Early medical abortion at home - future arrangements: consultation analysis

Introduction

Background to the Research

In Scotland, the majority (over 80%) of women opting for an abortion (also known as a termination of pregnancy) have an early medical abortion (EMA), i.e. an abortion in the first twelve weeks of pregnancy where the woman takes two sets of pills (mifepristone and misoprostol) to end the pregnancy (as opposed to a surgical abortion). Until late 2017, women were required to attend a hospital clinic on two separate occasions to take the two sets of pills. Since the end of October 2017, many women have been able to take misoprostol at home, but still had to attend a hospital clinic to take the first medication (i.e. mifepristone).

As a result of the COVID-19 pandemic, however, the way that EMAs were conducted was changed. In March 2020, the Scottish Government put in place an approval to allow eligible women to take both pills required for an EMA in their own homes following a telephone or video consultation with a doctor or nurse, and without the need to first attend a hospital or clinic for an in-person appointment. Both pills could either be collected from a clinic or sent to the patient via courier/post. This method of early medical abortion from home (EMAH) aimed to allow access to abortion services without delays, while minimising the risk of COVID-19 transmission.

After six months of operating these new EMAH procedures, the Scottish Government conducted a public consultation seeking views on whether the arrangements should be made permanent, or whether it would be preferable to revert back to the previous arrangements. The consultation ran from 30th September 2020 to 5th January 2021. It sought feedback on the impacts and risks associated with the current arrangements, as well as potential impacts on certain groups of continuing these arrangements (i.e. equality groups, socio-economic equality and for those in rural and island locations), and views on what the future approach should be.

Views were sought from both individuals and organisations via the Scottish Government's online consultation tool, Citizen Space. Due to the COVID-19 restrictions no face-to-face consultation activities or events were possible.

Respondent Numbers and Profile

A total of 5,607 responses were received, however, two of these were removed from the analysis for being invalid (one was blank and the other gave a response at Q1 only which was not relevant to the consultation questions). In addition, 68 sets of duplicate responses were identified (i.e. where the same individual had submitted two separate responses with the same content). These were reconciled into a single response for each while ensuring there was no loss of content.

As such, the final number of substantive responses included in the analysis was 5,537. This includes 5,465 responses from individuals and 72 from organisations.

More than half of the included responses (3,165) were submitted via email, although the majority of these (3,110) were generated by an organised campaign (discussed in more detail below). A further 2,329 responses were submitted via Citizen Space and 43 responses were received by post.

While respondents did not have to say whether they had any experience of abortion services, several did self-identify themselves as such within their responses. Overall, 46 respondents indicated that they had either had an abortion at some point in the past (n=34) or had experience of closely supporting someone who had had an abortion (n=12).

Most responses followed the standard format, although several were received which did not address the specific consultation questions and/or which provided views in relation to abortions more generally. All responses were considered by the analysis, with a synopsis of additional issues discussed included in the 'Other Comments' chapter below.

Campaign Responses

Several organisations (mostly pro-life) ran campaigns encouraging people to respond to the consultation. While some organisations may have encouraged their members/service users to participate, seven campaigns were identified where respondents followed some form of standardised response. Both standard responses (i.e. where answers were identical to the original materials) and non-standard responses (i.e. where responses followed the campaign text in places but not throughout and/or included additional information) were identified, as follows:

Campaign Responses

Campaign	Standard Responses	Non-Standard Responses
Right to Life	2780	363
Society for the Protection of Unborn Children (SPUC)	8	93
CARE: Short Version	1	16
CARE: Long Version	0	6
Christian Institute	0	24
Catholic Parliamentary Office	0	10
Engender, British Pregnancy Advisory Service (BPAS) and Amnesty International	0	40

Although many of the individual campaign responses were similar and made the same substantive points, they were classified as non-standard if the content of the response closely followed the original campaign material despite the phrasing being different, or if text had been taken verbatim but was supplemented with additional information.

Given the scale and level of detail provided in the Right to Life campaign, and the large numbers adhering to the standard response format in particular (i.e. accounting for 50% of all responses), dedicated coverage of this has been provided in Appendix A. The views provided by these respondents are also represented throughout the main body of the report for fullness, and in many cases were consistent with the views expressed by non-campaign respondents. When interpreting the results overall, however, it should be borne in mind that findings will be skewed by the large numbers of standard campaign respondents who answered each question.

As the other campaigns (and non-standard Right to Life campaign responses) were smaller in scale, with individuals often offering unique responses, a dedicated synopsis has not been included for each. Those who provided non-standard responses often focused on fewer points than the full campaign, or provided additional information, discussed additional topics, or deviated from the campaign response entirely at individual questions. This means that a synopsis of these campaigns would not fully represent the individual contributions that were made. In addition, the issues discussed by the campaign respondents were typically highlighted in other, non-campaign based responses, therefore, providing a synopsis for each campaign would increase repetition within the report and would perhaps overstate the various points raised.

