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Abortion: Misoprostol

Volume 790: debated on Tuesday 20 March 2018


Asked by

To ask Her Majesty’s Government, further to the Written Answer by Lord O’Shaughnessy on 21 January (HL5321), why there are no plans to enable women undergoing early medical abortion to take the second dose of the medication, misoprostol, at home, if they so wish.

My Lords, the Government’s priority is to ensure that women who require abortion services have access to safe, high-quality care. Abortions must be performed under the legal framework set by the Abortion Act 1967. We are not currently in a position to approve homes as a class of place under the Act. However, we will continue to keep this matter under review and assess further evidence as it arises.

I thank the Minister for his Answer, but can he inform the House of the expected timeframe for the Government’s decision regarding enabling women to choose the dignity of being as comfortable as possible in their own homes when they experience medical abortion, rather than some of them suffering while travelling home from the clinic? Journeys of over two hours are not uncommon, particularly for women from rural areas. It is also worth noting that the procedure is endorsed as a safe practice by the World Health Organization.

I thank the noble Baroness for her question. No timeframe has been set for any decision on a policy change. She will understand that any change of policy would need to be done cautiously, in the light of the evidence and of legal developments—for example, relating to Scotland’s decision to name homes as a place. It is on that basis that we will consider any further evidence.

My Lords, if women in Norway, France and now Scotland can take this drug at home, not in a clinical setting, with careful safeguards and support in place—I have looked at what has happened in Scotland, and there is no doubt about that at all—it is important that the Government should afford the same facility to women in England. I would like the Minister to perhaps go further than he has now and say that there will be a timetable for this to happen.

In terms of the experiences in other countries, of course only the countries of the UK are operating under the auspices and obligations of the 1967 Act, which any Government would have to act under. The Scottish Government have made that decision, but the noble Baroness will know that it is subject to a dispute and that a judicial review has been brought against it by the Society for the Protection of Unborn Children, which is obviously testing the legality of the Scottish Government and their powers to act. We shall look closely at developments in these legal proceedings, as well as any other evidence that arises. Unfortunately, this is why I am not in a position to give her a timetable.

My Lords, a study of 42,600 early abortions in Finland—where there is good registry data, unlike in England and Wales—found that, six weeks post abortion, complications after medical abortions were four times higher than after surgical procedures: 20% compared with 5.6%. The Royal College of Obstetricians and Gynaecologists cites one study in the UK where 53% of late medical abortions required surgical intervention. Given these facts, are Her Majesty’s Government not also concerned that so-called home abortions outside of a medical setting would compromise the health and safety of women, especially young women who may use these powerful chemicals secretly at home?

This is obviously a concern. There has been an increase in women buying online the drugs necessary for medical abortions, and that is something on which we are attempting to crack down. It is worth pointing out that 90% of abortions are NHS funded and therefore provided for in that way. The noble Baroness was talking about medical abortions at a late stage; it is worth pointing out that, actually, there has been an increase in the number or percentage of abortions that are happening at an early stage, which is obviously in the interests of women’s health.

The noble Baroness, Lady Eaton, mixed up two completely different things. She mixed up early medical abortions and late abortions. Can the Minister confirm that a 2011 court case brought by BPAS established that the Secretary of State has the power to allow early medical abortions to happen at home? If he agrees, and if the evidence from the Scottish trial is convincing and underpinned by the decision of the Scottish courts, will the Secretary of State then undertake to look at the development of a facility for legal abortion which may well be to the benefit of thousands of women in this country, particularly those who live in rural areas?

I am aware of the opinion in that judicial review. It is worth pointing out that there is still uncertainty about the legal position. This is why we will watch the developments in Scotland carefully and proceed cautiously. It would be wrong of me to prejudge either the opinions that come from the court or indeed any evidence if this scheme does get up and running in Scotland.

My Lords, does the Minister agree that, up to nine weeks, it is perfectly safe for a woman to take the pills for a medical abortion? It is much better and more comfortable for her to have the consequences at home. Does he also agree that this would mean each woman would have to make half the number of appointments to get a medical abortion—a huge saving for the health service?

The importance here is making sure that, under the auspices of the Act, women have access to safe and legal abortion, and that is what they have a right to do. An important point here is that, the earlier these abortions happen, the safer they are. The proportion of abortions under 10 weeks has risen from 68% to 81% in the last 10 years. At the moment, both courses of treatment for early medical abortion should take place in a clinical setting approved by the Secretary of State.

My Lords, has any research been undertaken on the psychological feelings of people who have had abortions in their own homes?

I am not aware of any research, but I shall ask the department to see if there is any. If there is, I shall write to the noble Baroness.

My Lords, if the information we have just had is correct that more women, especially young women, are buying abortion drugs online, surely that proves the point that we need to improve the abortion services that we have within the NHS and the advice that is given to young women.

No, I do not think it proves that. The fact that illegal drugs of all kinds are being bought online, whether they are illegal drugs or prescription drugs bought illegally, is a feature of modern life. Rates of abortion in the under-18s are falling, as is the teenage pregnancy and conception rate. Those are separate issues.

My Lords, is my noble friend aware that, as well as in Scotland, the home use of misoprostol is common practice in the United States, Canada and multiple other European countries?

Yes, I am aware of that. As I said, those countries operate under a different legal framework from ours.