Abortion at Home – eight weeks in

On March 30th, 2020, the Secretary of State for Health and Social Care gave approval to a change permitting women to self-administer both abortion pills at home. This temporary approval was made in the context of the Covid-19 pandemic and the need to restrict travel and clinic visits.

RCOG Changes 200321On March 21st, anticipating this approval, the Royal College of Obstetricians and Gynaecologists (RCOG) issued guidelines to be used in the provision of abortion services during the Covid-19 pandemic. This screenshot shows the changes recommended to minimise Covid-19 exposure for women and providers.

In an earlier post I noted the public health mandate for these changes, but also noted the need for an ongoing evaluation of the impact.

It is now eight weeks since the approval came into effect and I am making the following projections based on the 2018 data which are the latest published by the DHSC.

  • 24,000 women will have presented at <10 weeks gestational age and requested a termination of pregnancy.
  • Of these, some 9,500 will have noticed the differences in how the service is being provided now compared to when they last had an abortion. They will have noted that the clinic visit is no longer required and a few of the steps which they previously followed are no longer part of their client journey towards an abortion. There was no ultrasound scan and so they were asked to self-assess the GA of their pregnancy based on their recall of LMP.
  • Perhaps as many as 1,600 will have discovered that the surgical procedure, which they had chosen the last time, was either not offered or not so easily accessible due to clinic closures and the Covid-19 lockdown restrictions on travel.
  • Based on the most optimal outcome projections, for some 750 women their abortion will not have been complete after taking the prescribed treatment. They will either have needed to take the additional dose of misoprostol provided in the treatment pack or travelled to a clinic for surgical intervention.

 

About Kevin Duffy

Interim Management and Consulting - Healthcare Development. Kevin has thirteen years senior management experience in the development and delivery of healthcare services in Africa and South Asia.
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