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Allow English women to take medical abortion pill at home, say doctors

BMJ 2018; 361 doi: https://doi.org/10.1136/bmj.k2879 (Published 29 June 2018) Cite this as: BMJ 2018;361:k2879
  1. Jacqui Thornton
  1. London

Wales has joined Scotland in allowing women to take the medical abortion drug misoprostol at home, sparking calls for England to follow and “extend them the same dignity.”

Currently in England, women who have an early medical abortion take one drug, mifepristone, in the clinic then need to return to take a second drug, misoprostol, 36-48 hours later.

On 29 June, Vaughan Gething, the Welsh government’s cabinet secretary for health and social services, announced a change in the rules to allow women to take the second drug at home, increasing choice for women and reducing the burden on clinical resources.

In October 2017, the chief medical officer and health secretary in Scotland recognised that a woman’s home is a safe and acceptable place to take misoprostol. This process is endorsed by the World Health Organization, which cites a study that found no evidence that home based medical abortion was less effective, safe, or acceptable than clinic based medical abortion.1

In April 2018, the Royal College of Obstetricians and Gynaecologists (RCOG) and the Faculty of Sexual and Reproductive Healthcare (FSRH) signed a letter with over 20 medical and women’s groups calling on Jeremy Hunt, the secretary of state for health and social care, to allow women in England to take misoprostol in a setting of their own choice. This letter, published in the Times, said that this “simple measure” would substantially improve the wellbeing of women.

Today, the RCOG and FSRH issued a joint statement saying that England must join Scotland and Wales. They urge Hunt to “extend the same dignity that the Scottish and Welsh governments have offered to women.”

Lesley Regan, president of RCOG, said: “The need for this second visit to the clinic frequently acts as a barrier to women accessing safe, regulated abortion care and is medically unnecessary and incurs significant NHS costs. Many women also experience the distress and embarrassment of bleeding and cramping pain during their journey home.”

Gething said that the new guidance, which will be issued to health boards in Wales today, was taken after listening to the views of clinicians and women’s groups. He added: “Women will still have the option to attend a clinic if they prefer, enabling them to complete treatment in an environment where they feel most comfortable.

“It will also enable a greater number of women to access abortion provision at an earlier point in their pregnancy.”

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