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We would like to thank Drs McCarthy and Pike for their interest1 in our editorial,2 and especially for their openness about whom they represent. We note that the Society for the Protection of Unborn Children (SPUC) is opposed to abortion in all circumstances, and that this opposition includes the use of postcoital contraceptives, implants and injectable contraceptives and also the creation of embryos through in vitro fertilisation (IVF).
Our editorial2 cited some of the major reviews that demonstrate the safety, efficacy and acceptability for home use of abortifacients, alongside examples of five national and international guidelines that themselves are based on systematic review. Drs McCarthy and Pike have not explained why the women of England should be denied access to the same evidence-based care. Furthermore they seem not to trust women. Why would women be unable to follow instructions as to the "correct" time and route of administration of misoprostol and need medical supervision – do they infer that women should also not be trusted to take other prescription drugs at home, many of which may have greater potential for toxicity or side effects, or that they cannot differentiate oral from vaginal routes of administration? The premise that there has to be "precision in timing" is flawed – even with simultaneous regimes which are known to have higher failure rates, 94.5% of procedures are still successful.3 Even if there did have to be precision, empowering the woman to self-administer would be more likely to deliver that exactness rather than expecting a perfectly timed drug round on a busy gynaecology ward.
One of the major concerns of forcing women to take misoprostol in hospital is in the risk of aborting on the journey home. In publicity that followed publication of our editorial, several women bravely spoke out and gave harrowing accounts of what this actually means.4 This is not the spotting or light bleeding that Drs McCarthy and Pike suggest, but a deeply distressing experience. The accounts were from women from London with good public transport and limited journey times; rural areas fare worse. Drs McCarthy and Pike cite median times for bleeding to begin, but by definition half the women will of course develop their symptoms before that. The question as to whether women in rural areas have sufficient access to emergency services is a valid one, but the literature and national guidelines are reassuring that early medical abortion (EMA) at home is safe and significant complications are very rare. In a developed, populous nation like England, almost nobody will be beyond the reach of emergency services. Complications that do arise from EMA are very rarely acute emergencies and almost all are best managed back in the clinic on a planned basis.
There are scenarios where treatment at home is not appropriate, and we agree that each woman must have a choice, guided and supported by the clinical team. While there may be safeguarding issues and coercion, this can work both ways with a controlling partner seeking to deny the woman access to treatment or repeated transport. These are not arguments that should be used to restrict access to best practice for the overwhelming majority of women who are clear about their decision and able to give fully informed consent.
We fully respect the right of SPUC to hold different views, but not of any attempt to impose those minority views on others. Since our editorial was published, we are delighted that the Government has announced that they will grant women in England the same compassion and access to evidence-based care as is available in Scotland, Wales and most countries where abortion is legal.5
Contributors Lead author.
Patient consent Not required.
Provenance and peer review Commissioned; internally peer reviewed.
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