Introduction

Abortion legislation in the British Isles is fragmented and no longer fit for purpose. In Scotland, recent changes in the application of the 1967 Abortion Act have improved care for women opting for early medical abortion (EMA), bringing medical practice into line with international standards. Similar changes are planned for Wales, and new regulations are currently under review in the Isle of Man parliament. Following the emphatic result of the referendum in the Republic of Ireland to permit abortion, it is likely that safe, evidence-based, woman-centred regimens will be available there soon.1 Despite women making up 51% of the population, the governments in England and Northern Ireland have yet to show the same compassion for women’s health and safety.

Abortion is common. Worldwide it is estimated that 25% of all pregnancies end in abortion.2 In England and Wales, 2.5% of all women aged 20–29 years have an abortion each year,3 while an estimated one in three women will have an abortion by the age of 45 years.4 The majority of these occur early in pregnancy when an EMA is most effective, and this is what most women choose. Of the 146 912 women in Great Britain who had an abortion before 9 weeks’ gestation in 2016, 75% of those living in England and Wales and 89% of those living in Scotland chose a medical abortion.3 5

The most effective regimen, mifepristone (200 mg oral) followed by misoprostol (800 µg vaginal, sublingual or buccal), is safe and well-tolerated by women, but is most effective when there is an interval of 24–48 hours between the two drugs.4 This raises the question as to where the second dose is administered. In Scotland, and soon in Wales, misoprostol can be taken in the woman’s home, but in England it must be administered within a licensed …