Ruling prevents women taking second abortion pill at home

The United Kingdom’s largest independent provider of abortion services has lost its High Court bid to force the secretary of state for health, Andrew Lansley, to let women having early medical abortions in England, Scotland, and Wales take some of the treatment at home rather than in a clinic.

BPAS (formerly the British Pregnancy Advisory Service) had asked Mr Justice Supperstone to reinterpret the 1967 Abortion Act in line with advances in medical science, to allow the second dose of the two drug treatment, mifepristone and misoprostol, to be administered by the woman at home (BMJ 2011;342:d264, 14 Jan, doi:10.1136/bmj.d264). The charity argued that this would be in line with practice in some other countries and that the restriction meant that women faced the possibility of miscarrying on the way home from the second round of treatment.

The charity argued that “treatment” under the act covered the prescription but not necessarily the administration of the drugs. Mr Lansley argued that the act required both the first and second doses to be taken under supervision at a hospital or other medical premises.

The judge upheld the government’s interpretation that the administration of both doses constituted “treatment” that must be carried out by a registered medical practitioner on premises approved under the act.

A spokeswoman for BPAS said that the charity was disappointed and was taking legal advice on a possible appeal. But it was “very pleased” that the judge ruled that the act gave the health secretary “the power to approve a wider range of place, including potentially the home, and the conditions on which such approval may be given relating to the particular medicine and the manner of its administration or use.”

Since the case went to court the Royal College of Obstetricians and Gynaecologists has produced new evidence based guidelines noting the weight of evidence in support of home use of misoprostol for abortions up to nine weeks’ gestation and the importance of giving women a choice of method.

BPAS said that resolving the issue was now “a matter of great urgency,” as there were around 70 000 early medical abortions in 2009, accounting for almost half of all early abortions, up from 18% in 2002.

Its chief executive, Ann Furedi, said, “If the law as it stands cannot allow what is safe, right, and proper then it is not fit for purpose and must be changed to reflect modern medical practice. But if the law as it stands allows the secretary of state to approve a woman’s home as a ‘class of place’ for abortion then this is what he must do. We look forward to discussing with ministers and officials how quickly this can happen.”