Early medical abortion at home - future arrangements: consultation analysis

Conclusion

The public consultation exercise elicited feedback from a large number of respondents, covering both individuals and organisations with an interest in the provision of EMAs.

The number of those against EMAH was significantly higher than those in support of it. However, it should be noted that a large number of the respondents who were against EMAH had either submitted a campaign response or had been influenced by one of several campaigns organised by pro-life or faith groups. Further, a significant proportion of those against EMAH were also against any and all forms of abortion and, as a result, some of the concerns raised were more applicable to abortion generally, rather than being specifically related to EMAH.

Common Issues

A range of views were offered consistently throughout the consultation questions, with feedback being split generally based on whether respondents were supportive or against EMAH. This was true for both individuals and organisations, and so differences were largely observed on this basis rather than between individuals and organisations or by organisational sector.

Common Concerns

Key areas of concern for women and pregnant people accessing EMAH, which were discussed in several areas across consultation responses, included perceived reductions in safeguards with regards to both the administration of the medication and the physical and psychological safety of the patient. It was argued that the EMAH method removed too much of the oversight and control from medical professionals and placed women at much more risk as a result. Respondents also felt that the EMAH approach did little/nothing to support women with any immediate or future psychological impacts (which were either related to their reason for the crisis-pregnancy, or resulted from undergoing the abortion).

It was felt that the EMAH model did not provide sufficient information or support for women to access alternative options/services which may be more appropriate for them, and did nothing to tackle the root causes of crisis-pregnancies in order to provide a longer-term and more positive outcome in the future. Rather, many considered that it provided a 'quick-fix' which was largely inappropriate.

Reasons for Support

Those who were largely supportive of the EMAH approach argued that this was safe and involved no greater risks than the previous EMA model (indeed some argued that EMAH could be safer), that complications were rare, and that the teleconsultation method had been demonstrated to be successful in identifying (and had provided patients with the confidence to disclose) abuse and coercion.

They felt it provided a more patient-centred service where women were afforded greater autonomy over their bodies and healthcare. Indeed, a few suggested it helped to redress the way women were treated within a patriarchal society/system. Further, EMAH was considered to provide greater access, particularly for vulnerable patients and those who had previously found access to abortion difficult or impossible. EMAH was applauded for meeting the aim that 'abortion services should be accessible and free from stigma' as EMAH had improved accessibility, but also allowed patients to avoid the judgment and 'harassment' of pro-life/anti-abortion campaigners who can be gathered outside abortion clinics.

Going Forward

Preferences were split in terms of what the arrangements for EMA should be once COVID-19 did not represent a significant safety risk. There was a clear preference for the previous arrangements to be reinstated when all responses were considered. However, this was driven largely by the Right to Life campaign, and respondents in this cohort wanted tighter restrictions with the administration of both sets of medication being supervised in a clinic/hospital (and so does not truly represent a return to the previous arrangements). When looking at the responses of the other respondents, there was a reasonably even split between those wanting to retain the current EMAH model and those who sought 'other' models - which ranged from the provision of a blended service offering, providing more information and support, through to returning to a more clinically based approach or even revoking the Abortion Act 1967. Even for those who supported EMAH, however, it was important that choice was provided, and therefore, it was felt that both in-person and at home methods should continue to be offered.

Overall, the consultation elicited considerable levels of feedback on the EMAH approach and preferences for future provision. The Scottish Government intends to consider this feedback, alongside any other evidence that is available, ahead of making any decisions as to the nature of future EMA provision. However, it should be noted that several respondents felt that the consultation paper lacked sufficient details regarding robust data and evidence, and so there may be a case for delaying any decision on the future arrangements (after COVID-19 no longer presents a significant risk) until more data becomes available and greater levels of research have been undertaken to establish the impacts of the current EMAH arrangements.