Packer was let down by Lord and his team

On 08 May 2025, Nicola Packer, who was arrested on suspicion of an illegal abortion in November 2020, was cleared by the jury at Isleworth Crown Court. Her case is already being used as a cause célèbre by those campaigning for the decriminalisation of abortion, chief amongst them Jonathan Lord, an NHS consultant gynaecologist and the clinician in charge of Packer’s care while working at MSI Reproductive Choices. Taking a stand against abortion decriminalisation risks you being called out as being cruel and vindicative, of not having any compassion for these vulnerable women who, undoubtedly, face the awful trauma of years-long prosecutions. It is however time to stand firm and to objectively review the evidence, to not give into the huge emotions surrounding cases like hers.

At the start of the second Covid-19 lockdown in November 2020, Packer called MSI-RC after a positive pregnancy test and a few days later she received and used the abortion pills-by-post. She had told the MSI-RC call centre agent that she was less than 7-weeks pregnant based on her recollection of the first day of her last menstrual period (LMP), a date that she would have subsequently confirmed to the MSI-RC nurse on the final consenting phone call. One can imagine just how shocking it would then have been for Packer when she passed a dead fetus estimated to be 26-weeks gestational age.

Telemedicine abortion and pills-by-post can only legally be used by women who are less than 10-weeks pregnant. Between 10 to 24 weeks, a woman has a legal right to an abortion on request but this can only be performed at a regulated abortion facility. After 24-weeks, the gestational age of viability, an abortion is only legal in those cases in which the woman’s health or life is at risk, or if there is a fetal anomaly.

Nicola Packer would not have been prosecuted, she would not have endured those four and a half years of trauma, if she had been clinically assessed in-person at the MSI-RC clinic. Her gestational age would have been correctly determined and if less than 24w, she could have had a legal abortion. The fault does not lie with the Offences Against the Person Act 1861, the fault lies with the inadequacy of GA assessment by telephone, relying solely on a woman’s accurate and honest recall of her LMP.

Jonathan Lord can rant against everyone else, the NHS hospital staff, the police, and the Crown Prosecution Service – and rant he does, calling the CPS vindictive and brutal, and others he labels callous [i] – but in reality, it was he and his fellow campaigners that caused this, and he needs to own that.

In 2021, when trying to convince the government to make telemedicine permanent, he co-authored a study entitled “Effectiveness, safety and acceptability of no-test medical abortion provided via telemedicine: a national cohort study.” [ii]  In this, he argues that there are no concerns or issues when certifying a woman’s gestational age without an ultrasound; he cites earlier studies and writes:

“The proportion of cases where gestational age was later than expected based on LMP was low, as might have been expected given the evidence that women can determine the gestational age of their pregnancy with reasonable accuracy by LMP alone. Nevertheless inadvertent treatment of gestations over 10 weeks is inevitable and, consistent with our findings, the consequences for most are unlikely to be medically significant.”

The most recent of the two studies cited, indicates that just 1% of women would incorrectly, underestimate their GA; the other study suggested a proportion of 1.6% and this was in cases of a woman recalling her LMP along with a physical examination (not ultrasound).

Writing in The Guardian, Lord says, “[Packer] had suffered a rare complication in her abortion treatment.” [iii] That is how he describes a later term, at-home medical abortion resulting in the passing of a fetus at 26-weeks – “a rare complication”.

As is often the case with Lord, he uses words to mislead his readers; the National Institute for Health and Care Excellence (NICE) states that side effects occurring in 1 in 100 to 1 in 10, are ‘Common’ [iv] – Lord should use this descriptor, what happened to Packer, an incorrectly assessed gestational age when relying on a no-test protocol, is common.

Based even on the low estimate of 1% cited by Lord et al, this could mean that more than 5,000 women using telemedicine abortion since April 2020 have had their gestational age incorrectly assessed, and as a result may have been past the legal limit of nine weeks and six days when they used the pills-by-post at home.

In the study mentioned above, Lord et al state that these later term medical abortions are unlikely to have any significant medical consequences. However, in its guidance for abortion providers, the Royal College of Obstetricians and Gynaecologists states that from 22-weeks gestational age, feticide is recommended before using the abortion pills, to “avoid [the] fetus being born with signs of life, which can cause distress for women and their care providers.” [v]

But, as he tries to tells us, the possible signs of life and distress for the woman would just be ‘a rare complication’.

A key point in this tragedy is summed up by Nicola Packer when she says:

“I just felt really bad, I didn’t know I was pregnant or that far along…If I had known I was that far along I wouldn’t have done it… I wouldn’t have put the baby or myself through it.” [vi]

The move to telemedicine and the subsequent incorrect assessment of Packer’s GA caused the tragedy of her traumatic at-home late abortion and the years of prosecution. Yes, I’ve already heard the cries of Covid and it was a lockdown. However, we are no longer in the Covid-19 emergency and yet we still allow more than 60% of all abortions to take place using telemedicine and pills-by-post, more than 400 each and every day. There is no reason why a woman should not first attend a clinic and have an in-person assessment, and if her GA is less than ten weeks and she wants to, then she could still take the abortion medication at home.

When Packer realised that she really was that far along, she called the NHS not the MSI-RC team – Lord was accountable for Packer’s care and treatment but he and his team were nowhere to be found when it all went wrong. He wasn’t there when the police were called, he wasn’t there to explain that this was a rare event, no fault of Packer’s and no fault of his given his team had prescribed in good faith.[vii] To be fair, Lord says that he was one of those who later sought to help and advise Nicola, but given his recent rants, what he really wanted, was to use her tragedy as emotional leverage to further his ideological aims of making it legal for all women to self-manage their later term medical abortion at home.

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[i] (2) Public Shaming & Humiliation – yet another criminal trial following an abortion in England | LinkedIn. (2025, May 8). https://www.linkedin.com/pulse/public-shaming-humiliation-yet-another-criminal-trial-jonathan-lord-vblye/

[ii] Aiken, A., Lohr, P., Lord, J., Ghosh, N., & Starling, J. (2021). Effectiveness, safety and acceptability of no‐test medical abortion (termination of pregnancy) provided via telemedicine: a national cohort study. BJOG an International Journal of Obstetrics & Gynaecology, 128(9), 1464–1474. https://doi.org/10.1111/1471-0528.16668

[iii] Lord, J. (2025, May 12). The case of Nicola Packer tells us this: Britain is shamed by its abortion laws – and must change them. The Guardian. https://www.theguardian.com/commentisfree/2025/may/08/nicola-packer-prosecution-abortion-laws

[iv] Adverse reactions to drugs | Medicines guidance | BNF content published by NICE. (n.d.). https://bnf.nice.org.uk/medicines-guidance/adverse-reactions-to-drugs/

[v] Duffy, K. (2024, April 24). RCOG guidance for later abortions. Percuity. https://percuity.blog/2024/04/24/rcog-guidance-for-later-abortions/

[vi] Cooke, C. (2025, May 9). UK woman acquitted of 26-week illegal abortion. Live Action News. https://www.liveaction.org/news/uk-woman-trial-abortion-pill-26-weeks/

[vii] Duffy, K. (2023, November 27). There is no ‘Good Faith’ without an in-person consultation. Percuity. https://percuity.blog/2023/11/19/there-is-no-good-faith-without-an-in-person-consultation/