Guest Column

At least 39,000 women treated for DIY abortion complications in five years in UK

pregnancy resource center

(Percuity) In the last five years across England and Wales, at least 39,000 women have been treated at NHS hospitals for complications arising from failed or incomplete DIY medical abortions at home; in the past, these complications would have been treated at the abortion providers’ facilities.

Five years ago, abortion was only provided at approved abortion facilities. On 27 December 2018, the Secretary of State for Health and Social Care permitted women to self-administer the second part of a medical abortion, misoprostol, at home. At the end of March 2020, in an emergency response to Covid-19 lockdowns, the Secretary of State expanded this permission to allow women to self-manage both parts of a medical abortion, mifepristone and misoprostol, at home.

The Royal College of Obstetricians and Gynaecologists (RCOG) warns that up to 1% of all medical abortion cases fail, meaning that the woman is still pregnant after taking both the mifepristone and misoprostol. RCOG also says that medical abortion can be incomplete in up to 6% of cases, leaving parts of the placenta and/or embryo in the uterus, a complication referred to as retained products of conception (RPOC), which requires the woman to seek further medical attention. The stated complications rate of 6%, 1-in-17 of women using medical abortion, is consistent with the rates published by the manufacturers of mifepristone, as detailed here.

Abortion providers and the DHSC have been under-reporting these complications; earlier this year, Lord Jackson tabled several written questions to the Department about this. In response, Lord Markham, Parliamentary Under-Secretary Department of Health and Social Care, acknowledged the gaps in reporting by providers under the Abortion Notification System and noted that complications are recorded in a different system, Hospital Episode Statistics, when a woman presents for treatment of RPOC at an NHS hospital. Lord Markham went on to say: “To improve the quality of data available on abortion complications, the Department is taking forward a project to improve our understanding of the data.”

That project culminated in a report published by OHID on 23 November 2023, that provided statistics for the numbers of women being admitted for inpatient treatment of abortion complications. When a woman presents at A&E with retained products of conception from an incomplete abortion, one of three different treatments will be provided. The first two of these are outpatient treatments, one in which more misoprostol is administered and the other taking a wait and see approach, referred to as expectant management. The inpatient treatment, a surgical evacuation of retained products of conception (ERPC), is the one reported by OHID. Our Analysis of this report and its data showed that 2.8% of women self-managing their medical abortions at home were subsequently admitted as inpatients for ERPC, meaning that 3.2% (making a total of 6%) would have been treated as outpatients. These treatment rates are consistent with the findings from our FOI investigation.

The OHID statistics for the first half of 2022 show an increase of 17% compared to the same period in 2021. Both BPAS and MSI Reproductive Choices have indicated that this sharp increase continued throughout the second half of 2022, and into 2023. MSI-RC recently submitted written evidence to Parliament in which it reported a 32% increase in the first period of 2023 compared with the same period in 2022. These are unprecedented increases but not yet reported in official data.

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