Abortion is a common gynaecological procedure experienced by around one in every three women of reproductive age, as shown in statistics for Scotland, England and Wales. The majority of abortions across the United Kingdom (UK) now use a combination of two medications, rather than surgical methods, which have become less common. The medications involved – mifepristone and misoprostol – are extremely safe.
Most abortions in the UK also take place before the 12th week of pregnancy. Since the Covid-19 pandemic, it has become increasingly common for those seeking abortion in the UK to self-manage the abortion process at home, rather than in a clinic or hospital. Clinics remain available when this is not a suitable or safe option (for example in situations of domestic abuse) and for abortions later in pregnancy.A
study carried out by Open University researchers highlighted several factors which
it may be useful and important for health professionals and those seeking
abortion to be aware of. The factors identified relate to how someone
self-managing abortion might be best supported; as well as the importance of effective
communication about pain and
other effects of the medications that might be experienced in the course
of medical abortion.
A key advantage of self-managed abortion is that it enables the person ending a pregnancy to do so in the privacy of their home. The women1 we spoke with in our study generally welcomed this option and talked positively about doing so. The study highlighted that feeling cared for during telephone consultations was important to a good overall experience. Participants appreciated compassion from health professionals, and emotional support eased their anxieties about self-management. A positive initial experience helped individuals to feel supported throughout the abortion experience.
Personal relationships and the comfort of the home environment can also play an important role during the abortion process. Participants appreciated support from partners, friends and family, which enhanced their overall sense of ease. However, some felt worried or uncertain about the abortion process itself, suggesting a complex mix of feelings may be common. An absence of sufficient in-person support, and difficulties in understanding written instructions, contributed to these feelings.
The study was conducted while restrictions relating to Covid-19 were in place. For some, the isolation created by the pandemic worsened feelings of loneliness and fear around their abortion. While this may have been magnified by the pandemic context, a sense of isolation can be a more general issue around self-managed abortion, and abortion more broadly. The stigma and taboo surrounding abortion mean those undergoing it may be reluctant to tell friends and family at a time when they could use additional support. Those self-managing abortion may feel concern, frustration, or uncertainty about what is ‘normal’, because of gaps in shared information and understanding. It is important that abortion services do as much as possible to offer clear, accessible information and support for self-management. Continued efforts to eliminate the stigma around abortion would also make a positive contribution to improving this situation.
Importantly, some had serious concerns that the intensity of the pain they experienced must mean something was going wrong. A mismatch between expectations and reality can be a significant problem. It may result in those undergoing abortion having a negative overall experience, with lasting effects, as well as being deterred from seeking abortion again in future.
Despite these challenges, most participants in our study firmly believed self-managed medical abortion should remain an option for anyone in the UK who needs to end a pregnancy in future. This highlights that, even when the abortion process is challenging, those who want or need to end a pregnancy are not deterred from doing so. Our research points to a need for improved pain management information and options, ongoing provider support, and maintaining surgical alternatives to medical abortion for those who prefer not to self-manage the process at home.
1 While we acknowledge that other genders also need support to access abortion services, we use the term ‘woman’ here as all participants in this study identified as cisgender women.
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