Caroline Gazet, UK Clinical Director for MSI Reproductive Choices, says that she is both saddened and angered by the term ‘DIY abortion’. This made me smile. It is ironic for a senior member of the Marie Stopes team to complain about others using such terminology to describe abortion at-home when they themselves are fixated on their ‘self-managed’ medical abortion strategy and consider this a ‘reproductive choice’ in which a woman will ‘pass the pregnancy tissue’.
A few months ago, I paused before using the term DIY to describe telemedicine abortion, I wanted to be sure that this was an appropriate term and not just playing to the headlines. The abortion by phone process is as follows:
- The woman self-refers to the abortion provider, she initiates the contact without needing to involve her GP.
- The woman shares her medical history in response to a set of scripted questions from the abortion provider, which could be done using an online form just as easily as on the phone.
- The woman self-assesses the gestation of her pregnancy based on her recall of the first day of her last period. She decides if this period was ‘normal’.
- The woman self-assesses if she has any indications of an ectopic pregnancy, in response to a couple of questions from the provider.
- The woman self-administers the abortion pills following the instructions in the treatment pack.
- The woman self-assesses if the abortion pills are working e.g., is she bleeding enough or is she bleeding too much.
- The woman self-manages the expulsion of the embryo/fetus and the disposal of the remains.
- The woman self-manages her pain and discomfort during the abortion.
- The woman is the one watching out for any indications of complications and is the one who, in up to 5% of cases, decides it is time to go to hospital for help.
- The woman self-assesses if her pregnancy has ended by considering her symptoms and using a pregnancy test.
In the interests of balance:
- The abortion provider answers the woman’s phone call and asks a set of scripted questions, following a decision tree.
- The abortion provider takes verbal consent from the woman, prescribes the abortion treatment, posts the package, and certifies the abortion using the HSA forms.
- The abortion provider will respond to any subsequent calls from the woman but will not usually make any proactive, outbound follow-up calls except those for marketing purposes.
Gazet writes in bold: “Since telemedicine’s introduction, 150,000 women and girls across the UK have been able to access the safe, effective and high-quality care they need and deserve.” It would have been more accurate for her to give the numbers of women using telemedicine, approximately 80,000, rather than using the larger number of all abortions by telemedicine or in-clinic. Why mislead the reader?
She also says: “Had telemedicine not been available, there is a real danger that these women and girls may have turned to illicit sources for abortion pills, without the safeguarding and aftercare provided by a regulated service”. I have to say that after many years of reviewing these services, I do not see any significant or noteworthy difference between telemedicine abortion provided by Marie Stopes and e.g., the online service provided by Women on Web, except of course the former is currently legal in GB. As found in our mystery client investigation the safeguarding is weak at best and to even mention ‘aftercare’ is ridiculous, it just isn’t a reality for the majority of MSI RC clients.
The term ‘illicit sources of abortion pills’ is worth noting given that MSI Reproductive Choices is set on a global strategy to make self-managed medical abortion more easily accessible to women over-the-counter at their local pharmacy; this service delivery model is how Marie Stopes delivers 80% of its global abortions, often in countries in which such provision is not always compliant with local national laws.