Dear Adam,
Many thanks for enquiring about our online class explaining how to use abortion pills at home safely. This is part of the joint activities with our partner the Abortion Rights Campaign to commemorate International Day of Safe Abortion. The theme this year is 'I manage my abortion' and our local theme is 'care at home'. The home use of abortion pills following consultation with a medical professional is safe and it is healthcare that should be commissioned by the Department of Health in NI following the regulations. People should not be forced to travel to GB to access abortion care, which the NIO and DoH suggest as an acceptable pathway. Currently across GB there are measures for telemedicine and home use of pills in place, NI once again stands as a place apart failing to offer those who need abortions care even though there is now a legal obligation for these services to be provided.Our session on abortion pills, details the drugs used for early medical abortion, the methods of taking the pills for the most effective outcomes, the safety measures for afterwards, how to look out for complications and what to do if they arise. Alliance for Choice have been running similar workshops for almost 7 years and the medical advice and evidence we use is based both on the recommendations of the World Health Organisation and the advice of providers such as BPAS, Women on Web and Women Help Women, all of whom follow strict clinical guidelines and ask patients to go through either an online or telephone consultation before accessing the pills.
The World Health Organisation released a report in 2018 outlining the safest methods of delivery for medical abortion, based on global evidence, they concluded,
“Given the nature of the medical abortion process, it is also possible for individuals to play a role in managing some of the components by themselves, outside of a health-care facility. Another existing WHO guideline, Health worker roles in providing safe abortion and post-abortion contraception (2015), recommends that in specific circumstances, individuals may self-manage their mifepristone and/or misoprostol medication without direct supervision of a health-care provider, as well as self-assess the success of the abortion process using pregnancy tests and checklists.”
For women and pregnant people in Northern Ireland, currently the main method of delivery of abortion up to 10 weeks gestation, is with the pills mifepristone and misoprostol, with the 1st pill being taken at a clinic and the second set of pills at home. Despite the law saying abortion should be on request up to 12 weeks and pills being recommended up to 13 weeks by the World Health Organisation, our health service stops at 10 weeks as it has not been properly commissioned by the Department of Health due to political prevarication. This has meant many people are not able to properly access abortion with pills via the Northern Ireland Health Service, even though legally they should.
For some in NI, if they qualify, they can order the pills to be delivered by post from BPAS https://www.bpas.org/abortion-care/abortion-treatments/the-abortion-pill/remote-treatment/ and others continue to use the services of Women on Web and Women Help Women, which is currently not a criminal offence. If you look online, information on how to access abortion in Northern Ireland has not been published by any of our Health Trusts, again, due to a failure of the Depart of Health to provide information and services. Informing Choices NI do sterling work in supporting people with access up to 10 weeks but again are not supported to do this by our Health Department and have to rely on charity funding.
Once England pressed ahead with self-managed telemedicine abortion due to Covid-19, Dr Edward Morris, President of the Royal College of Obstetricians and Gynaecologists, said:
“Giving women the option of taking both abortion pills at home following a video consultation is safe and effective and has rightly been judged as a vital and necessary step if we are to limit the spread of COVID-19. Many women will no longer be forced to make the difficult decision between leaving their home and continuing with an unwanted pregnancy. This change in practice will reduce pressure on the health system while limiting the unnecessary risk of infection for women, their families and health workers. We now urge Scotland, Wales and Northern Ireland to introduce similar measures to help protect frontline staff."
Equally on 24th March 2020 when the UK government were failing to allow for home use during covid, the Royal College of Midwives (RCM) and the Royal College of Obstetricians and Gynaecologists (RCOG) stated,
“We are disappointed by the Government’s decision not to allow home-use of mifepristone, the first drug used for early medical abortion. This change in practice which the Government announced and later revoked would have enabled women to access care remotely through video and teleconference, with treatment sent by post. This would have reduced pressure on an already overwhelmed health system, limited risk of coronavirus infection for women, their families and healthcare professionals, while ensuring safe and timely access to abortion care.”
We appreciate your concern for the safety of women and pregnant people needing abortions. We want everyone to have access to free, safe, legal, and local abortion care should they want or need it. Therefore we have asked both the NIO and DoH for all services, as mandated by law, to be provided to people in NI through our Health Service. These services should include home use, as recommended by the World Health Organisation, and telemedicine as in place across GB. We urgently need the DoH to commission services in line with the regulations, fulfilling their legal duty, as well as a public awareness campaign and training for healthcare professionals. Until the government does their job, Alliance for Choice will continue to share international best practice guidance and support those who need to access abortion.
Kind Regards
Emma Campbell & Naomi Connor