The Welsh government has confirmed that women in Wales will now be able to take abortion pills at home, but in England, women will continue to have to take the pills at a clinic.
Wales follows Scotland, which last year revised licensing of the drug misoprostol, commonly used in medical abortion procedures, to allow women to take the drug at home.
Medical abortion typically requires taking two drugs – mifepristone followed by misoprostol 24–72 hours later. Bleeding begins shortly after taking misoprostol. While women will still be required to take mifepristone at a clinic, in Scotland and Wales they can now take misoprostol at home, meaning they will have more control over where they are when they begin to bleed.
"This change in practice offers additional choice to women requesting an abortion and enables them to complete treatment in an environment where they feel most comfortable," Wales's health secretary Vaughan Gething said.
"It will also reduce the burden currently placed on clinical resources, increase the availability of appointments for women who want to access termination of pregnancy services and enable a greater number of women to access abortion provision at an earlier point in their pregnancy."
In England, no change will be made to the licensing of misoprostol, meaning women will continue to have to attend a clinic to take both drugs when undergoing medical abortion. A spokesperson for the Department for Health and Social Care told BuzzFeed News that there was currently no plan to revise this policy. "We will continue to monitor the evidence surrounding home-use," they added.
Clare Murphy, director of external affairs at the British Pregnancy Advisory Service, which provides the majority of abortions in the UK, welcomed the move by the Welsh government but said that England needed to follow suit in order to best meet the needs of women.
"We urge Mr Hunt to respect the needs and dignity of women at what can be a challenging time in their lives, and follow his Scottish and Welsh counterparts in authorising home use," Murphy said.
"Home use of misoprostol for early abortion is not controversial – but denying women safe, evidence-based healthcare certainly should be.
"The power to make this simple change lies with Mr Hunt, and we ask him to use it."
Home use of misoprostol is considered safe by the World Health Organisation and is common practice in several European countries.
"Women already use misoprostol at home in other countries, including in the United States, as a matter of best clinical practice," Dr Abigail Aiken, who has conducted extensive research into medical abortion and advised the Irish government on best practice ahead of their referendum on legalising abortion, told BuzzFeed News.
She said that home use "results in more patient-centred care because women can manage the side-effects of pain and bleeding in the comfort of their own home rather than in the car or on the bus on the way home from the clinic."
"Indeed, the only difference between a woman taking misoprostol [at] home versus returning to the clinic to receive it is the presence of a healthcare professional watching her dissolve the tablets under her tongue," Aiken added.
"It's a really unnecessary requirement that runs the risk of causing distress to patients and places significant barriers to care in the way of the least advantaged and most vulnerable."
Research by Aiken published last year in the journal Contraception showed a dramatic increase in the number of women in the UK who had bought abortion pills online and taken them at home illegally.
In Northern Ireland, abortion remains illegal in almost all circumstances, which has led many women to access pills illegally there, but a growing number of women in England, Scotland, and Wales have also bought pills online, despite abortion being legally available in a clinical setting.
Many said that they had difficulty traveling to a clinic for the two appointments needed for a medical abortion procedure, particularly those in rural areas or who already had children.
"Unfortunately, my local area is somewhat out of the way. I do not drive and cannot afford the public transport to attend the 3–4 appointments that they require to complete the abortion," Lisa*, a 25-year-old from England, told researchers.
She added: "I'm really desperate and I've been told there is a 3-week wait, I'm really distressed and I just want the procedure over and done with."
Others preferred to be able to take the drug at home so that they knew they could be somewhere comfortable when they began to bleed.
The move in Wales follows lobbying by the Royal College of Obstetricians and Gynaecologists (RCOG) and Faculty of Sexual and Reproductive Healthcare (FSRH) who, in a joint letter to Health and Social Care Secretary Jeremy Hunt in April, said that allowing home use of abortion pills would be a "simple measure" that would "significantly improve the wellbeing of women".
Following the decision to allow home use of misoprostol in Wales, RCOG professor Lesley Regan, renewed the call to Hunt to reconsider home use of abortion pills in England, urging him to "extend the same dignity that the Scottish and Welsh Governments have offered to women".
"In England, women who have an early medical abortion are forced to return to the clinic to take misoprostol," Regan said.
"The need for this second visit to the clinic frequently acts as a barrier to women accessing safe, regulated abortion care, and is medically unnecessary and incurs significant NHS costs.
"Many women also experience the distress and embarrassment of bleeding and cramping pain during their journey home."
FSRH president Dr Asha Kasliwal noted that because women in England are already permitted to take misoprostol at home following a miscarriage, there was no reason to consider that it would not be safe to take at home for abortion use.
"Evidence suggests that misoprostol is safe, and allowing women to take it at home is a question of patient safety, as it would prevent women from having to deal with the effects of the medication on their way from a clinic," she said.
Research published by the British Medical Journal last year showed that 94% of women who took part in a study exploring the safety of taking abortion pills with no medical supervision reported no adverse effects.
Labour MP Diana Johnson, who in the last parliament introduced a bill on the decriminalisation of abortion, also urged Hunt to reconsider the introduction of home use of misoprostol in England.
"I have heard dreadful stories of women who are currently required to visit a clinic twice and have miscarried on public transport or in public toilets on the way home," she said.
"Scotland has led the way on this and Wales is now recognising this is both clinically the right thing to do and in the interest of women. It’s now time for England to put women’s healthcare needs at the heart of abortion provision."
*Name has been changed to protect the woman's identity.