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Health & Fitness A Really Useful Explainer On The Abortion Pill, Including How To Get It By Post

19:15  10 july  2020
19:15  10 july  2020 Source:   elleuk.com

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a close up of a person sitting on a table: Everything you need to know about the abortion pill otherwise referred to as a medical abortion. Learn about the 'pill by post' scheme and the pill's risks. © Grace Cary - Getty Images Everything you need to know about the abortion pill otherwise referred to as a medical abortion. Learn about the 'pill by post' scheme and the pill's risks.

Our ability to offer abortions is a vital part of healthcare and cements the right among women and girls across the world to make decisions about their own bodies.

It’s estimated that that one in three women in the UK will have an abortion by the time they’re 45.

Knowing this, it is essential that we are as informed as possible about what abortions are, the different ways a woman can undergo a termination, how to access the health service and what the process entails.

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As well as more invasive procedures, if a pregnancy is at an early enough stage, one of the types of termination offered is the 'medical abortion', which involves taking two different medicines in tablet form, to end a pregnancy.

From how an abortion pill works and how to organise a termination, to the cost of an abortion pill and understanding the ‘pill by post’ service, we’ve rounded up everything you need to know about this form of termination.

What are the different methods of abortion?

The are two main types of abortion: a medical abortion (otherwise known as the abortion pill) and a surgical abortion.

The abortion pill involves taking a medicine to terminate the pregnancy, whereas a surgical abortion involves the removal of the pregnancy via a procedure at a doctor's surgery.

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a woman sitting at a table: Woman holding pill © PORNCHAI SODA - Getty Images Woman holding pill

In the UK, we allow terminations to occur up to the 24th week of pregnancy. However, in certain circumstances, an abortion can take place after this time period for reasons including a risk to the mother’s life or if there are severe issues with the foetus' development.

The NHS states that patients should be offered a choice of which method they'd prefer whenever possible. And, according to Dr Yvonne Neubauer, Associate Clinical Director for MSUK, 'in theory, both medical and surgical abortion can be offered up to the legal limit of 23 weeks and 6 days. However, abortion services may only offer certain methods within a particular pregnancy range depending on local protocols and expertise.'

Between six and nine weeks of pregnancy, the abortion pill is usually the preferred method of termination, as it involves very little time at the clinic.

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'Beyond 10 weeks’ gestation, [while medical abortions are still possible] women have to stay overnight and so most women opt to have a surgical procedure, since it’s a quicker process,' a spokesperson from the The British Pregnancy Advisory Service (BPAS) tells ELLE UK.

Official government figures show that approximately 180,000 abortions are carried out in England each year, with medical abortions the most common choice to end a pregnancy.

What is the abortion pill?

An abortion pill (actually a series of two different tablets) is not to be confused with a morning after pill. Their chemical components are entirely different.

Planned Parenthood clarifies this common confusion, explaining: ‘The morning-after pill, also known as emergency contraception, helps prevent pregnancy; the abortion pill, also known as medication abortion, ends pregnancy.’

'There is no evidence that emergency contraception can cause an abortion if it is taken when already pregnancy,' adds a BPAS spokesperson.

A medical abortion involves taking not one tablet but two different types of medicines.

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The first tablet contains a medicine called mifepristone. Its job is to block the main pregnancy hormone, progesterone. Without this hormone, the lining of the uterus breaks down, ending the pregnancy's viability.

The second medicine called misoprostol. This is a chemical that forces the womb to begin cramping, a bit like the contractions of labour. This drug helps your body to eject the now inviable pregnancy.

a close up of a hand: Abortion pill © LightFieldStudios - Getty Images Abortion pill

How do you take the tablets?

These medicines are prescribed by the hospital or abortion clinic and are usually taken one to two days apart.

Following an assessment, those who decide to proceed with the termination will usually be asked to sign a consent form and the clinic or hospital will arrange a date for the abortion. Patients are able to change their mind at any point up to the start of the abortion.

‘The mifepristone tablet can be taken at the hospital or clinic, and you'll be able to go home afterwards and continue your normal activities,’ the NHS explains.

A day or two later, a patient must take the second medicine, the misoprostol. This tablet should be placed under the tongue, between the cheek and gum or inside the vagina.

A BPAS spokesperson tells us that it is inadvisable for someone to take the first pill without the second.

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'The first pill (mifepristone) is regarded as the start of the abortion procedure,' they explain. 'Some anti-abortion campaigners have tried to claim that the effects of mifepristone can be reversed, but there is no evidence to support this.'

a woman standing in front of a window: Abortion Pill © franckreporter - Getty Images Abortion Pill

Within a period of four to six hours after taking the second medicine, the lining of the womb will break down, which can involve pain, bleeding and ultimately, the passing of the pregnancy from your body. In most cases, the vaginal bleeding and discomfort should subside within several hours, or up to a day, but some discomfort and bleeding can continue for up to two weeks.

‘Sometimes you need to take more doses of misoprostol to get the pregnancy to pass,’ the NHS adds.

