The majority of terminations now take place away from clinics – often using pills prescribed online
When Emily Price discovered she was pregnant in May, aged 23 and having just broken up with her boyfriend, she concluded that she wasn’t ready for motherhood.
She booked herself a telephone consultation with a nurse at the British Pregnancy Advisory Service (BPAS) and, as a result, decided to terminate her pregnancy by taking pills at home.
‘Because this was so private I wanted to be in the comfort of my own home,’ says Emily, a PR executive from Swindon, Wilts. Having provided the nurse with the date of her last period to ascertain she was nearly seven weeks along — and having declined the offer of a scan and counselling — she received her early medical abortion pills by post.
In the envelope were two sets of medication to be taken 24 to 48 hours apart — a tablet containing mifepristone that ends the pregnancy, followed by further tablets containing misoprostol that breaks down the womb lining to expel it.
![Emily Price (pictured) discovered she was pregnant in May, aged 23 and having just broken up with her boyfriend, she concluded that she wasn’t ready for motherhood and decided to terminate her pregnancy by taking pills at home](https://i.dailymail.co.uk/1s/2022/08/24/21/61697509-11142507-image-a-17_1661371472701.jpg)
Emily Price (pictured) discovered she was pregnant in May, aged 23 and having just broken up with her boyfriend, she concluded that she wasn’t ready for motherhood and decided to terminate her pregnancy by taking pills at home
‘The nurse told me I might feel a bit of pain, but some women find it harder than others and some have had periods that are worse,’ says Emily, who lives with her mother.
However, within hours of taking the second dose she was hunched over the toilet, throwing up in a bucket and screaming in agony. ‘I have a high pain tolerance. I’ve broken bones and suffer chronic migraines, but I’ve never felt pain like it. I was terrified.’
When we speak, eight weeks later, she is still bleeding. ‘People need to be aware this is not an easy way out. It will stick with me for ever,’ she says.
In June, government data revealed 52 per cent of all abortions in 2021 involved women taking these tablets unsupervised.
It followed temporary measures introduced in March 2020, at the start of the pandemic, to allow women to take both sets of pills for early medical abortion at home, without needing to attend a hospital or clinic first. MPs then voted in March this year to make the changes permanent and, on Tuesday, it was announced that they will be written into law next week, consolidating the most seismic shift in abortion protocol in this country in recent times.
According to MSI Reproductive Choices, which used to be called Marie Stopes International and is one of the UK’s two biggest abortion providers along with BPAS, as recently as 2017 some 52 per cent of its patients opted to have a surgical termination, which is performed under anaesthetic with the pregnancy removed by a doctor.
![In June, government data revealed 52 per cent of all abortions in 2021 involved women taking tablets, for termination of pregnancies, unsupervised](https://i.dailymail.co.uk/1s/2022/08/24/21/61697507-11142507-image-a-18_1661371537759.jpg)
In June, government data revealed 52 per cent of all abortions in 2021 involved women taking tablets, for termination of pregnancies, unsupervised
In 2018, when misoprostol was approved for administering at home, surgical abortions declined to 33 per cent. Now these account for just 13 per cent of the total figure. While some choose to start a medical abortion in a clinic, the majority now happen at home.
So why has this become the mainstream option? And what are the ramifications for women? Being able to keep the procedure private is a huge draw, as is the fact that women can end a pregnancy more quickly as they’re no longer required to travel to a clinic.
‘We know it has a real impact for vulnerable women — those experiencing domestic abuse who can’t get to a clinic without their partner discovering they’re pregnant, or women living with their parents who might not want them to know they are pregnant,’ says Katherine O’Brien of BPAS.
Medical abortions are also more likely to be successful when pills are taken at home because women are more likely to be able to take them at the recommended intervals.
There are presumably benefits for the beleaguered NHS, too, which pays providers per abortion. Not only do remote consultations help clear waiting lists, but medical abortions are cheaper than surgical — £480 compared with £680, when quoted privately by BPAS.
But are women paying a price in terms of the pain involved? And would some still be better off having the surgical procedure?
‘Medical abortion, there’s no getting around it, it’s really quite painful,’ says Jonathan Lord, medical director at MSI Reproductive Choices. He adds that this pain has historically been ‘poorly communicated’.
Emily, who had been using condoms and tracking her menstrual cycle as contraception, discovered she was pregnant when her period was eight days late. ‘Panic set in,’ she recalls. ‘I was single, in a new job I loved.’
That evening, she told her exboyfriend. ‘We agreed it wasn’t the right time, and that having a baby wasn’t a reason for us to make it work as a couple.’ The following day, she went online to book an appointment with BPAS. Four days later, a nurse called for a 40-minute consultation, during which women are asked their medical history, date of birth and feelings about the pregnancy.
‘Everybody is offered counselling,’ says Katherine O’Brien. ‘If we had concerns about somebody’s safety, we would bring them in for an appointment.’
