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Home abortions are dangerous for women: here's ten reasons why

Posted by Alithea Williams on 11 July 2018

Women are being told that medical abortion is a safe and easy solution to unplanned pregnancy.

Following the recent decision in Wales to license the second stage of medical abortion for home use, there have been increased calls for England to follow suit.

In a piece in the British Medical Journal published on Tuesday, the heads of the Royal College of Obstetricians and Gynaecologists, the Faculty of Sexual and Reproductive Health, and the British Society of Abortion Care Providers called on Jeremy Hunt to allow abortion pills to be taken at home (a stunt that was slightly derailed by the fact that he'd been replaced as Health Secretary the day before).

SPUC supporters will know that the Society has taken the Scottish Government to Court for introducing this same policy. Like many in the media, perhaps you assume that the reason we are doing this is because we oppose abortion in all circumstances, and any attempt to widen access. However, we really believe that not only is such a move illegal, it has serious health consequences for women. Indeed, the more I look into this, the angrier I am that medical professionals are promoting something that is so obviously ideological at the expense of women's safety, and that the media allows this to go unquestioned.

So, here are ten reasons why allowing the abortion pill to be taken at home is dangerous and must be opposed.

1. Complications for medical abortion are common

There has been much talk of medical abortion being "safe" and "easy". However, medical abortion isn't just taking a pill that makes the baby disappear. As the stories of women promoting home abortion illustrate, a medical abortion causes cramping, heavy bleeding and nausea. As Marie Stopes said on their website (on a page that has now been taken down), it is normal to experience "bleeding and strong cramps (like period pains) that can last for several weeks." Other side effects include "diarrhea, nausea, vomiting, dizziness, warm flushes, chills, headaches and pains. Medical abortion can also worsen symptoms of migraines and asthma in some people."

Marie Stopes also lists the rare but possible complications: haemorrhage, infection, failed abortion, incomplete abortion, thrombosis and death. And some of these are not as rare as Marie Stopes may wish to suggest.  For later medical abortions, after 13 weeks gestation, the proportion of incomplete medical abortions that needed subsequent surgical intervention varies widely between studies, ranging from 2.5% in one study up to 53% in a UK multicentre study. Even for early medical abortions, up to 9 weeks gestation, the RCOG reports (p41) a Finnish study that found 6% of women needed subsequent surgical intervention compared with less than 1% of those having surgical abortions. And, contrary to claims by the Scottish Government, medical abortions are not safer than surgical. A study of 42,600 first trimester abortions in Finland (where there is good registry data, unlike in the UK) found that six weeks post abortion the incidence of complications after medical abortion was four times higher than after surgical abortion – 20% compared to 5.6%.

With all these possible side effects and complications, how is removing abortion from medical supervision, while continuing to promote it heavily to women, in any way a good idea? Women may be unaware that their abortion is incomplete and may therefore only seek medical help when infection develops. Taking the second pill outside of medical supervision will compound this.

2. The precise time interval is important

There has been much focus on the desirability of taking the pill at home, so that women can choose a convenient time to induce their abortion. "If I had been able to take the second abortion pill at home, I would have been able to access everything I needed," says Claudia, the woman fronting the home abortions campaign. "I wouldn't have been rushed and panicked and worried about going through an abortion in a taxi, and I could have taken the pill in the place and time that was right for me." Well, actually, no. The precise time interval between taking mifepristone (the first pill) and taking misoprostol (the second) is critically important in the effectiveness of the regimen and directly affects how likely the woman is to experience a failed drug-induced abortion and require surgery. Misoprostol is recommended to be taken 24 to 48 hours after taking mifepristone, otherwise its effectiveness is significantly lowered. Yet there is nothing to stop a woman taking the second pill outside the recommended hours if she is outside of medical supervision. Research has shown that, unsurprisingly, women prefer a short time frame between the pills, and so may inclined to take the second pill less than 24 hours after the first. But this leads to a significantly increased failure rate with one study finding that nearly one out of every three to four women who took buccal misoprostol shortly after the mifepristone failed to abort.

This means that removing control over the timing of misoprostol administration, allowing women to take it at a time 'convenient for them', will increase failure rates, complications and need for subsequent surgery. (Of course, we ourselves would never see as 'failure' the survival of the baby, as opposed to a baby already dead failing to leave the woman's body.  Some babies do survive after the first pill is taken, and some women have a change of heart and refuse to take the second pill, hoping their baby is still alive.

