Pro choice or no choice?

(Photo: Unsplash/Liv Bruce)

Since the height of the Covid pandemic, abortion providers in the UK have been legally permitted to send out the two pills that induce medical abortion by post. This means that women who are under 10 weeks' pregnant can currently request, receive and take these pills without any human contact other than a short telephone call. One woman described the process of getting the abortion pills as "easier than getting a takeaway".

This kind of service is fraught with difficulties. How can the provider ensure that the woman is below the 10-week safety limit for medical abortion? How can they make sure these controlled drugs are taken by the woman who calls and not, for example, to cover up the abuse of a teenage girl? How can abortion providers rule out coercion from a partner or member of the family?

But crucially these services seem to have increased the number of women who immediately regret their decision to abort.

The first abortion pill, mifepristone, starts to break down the attachment of the fetus to the wall of the uterus. In the circumstances where an unwanted miscarriage is threatened, a woman may be offered progesterone treatment. Although not specifically licensed for use to reverse the effects of mifepristone in the UK, a treatment of progesterone to reverse the effects of the abortion pill makes medical sense. Americans know this well and the significant research undertaken there demonstrates that it is a safe and effective treatment.

So how do abortion providers in the UK such as Marie Stopes respond to a woman who gets in touch in a distressed state having taken mifepristone and then changed her mind about wanting to abort her baby? A recent statement claims that they offer "support and counselling" in this situation, but the reality seems rather different. The women I have spoken to say they have been told that they "must take the second pill" and have been pressured to do so; "to consult their GP"; or to "do nothing and see what happens".

A systematic review of the studies into survival rates after taking only mifepristone put the survival rate of the baby as only 10-23%. The best evidence currently available demonstrates that giving progesterone to women who request rescue treatment after taking mifepristone is far superior to expectant management alone, leading to up to a 68% chance of the fetus surviving. The narrative put out by UK abortion providers is that progesterone treatment is "dangerous"; in fact it is safer for a woman to take progesterone than to take mifepristone and then misoprostol. This is because abortion pills can cause haemorrhaging, as evidenced by a Freedom of Information request to the NHS Ambulance Services which indicated that 36 women make 999 calls every month after medical abortions.

Marie Stopes, recently rebranded MSI Reproductive Choices, so believes in choice that it reports doctors offering progesterone treatment to these women to the General Medical Council. Two of them are now facing disciplinary proceedings in the Medical Practitioners Tribunal. One woman's story has been used without her consent as a complaint when in fact she had nothing but praise for the doctor concerned, even though in this case the treatment was unable to save her baby.

Many women feel unbelievably grateful to these doctors who helped them to save their babies. Even where the babies were not saved, or where they decided to decline the progesterone treatment, they feel that these doctors cared for them and helped them when they most needed it. They step into the breach where the abortion providers are manifestly failing.

In any other area of medicine, treatment would be stopped if consent was withdrawn. Is ideology and the vested interests of abortion providers in the UK getting in the way of the woman's right to choose?

Rebecca Bensted is a barrister and Director of the Christian Legal Centre.