The abortion pill does not require surgery or an anaesthetic. However, occasionally, the pregnancy does not pass and a further procedure is needed to remove it.

Can you take the abortion pill at home?

For years, medical abortions in England have had to be initiated in a hospital, by a specialist provider or a licensed clinic.

However, in March, the governments in England, Wales and Scotland made a landmark decision to change the law, now allowing women and girls to take the abortion pill for early medical abortions (up to 10 weeks into the pregnancy) in their own homes during the Covid-19 outbreak.

‘This measure will be on a temporary basis and must follow a telephone or e-consultation with a doctor,’ the Department of Health in England stated at the time of the announcement.

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a person standing in front of a building: Abortion Pill © Bonnin Studio - Getty Images Abortion Pill

In response to the news, Dr Edward Morris, President of the Royal College of Obstetricians and Gynaecologists, said: ‘This change in practice will reduce pressure on the health system while limiting the unnecessary risk of infection for women, their families and health workers.’

The at-home medical abortion is now commonly referred to as 'pill by post' or 'remote abortion pill treatment'.

‘This service is a safe and legal way to end a pregnancy at an early gestation without needing to attend a clinic for treatment,’ explains BPAs.

Those wanting a pill by post will have to complete a consultation and medical assessment over the phone. During the consultation, BPAS will explain the known risks and complications of the treatment, which can be read here.

If you opt for a pill by post, you will receive the treatment package from a pharmacy from one to three days after the telephone consultation. If, for any reason, the package is delayed in the post, the organisation advises women take the tablets as directed once they do arrive.

Note: The package is plain with no indication of its contents, it will be tracked but not signed for.

The package will contain the following:

  • Abortion pill medication (one tablet mifepristone and six tablets of misoprostol - packaged together or separately)
  • Pregnancy test
  • Codeine (only provided if suitable)
  • Progestogen only contraceptive pills (if requested and suitable)

When it comes to passing the pregnancy, BPAS advises women to use sanitary towels to monitor the bleeding and notes that a woman’s next period might be heavier than usual.

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The majority of patients will pass their pregnancy at home, or a place of their choosing, and decide how they wish to dispose of its remains. ‘They can be flushed down the lavatory or wrapped in tissue, placed in a small plastic bag and put in the dustbin,’ BPAS notes.

How much does an abortion pill cost?

In the majority of UK cases, the abortion pill is free of charge.

BPAS and abortion provider Marie Stopes UK (MSUK) state that the majority (97-98 per cent) of women who require their services have their treatment paid for by the NHS (or another governing body).

In order to assess a patient's eligibility for an NHS-paid abortion, BPAS requires their address and the name and address of their GP. Those who choose to be treated privately at the organisation will need to pay for their abortion.

a person looking towards the camera: Portrait of serious young woman behind glass pane © Westend61 - Getty Images Portrait of serious young woman behind glass pane

According to the service’s prices from April 10 2019, the total price (including an initial consultation and treatment) of an abortion pill (under 10 weeks) is £480. You can see the full list of prices here.

BPAS also offers special prices for women from the Republic of Ireland, and the Channel Islands (Jersey and Guernsey).

‘While abortion care is not available on the NHS for women in Northern Ireland, in June 2017 the UK Government announced they would commit to cover the cost of abortion care for women from Northern Ireland who are treated in England,’ explains Marie Stopes.

Visit the Abortion Support Network to donate to fund abortions and travel of clients from outside of the UK here.

What risks are involved with the abortion pill?

Common side effects for women following an early medical abortion can include feeling dizzy, nauseous, a headache and temporary flushes or sweats which usually pass after a few hours.

However, there are more serious risks associated with both a medical and surgical abortion depending on far along you are in your pregnancy.

The NHS explains that before 14 weeks of pregnancy, the main risks of an abortion pill include requiring another procedure to remove parts of the pregnancy that have stayed in the womb, plus heavy bleeding.

From 14 weeks of pregnancy, the risks include needing a follow-up procedure to remove parts of the pregnancy that have stayed in the womb and there is more risk of infection or injury to the womb. Find out more about any complications here.

'Abortion is an extremely safe procedure, and it’s even safer the earlier it is performed,' states a BPAS spokesperson.

'With early medical abortions, there is a small chance of infection, or that the procedure may not be successful, which is why we provide all women with information on the signs and symptoms to look out for and a pregnancy test to take home with them.'

Dr Neubauer tells us that the majority of women choosing to have an abortion 'are sure that this is the right option for them, but a small number prefer to have counselling to help them with their decision'. Both BPAS and MSUK offers pre-and post-abortion counselling to all clients.

Does an abortion pill affect fertility?

Having an abortion will not affect your chances of becoming pregnant and having normal pregnancies in the future, the NHS outlines.

a man wearing a sweater: abortion pill © Carlo107 - Getty Images abortion pill

BPAS emphasises this in the Q&A section on its website, noting: 'There is absolutely no evidence that safe, legal abortion will lead to infertility. In fact, after an abortion, fertility returns almost immediately.'

The NHS notes that many women are able to get pregnant immediately after a termination and advises them to start using contraception right away if they don’t want to get pregnant again.

