RCOG guidelines facilitate illegal abortion

The Royal College of Obstetricians and Gynaecologists (RCOG) has recently released new guidelines for healthcare professionals providing abortions since ‘DIY’ home abortion was legalised during the current coronavirus lockdown. The measures suggest ways to provide cover for women who break the law, including advice advocating for feticide and facilitating abortions past the new 10-week limit.

Andrea Williams, chief executive of Christian Concern, is calling for an ‘urgent review’ into the activism and campaigning role of the RCOG.

Kill first, remove later

The new guidance includes guidelines on performing feticide. This means actively killing the baby by lethal injection and then removing the body later. For women who contract Covid-19, the guidance suggests:

“If the pregnancy is at risk of being over 23 weeks’ gestation when the COVID-19 concern resolves (including time needed for cervical preparation):

…

• • If either clinical condition prevents an abortion or the woman is approaching the legal limit, perform feticide and manage the abortion after her condition stabilises.”

Similarly,

“If the woman’s clinical condition prevents abortion, and she risks exceeding the gestation limit, feticide should be performed in collaboration with local fetal medicine services if necessary, to enable delay in the procedure to evacuate / empty the uterus.”

And in order to ‘manage resources and workload’ during the current pandemic, the guidance suggests feticide for second trimester abortions as well:

“Second trimester medical abortions can be completed as day cases when the interval between mifepristone and misoprostol is 36-48 hours (mean induction to abortion time of 6–8 hours). Feticide is recommended at 22 weeks (22+0) or greater; this should be facilitated collaboratively with fetal medicine services.”

Facilitating illegal abortion

The guidance also facilitates illegal abortion at home, past the 10-week legal restriction.

At the end of March 2020, despite statements from the government to the contrary, abortion regulations were amended by the government to allow women to abort their child at home. The new regulations allow women and girls to take the two abortion pills up to 10 weeks into the pregnancy at home without attending a hospital or clinic first.

The new regulations make clear that doctors must carry out abortions “in line with the criteria set out” in the document released by the Department of Health and Social Care.

However, the RCOG guidelines go beyond the law, suggesting ways to provide cover for women who want abortions beyond the 10-week legal limit. In fact, the guidance seems to suggest that it is ‘inevitable’ that women past the 10-week limit will still be given the pills to abort their baby. Given that “there is no requirement for an ultrasound to determine gestation age for a doctor to authorise an abortion under the requirements of the Abortion Act 1967,” the guidance states that:

“Inadvertent treatment of gestations over 10 weeks is inevitable in some women, although the consequences for most are unlikely to be significant.”

It then continues by suggesting that neither the doctor nor the woman should face any legal consequences of having broken the law:

“There should be no legal consequences for either the clinician or the woman, even if gestation is unexpectedly advanced, when they can demonstrate that they have acted ’in good faith’. … It should be noted that terminations of pregnancy (of any gestation) carried out within the law are not subject to a child death review.”

Facilitating illegal abortion for women with Covid-19

The RCOG guidelines also suggest that a woman suffering from Covid-19 should have just as much access to abortion as anyone in good health. However, if the woman’s quarantine takes her over the 10-week limit, doctors can still facilitate an abortion for her, according to the advice:

“Given that it is especially important to reduce contact during the COVID-19 pandemic, providing a second dose of misoprostol for women to use 3–4 hours after the first dose if they have completed the abortion would seem prudent. If units do not have supplies of one additional dose of 400 micrograms and are unable to pack down their stocks of 800 micrograms, they should give two sets of 800 micrograms and advise the women to use this for a second dose if required. Higher doses (either one of 800 micrograms or two of 400 micrograms) may be particularly beneficial after 10 weeks if home use approval is granted at these gestations.” [emphasis added]

Investigation of 28-week home abortion

Evidence already suggests that home abortions are taking place illegally during the coronavirus lockdown. In May, police announced they were investigating the still birth of a child born at 28 weeks after the mother took abortion pills she had been sent by abortion provider BPAS through its ‘pills by post’ scheme – four weeks after the legal limit for medical terminations and 18 weeks past the 10 week restriction for home abortion.

At the time, BPAS announced that it was investigating at least 9 cases where the abortifacients had been prescribed beyond the 10-week limit. However, the new guidance suggests that there could be far more cases.

‘Far from impartial’

Andrea Williams, chief executive of Christian Concern, is now calling for an urgent review into the activism and campaigning role of the RCOG. She commented:

“It is shocking that a Royal College is blatantly suggesting ways to get around the law and giving ideas on how to provide cover for those who break the law.

“It exposes starkly the activist and campaigning role of the Royal College. Their role advising government, together with the major abortion providers, is far from impartial and needs to come under urgent review.”