United Kingdom

Wales Legalizes Take-Home Abortion Pills

Plus, what they might be like in a post-Roe world



Last week, the Welsh government approved take-home abortion pills, meaning most medical, non-surgical abortions can be done at home, without the supervision of a doctor.

Currently, Scotland, Sweden, and France have similar protocols in place, though England lags behind on this front. Given that around three-fourths of the total abortions performed in Wales last year were medical, this recent change could mean easier abortion access for women who live in remote parts of the country.

Medical abortions are typically available in the first trimester, up to about nine weeks of gestation. In the past, women had to take two pills while supervised at a clinic. On her first visit, a woman will take mifepristone. Between 24 and 72 hours later, she must return to the clinic to take a second pill, called misoprostol.

Wales' new policy means women can take these pills in the privacy and comfort of their own homes. Harmful side effects are rare and the instructions are not particularly difficult to follow, so this risks are low. The benefits to women, meanwhile, are real and significant.

Misoprostol induces normal-but-heavy bleeding, and it's not always clear when it will begin. Women who must travel any serious distance to attend a clinic—either in a car or on public transit—were subjected under the old policy to unpredictable inconveniences and embarrassment. The new policy recognizes women's competence to decide when they need medical attention, and spares them the indigity of bleeding while in transit.

The new measure could also help women reduce time they must take off of work, a retired nurse named Bronwen Davies told the BBC. Administering the pills at home means they don't need to leave a job in the middle of the day or workweek to comply with clinic hours.

Medical, non-surgical abortions aren't growing in popularity just across the pond—they're on the rise in the U.S. as well. In 2014, Planned Parenthood reported that 43 percent of total abortions performed by the center were pill-induced, compared with just 35 percent in 2010.

As media outlets and pundits stoke pro-choicers' fears that the Trump administration is moving toward a world where Roe v. Wade is repealed, and abortion activists warn us that so-called coat hanger abortions will rise, it's worth considering whether these worries reflect modern abortion practices.

As Reason's Elizabeth Nolan Brown has previously written, coat hanger imagery might not be an accurate portrayal of what a Roe-repealed America would look like. In all likelihood, we'd see the rise of pill-induced medical abortions, and perhaps increased demand for black-market mifepristone and misoprostol.

There would, of course, be real medical concerns associated with a dramatic increase in DIY abortions, particularly if criminal penalties are signed into law. Would women who experience complications from medical abortion be able to seek emergency medical care without suffering legal consequences? What kinds of quality control issues are likely to arise when women get their medicine from mysterious sources rather than legal pharmacies?

The idea of DIY abortions shouldn't instill women with nearly as much fear as the name implies––they're likely already done in many parts of the U.S., where onerous abortion restrictions have made it harder for women to go into clinics.

Economist Seth Stephens-Davidowitz detailed this issue in a 2016 New York Times article. When he looked at states where abortion is most criminalized and clinics are far and few between, he found that had fewer abortions and more live births. But he also realized that the margin didn't fully make sense—in other words, some pregnancies were unaccounted for or "missing," meaning they were likely terminated (successfully) at home.

In the ten states with the fewest abortion clinics, women had "54 percent fewer legal abortions—a difference of 11 abortions for every 1,000 women between the ages of 15 and 44." These were also more live births for women in these states—but only six per 1,000 women. Stephens-Davidowitz suggests that miscarriage could play a role, but that, even accounting for that, there's a pretty significant difference between legal abortions and live births, which warrants further study.

Stephens-Davidowitz also found that Google searches for how to buy abortion pills and how to self-induce abortion have spiked in states where abortion is more criminalized. As data are gathered from places like Wales, it will be interesting to gauge safety outcomes from pill-induced abortions. Early evidence suggests that even without doctor supervision, the two-pill combination is often successful at terminating early-stage pregnancies with only rare complications.

Abortion activists' fears are partially founded and partially misplaced: on one hand, aborting a pregnancy relatively safely in the privacy of one's own home is more of a possibility today than it has been in the past. On the other, an unfettered black market for misoprostol and mifepristone, plus potential criminal consequences for seeking help in the event of complications, is far from ideal.

NEXT: SCOTUS Kicks Off Scramble to Legalize Sports Betting

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  1. Libertarians applaud.

    Faux libertarians fret.

    Stale-thinking authoritarians object.

    Superstitious right-wingers vow prohibition and revenge.

    Carry on, clingers.

  2. Killer fact: Welsh people are spontaneously generated when rain falls on an exposed coal seam (which is also a Welshman’s primary source of food).

