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Scotland becomes first UK nation to approve home-based medical abortion

Scotland has become the first nation in the UK to allow women to complete medical abortion procedures at home.

Medical abortions are induced by a combination of two medicines: mifepristone and misoprostol.

Mifepristone, which blocks the action of progesterone and triggers uterine contractions, is taken first. This is followed by misoprostol, which triggers further uterine contractions and completes the abortion process.

Under new guidance approved by Scottish government ministers, women in Scotland who have been pregnant for fewer than nine weeks and six days will be able to take misoprostol at home without direct medical supervision, although they will still be required to take mifepristone at a registered clinic. In England and Wales, both medicines must be taken at a clinic.

NHS chief executives were informed of the change in a letter from Catherine Calderwood, Scotland’s chief medical officer, sent on 26 October 2017. The letter included guidance from the Scottish Abortion Care Providers Network, who said “evidence has clearly demonstrated that early medical discharge with at home self-administration of misoprostol is a safe method of abortion, with no higher risk of complications than medical abortions as a day case.”

“We support optimising access to medicines and maximising patient choice, as we have set out in our Access to Medicines policy statement”, said Aileen Bryson, policy and practice lead at RPS Scotland.

“While we appreciate this is an emotive and sensitive issue, this is an example of person centred care, designing a service around the needs and preferences of patients and reducing unnecessary hospital visits”.

In 2016, medical abortions made up 82.9% of the 12,063 abortions carried out in Scotland. Figures for the same year in England and Wales show that medical abortions accounted for 62% of the 190,406 abortions administered.

Citation: The Pharmaceutical Journal DOI: 10.1211/PJ.2017.20203818

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