When lockdown was introduced in the UK, no one could have predicted its scale or impact. Every aspect of normal life has been affected by it – and those seeking an abortion haven’t been exempt, either.
Ellie*, 22, became pregnant in early April. She knew that she didn’t want to continue the pregnancy but was terrified she wouldn’t be able to get a termination due to COVID-19. “There was so much in the news and on social media through March about delayed and cancelled abortions in England,” she told VICE. “People had been campaigning against the [cancellations] all over Twitter. I was terrified about what might happen to me.”
By the end of March, social distancing measures prompted the government to introduce new policy on early abortions in England and Wales. Those who wish to terminate a pregnancy during the pandemic can receive the two pills required to induce a medical abortion – mifepristone and misoprostol – and take them from the comfort of their own home. For the first time in UK history, a doctor’s referral isn’t necessary.
The usual process for abortion works like this: patients must attend two in-person appointments with a doctor and receive a referral. From there, they can opt for a medical abortion (with one pill taken in-clinic and the other at home) or a surgical abortion. According to the British Pregnancy Advice Service (BPAS), approximately 44,000 abortions would have been delayed without a lockdown plan. For many patients, delaying termination would mean having to go through with an unwanted pregnancy.
The road to this decision has been rocky, with the government posting then deleting a proposed change to abortion services on their website in early March. But after opposition from the World Health Organisation (WHO) and women’s charities, it finally confirmed its plan to relax abortion access during the lockdown – and home abortions have also been allowed by the Scottish government, too.
In Northern Ireland, services are more complicated. Although abortion was decriminalised in 2019, Irish women have to continue travelling overseas to access abortion as no services have been made available to them yet. Those wishing to terminate a pregnancy, however, can still apply to receive pills through BPAS under a legal provision to prevent grave, permanent injury to their physical and mental health.
If you are pregnant and interested in accessing telemedicine, you can get in contact with abortion providers Marie Stopes in England and Wales, or BPAS for all of the UK, including Scotland and Northern Ireland, for a phone consultation with a trained nurse lasting around 40 minutes. Terminations beyond the 10-week mark may still require visiting a clinic, which is why your suitability for the self-termination service will be assessed by a doctor beforehand.
These alterations, though temporary, are something many women's rights activities and pro-choice campaigners have actively requested for years. This pandemic has exposed the myth that abortions can only be carried out in a clinic, and has left many people wondering: why wasn't it like this before?
The idea of women attempting abortions on their own conjures up a difficult history, symbolised by images of the dangerous methods women used before abortions were accessible. But organisations like Marie Stopes argue that self-managed abortions are safe and easy to induce at home using a medical termination. In fact, most abortions in the UK are performed in the first 10 weeks of pregnancy. The Department of Health records that 71 percent of abortions in 2018 were medically induced using "the abortion pill", and since 2014, medical abortions have been the most common method of termination.
Since medical abortions are clearly chosen over a surgical abortion most of the time and can be safely induced at home, shouldn’t patients always have this option – lockdown or not?
26-year-old Londoner Demi discovered she was pregnant on the 24th of April. "I felt like I wasn't ready [to have a baby], emotionally or financially, so my partner and I decided together that I would terminate the pregnancy."
Demi had done her research and knew she could opt for a self-managed abortion during the lockdown period. "I felt like the services were still really accessible. It was easy to find telemedicine services online." At first, she had reservations about self-managing her own termination: "I felt like I needed to see someone face to face first, but once I'd talked through the process with a nurse on the phone, I felt reassured and completely safe to do this."
Demi accessed telemedicine through Marie Stopes: "I had two different phone consultations across two days and found them really helpful and reassuring. I'm yet to receive the pills and was told on Tuesday that they'd arrive between five to eight working days. I feel like that's longer than it should be, and hoped they'd be sent sooner, but it is what it is.”
Once Demi receives the package, she has been advised to take the first pill and another 24 to 28 hours afterwards. The medication packages also contain detailed instructions and contact details for a helpline if she needs support.
"If coronavirus wasn't preventing it, I probably would have opted to visit [a clinic],” Demi says. “However, once the process was explained to me, I learned that you only really pick up the pills from the clinic. You take one there, and one at home. You don't actually experience the termination in the clinic, so I don't see a whole lot of difference between the two methods. I don't see why self-managed abortions can't continue being available."
Ellie, 22, ended up performing her own abortion earlier this month, in the middle of lockdown. Like Demi, she was pleasantly surprised how easy the new services were to navigate – she also used Marie Stopes and received the pills in the post shortly after.
"This is the first time I've had a termination,” she explains. “Though it wasn't that long ago [that I self-managed the termination], I don't think I've experienced any lasting psychological impact. My friends, who've had abortions in clinics, found it to be unnecessary stress sitting in a waiting room for something that would be so quick."
Ellie believes self-managed abortions should remain available, even after the lockdown lifts. "The ordering process was really simple to navigate and though the termination itself was really painful, I felt in control and safe the whole time." Access to a 24-hour helpline, she says, was all the assistance she needed.
Though these women describe their experiences positively, it’s important to note that not all abortion patients have a substantial support network at home. For some women, especially those living in abusive environments, an abortion clinician may be the first face-to-face positive conversation they have about their decision. They may even be the first person they’ve told at all. Clinicians are also specifically trained to spot red flags in patients and act accordingly if they believe patients could be in danger. Some find these clinic-specific experiences invaluable.
Choice is integral when accessing abortion. Allowing people the decision between telemedicine and visiting a clinic beyond lockdown will only broaden every patient’s choice. Ultimately, self-managed abortion has existed for as long as pregnancy has. Offering it through a nationalised healthcare service only ensures patient safety. As long as their safety can be ensured through virtual support (or, after lockdown, an optional invite to the clinic), the "pills by post" system should stick around for those who need it.
For enquiries, consultation and advice about abortion services during the pandemic, you can contact BPAS on 03457 30 40 30.