarized on the issue of abortion, it has been permitted since 2000. A telemedicine option is being tested in five U.S. states, showing some level of commitment to improving access to legal abortion for women. How, then, has the U.K. taken so long to catch up?

It is simply a matter of politicians appeasing the anti-abortion groups. This effort can be traced back to the UK’s Abortion Act 1967. It was certainly not groundbreaking feminist legislation, as it does not afford women an absolute right to abortion at their own discretion. Instead, it depends on the judgment of their doctors. The deciding factor – “Ground C” in the Act – is usually whether a doctor determines that termination would result in less harm to a woman’s physical and mental health than proceeding with the pregnancy.

This reluctance to spark opposition is the only possible reason that policy-makers took so long to allow home use of misoprostol. Clearly, it is not based on medical concerns, as misoprostol has long been prescribed for home use in the event of a spontaneous miscarriage. Further, once the drug has been administered in a clinic a woman may leave immediately; there is no observation period that would suggest concerns over women’s reactions to the drug. The experiences of countries that had already permitted the practice also gave no rise to concerns. In 2007, the House of Commons Science and Technology Committee concluded in a report that there was no reason for the change not to be made, yet it took a decade for any real movement. Then, in 2017, Scotland announced that home use would be permitted, swiftly followed by Wales. After an unsuccessful legal challenge from SPUC in Scotland, England followed suit.

That it took so much pressure and campaigning for this change to come about, such a simple change that affords women a shred of dignity at what is often a very difficult time, is outrageous. It is likely that England’s new policy will survive legal challenge. We can only hope that, following its recent referendum, Ireland recognizes the importance of home use as a basic element of abortion provision, and that the referendum will be the nudge that Belfast needs to legalize abortion.

Jordan Parsons is an incoming postgraduate research student at the University of Bristol in the U.K. He was a visiting scholar at The Hastings Center in August and September. Twitter: @Jordan_Parsons_.

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