Data obtained from five NHS Ambulance Trusts in England, show that emergency ambulance responses for complications arising after a medical abortion are three times higher for women using pills-by-post at home, compared to those who have their medical abortion in a clinic.
Using our rights under the Freedom of Information Act, we asked each of the ten NHS Ambulance Trusts in England to provide data related to the number of emergency ambulance responses made when the caller indicated complications arising from the use of abortion pills, a combination treatment of mifepristone and misoprostol. Data was requested for three time periods:
A – during 2018, when all medical abortions were provided in a clinic.
B – during 2019, when women were able to self-administer misoprostol (the second part of the combined treatment) at home, after having received the mifepristone (the first part of the combined treatment) at an abortion clinic.
C – from April 2020, when women were able to self-administer both mifepristone and misoprostol at home.
There is no code in the Advanced Medical Priority Dispatch System (AMPDS) which relates specifically to abortion. Thus, to provide the data, each of the Trusts used a wildcard search of the call data for each period, using variations of “Abortion Pill”, “Mifepristone”, and “Misoprostol”, (a sample query might include “LIKE %abort% or %misop% or %mifep%”.) It was reported to us by one of the Trusts that these calls are almost always entered by the call taker as “Taken Abortion pill” or “Taken Abortion tablet”.
Of the ten Trusts, two failed to respond, three reported that they did not hold the required information, and five provided data for each of the requested time periods. These five cover more than 55% of the total population of England.
In calculating the relative risk of requiring an emergency ambulance response we allowed for the total number of medical abortions in each of the respective time periods and took account of the proportion in which either the misoprostol or both tablets were self-administered by the woman at home. Data in the first two rows above, (a) and (b), were sourced from official abortion statistics published by the Department of Health and Social Care on the Government website.
This finding is not about the absolute number of emergency ambulance responses for medical abortion complications, it is about a comparison of the relative volume of responses before and after the approval for at-home abortion was given and then expanded. We understand that the numbers of ambulance responses for cases of complications arising after a medical abortion are a very small part of the total number of ambulance responses for all causes.
In a related freedom of information investigation, we found that complications arising from the failure of medical abortion treatment result in 590 women presenting at the emergency department of their local NHS hospital in England every month. The treatment failure rate is 5.9%, 1-in-17.
Workings: 639 in period C is adjusted to 519 to take account of the difference in total medical abortions between periods A and C. Based on the 67% of all medical abortions being performed at home, we have calculated that of the 519 cases, 77 are probably due to in-clinic cases and 442 at-home. 442 divided by 66% is 671. The ratio of 225 (in-clinic) to 671 (at-home) is 2.99.