Abortion provision in the United Kingdom has undergone significant changes in recent years. 2018 saw permissions in Britain for home use of the second of two medications used in early medication abortion (EMA). And, in 2019, abortion was decriminalised in Northern Ireland. The Covid-19 pandemic led to approval of home use of both EMA medications in Britain from mid-2020 onward.  

While these permissions now have some longer-term security, abortion in Britain remains legal only in specific circumstances, and is otherwise a criminal offence. Troublingly, the number of women prosecuted under abortion laws has increased substantially in recent years. In Northern Ireland, over four years on from decriminalisation, telemedical abortion is not yet provided by the NHS (National Health Service). Recognised international providers continue to offer this, supported by activist groups like Alliance for Choice. NHS second trimester surgical abortion became available in late 2023.

Early in the pandemic, we began a joint research study between the Open University, Ulster University, and the University of Glasgow, designed to capture experiences of abortion across the UK (United Kingdom), as they morphed from requiring clinic attendance to being primarily home-based. We set out to understand what the support needs might be for those self-managing abortion at home. From late 2020 to early 2021, we carried out telephone interviews with 20 women (self-identified) who had recently undergone abortion. Much of what participants had told us related to support and a sense of connectedness.

We drew out the idea of ‘social connectedness’ – a counterpoint to the idea of ‘social distancing’ which was so ubiquitous throughout the pandemic – to help us understand the most important components of support in this context. As we explain in a recent paper published in the journal Culture, Health and Sexuality, this allowed us to identify key aspects of those experiences. These related to feeling cared for, feeling connectedness at home, and what presented disruptions or challenges to connectedness. Looking in-depth at these themes allowed us to understand some of the implications of the shift to very minimal contact with health professionals around abortion and to highlight gaps in support needs. While the majority of participants in this study were in favour of continuing home self-management as an option, they highlighted numerous elements which could have improved their experiences.

Participants valued feeling cared for, which included a sense of connection with, and trust in, health professionals they encountered, typically established in an initial consultation. The also valued connectedness at home, with in-person support networks of family and friends present during the abortion process – difficult or limited for some, given the restrictions on social interaction in force at the time – and with home as a place of safety and comfort. While participants were glad to have home self-management available, it was easy for fear and anxieties to creep in. ‘Home comforts’ helped to minimise negative experiences.

The wider isolation of the pandemic context magnified isolation which can occur around abortion, even in more ‘normal’ circumstances, and was exacerbated by an absence of familiarity with what abortion entails. Where participants felt connected with health professionals, they appeared to feel supported, whether or not they actually sought follow-up care. The sense of safety and comfort this helped create was balanced against the fact that many felt under-prepared for the physical experience of EMA, including the associated abdominal pain, bleeding, vomiting and diarrhoea and, for some, the time it took to finally pass all of the pregnancy tissue.

Together, these various elements of connectedness spoke to persistent and burdensome challenges faced by those seeking abortion, a component of sexual and reproductive healthcare which has been legally provided in Britain for almost 60 years. These difficulties are perpetuated by stigma, negativity, silence and exceptionalisation – that is, the marking out of abortion as somehow fundamentally different to any other aspect of reproductive healthcare. Access has, in many ways, improved drastically since 1967, and has begun to recover from the restrictions imposed in the Covid-19 pandemic. Development of NHS services in Northern Ireland is still a work in progress, while abortion rates are rising across the UK. Getting abortion provision right therefore has immediate relevance to the widest number of people that it has for some time. Fostering clarity around what contemporary abortion care comprises, and appropriate support for that care, will play an essential part in moving forward, rather than backsliding into a culture of fear and hostility around reproductive rights.