What do new abortion figures from Scotland reveal?

Independent public health consultant Kevin Duffy writes on new abortion data from Scotland.

On 25 May 2021, Public Health Scotland (PHS) released its official abortion statistics for the year ending December 2020.

You may have already read that in 2020 there were a total of 13,815 abortions, the highest annual total since 2008, and that 36% of these were repeat abortions, which continues an increasing trend year-on-year. In this short post, I want to address the abortion rate and the increased number of abortions at home.

Abortion rate in Scotland

In Scotland, the 2019 abortion rate was 13.2 abortions for every 1,000 women aged 15 to 44; the equivalent rate in England and Wales was 18.6, which is 40% higher. It would be extremely helpful to uncover the social, economic, and cultural drivers which influence these rates, as had the rate been the same in England and Wales as in Scotland, there would have been 148,000 abortions rather than the historically high number of 209,519; a potential of 61,000 deaths averted.

At the end of March 2020, the government approved a woman’s home as a place in which both abortion pills (mifepristone and misoprostol) could be taken, and permitted consultations by phone rather than requiring women to visit abortion clinics. In Scotland in 2020, 36% of all abortions (5,062) were by telephone, meaning that these women did not visit a clinic and did not have the prior routine clinical assessment of eligibility for the medical abortion procedure. In the same period, 75% of all abortions (10,300) were completed by women self-administering misoprostol at home; this is a significant increase from 43% in 2019, no doubt driven by the political approval for telemedicine abortion as a temporary measure to safeguard against the Covid-19 pandemic.

Later telephone abortions

In Scotland, a woman is permitted to have a telephone abortion at home up to the start of her twelfth week of gestation (11 weeks and six days from the first day of her last menstrual period). This is different from the approval in England and Wales, where the limit is 9 weeks and 6 days. This difference is important, and it needs our careful consideration.

As a woman approaches her twelfth week of pregnancy, she is usually preparing for her first antenatal visit with her midwife, at which she will have her first ultrasound scan and shortly after that visit she will happily make her first announcements to family, friends, and maybe even to her employer. By this stage of pregnancy, the baby is fully formed, all the organs, muscles, limbs, bones, fingers, and toes are in place, and the sex organs are well developed.

In Scotland in 2020, there were 1,707 abortions at gestational ages of more than 10 weeks. More than 800 of these were performed by the woman herself at home, using the PHS officially approved EMAH (Early Medical Abortion at Home) procedure. That is more than two women each day, choosing to end the life of their baby at a stage of development when the baby is fully formed, needing only to continue growing and maturing before his/her natural birth. By the end of this permitted period, 11 weeks and six days, the baby is about 7.5cm long and weighs about 18g, so they would certainly be visible and identifiable when passed by their mother under the contractions caused by the misoprostol; little wonder then that abortion providers advise women to sit on the toilet and to flush without looking.

A caring nurse with a few pills?

An ex-colleague of mine recently tweeted: “A caring nurse with a few pills and a kind word is the 21st century norm in abortion care.” I do not agree; that is not what I am seeing and it is not what these official data tell us. Every day across Britain, women are doing it by themselves, there is no caring nurse alongside them and no kind words. Women are being left alone by those charged with their care. This is not a norm which I am prepared to accept.

It is shameful that our society not only permits DIY abortion at home but that many are willing to celebrate and shout about it. Abortion is never the right answer for any woman, and we should all want better care for all women facing these difficult life choices.