Abstract
An abortion is defined as the termination of pregnancy resulting in the expulsion of an embryo or foetus prior to a specified gestational age, beyond which the event is classified as stillbirth. Abortions may occur naturally, referred to as miscarriages or may be induced. In the United Kingdom, the Abortion Act 1967 permits abortion under certain conditions and up to 24 weeks’ gestation; however, it does not fully decriminalise the procedure. On 17 June 2025, Parliament voted to approve an amendment that would remove all criminal penalties for women related to abortion, though the legislation is still proceeding through Parliament.
A medical abortion is a non-invasive method used for terminating a pregnancy, brought about by the medicines mifepristone, a progesterone receptor antagonist and misoprostol, a prostaglandin analogue. Taken 1 or 2 days apart, the combination of these pharmaceuticals act on the uterus and cause contractions and expulsion of the foetus which is normally passed 4–6 hours after the second medicine.
Medically managed abortions are normally safe to manage at home in the first 9–10 weeks but after 10 weeks the law in England and Wales requires the medicines to be taken in clinic or hospital and depending on local services, the pregnancy may be passed either on the premises or at home. 1 Most medically managed abortions happen between 3 and 9 weeks gestation giving a complication rate of between 1 in 1000 women. 2
Between 14 and 24 weeks of gestation, women still have the choice between medical and surgical abortion. However, the risks involved are higher later in pregnancy. For those who choose a medical abortion during this period, about 13% will need a follow-up surgical procedure to complete the process. In contrast, only 2.8% of people who have a surgical abortion from the start require further intervention. Both types of procedures must be done in a hospital. The risk of severe bleeding also grows after 14 weeks; it may affect up to 1 in 10 patients, though this number could be an overestimate. Still, studies show that the total blood loss is similar for both methods.2,3
There are valid reasons why some women choose telemedicine for healthcare including not only convenience, but protection in the context of domestic abuse. Insisting on face-to-face consultation for all cases would not protect more vulnerable individuals. Determining accurate gestational age from last menstrual period can be challenging, as spotting can occur during pregnancy and without access to ultrasound scanning or biochemical markers in cases of uncertainty of dates there can be difficulty.
The two-doctor rule has been (and shall remain in place) despite the changes. This states that two doctors must decide on abortion and certify in good faith that the legal grounds for ending a pregnancy are in place. Nevertheless, it remains essential for doctors to ensure that both women and foetuses are protected throughout the process.
Emma Cave (Professor in Healthcare Law and Ethics, Durham University) has previously discussed the Nicola Packer case, in which a woman, believing she was within the 10-week telemedicine medical abortion window, instead delivered a stillbirth at approximately 26 weeks. Nicola Packer had used telemedicine due to COVID-19 restrictions to have a medical abortion at home. She was subsequently prosecuted under the Offences Against the Person Act 1861 when she went to hospital having delivered a stillbirth and then underwent a 4.5 year wait before being acquitted by a jury. Emma Cave contended that such prosecution was detrimental to clinical care, safeguarding and served a punitive function. 4
The viewpoint that reporting women with similar experiences to law enforcement is both harmful and counterproductive has received broad support. Ranee Thakar, President of the RCOG (at the time of writing), noted that involving the police when women seek abortion care is not in anyone’s best interests. This practice may deter vulnerable women from accessing necessary assistance, place healthcare professionals in challenging situations, draw law enforcement into sensitive matters and further contribute to social stigma. Prior to recent legal reforms, statutory constraints reportedly limited judicial discretion in these cases. 5
Abortion law is changing which I personally feel is a positive and necessary step, as do many. The Commons vote to remove criminal penalties is the most significant reform since the 1967 Abortion Act. However, as doctors we must remain alert to the challenges ahead if we are to continue protecting and safeguarding women and foetuses. Uneven access to services, difficulties with gestational dating and the practicalities of telemedicine may leave doctors feeling exposed. The 24-week limit and the two-doctor rule remain, but the task now is to ensure that these reforms strengthen safe, compassionate care and give women greater confidence in the support available to them.