3. The precise manner of taking the drugs is important

The precise way in which the drugs are taken also affects failure rates. The popular image of the abortion pill is of taking it orally, like a painkiller, but actually, vaginal and buccal administration is generally recommended over oral. Oral administration of misoprostol combined with the recommended low dose of mifepristone is not as effective in emptying the uterus after the unborn child has died and results in a higher failure rate, but is nonetheless preferred by women over the other methods. The second visit to a hospital or clinic builds in an important safety feature by allowing for direct observation and monitoring of the administration of misoprostol at a precise time and in a precise way after mifepristone administration. Many people (offensively) compare medical abortion to miscarriage management, but it should be noted  that although medical treatment for miscarriage may be self-administered, it only requires a dose of misoprostol, not mifepristone, so timing and manner of administration are not as significant.

4. No control over who takes it or where

The second visit also means there is medical control over who is taking the abortion pill, and where. Once a pill has left the clinic, there is no way of knowing who is going to take it, and whether they are doing so freely, or under coercion. There is also no control over where it is being taken. All the talk has been about a woman taking the pill in her home (and that's what the Welsh and Scottish Governments have changed the guidance to allow), but once it has left the clinic, it can be taken anywhere – in a school, in the back of a car, or, irony of irony, in the backstreets. There is also nothing to stop it being taken at the wrong stage of gestation, which can be very dangerous for the woman.

5. Keeping abuse victims away from authorities

All of these points about who is taking the pill and where lead to genuine concerns that the abortion pill is useful for those who want to keep women away from the authorities as much as possible – for example, the victims of abuse or women who have been trafficked.

6. "Home" could mean anything

For all the talk about women being able to take the pill in the "comfort of their own home" there has been no discussion as to what this means in practice. In fact, unlike 'hospital' and 'general practitioner's surgery' there are no specifications or requirements as to what is classed as a home. It could vary from a palace to a caravan or a tent or houseboat. There is no requirement for any inspection process to be carried out of the 'home' in order to evaluate and confirm a specific and agreed standard, or to confirm the availability of equipment which may be necessary if required for a medical emergency or even for basic comfort during the abortion 'procedure'.  This includes even such basic things as a bed, pillows, towels, a sick bowl, a working toilet, hot and cold running water, heating, lighting, a working telephone in case of an emergency…There are just no requirements at all, and no way of enforcing them if there were.

7. Home could be miles away from a hospital

As there are possible complications with a medical abortion, one might expect, on the part of those advocating such abortions, some concern for women being able to get to hospital in the case of an emergency. However, with their rhetoric about transport difficulties in coming into the clinic for the second pill, proponents of home abortion argue that it should be available to precisely those women who would have difficulty getting to a hospital!  It is dangerous to give women medical abortion if they are not easily available for follow-up contact or medical evaluation.

8. Leaving women alone

The Scottish guidance makes it clear that another adult should be at home with a woman while she is suffering the effects of the abortion pill. But how is such a check to be carried out? The second adult could be anyone aged 16 or over or even someone very old and frail and incapable of supervising a medical abortion. It could foreseeably be an abusive partner - or even a pimp - who may have no consideration for the pregnant woman's care other than the desire that she abort this baby and be seen to have done so. Moreover, an adult is neither a medical professional nor a registered medical practitioner. There is no requirement for any standard of first aid qualification or medical knowledge in case of emergency or simply that the person care for the pregnant woman whilst she suffers the adverse effects of the drug she has taken. The Welsh Government has not even specified that an adult be present.

9. The psychological effect of aborting at home

We know that a medical abortion can be deeply traumatic, and physically very painful for women who endure it, whatever the circumstances. Even the BBC programme Abortion on Trial, though generally very sympathetic to abortion, made this clear: several of the women described the horrific physical pain of a medical abortion, and the distress of having to see the dead baby. One participant said: "I wish someone had told me I would see the product of the pregnancy", while another described passing the baby in the shower. We know from the testimony of those who have counselled women through Abortion Recovery Care and Helpline (ARCH) that the place where an abortion happens can trigger traumatic flashbacks. How much worse is this when the place is your own home, rather than an anonymous clinic you can leave behind? The psychological fallout of having to see, and flush away, the baby yourself is severe. How can promoting this be in the best interests of women?

10. Trivialising abortion

Finally, allowing abortions to take place at home trivialises abortion. Of course, this is bad for babies, but it is also bad for women. It will inevitably lead to women being told that they can easily opt for abortion, when that might not be what they truly want. It makes it more likely that they will be coerced into abortions, and left to deal with the aftermath by themselves. Abortion being treated as something that can be done over the weekend with no medical supervision, rather than as a serious procedure with genuine risks and side-effects, means women's health is being sacrificed to an ideology that only cares about widening abortion access at all costs.

If you are struggling after abortion call the Abortion Recovery Care and Helpline on 0845 603 8501

I gratefully acknowledge the excellent research of Philippa Taylor in these blogs: Ideology or evidence? The battle over abortion pills and Abortion pills: a safer, easier and more convenient option? The evidence says 'no', from which several of the points are taken.

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