What’s wrong with ‘do-it-yourself’ abortions?

The British press always gets itself in a tangle over abortion, largely because it tries to follow public opinion and public opinion is muddled. Nobody likes the idea of abortion but most people think it is necessary – ‘the least worse option’ for a woman with an unwanted pregnancy. Most people want abortion to be provided safely and legally and preferably as early in pregnancy as possible.

Typical media muddle-headedness was expressed in The Times (London) last week. In response to news that the number of women using the abortion pill was rising rapidly, a Times leader column on 29 May argued that ‘the popularity of early medical abortion should prompt soul-searching….’

The news that in 2005 the number of women using the abortion pill at British Pregnancy Advisory Service clinics had doubled to 10,000, and that the charity, which provides a quarter of all British abortions, was seeing 65 per cent of clients in the first nine weeks of pregnancy – up from 56 per cent the year before – could and should have been an unequivocally ‘good news story’.

Early medical abortion – or EMA – is when a woman takes a pill that results in the ending of her pregnancy. It is recommended by medical organisations as the best way to end a pregnancy in its earliest weeks. It avoids any surgical intervention, which reduces the risk of complications, especially infection. It is also cost effective for the National Health Service because it doesn’t involve the use of theatres, gynaecologists or anaesthetists. The woman attends her clinic to be provided with the necessary medication and then returns home where she loses the pregnancy, much as she would do if she were to have a spontaneous miscarriage.

The use of early medical abortion also allows women to access services more quickly. Doctors are sometimes reluctant to carry out surgical abortions at very early gestations, because it is more difficult for them to be sure they have completed the procedure – but with early medical abortion, earlier is always better. And this in itself makes it preferable for many women. Today’s pregnancy tests can confirm a pregnancy even before a woman has missed her period, and most women wanting abortion care want it as soon as possible. Preferably yesterday.

Improving access to early abortion is central to the UK government’s sexual health strategy. Local Primary Care Trusts (PCTs) have been given additional funding to help them achieve targets for the number of abortions that are carried out before 10 weeks of pregnancy, and access to the abortion pill is widely understood to be a means to achieve this. The Department of Health has specifically advised PCTs that they should ensure women have the option of the abortion pill.

So why the soul searching? The Times leader said: ‘The rise in EMA’s popularity may be explicable; it is not necessarily to be welcomed. Parliament has repeatedly reaffirmed a woman’s right to choose. Such a choice must never be easy.’ Why not? The Times also said that the abortion pill has many critics who say that EMA ‘could give rise to a false impression that an abortion even in the early stages of pregnancy is relatively simple without physical or psychological risk. This is not true.’

Well, actually it is – almost. Of course, no medical procedure is entirely risk-free, but the risks of early medical abortion are extremely small and considerably less than the risks of pregnancy. And studies have shown repeatedly that early abortion of an unwanted pregnancy does not put women at risk of psychological damage.

The ‘many critics’ who disturb journalists so much are not just concerned about the abortion pill but about abortion in principle. They are horrified by the existence of a drug that makes the experience of abortion easier for women.

The critics are entitled to their views. It is understandable that if you believe the destruction of fetal life is evil, you will oppose the use of a pill that allows this to be achieved more easily. That is honest opposition. What is dishonest, however, is to brief journalists that women can’t cope with the experience, or that women’s health is harmed. It is fair enough to say the abortion pill is wrong, if you believe that; it is intolerable to claim that it is unsafe.

Medical abortion is not new. Women have tried to use herbs and medicines for abortion for as long as they have wanted to end pregnancies. Evidence that women used abortifacient herbs dates back to the Egyptians. In the past, though, the success of the methods were somewhat hit and miss; usually more miss. Beecham’s remedies never have been an effective way to interrupt a pregnancy; other more traditional folk remedies, such as ergomot, may have achieved the desired result sometimes, for some women. Today, however, women can legally access a safe, reliable, effective method of medical abortion. The latest figures show that they are doing so in ever-growing numbers.

No woman ever wants to have an abortion. It is the solution to a problem they wish they didn’t have. Most women struggle with their decision to end a pregnancy. The availability of the abortion pill does not make their decision easier. It may, however, make the process easier. And why should that be wrong?

Ann Furedi is chief executive of bpas.