In the judicial review of the government’s decision to allow home abortions this week, the government revealed the advice it received to make this decision.
Insider’s expert witness statement
The judicial review was supported by an expert witness statement from Kevin Duffy. Kevin Duffy began his statement by explaining that he is a former director of a major abortion provider, Marie Stopes International. He is therefore an insider from the abortion industry. Mr Duffy was appointed in November 2014 as the director responsible for the development and implementation of Marie Stopes International’s global clinics standard operating procedures manual. This is an extremely influential position in Marie Stopes. He became an independent consultant to Marie Stopes International from March 2017 to February 2019. Whilst working for Marie Stopes he travelled to fifteen different country programmes and conducted management review visits of more than 100 abortion clinics.
The need for a clinical visit
Civil Servant, Andrea Duncan, provided a witness statement for the government. She is the Head of policy for Alcohol, Sexual and Reproductive Health (which includes abortion policy) and Physical Activity in the Healthy Behaviours Team in the Department of Health and Social Care. Her statement was made to explain the government’s decision to grant approval for home abortions.
Andrea Duncan omitted the key reasons why a clinical visit has been required before the first abortion pill is prescribed. Her statement made it appear as if the clinical visit is merely to collect the pill. In fact, as Mr Duffy explains in his witness statement, various clinical assessments are made in that visit, including an ultrasound scan and a blood pressure check, blood tests, and various other tests. The ultrasound scans, in particular, enable an accurate assessment of the gestational age. Without this, the gestational age is an estimate based on the mother’s recollection of when her last period was. The new regulations only allow home abortions for less than 10 weeks gestation. As the gestational age increases, so do the risks of side-effects. Ms Duncan omits to mention any of the clinical tests that are routinely carried out and important to assess the risks of the pills for the patient. Therefore, there is no mention of the increased risks to the mothers of not having a clinical assessment as a result of the new regulations.
Advice to the government omits to mention any clinical assessment
As part of its defence, the government also released the submission to the Secretary of State requesting approval of home abortions. This submission also failed to mention any clinical assessments on the first visit. It stated:
“Women attend a clinic where they take the first pill (mifepristone), and then have the option of either returning to the clinic to take the second pill, or taking the second pill at home.”
This advice to the government was misleading. It made it appear that there are no clinical implications arising from not having a clinical visit before taking the first pill. Again, in another paragraph, the submission to the Secretary of State said:
“However, all women must attend a clinic or hospital in person at least once, to take the first pill.”
As previously noted, this makes it appear as if the only purpose of the clinical visit was to take the pill, when in fact important clinical assessments are made on that visit.
It gets worse; the submission to the Secretary of State says:
“This approval would enable a woman to be assessed via telemedicine, following which both abortion pills would be prescribed, dispensed by a pharmacist and posted to the woman. The consultation would be equivalent to the current in-person consultations.”
But it is not true that a telemedicine assessment is the equivalent to the in-person consultations. The in-person consultations include clinical assessments which are not possible with telemedicine. This crucial fact was omitted and the advice to the government was therefore incorrect.
BPAS also misled the government
The government also produced a letter from the UK’s leading abortion provider, BPAS, addressed to Matt Hancock asking him to approve home abortions. The letter states:
“This would remove the requirement for women … to attend a treatment unit for the sole purpose of ingesting the mifepristone tablets.”
Once again, this is incorrect. The purpose of attending clinic is not for the sole purpose of ingesting tablets. Important clinical assessments are undertaken. The BPAS website stated this at the time. BPAS may well have deliberately misled the government on this point.
Evidence highlighting safety risks omitted
In her evidence, Ms Duncan cited a NICE review of abortion services by telemedicine which found that telemedicine abortions would increase access to abortions and save costs. Mr Duffy explains that there are several other studies which could have also been included “in the interests of balance.”
In particular, Mr Duffy cites a study on the safety and acceptability of telemedicine abortion published by BJOG in 2018. Key points highlighted from this study include:
- 45% of women at <=9 weeks gestation reported their rate of bleeding was higher than expected.
- One third of all women reported their rate of pain was higher than expected.
- One-in-nine women taking the abortion pills at home required surgical intervention to complete their abortion.
- The higher the gestation age, the greater the risks involved, and with telemedicine the gestational age cannot be accurately assessed.
The portion requiring surgical intervention was much higher than expected.
The government should reverse its decision
The government made the decision to allow home abortions on the basis that the sole purpose of an in-person consultation was to ingest pills. This is false and misleading. The government was also not informed about the safety risks concerned for the women taking these tablets without any clinical assessment. The government should therefore reverse its decision and require a clinical consultation before abortion pills are prescribed.
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