Caroline Johnson: It’s time to stop the “pills by post” system for abortions

Dr Caroline Johnson is a Consultant Paediatrician and the Conservative MP for Sleaford and North Hykeham

MPs are about to consider the sensitive subject of abortion when amendments to the Crime and Policing Bill are debated.

Abortion is a complex subject that divides people. However, I hope every MP will agree, whatever their personal views, that safeguarding considerations are paramount and we have a responsibility to ensure women who access abortion services are kept safe.

It is for this reason that I have tabled an amendment to the Crime and Policing Bill that would reinstate prior in-person consultations for women who wish to have an abortion. Face-to-face appointments were mandatory until the pandemic when the ‘pills by post’ scheme, which allows women to obtain abortion pills via telemedicine and then take them at home, was introduced as a temporary measure. Following a government consultation which found that 70 per cent of respondents believed the scheme should end after the pandemic, the government announced in-person appointments would return from summer 2022.

However, this decision was narrowly overturned via an amendment tabled to the Health and Care Bill in March 2022, which made the pills by post scheme permanent. I was very concerned about this at the time and sadly my concerns have been borne out in the years since.

Restoring the requirement for in-person appointments would allow clinicians more easily to assess the possibility of coercion or abuse, as well as being able to accurately assess a woman’s gestational age and any health concerns.

Without an in-person appointment, there is no guarantee that abortion pills won’t fall into the wrong hands. Six months ago, Stuart Worby was jailed after persuading a friend’s girlfriend to phone up an abortion provider, pretend to be pregnant and obtain pills which Worby then used to induce a woman to have an abortion against her will or knowledge, after spiking her drink.

In-person appointments would prevent cases like this by allowing medical professionals to ensure a woman seeking abortion pills really is pregnant and is seeking pills for her own use. The privacy of a one-to-one appointment also allows clinicians to check whether a woman is being coerced into an abortion against her will or if she has become pregnant as a result of abuse or trafficking. A lack of in-person consultations enables such abuse to be covered up more easily.

Safeguarding not only involves assessing any signs of abuse but also protecting women from the dangers associated with taking abortion pills later in pregnancy. There have been rare, high-profile cases of women misleading abortion providers about their gestation. However, pregnant women are sometimes genuinely unaware of their true gestational age and may think their pregnancy is at a much earlier stage than is the reality. Without an in-person appointment, whereby gestational age can be reliably assessed, it is impossible to detect such cases. In the debate that preceded the pills by post scheme being introduced permanently, I pointed out that some women bleed in the early stages of pregnancy and mistake this bleeding for a period, meaning they underestimate their baby’s gestational age.

When it comes to abortion pills, such checks are essential since, after ten weeks, the law does not allow abortion pills to be taken outside of a clinical setting because of the increased medical risks associated with doing so. For example, a November 2023 government review found that the complication rate for medical abortions after 20 weeks occurring in clinical settings is over 160 times higher than for medical abortions under 10 weeks.

Finally, in addition to detecting coercion and assessing gestational age, my amendment would ensure any medical risks can more easily be picked up. Last year, the Irish Medical Journal published a paper that described how a woman almost died from an ectopic pregnancy after having a medical abortion. The paper explained that the incident “could have been prevented by an ultrasound”.

My amendment is neither pro-life nor pro-choice.

It is a simple matter of safeguarding women and returning to what was standard practice, for good reason, before the pandemic. Indeed, my proposal is deliberately moderate: it would not prevent women from continuing to be able to take both sets of abortion pills at home. It simply seeks to ensure an in-person appointment first.

I am aware that other amendments relating to abortion have been tabled to the same Bill, also in the name of protecting women. My concern with these, whatever the intention, is that they could actually put women at greater risk by removing a deterrent against taking pills later in pregnancy. Given the aforementioned risks with this, if we wish to protect vulnerable women, there is a better way: to ensure access to abortion pills is more responsibly regulated.

Safeguarding ought never to be sacrificed for convenience or the sake of ideology – we have a duty of care towards all patients at all times.

It is time to put women’s safeguarding first and reintroduce in-person consultations. I am delighted that around 40 colleagues from six parties have already agreed to support my amendment. I hope many others will choose to do the same.