Organisation Responses

Although organisations were not required to identify which sector they represented within the consultation response, most provided their organisation name. This allowed for organisations to be categorised into sectors during the data cleaning phase. The number of organisations per sector are outlined below.

Organisational Sectors

	Number	Percent
Pro-Life and/or Faith Groups	31	43%
Professional Bodies (including Royal Colleges, Professional Organisations of Healthcare Providers, Universities/Academic Bodies, Trade Unions and Voluntary Sector)	13	18%
Healthcare Providers (including NHS, Third Sector and Private)	12	17%
Women's or Abortion Support Groups	12	17%
Other	3	4%
Not Specified	1	1%
Total	72	100%

Analytical Approach

The analysis of the responses was carried out by Wellside Research. Wellside Research was contracted to prepare this report on behalf of the Scottish Government, but carried out the analysis independently.

All responses were logged into a Microsoft Excel database and screened to identify any campaign, blank, non-valid (i.e. where responses were not relevant to the current consultation), or duplicate responses. These responses were categorised, removed or cleaned as detailed above. Remaining feedback was then analysed, and is presented under the appropriate sections below.

Closed question responses were quantified (in Excel) and the number of respondents who selected each response option reported.

Qualitative comments given at each question were read in their entirety and manually examined to identify the range of themes and issues discussed. Microsoft Excel was used to record and quantify responses (where possible) as positive, negative and mixed at some questions (i.e. Q4, Q5 and Q6). Analysis was also conducted to identify any differences in views between respondent groups (i.e. between individuals and organisations, or between organisational sectors). Recurring themes which emerged throughout the consultation were recorded, and verbatim quotes were extracted in some cases to illustrate results. Only extracts where the respondent consented for their response to be published were used.

Caveats and Reporting Conventions

Findings are presented as they relate to each question in the consultation. Where individual respondents offered views at the open questions that differed from those submitted by organisations, or where views differed between the different organisational sectors, this was identified and outlined in the narrative of the report.

It should be noted, however, that there was substantial consistency between the views of individuals and organisations, with responses split typically by whether respondents were supportive or not of the EMAH approach. For example, pro-life and faith organisations views were largely consistent with those individuals who were against the current arrangements (or abortion more generally), while healthcare providers were largely supportive. Within organisational categories there were also splits in opinion, again based on the nature of their work and the experiences of their client base. For example, women's and abortion support services were split between those in favour and those against, depending on whether their role facilitated access to choices for women in healthcare or those who tended to support women who had had traumatic experiences as a result of the abortion process.

Some respondents opted not to answer closed questions, but did offer open-ended responses to the same question meaning that there was not always a direct corelation between the number of people who supported/did not support a particular statement and the number of people who gave a qualifying comment. For fullness, all responses were included in the analysis, even where the closed component of the question had not been answered.

There was also considerable overlap in the issues discussed by respondents selecting different closed response options within questions. For example, those selecting there were no impacts, mixed impacts or stated they did not know, often provided qualitative comments which focused on similar issues to those who had felt the impacts were positive or negative. In order to avoid repetition, the issues raised in the qualitative comments have been summarised under the relevant positive or negative headings, irrespective of the closed option selected at each question.

In addition to the campaign responses that were identified, there was also evidence of respondents co-ordinating or sharing responses more generally. This was evident between organisations who cited information or arguments provided by others or provided the same information in the same way as part of their answers, and individuals who appeared to have consulted organisations' responses to inform their own.

The purpose of this report was to detail the various issues and topics identified and discussed by respondents. As such, the views presented represent those of the respondents and not the authors or the Scottish Government. It should also be noted that inaccuracies in the information presented by respondents may have been retained. While every effort has been made to fact-check such information and caveats have been included where appropriate, this has been retained as it represents the views and opinions of those respondents. Similarly, while terminology may not be medically accurate in places, the report largely retains the terms and wordings commonly used by respondents throughout.

It should be noted that, consistent with the consultation paper, this report refers throughout to 'women' accessing abortion, but this is intended to refer to any patient who may seek an abortion, regardless of their age or gender identity. It is understood that some trans-men and non-binary people could also require access to abortion services.

Further, the term EMAH (early medical abortion at home) has been used throughout to refer to the current arrangements in place for early medical abortions, i.e. for all aspects of the service to be accessible from home.

Many respondents referenced external sources to support their responses. The content of these external resources was not analysed here, but a full list of these references was provided separately to the Scottish Government for consideration.

The findings here reflect only the views of those who chose to respond to this consultation. It should be noted that respondents to a consultation are a self-selecting group. Therefore the findings should not be considered as representative of the views of the wider population.