Over many years, there has been a trend towards the preferred use of medication for abortions across England and Wales. DHSC data show that in 2008 the method mix for abortion was 62% surgical and 37% medical. In 2013-14, the proportional use of each method is equal, and since then medical abortion has been the predominant method. In 2019, 73% of all abortions were induced using medication.
This upward trend for MA continues in 2020, with an uptick in Q2 because of the COVID-19 lockdown measures and subsequent introduction of telemedicine and abortion at home. In Q2, the percentage of abortions which were medical was 88%; 43% of all abortions in Q2 were fully remote, in which both medicines (antiprogesterone and prostaglandin) were administered at home.
There could be a number reasons for this long-term trend towards the predominance of medical abortion; some to do with clients’ choices and some to do with provider bias and strategic preference.
When providing medical abortion, the doctor (RMP) is only required to authorise the official notification forms and supervise the multi-disciplinary team, they rarely have direct contact with the client. Abortion consultation services can be provided by nurses, midwives, and nurse practitioners, which helps with resource management and cost control. When providing medical abortion, these clinicians have little or no direct involvement in the actual process of expulsion, which, in about two-thirds of MA cases, is being left up to the client to self-manage away from the clinic.