Public opinion on abortion and access to abortion care remains divided across the world. Many people still query why women in the UK are not permitted to administer abortion medication themselves at home and are instead required to start the process under medical supervision, before completing the second stage themselves. This remains standard practice despite an independent report by the National Academies of Sciences, Engineering and Medicine confirming that “there is no evidence that the dispensing or taking of [medication abortion pills] requires the physical presence of a clinician.”  

The World Health Organization categorizes reproductive health as a “high priority” essential service and urges countries to maintain access to reproductive health services throughout the COVID-19 pandemic. Therefore, the provision of sexual and reproductive health services is considered essential under both international and regional human rights law and global medical standards, and states must include sexual and reproductive healthcare as a vital component of basic health services. 

On 30 March 2020, The UK’s Department of Health and Social Care granted temporary approval for home use for both stages of early medical abortion in response to the COVID-19 pandemic. A brand-new telemedicine service was launched on 6 April in the UK to deliver early medical abortion care, ensuring that all compulsory requirements of the Abortion Act 1967 were still fully met. The new measures are fully in line with the UK NICE Guidance on Abortion Care, which recommends telemedicine as a safe and effective way to manage early medical abortions, and to ensure timely and equal access to abortion care, while also easing the burden on abortion providers. 

This meant that, following a screening process to check for eligibility, and a full nurse-led telephone consultation with safeguarding checks, eligible women under 9 weeks and 6 days’ gestation would be able to take both sets of abortion pills in the privacy of their own home, without attending a clinic.  Women then receive the abortion pills through the post as a part of a Medical Abortion Pack. Or, they were able to collect them from their preferred clinic, which is the usual practice in the US and Australia.

Women whose pregnancies were past 9 weeks and 6 days still must go to a clinic to take the tablets in England and Wales. However, in Scotland they could remain safely at home until 12 weeks. Those who wished to attend a clinic for a surgical abortion were still be able to, as the Government’s measures outlined that such procedures could continue – as long as they were carried out safely, with COVID-19 precautions in place.

Marie Stopes, a leading independent provider of sexual and reproductive health services in the UK, spoke positively of the new telemedicine service; 

“The move will prevent thousands of women each month from having to make medically unnecessary journeys while travel restrictions are in place during the COVID-19 pandemic, supporting social distancing measures and reducing the risk of spreading COVID-19 amongst women, clinic team members including doctors, nurses and midwives and the wider public.”

In July, the UK government announced that there would be a public consultation on whether the new regulations enabling telemedicine for abortion care should be retained once COVID-19 arrangements expire. Data from BPAS, the leading abortion provider in the UK, shows that waiting times for appointments have more than halved, and that the average gestation at which women have their consultation has also fallen by over a week. The charity’s figures show that 50% of abortions were performed before 7 weeks gestation from January to June 2020, compared to almost 40% for the same period in 2019.  

But not everybody has welcomed these changes. The Court of Appeal heard arguments in July from Christian Concern, a Christian organisation with their own Christian Legal Centre. The purpose of this team is to “seek justice and protect the vulnerable. The Christian Legal Centre is particularly well known for helping Christians who suffer in the workplace because of their Christian faith but we also work to protect families, unborn children, disabled and elderly people, and those who want to leave Islam, for example.” The organisation submitted that the Government’s decision to allow women to have medical abortions at home during UK lockdown went against the purpose of the Abortion Act. 

On 25 September 2020 the Judges denied their appeal, and ruled that the Government’s abortion measures in light of COVID-19 were indeed lawful. The appeal hearing went further to reveal evidence of an undercover investigation, which had been conducted by Christian Concern prior to their appeal, and also contained leaked internal documentation from the NHS, both of which have been publicly posted on the group’s personal site for public viewing. BPAS declared this evidence gathering to be nothing more than “bungled, wasteful and dishonest “mystery shopping” where they tried and failed to manufacture evidence to underpin their case.” 

Nevertheless, Christian Concern have not been deterred by this ruling. They made their next steps clear as soon as the judgment was served. Andrea Williams, chief executive of Christian Concern, declared that they have plans to “fight for justice at the Supreme Court.” They maintain their viewpoint that “abortion pills through the post is a system that needs to be stopped immediately and a thorough investigation needs to occur around the legality and practices of the two major abortion providers in the UK.” 

Meanwhile, Diane Munday from BPAS also spoke publicly following the judgment, directly condemning the actions of Christian Concern.

“In 1967, the Abortion Act statute was deliberately drafted to allow future changes in the places in which legal abortions could be carried out to be made by the Minister or Secretary of State for health without being put before Parliament. Those who brought this case were clearly carelessly or deliberately wasting public money and the time of The Supreme Court on bringing a case that had no chance of success.”

The US have also made use of telemedicine to provide abortion care in light of COVID-19. This has expanded the availability of safe quality abortion care in numerous states. However, this change has also received pushback and some states have continued to restrict access to medical abortion in light of COVID-19, for reasons unrelated to medical necessity. Moreover, eighteen states prohibit the use of telemedicine for abortion entirely which means these patients still have to visit the prescribing provider in person. The Centre for Reproductive Rights, have presented strategies to continue to improve the access to abortion care, one of which is the suggestion that licensing requirements are waived for out of state providers, so all patients can access the telemedicine abortion care.

On a global scale, the Guttmacher­-Lancet Commission, an international collaboration focussed on sexual and reproductive health and rights issues, recommends the formation of a comprehensive package to be implemented in national health systems across the world. Susan Jaffe, an academic for The Lancet, discusses the vital role of health-care professionals and indicates that their involvement must be as “doctors not lawyers”. She continues to say that “health-care professionals must participate, and not emote, in the abortion debate. It involves listening and engaging with the women of today and not telling them they must have the same desires and values of women in the 1960s and 1970s.”

To conclude, it is clear that upholding commitments to sexual and reproductive health and rights would result in better outcomes for all, and whilst this may involve some flexibility as society changes, it will be necessary to achieve the targets for equality and access to safe abortion care set forth in programs across the world. It is clear that these future changes will not be easily granted. Nevertheless, the pro-choice community remain hopeful that these “temporary” measures for abortion care will soon become permanent in the UK and that the rest of the world will follow in the same direction, allowing women to safely access home abortion care long after the COVID-19 measures are lifted.

Olivia is part of the Human Rights Pulse team. She publishes online content and manages subscriber communications as part of the Social Media and Marketing Team. Olivia is studying the BPTC LLM and hopes to be called to the Bar of England and Wales in the near future.

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