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Photography Gayatri Malhotra

How ‘pills by post’ revolutionised reproductive healthcare

The scheme, introduced at the start of lockdown, has been a lifeline for vulnerable people seeking abortions – but now it’s set to be scrapped in September

The start of the pandemic saw a win for many women across the UK: the introduction of the abortion ‘pills by post’ scheme. The service allows people in the early stages of pregnancy (up to 10 weeks) to have the two pills required to end a pregnancy delivered to their door, following a telephone or e-consultation with a doctor. Under the scheme, people could carry out their abortion safely and legally at home, without needing to attend a clinic. However, the scheme was always meant to be temporary; and last month, the public health minister Maggie Throup confirmed that it would be scrapped from September this year after a six-month extension. 

The decision has sparked outrage among campaigners, not least because in its first quarter, the scheme drastically decreased early medical abortion wait times to two days – a difference of 50 per cent compared with 2019. The scheme was clearly working: an initial report from The British Pregnancy Advisory Service (BPAS) showed that 97 per cent of clients were satisfied or very satisfied with their experience of the service.

Megan* used the pills by post scheme in May 2021. “I don’t think my anxiety would have allowed me to go to an appointment as I sometimes get anxiety so badly that I cannot leave the house,” she says. “I was almost scared into not having the abortion purely out of fear of judgement, but I was unfortunately not in a place where I could afford to have a child and I was not emotionally ready.”

She said it took around a week for her to build up the courage to contact BPAS. “They were incredibly helpful and the nurse over the phone was very kind,” says Megan. “She gave me very detailed instructions and sent them to me in an email as well as numbers for counselling services. I was able to take both pills when I was comfortable and ready.”

Leah* who used the service in November 2021, also suffers with anxiety. “The relief I felt when I knew that I didn’t need to go into a clinic or sit in a doctor’s office was indescribable,” she tells Dazed. “I suffer with anxiety anyway, so to know I could go through something so intense and potentially traumatic in the comfort of my own home and space really made me feel at ease.”

As well as helping those who suffer with anxiety, the scheme provided a lifeline to those who don’t live close to a clinic and aren’t able to travel to one by car, people on low income, full-time carers, and parents with no childcare support. 

“I began to feel pain around 20 minutes after taking the first pill,” Megan explains. “If I had gone to an appointment, this would have prevented me from driving home and due to buses taking 20 to 30 mins, I could have potentially had the embarrassing experience of heavy pain and blood loss on the bus.” Not only would this have been “embarrassing” – it would have doubtless been traumatic. “I was bed-bound for the whole day due to the pain and the thought of having to experience that process starting while in public is horrifying to me.”

“The relief I felt when I knew that I didn't need to go into a clinic or sit in a doctor's office was indescribable” – Leah

The decision also threatens the ability of people in domestic abuse situations to access abortion healthcare. Elizabeth Hart, a domestic abuse survivor and business owner, said the decision to scrap the scheme will have devastating consequences for women in abusive relationships. She tells Dazed: “When your world is made so small and restrictive, the benefits of being able to access an abortion pill by post is life-changing. From my own experience, the impact of having children with an abuser is that even when they have no interest in the children, they can and will use the children as a weapon and continue to abuse you.”

“The scheme has significant benefits to women and young women, and scrapping it highlights the government's inability to understand women’s needs,” she continues. “For vulnerable women, this could have life-changing consequences.”

Restriction to abortion pills by post won’t force people into unwanted pregnancies: as if someone wants to terminate a pregnancy, they will find a way – safe and legal or not. “Prior to the introduction of telemedicine, on average two women a day sought [illegal] online abortion medication due to barriers accessing in-clinic care,  including women experiencing domestic violence, who couldn’t risk attending an appointment for fear that their abuser would discover their pregnancy, and also women caring for disabled children,” explains Katherine O’Brie, associate director of communications and campaigns at BPAS.

“Since abortion remains in criminal law, ending a pregnancy using pills purchased online remains a crime carrying a sentence of up to life imprisonment,” she continues. “If the government does revoke permission for telemedicine in August, women would once again turn to illegal online pills.”

She adds that abortion services “will not cope” if the scheme is scrapped and all women are forced to return to clinics or hospitals regardless of clinical necessity. “There will be a very serious escalation in waiting times and staffing pressures, forcing women to undergo later surgical procedures. To deliberately compel services to run in a manner which is less efficient when there is no clinical or ethical reason to do so, seems to [BPAS] to be both indefensible and inexplicable.”

In a statement, the Department of Health and Social Care said: “Domestic abuse was raised as an issue in the public consultation [that sought views on whether to make measures permanent] and we intend to work closely with the Violence Against Women and Girls sector and the Domestic Abuse Commissioner to ensure safeguarding and domestic abuse are central to ongoing work. The wellbeing and safety of women requiring access to abortion services has been, and will continue to be, our first and foremost priority.”

The pills by post scheme are invaluable, particularly to the 2,000 people a week who have used the service since the start of the pandemic. As Megan says: “The scheme saved me from an unwanted pregnancy that could have changed my life, and I am very grateful I was able to have the option.” Leah echoes this: “I can't even imagine what I would've done if this scheme didn't exist,” she tells Dazed. “It provided such a necessary lifeline to me and so many women accessing this type of healthcare.”

*Names have been changed to protect identity