Allow DIY abortions after three months, doctors urge as at-home pills shown to be safe

Doctors are calling a change in law to allow at-home abortions after three months of pregnancy, following new evidence proving its safety.

Research published in the medical journal The Lancet found women who had abortions at home after 12 weeks spent less time in hospital and needed fewer overnight stays compared to women who had them in clinics.

The World Health Organization currently recommends women only have self-managed medical abortions before 12 weeks of gestation. 

In England and Wales, medical abortions, where women take two pills at home, are allowed until 10 weeks under the ‘pills by post’ scheme. 

Abortion providers called for ‘urgent’ change, adding that it was ‘concerning’ that the research, carried out in Sweden, could not have been conducted in the UK because of the current law, the Times reported. 

Mifepristone is one of two drugs that form part of the ‘pills by post’ service allowing women to terminate early pregnancies at home 

In the study, 435 women who were between 12 and 22 weeks pregnant (five months) were given mifepristone in a clinic, which is the first drug used for an abortion.

Half the women took the second pill, misoprostol, at home. They then went to the clinic two hours later so doctors could check the abortion was complete.

The other half attended a clinic to receive both drugs and stayed throughout.

Researchers found that 71 per cent of the patients who took the second pill at home spent less than nine hours in hospital and did not need an overnight say. 

However, 46 per cent of those who took the second pill in hospital spent more than nine hours in the clinic.

Babies born before 37 weeks are considered pre-term. Their odds of survival vary greatly depending just how early they are born but medical advances mean those born at 34 weeks and above have the same equivalent chance at life as a baby born at full term 

Access to abortion varies around the world with some countries allowing full access though  gestational limits still apply. Others only allow abortions on medical grounds or forbid it entirely. The UK is considered a European outlier, only allowing abortions on both health as and economic grounds whereas most of its neighbours are more flexible. Abortion access in the US has undergone a radical shift recently and now varies greatly on a state-by-state level

The study revealed there was no difference between the two groups in the average pain score, the number of side effects, or rates of hospital admittance earlier than planned. 

Most women also preferred to take the pill at home, the study found.

‘Currently, most abortions after 12 weeks of pregnancy take place in hospitals and may require an overnight stay, which some women find stressful and isolating,’ Dr Johanna Rydelius, an author of the study from the University of Gothenburg said. 

She added that offering the choice to take the drug at home ‘provides a safe and effective alternative’.  

Women can legally request an abortion in the UK until 24 weeks pregnant, but it is up to medics if it is granted.

Under the 1967 Abortion Act terminations are granted on grounds of physical or mental health as well as financial reasons, such as being unable to afford to care for a child.

There is no access to abortion on demand in the UK. A woman cannot terminate a pregnancy without cause, she must have reason.

Abortions can still be carried out after the 24-week limit but only under very strict circumstances.

These include the mother’s life being at risk from the pregnancy or if the child would be born with a severe disability.

Before 10 weeks abortions can be carried out at home out using only medication. After this period the procedure needs to be conducted in a specialised clinic.

The ‘pills by post’ scheme, which started in 2020, is an at-home abortion procedure for pregnancies under 10 weeks. It consists of two drugs, mifepristone and misoprostol, taken at least 24 hours apart.

Women take mifepristone first. The pill blocks progesterone, a hormone needed to maintain the pregnancy, from working.

The second, misoprostol, contains a hormone called prostaglandin that causes the uterus to contract, triggering the abortion.

However, under pre-pandemic rules, women took the first pill at an abortion clinic or hospital under supervision from a clinician. They were then able to take the second at home up to 48 hours later.

Dr Patricia Lohr, director of research and innovation at the British Pregnancy Advisory Service told The Times: ‘Women prefer to have more choice and control over their abortion. 

‘But for us, the more concerning fact is that the study could never have happened in the UK.’

‘The law must change and it must change urgently,’ she added.