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and pundits stoke pro-choicers' fears that the Trump administration is moving toward a world where Roe v. Wade is repealed, and abortion activists warn us that so-called coat hanger abortions will rise, it's worth considering whether these worries reflect modern abortion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