  3. Why is the article illustrated by a photo of a *living* child?

    1. Carry on, clinger.

      1. Klingon, carrier.

        1. Qapla’!

    2. The parents should’ve done the right thing and not given birth to a baby who would eventually get a dragon face tattoo /sarc

      1. This is a rare condition from watching the recent spate of “How to Stain Your Dragon” movies: “Dragon Face.”

    3. If Reason’s writer’s did not have poor taste, they would not have any taste at all. Besides, they are just showing what is being eliminated.

    4. Before and after?

  4. It’s hard to imagine how much room there really is to grow here, though. If 43% of PP’s abortions in 2014 were medical, that’s great, but 9 weeks isn’t very long and realistically a large share of women seeking abortions will continue to need surgical procedures. Pills aren’t going to take care of everyone’s problems, with or without Roe.

  5. “In the ten states with the fewest abortion clinics, women had “54 percent fewer legal abortions?a difference of 11 abortions for every 1,000 women between the ages of 15 and 44.” These were also more live births for women in these states?but only six per 1,000 women. ”

    Uhhh, if this means what I think it means there’s a pretty obvious answer… Maybe in states where they tend to be anti abortion, women get knocked up less and don’t NEED abortions? I’m sure those are probably pretty religious states, and it sounds like he’s just assuming birth rates should be the same everywhere, which isn’t the case. If that is not what is being implied then the wording here is not awesome.

    1. No. They travel to the next state. It’s the beauty of federalism.

      1. Until some state makes it illegal for a woman to cross state lines for an abortion.

        1. I doubt that’s going to happen… And it’s unenforceable anyway.

      2. Possibly. But the way that was written it almost implies he expects a static number of abortions/birth ratio or something. If what he meant was NOT that, then your reasoning could explain it.

  6. To prevent giving birth to something hideous like that?

  7. I see that the Welsh imbue their children with a sense of Welsh Exceptionalism quite early on.

  8. My question for american pearl-clutchers over abortion: was Wales (and previously Ireland) an oppressive regime of authoritarian misogyny a la Handmaid’s Tale until this year?

    (Hint: no)

  9. Well we certainly wouldn’t want to subject women to “inconveniences and embarrassment”, nor missed time from work to abort an unwanted pregnancy. So when do we afford MEN the same right to reproduction? More gynocentric BS, a woman should be able to carry a baby to term and force a guy to pay for it, or she should be able to abort even if the guy wants his baby. And lets not forget the nanny/daddy state, ready to pay for her choice to give brith all the while disenfranchising the father from his children. Maternity leave, state subsidized child care, free medical. This as a reward for being stupid and inconsiderate and not using the multitude of brith control options available to her. One does wonder when we’ll hold women personally accountable for their actions.

    1. Good idea: Make reliable long-term birth control more available, cheaper. Make pills available without a prescription. The pro-lifers idea: Make reliable long-term birth control (like pills, implants and IUDs) illegal because it might “abort” a zygote (a couple of cells at that point) by preventing implantation. Not that it even does that per the science.

      1. Science is witchcraft for smart people.


        1. 1. When a distinguished but elderly scientist states that something is possible, he is almost certainly right. When he states that something is impossible, he is very probably wrong.

          2. The only way of discovering the limits of the possible is to venture a little way past them into the impossible.

          3. Any sufficiently advanced technology is indistinguishable from magic.

          Arthur C. Clarke

    2. Yup. Our society is horribly slanted towards favoring women through state power… Hence things like the MGTOW movement, and even normies recognizing how stupid and unfair a lot of it is.

      I’m glad I never got into a situation where I had to contemplate whether to keep a baby or not. When I was very young I certainly would have leaned that way, nowadays if I had an accident with an unworthy-to-bear-my-children type woman it would be a lot harder call though.

  10. Didn’t the progs freak out recently when it was suggested that birth control pills be made available OTC? They claimed that it would make them more expensive for poor women, who can get them for free at PP, and also something about having to go to the doctor to get a prescription is important for their health. Same thing will happen with abortion pills, of course, the real reason is PP doesn’t want to lose its funding if women no longer need its services as much.

    1. I believe that is all correct, and shows where the Progs really are on it all… The same as they always are, really just seeking power, and using people (women in this case) as pawns in their game.

  11. Makes “suffer the little children” sound almost …..prophetic.

  12. There is no medical basis for a law requiring Misoprostol to be administered in clinic rather than at home

    Wales got rid of an outdated policy.

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