‘As a millennial woman navigating a ‘pro-choice’ UK culture, the relaxation of our standards of care leaves more than a bitter taste in my mouth,’ writes Lois McLatchie
By now, you may have seen: the practice of ‘telemedicine abortions’ has been authorised in the UK for the duration of the COVID 19 lockdown period. This announcement from the Department of Health & Social Care dissolves any notion that legal abortion ‘protects women from causing harm to themselves at home,’ with the procedure being moved out of the clinic and to the bathroom as of Monday 30th March.
The new regulations stipulate no need for a medical professional to see the woman in need – instead, ‘consultations’ can take place by video, telephone or ‘other electronic means’ – resulting in serious ethical and physiological concerns. A number of concerned civil society groups have said they will mount a legal challenge.
The move rings bells reminiscent of headlines printed almost two years ago, when Ireland was in the heated throes of debate. Campaigners gathered outside Leinster house, holding abortion pill packets aloft and calling for an end to a policy that they said meant in practice that young women are taking abortion pills ‘alone, unsupervised, scared and stigmatised’.
The claim was not a new one for UK observers. When Westminster debated legalisation in the 60s, the winning refrain was that abortion should be safe, legal and rare.
“If women don’t have access to clinics, they’ll become victims of their own DIY attempts!”
But, fifty years on, the government seems to have changed its mind. Indeed – it changed its mind again, and again, making multiple U-turns on its conclusions in the space of several days, before arriving at this decision that has serious ramifications for women’s health.
Taking pregnancy-terminating drugs – mifepristone and misoprostol – may cause severe adverse effects for the health of the woman. This is far different from typical at-home care such as taking paracetamol. One only need extrapolate from existing data to foresee that such effects would be far more severe if these drugs were to be administered at home without sufficient safeguards, as the new regulations allow.
In trials, almost all women ingesting misoprostol experienced abdominal pain, and many suffered nausea, vomiting, heavy bleeding, and diarrhea. Government figures for England and Wales show complications involving hemorrhage, uterine perforation and/or sepsis are more than twice as likely after medical abortions than after surgical ones. Adverse symptoms can occur even when there is no leftover “fetal tissue” remaining in the womb. A mismatch between dating and dosage can leave an abortion procedure “incomplete” – a consequence that requires a physical examination and surgical intervention in most cases.
We’re often called to “trust women” in regard to their own healthcare. However, asking patients to assess the dating of their own pregnancy without the confirmation of a scan is an act of reckless endangerment rather than trust. Beside the fact that studies show that only around half of women are able to accurately recall their last menstrual period, even this knowledge would not equip them with sufficient information to pinpoint exactly when ovulation, and thus conception, took place. This is not a matter of trust, but of information that only an ultrasound can confirm with precision.
Should a legal challenge to the validity of the regulations move forward, the Court should pay careful attention to the question of increased abortion access for adolescents. The regulations, as they were passed, apply not only to adults, but also to young adolescent girls. Parental oversight is not legally required. Young girls, then, could be experiencing at-home abortions entirely alone. A surge in hidden procedures in response to rape, trafficking, and other violent abuses could well follow.
In many cases, medical professionals are the first to notice the signs of abuse, and the only hope for many trauma survivors. Increased attention is being given worldwide to equipping doctors and nurses to recognise these signs and follow-up with appropriate intervention to extricate the victims from their abusers. This is all rendered moot when perpetrators of violence no longer need to bring the victims to the doctors in order to procure abortion services.
With the current regulations, at-home abortions will be carried out with no way to be sure that the dating of the pregnancy is correct; no way to ensure the correct dosage is administered; no way to check that the woman is in a safe environment with the appropriate emotional support; no way to determine her age and ability to consent; and perhaps, most sinisterly, no way to check that her abortion is not the result of manipulation from an abusive partner.
As a millennial woman navigating a ‘pro-choice’ culture in the UK, the relaxation of our standards of care leaves more than a bitter taste in my mouth. The relaxation of standards of care raises serious questions as to whether today’s abortion movement can truly claim to champion “women’s health” as its central premise. Leaving aside important debates about the value of unborn life at six, twelve, twenty-four or even forty weeks – if the notion of leaving a woman alone to self-administer life-ending drugs with no more than guidance from a screen is her best option, it is clear that “female empowerment” in 2020 is far from realised.
Lois McLatchie, Legal Analyst (UN) for ADF International.