Corona Daily 324: Pills by Post

The pandemic has brought in a welcome change for women in the UK, and it is likely to last beyond.

In Europe, most planned abortions in the first ten weeks happen when the pregnant woman takes two pills. The first pill, mifepristone, stops the hormone that allows the pregnancy to continue working. The second, misoprostol, is normally taken 24 to 48 hours later, and encourages the womb to contract to pass the pregnancy. After four to six hours the lining of the womb breaks down, causing bleeding and the loss of pregnancy.

UK's 1967 abortion act still requires the physical presence of the woman at a clinic to comply with the law. Not doing so is a criminal offence, in theory liable to life imprisonment under an ancient 1861 law. In the 1960s, no abortion pills existed, only surgical procedures.  

English women with unwanted pregnancies have been taking appointments, visiting the clinics. The first pill was administered in the clinic; the second taken at home.

Women in Northern Ireland were in a worse state. Abortion was decriminalized only in October 2019. Even after that, they needed to come to England for abortions. In the coronavirus lockdown, the only way was to take an eight-hour ferry ride from Belfast to Liverpool. In England, after taking the pill in the presence of a doctor, many of them couldn’t afford overnight accommodation. They would take another ferry, risking miscarriage during the trip home.

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Fortunately, during the pandemic UK approved a rule change. Now a woman can phone or video call a doctor or nurse. The next day, she receives the abortion pills in plain packaging to ensure privacy. More than 90,000 women have ended their unwanted pregnancies by taking both pills at home.

Abortion is in any case a stressful business, irrespective of the circumstances behind the pregnancy. Visiting an abortion clinic in that stressful state is unpleasant, particularly if anti-abortion activists are protesting outside the clinic. English women were forced to take the first pill at the clinic’s convenience. Now, it doesn’t matter. Many working women planned the abortion on the weekend.

Abortion is time-sensitive. A delay can make a legal abortion illegal. The tele-medical abortion has made the process efficient by cutting down the appointments and physical travel. At home, the woman feels more comfortable, and can be surrounded by her loved ones if she so desires. Even before the pandemic, the second pill and the abortion happened at home. So whatever risks that existed have not changed due to the tele-call to the clinic.

The change has reduced the burden on the health services, and also the risk of the pregnant women getting coronavirus. The pills- by- post legislation was introduced for 18 months, but now all stakeholders are planning to make the change permanent.

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In the USA, abortion is a political issue that must be opposed by the Republicans and supported by the Democrats. Some states allow it, others don’t. Like the North Irish women, American women may have to travel to another state for an abortion. In July, a Federal court allowed medical abortions at home. Trump administration plans to appeal this in the Supreme Court.

In India, with large-scale abortions of female fetuses in the past, the laws are stringent. Chemists are reluctant to stock abortion pills because of excessive regulation. The one good thing India did was to declare abortion as one of the 20 essential health services on 14 April. This allows abortions in clinics or hospitals even during the pandemic. It will be a long time before pills can be posted to Indian women in plain packages.

Ravi