![Emily, who had been using condoms and tracking her menstrual cycle as contraception, discovered she was pregnant when her period was eight days late.](https://i.dailymail.co.uk/1s/2022/08/24/21/61697513-11142507-image-a-19_1661371565322.jpg)
Emily, who had been using condoms and tracking her menstrual cycle as contraception, discovered she was pregnant when her period was eight days late.
In hindsight Emily says: ‘It’s a bit concerning I didn’t have to prove I was pregnant. I could have been getting pills for someone else and they’d have no access to their medical information.’
O’Brien insists there’s no evidence the service is being misused. Emily’s pills arrived via registered post two days later, by which time she had told her mum. ‘She was supportive,’ says Emily, who took the first pill three days after that, at almost seven weeks pregnant. The first pill made her tired. After the second set of medication 24 hours later, she started bleeding within 15 minutes. After an hour, she says period-type cramps had turned into pain so severe she was doubled up on the toilet. ‘I was sweating but my body was freezing. I was crying,’ says Emily, who felt the urge to push three and a half hours after taking the second pill, and felt a ‘massive clump’ come out.
She says the experience was infinitely more painful than expected and she wishes she had gone to a clinic. ‘Being in an environment with medical professionals would have calmed me. If a friend had an unwanted pregnancy, I’d 100 per cent recommend having an abortion in a clinic instead.’
O’Brien concedes ‘we need to think about how we communicate pain to women’, adding every woman must be given the option of coming into a clinic for a consultation, which a ‘significant proportion’ of women still want to do.
With unprecedented demand for abortion — there were 214,256 for women living in England and Wales in 2021, the highest number on record — clinics can have waiting lists.
‘Abortion services in this country are underfunded,’ says O’Brien. ‘Any woman who wants to come into a clinic should be able to access an appointment in a timely manner. But, unfortunately, at the moment, for a lot of women, they would rather have the procedure sooner than wait.’
Katherine Telby had an abortion at home in May. She had previously had fertility treatment via a sperm donor, resulting in two pregnancies that had to be surgically terminated — the first, at 14 weeks in 2020, because her baby was found to have a heart defect; the second, last April at 13 weeks, after having a partial miscarriage.
Then, this May, she was in a new relationship when she discovered she was pregnant again.
‘I’d been tracking my period, but I’d begun to think that, because of what I’d gone through, I couldn’t get pregnant,’ says Katherine, 39, an administrator from London, who has a son from a previous relationship. ‘My boyfriend said it wasn’t the right time. My heart said I should keep the baby, but I didn’t want to do it on my own and worried this pregnancy could also end in miscarriage.’
![Medical abortions are more likely to be successful when pills are taken at home. Antonia Hoyle speaks to women who have had different experiences with them](https://i.dailymail.co.uk/1s/2022/08/24/21/61697511-11142507-image-a-20_1661371579370.jpg)
Medical abortions are more likely to be successful when pills are taken at home. Antonia Hoyle speaks to women who have had different experiences with them
BPAS called her three days after she filled in their online request for a consultation. She adds: ‘They asked if I was sure and offered counselling, but I said no. I wanted to get the conversation over and done with. There was no verification. I could have lied and been 20 weeks pregnant.’
In the week the pills took to arrive Katherine started to question her decision and called a different provider, MSI, to try to get an appointment to discuss her emotions. ‘The clinic was impossible to get hold of. I tried for five days but was put on hold for about an hour each time. When a nurse called, she was lovely but said they could only offer me the procedure in Manchester, which, as a single mother, I would have found it difficult to get to,’ she says.
‘If I wanted it in London I’d have to wait three weeks, by which stage I’d be 11 weeks pregnant. I couldn’t wait that long.’
Instead, she took the pills. She felt more pain than she had expected. ‘I thought an abortion at home would be less traumatic. But at least in hospital, under anaesthetic, I was pain-free. This was still horrible. I was writhing in agony. I had horrific cramps for five hours.’ She adds: ‘If I’d had counselling in a clinic, I think I would have decided to go ahead with the pregnancy.’
In response to Katherine’s waiting time, MSI says it faced ‘unprecedented demand’ after lockdown, but Jonathan Lord added women should now expect ‘to have their call answered in 30 seconds’.
Meanwhile, for many women an at-home abortion does offer the best solution. Aged 43, and with a six-year-old daughter and adult stepson with her husband, Tatiana Small knew she wanted a termination when she had a positive pregnancy test in May 2020.
Within an hour of calling BPAS’s helpline, she had been allocated a nurse for a consultation. After the second medication, she felt only as uncomfortable as she would during her period, for an hour.
‘I felt lucky to have been able to do the abortion at home,’ she says. ‘For someone like me, who’d had my family, to be able to terminate the pregnancy so quickly helped. It made it less traumatic.’
- Some names have been changed