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7 August 2006

Increase in early medical abortion: A good news story

By Ann Furedi, chief executive of bpas.

The British press always gets itself in a tangle over abortion, largely because it tries to follow public opinion and public opinion is muddled. Nobody likes the idea of abortion but most people think it is necessary – ‘the least worse option’ for a woman with an unwanted pregnancy. Most people want abortion to be provided safely and legally and preferably as early in pregnancy as possible.

Typical media muddle-headedness was expressed in the Times (London) on 29 May. News that the number of women using early medical abortion (EMA) was rising rapidly – the subject of discussion at a bpas medical conference on 30 May – was reported on the Times front page. Inside the paper, a leader column argued that ‘the popularity of early medical abortion should prompt soul-searching….’

The fact that in 2005 the number of women using EMA, also known as the abortion pill, at bpas clinics had doubled to 10,000, and that the charity, which provides a quarter of all British abortions, was seeing 65 per cent of clients in the first nine weeks of pregnancy – up from 56 per cent the year before – could and should have been an unequivocally ‘good news story’.

Early medical abortion is when a woman takes a pill that results in the ending of her pregnancy. It is recommended by medical organisations as the best way to end a pregnancy in its earliest weeks. It avoids any surgical intervention, which reduces the risk of complications, especially infection. It is also cost effective for the National Health Service because it doesn’t involve the use of theatres, gynaecologists or anaesthetists. The woman attends her clinic to be provided with the necessary medication and then returns home where she loses the pregnancy, much as she would do if she were to have a spontaneous miscarriage.

The use of early medical abortion also allows women to access services more quickly. Doctors are sometimes reluctant to carry out surgical abortions at very early gestations, because it is more difficult for them to be sure they have completed the procedure – but with early medical abortion, earlier is always better. And this in itself makes it preferable for many women. Today’s pregnancy tests can confirm a pregnancy even before a woman has missed her period, and most women wanting abortion care want it as soon as possible. Preferably yesterday.

Improving access to early abortion is central to the UK government’s sexual health strategy. Local Primary Care Trusts (PCTs) have been given additional funding to help them achieve targets for the number of abortions that are carried out before 10 weeks of pregnancy, and access to the abortion pill is widely understood to be a means to achieve this*. The Department of Health has specifically advised PCTs that they should ensure women have the option of the abortion pill.

So why the soul searching? The Times leader said: ‘The rise in EMA’s popularity may be explicable; it is not necessarily to be welcomed. Parliament has repeatedly reaffirmed a woman’s right to choose. Such a choice must never be easy.’ Why not? The Times also said that the abortion pill has many critics who say that EMA ‘could give rise to a false impression that an abortion even in the early stages of pregnancy is relatively simple without physical or psychological risk. This is not true.’

Well, actually it is - almost. Of course, no medical procedure is entirely risk-free, but the risks of early medical abortion are extremely small and considerably less than the risks of pregnancy. And studies have shown repeatedly that early abortion of an unwanted pregnancy does not put women at risk of psychological damage.

The ‘many critics’ who disturb journalists so much are not just concerned about the abortion pill but about abortion in principle. They are horrified by the existence of a drug that makes the experience of abortion easier for women. This agenda was challenged in a forthright column by Times science editor, Mark Henderson, on 3 June. Questioning the ‘real motive’ of the abortion pill’s critics, Henderson argued that clinics ‘are open about the fact that EMA causes painful cramps and heavy bleeding, and sometimes infection, and advise patients accordingly. If anything, the drugs increase a woman’s personal responsibility for her abortion: she must actively take a pill and a pessary, instead of submitting herself to a procedure performed by a doctor. It is hard to see how this encourages cavalier decisions to terminate.’

Michaela Aston, a spokeswoman for the anti-abortion organisation LIFE, told the Times that ‘RU486 is a powerful and dangerous cocktail of drugs.’ She claimed it had been responsible for the death of at least ten women and that the US Food and Drug Administration was currently considering a ban because of safety concerns. Such assertions, wrote Henderson, are ‘misleading to say the least.’ While it is true, he said, that the FDA is reviewing the drug, and convened a scientific conference on EMA in May, such monitoring is ‘common practice’ for any drug; and while the conference called for more research into Clostridium sordellii, a rare bacterial infection implicated in all five US deaths, it did not come close to recommending a ban.

For Henderson, the most striking evidence about the safety of EMA comes from ‘the vast number of women’ who have used it since the early 1990s: ‘In Europe, the drugs have been taken by over two million women and there have been only three confirmed deaths. In the US, over 500,000 have used them, and five have died’. He continues: ‘The makers of many other medicines would be delighted for a safety profile like this: Viagra’s associated death rate is at least five times higher, at 5 per 100,000 prescriptions.’

The critics of Early Medical Abortion are entitled to their views. It is understandable that if you believe the destruction of fetal life is evil, you will oppose the use of a pill that allows this to be achieved more easily. That is honest opposition. What is dishonest, however, is to brief journalists that women can’t cope with the experience, or that women’s health is harmed. It is fair enough to say the abortion pill is wrong, if you believe that; it is intolerable to claim that it is unsafe.

Medical abortion is not new. Women have tried to use herbs and medicines for abortion for as long as they have wanted to end pregnancies. Evidence that women used abortifacient herbs dates back to the Egyptians. In the past, though, the success of the methods were somewhat hit and miss; usually more miss. Beecham’s remedies never have been an effective way to interrupt a pregnancy; other more traditional folk remedies, such as ergomot, may have achieved the desired result sometimes, for some women. Today, however, women can legally access a safe, reliable, effective method of medical abortion. The latest figures show that they are doing so in ever-growing numbers.

No woman ever wants to have an abortion. It is the solution to a problem they wish they didn’t have. Most women struggle with their decision to end a pregnancy. The availability of the abortion pill does not make their decision easier. It may, however, make the process easier. And why should that be wrong?

*For details of the NHS funding to increase access to early abortion services see: Resource and cash limit adjustment in respect of improvements in early access to abortion services 2005/06, published 29 Sept 2005.

‘Abortion pill allows faster, earlier abortions’ say bpas doctors, bpas, 29 May 2006; Abortions at home for 10,000; Leader: Bedroom abortions; Treatment by tablet offers women the safer option, all from The Times, 29 May 2006; Junk medicine: early medical abortion, The Times, 3 June 2006; What’s wrong with ‘do-it-yourself’ abortions? spiked, 5 June 2006.

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