OUR CONCLUSION
118. The RCOG (echoed by Dr Vincent Argent) has recommended
that a trial needs to be done to assess the safety, effectiveness
and acceptability of self-administration of misoprostol at home,
although no reason is given as to what concerns there are that
a practice commonplace abroad, without problems with safety, efficacy
and acceptability, requires trials here. [155]
119. Dr Argent further pointed out that:
For patient safety there needs to be a comprehensive
advice service and back-up service with access to clinics that
can see the patient fairly soon. That would mean having access
at night and during the weekends.[156]
Such a service is already in place for those providers
who allow women the choice of going home to complete the termination,
but it may not yet be in place in more traditional settings.
120. We were impressed by the evidence that there
are no particular safety concerns about early medical abortions
on three grounds. First, the studies that have assessed the safety
of medical abortions have been conducted so as to compare the
relative safety of procedures with letting a pregnancy continue
to term. The fact that medical abortions also cause unpleasant
symptoms is not a reason for restricting the administration of
misoprostol to a clinic; especially when the majority of women
choose to go home after taking misoprostol, presumably because
they want to be as comfortable as possible when these symptoms
manifest. Second, the reported mortalities associated with medical
abortions are "rarer than anaphylaxis after being given a
shot of penicillin".[157]
Thirdly, women already take misoprostol at home to complete natural
miscarriages with no apparent safety concerns.
121. The RCOG guidelines, which have been peer-reviewed,
state:
41 "For early medical abortion a dose of 200
mg of mifepristone in combination with a prostaglandin is appropriate",
with an evidence base of class A[158];
and
43. "Based on available evidence, the following
regimen appears to be optimal for early medical abortion up to
9 weeks (63 days) of gestation. This advice is based on considerations
of efficacy, adverse-effect profile and cost:", with an evidence
base of class B[159].
122. The Minister admitted to us in oral evidence
that the slow progress in the Secretary of State specifying a
class of place to include a woman's home for the purpose of the
administration of the second stage of an EMA—over 16 years
since the 1990 Act allowed this—was not due to concerns
over safety, effectiveness or acceptability .[160]
123. We conclude that, subject to providers putting
in place the appropriate follow up arrangements, there is no evidence
relating to safety, effectiveness or patient acceptability that
should serve to deter Parliament passing regulations which would
enable women who chose to do so taking the second stage of early
medical abortion at home, or that should deter Parliament from
amending the act to exclude the second stage of early medical
abortion from the definition of "carrying out a termination".
This would enable a trial to take place.
124. We invite Members of Parliament to consider
our conclusions when considering the question of whether the 1967
Act should be amended or regulations passed to enable the second
stage of early medical abortion to be self-administered in a woman's
home.
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