Kevin Duffy, independent public health consultant and former Marie Stopes director, comments on the reality of #CareAtHome.
#CareAtHome is being used by many on Twitter lobbying for the provision of telemedicine abortion in Northern Ireland.
#CareAtHome – sounds so nice, who wouldn’t want it, but what’s the reality behind the hashtag?
I suppose #CareInMyBathroom or #CareOnMyToilet doesn’t have the same appeal.
Realities of abortion at home
On 28 May, the Daily Mail published a piece about abortions by post in which it shared the experiences of two women who had DIY abortions at-home. In this, Clare Murphy, speaking on behalf of BPAS, said: “…swift establishment of [pills-by-post] has been a phenomenal achievement in women’s healthcare, enabling women to safely access the care they need at home.”
The Royal College of Obstetricians & Gynaecologists is quoted saying: “Expert consensus is that it is… better tolerated for women to administer the drugs in the privacy of their own residence — this avoids the risk of distressing bleeding and pain on the journey home.”
Courtney says of her DIY abortion experience: “It was quite painful — really strong cramping. You do pass a lot of blood and I was warned I might see the foetus, so I sat on the toilet and didn’t look. I ended up lying in the bath trying to keep the pains at bay and I didn’t get much sleep that night. It was a lot worse than I’d expected. The pain, the physical process was horrible.”
Another woman the Mail spoke with says: “… she went through ‘hell’ after taking the pills… they left her in such pain she was convinced she was going to die. I understood I was going to have cramps, but I didn’t realise just how bad it was going to be… I started bleeding. I didn’t look because I knew it would really upset me. About six hours later the pain was unbearable. I was lying on my bathroom floor, curled in a ball. I was sweating, my temperature was 39.8, I couldn’t move. I had diarrhoea, I was being sick, I was shivering, shaking, sweating. I thought I was going to die.”
In The Guardian on 18 August, a woman who describes herself as pro-choice says this about her experience of an early medical abortion, (note the use of the term ‘miscarriage’ is hers): “My miscarriage started very fast… The bleeding started within an hour and the pain got much worse than the literature had suggested. For a while, I was bent double on the toilet, explosive diarrhoea and blood clots flowing out of me, while I vomited bile into a bowl. I was sweating and so weak I could barely tear loo roll.”
In October, Sophie shared her DIY abortion experience with The Telegraph. She was told by the abortion provider that the pain would be no more than a bad period pain, but she experienced “excruciating pain” and began bleeding heavily – a symptom which continued for ten days.
Expanding on this in a piece by Christian Concern, Sophie says: “When I took the second pill at home, I began to experience the most excruciating pain. It continued to escalate that evening to the extent I thought I was going to die. I was desperate for more pain relief. Fortunately, my friend prevented me from taking too much.”
Abortion at home is ‘similar to a miscarriage’
Today, on its website, BPAS describes an early medical abortion as being similar to a miscarriage, with cramping, bleeding and the loss of the pregnancy. To be fair, they have always been open about this.
Speaking to the Daily Mail in September 2001 about a ‘bedroom abortions’ trial run by BPAS, Ann Furedi insisted the process was “very close” to a natural early miscarriage. In a related piece on the same day she added: “We have allowed women … to … go home to miscarry in the privacy and relative comfort of their own homes.”
In August 2004, the Daily Mail wrote about a proposal from BPAS for women to be allowed to take the first pill in one of its clinics and the second at home. Ann Furedi said the scheme would “give women more control over their own abortion” and allow the most traumatic part of the procedure to take place in familiar surroundings. “They can use their own bathroom. The procedure becomes more normal,” she said.
In three years, this DIY abortion strategy had moved from the ‘bedroom’ to the ‘bathroom’.
Sit on the toilet, push, flush – don’t look
Many of the volunteers in our mystery client investigation were advised by the abortion providers to sit on the toilet and after passing the pregnancy, to flush it away, with no need to look.
Jane was told by the nurse:
“You’re going to have very bad period pains, cramping, clots the size of a 50 pence piece, quite bad bleeding, okay? … you’ll maybe see a sac, which is just like a bit of cling film… like a dischargy kind of thing. But fetus-wise, there’s nothing there. You won’t see a baby as such, you know what I mean? It’s completely not even there, do you know what I mean? It’s just going to be very, very heavy blood clots.
“And you’ll feel the urge to go to the toilet, go to the toilet, do what you need to do, and flush the chain. You don’t need to be looking around and searching for things, because you just want to pass it don’t you? So don’t be worrying about that, seeing things. It’s just cells honestly. It’s just cells.”
Ally was told:
“Okay, so bleeding, it’s the second part that causes the cramping and the bleeding, generally. And it would start averagely two to four hours after you put the vaginal tablet in. You’re likely to bleed heavily, okay? At that time. You may well see the products come away, you just need to get rid of your pads, same as you would any other. Some ladies actually pass it on the toilet, you can just flush it down. Size of an embryo at this stage… the embryo is about one and a half centimetres long.”
Gina asked her provider to tell her what she will see when passing the pregnancy.
“It will just be blood clots.
“What you can do to make it a bit more easier and more pleasant for you, when the pain gets really intense, that’s when you’re normally going to pass the pregnancy. So I normally suggest to clients sit, on the toilet seat, and let everything just fall in to the toilet.
“Rather than you having that in your pad.”
Gina asked for reassurance that she won’t see the fetus.
“You won’t recognise anything. Not if you’re seven weeks, no. It will just be clotting. If you’re eight, eight and a half, nine weeks, yes. You can do [recognise something].
“There is a heartbeat… it’s a human, but it’s just like really little.”
Find out more about DIY abortions