Early medical abortion at home

Women’s Health Minister Maree Todd has confirmed that early medical abortions will be able to continue at home, where it is judged clinically appropriate.

During the pandemic, women have been able to take both sets of pills required for an early medical abortion at home (EMAH).

Ms Todd said:

“We have seen that current arrangements for EMAH have helped access to abortion to continue without delays during the pandemic. I am satisfied that current arrangements should continue so today I am confirming that the provision of these services to continue as part of the standard treatments available within our NHS, when clinically appropriate.

“As with all treatment in the NHS, we will continue to monitor its outcomes and any findings of the ongoing expert evaluation being carried out by health professionals and researchers.”

Chief Medical Officer Professor Sir Gregor Smith said:

“The arrangements put in place from March 2020 have allowed patients to take both abortion medications, mifepristone and misoprostol, at home in certain circumstances as coronavirus has been considered a serious and imminent threat to public health. 

“Our primary concern is that services remain both safe and meets the needs of patients. That’s why we will ensure that any lessons from the ongoing evaluation of EMAH by NHS Lothian, NHS Greater Glasgow & Clyde, and the Universities of Edinburgh and Glasgow are reflected in the future.”

Background

The consultation on arrangements for EMAH once coronavirus (COVID-19) is no longer a significant threat was launched on 30 September 2020 to consider the longer-term arrangements for EMAH - Early medical abortion at home - gov.scot (www.gov.scot).  This evaluation is expected to be completed before the end of this year.

Text of the Letter to Committee 12 May 2022

I am writing to update the Committee on early medical abortion at home (EMAH) as I am aware that many Committee members have shown an interest in this matter.

As the Committee may be aware, in March 2020, the former Minister for Public Health issued a revised approval which allows patients to take both abortion medications, mifepristone and misoprostol, at home in certain circumstances whilst the coronavirus is considered a serious and imminent threat to public health.

Prior to that, patients could take the second abortion medication, misoprostol, at home, but needed to take mifepristone in a hospital clinic.

This approval was accompanied by guidance from the Scottish Abortion Care Providers network, which sets out the circumstances where patients can take their medication at home if they are under 12 weeks’ gestation (see https://www.sehd.scot.nhs.uk/cmo/CMO(2020)09.pdf for a copy of the approval and guidance).

In September 2020, the Scottish Government launched a consultation on the future arrangements for EMAH, which closed in January 2021.

A copy of the analysis of consultation responses is available online at https://consult.gov.scot/population-health/early[1]medical-abortion-at-home/.

This found that there were very strong views expressed both for and against continuing current arrangements and conflicting evidence was provided by respondents.

As a result, I announced last year that the Scottish Government was commissioning a clinical evaluation of early medical abortion at home to provide additional evidence to allow the Scottish Government to decide whether or not current arrangements should continue long-term.

NHS Lothian is leading this evaluation with partners from the Universities of Edinburgh and Glasgow and NHS Greater Glasgow and Clyde.

The evaluation will consider data regarding the safety of current EMAH arrangements, patient views, views of NHS staff working in abortion services and reviewing the procedures of each NHS Board to identify areas of good practice.

It is expected to be completed before the end of this year.

The March 2020 approval remains in place, but given that coronavirus infection rates and hospitalisations due to Covid-19 have been reducing, the Scottish Government is conscious that it may not be possible for NHS Boards to consider that the coronavirus continues to be a serious and imminent threat to public health throughout the duration of the EMAH evaluation.

Based on the views of the Royal College of Obstetricians and Gynaecologists and the Faculty of Sexual and Reproductive Health I consider that the current arrangements should be able to continue, but I will review the arrangements once the evaluation has been completed.

Therefore, I can confirm that I will soon be issuing a revised approval under section 1(3A) of the Abortion Act 1967 to allow mifepristone to continue to be taken at home in Scotland where this is considered clinically appropriate and this will no longer be reliant on whether the coronavirus is considered a serious and imminent threat to public health.

This approval enables the provision of these services to continue as part of the standard treatments available within our NHS, when clinically appropriate.

As with all treatment in the NHS, we will continue to monitor its outcomes and any findings of the ongoing evaluation being carried out by NHS Lothian.

I hope this information is helpful to clarify the Scottish Government’s position.

Yours sincerely,

Maree Todd MSP