‘There's a very small risk to your fertility and future pregnancies if you develop a womb infection that is not treated quickly. The infection could spread to your fallopian tubes and ovaries – known as pelvic inflammatory disease (PID).’

However, most infections are treated before they develop to this stage.

Can you buy abortion pills online?

Abortion pills are sold online but it is illegal to take them without medical approval in the UK.

According to data from the Medicines and Healthcare products Regulatory Agency (MHRA), which regulates medicines in the UK, there were 375 abortion pills seized in 2018, up from 270 in 2015 and 180 in 2014. In recent years, some women have been jailed for taking abortion pills bought online.

a person using a laptop computer sitting on top of a table: Remote working from home. Freelancer workplace in kitchen with laptop, cup of coffee © Maryna Andriichenko - Getty Images Remote working from home. Freelancer workplace in kitchen with laptop, cup of coffee

In July 2020, The Independent reported that several charities and MPs called for the law to change when it comes to the consumption of online abortion pills at home.

They argue the law disproportionately affects women and girls in ‘abusive relationships who seek illicit medication online’ who are unable to visit clinics ‘for fear their abuser will discover their pregnancy’.

How do you organise an abortion?

When it comes to getting an abortion, it’s important to note that terminations are only carried out under the care of an NHS hospital or licensed clinic.

There are three main ways to get an abortion on the NHS which include:

  • Speak to a GP and ask for a referral to an abortion service. The GP should refer you to another doctor if he or she has any objections to abortion
  • Contact a sexual health clinic and ask for a referral to an abortion service
  • Self-refer by contacting an abortion provider directly (eg. BPAS or Marie Stopes UK).

A BPAS spokesperson tells us that in the UK, GP surgeries don't fall under the category of a 'licensed clinic' so many women 'prefer to skip the GP visit and self-refer instead'.

If you want to go ahead with an abortion, you can find pregnancy termination services via the NHS website here. All you need to do is enter your location (postcode or town) into the website and it will give you a list of locations where you can enquire about a termination.

If you want to book a termination through BPAS, for example, you will have to make a consultation before your treatment to ensure it’s legal and safe to proceed. Call 03457 30 40 30 to book an appointment or make an enquiry, request an appointment via this form or request a callback.

a woman talking on a cell phone: Woman on phone © 10'000 Hours - Getty Images Woman on phone

You can make an appointment directly with BPAS without first consulting your GP or genitourinary medicine (GUM) clinic.

‘If you come to us for an abortion, we’ll ask for your reasons for wanting one, which we’re required to do by law,’ Marie Stopes explains on its website. ‘Two doctors need to make sure the requirements of the Abortion Act are met, and sign the relevant certificate. We will arrange this for you.’

The NHS notes that you should not have to wait more than two weeks from when you (or a doctor) first contacted an abortion provider regarding the termination.

Will an abortion be on a person’s medical record?

This entirely depends on how a patient has gone about organising their abortion.

‘If you ask your GP to refer you for an abortion it will automatically be put on your medical records at the time of your visit to your GP,’ the UK Health Centre explains.

However, if you go to a private abortion clinic, it won’t be automatically put on your medical records due to confidentially rules.

‘It is possible that sometimes if you are to be referred for an abortion through the Family Planning Association or Sexual Health Clinic that your abortion information is not sent onto your GP,’ the Centre states.

‘This may not be automatically be put onto your medical records even though it would be NHS funded.’

If a patient calls BPAS or Marie Stopes for advice regarding an abortion, they are not required to tell the service who they are and they won’t receive a call back unless they request one.

a man sitting on a table: Doctor working on a digital tablet with copy space © 6okean - Getty Images Doctor working on a digital tablet with copy space

When it comes to contacting a GP, both BPAS and Marie Stopes state that they won’t disclose information to a patient's GP or contact them without their permission.

The latter adds that the only circumstance where it would do this would be ‘when needed for emergency medical care or safeguarding concerns’.

It explains: ‘All clinical professionals are bound by the code of confidentiality and data protection laws.’

Additionally, BPAS says that while it wouldn’t contact a GP without a patient’s permission, they might need to share some personal information with other healthcare providers or organisations in order to provide care, such as gaining NHS funding or to understand a person’s medical history. You can read more about how BPAS uses your information here.

What are the laws surrounding abortion in the UK?

According to the Abortion Act 1967, in England, Scotland and Wales, you can legally have an abortion up to 23 weeks and six days of pregnancy.

In March 2020, Northern Ireland changed its abortion laws to allow terminations to be carried out in all circumstances in the first 12 weeks of a pregnancy. After that time period, abortions are legal in some cases - for example, there is no term limit in cases of fatal foetal abnormalities.

a person holding a sign posing for the camera: Pro-Choice Demonstration In London © NurPhoto - Getty Images Pro-Choice Demonstration In London

In England, Scotland and Wales, there is no gestational limit for abortions if there’s proof of a fatal foetal abnormality or a significant risk to the mother’s life if they were to proceed with the pregnancy.

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