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Cornwall, Regan et al 1 are to be congratulated for persuading the Government that it’s sensible to permit home use of misoprostol where an abortion has been approved according to the present law. Indeed the case for this change has been obvious for some years ever since the WHO reviewed research trials in a number of countries. However, isn’t this really the time to make both abortifacients, mifepristone and misoprostol, available off prescription?
They are safe, reliable and easy to use. Complications requiring further medical attention after self-administration are only marginally more common than when supervised by medical staff. Dire results are rare. Is this the time to recognise that the present, medically supervised, regulated system has been outflanked by pharmaceutical technology?
In fact abortion has become so easy that many women obviously prefer it to contraception. In 2017 approximately 74 000 abortions in England and Wales (39% of the total) were for women who had had at least one before. Whether or not repeated abortion by medical means in early pregnancy is undesirable or even harmful does not seem to have been established.
Pills over the counter would be a popular innovation because it would enable a pregnant woman to achieve a termination more quickly and with greater privacy than now. She would, for example, not need to run the gauntlet of abortion protesters outside clinics.
Of course there are snags and difficulties. It could not be done without a change in the laws which currently forbid self-induction of abortion and require each to be approved by two doctors. The control and supervision of this procedure by medical staff would be greatly reduced. Identifying other medical conditions would also be less frequent. A few women might use the drugs in late pregnancy, when the fetus was already viable, but they can do this already. Statisticians, without a medical certificate for every abortion, would have to make estimates.
Making such a radical change in the present parliament would not be easy, but it might help British society catch up with the reality that these pills are available fairly cheaply, worldwide, right now. If most women could manage the whole process themselves, it would be a further step towards equality with men.
Competing interests None declared.
Patient consent Not required.
Provenance and peer review Not commissioned; internally peer reviewed.
Author note KH is the author of Abortion Law Reformed (with Madeleine Simms) and a former Vice-Chairman of Pregnancy Advisory Service.
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