Discussion
Although mifespristone or misoprostol might not be registered in a particular country, it is not illegal in many countries to import prescription drugs for personal use. However, under many criminal codes, abortion is not legal unless carried out by a designated health care professional under specified conditions. In many countries, the woman herself commits a criminal offence if she procures her own abortion. The terms of Women on Web hold the user solely responsible for any violation of their country's law and any ensuing consequences. The position of the doctors who run Women on Web with respect to the laws and the professional regulators of the unknown country from which they operate is uncertain. They may be subject to laws similar to the English legislation on conspiracy to commit an offence abroad. But for many women living in countries with restrictive laws the options are even less safe: they include self-induced abortions with products not regulated as pharmaceuticals or going to clandestine operators who often do not have the requisite skills and do not work in a safe environment.
In the UK, it appears that politicians are not in touch with scientific progress, even when the evidence is presented to them so clearly by their own Science and Technology Committee. The politicians did not take account of the opinions of leading academic lawyers and ethicists who are agreed that current restrictions on women's reproductive autonomy during the first 24 weeks of pregnancy are not justified. An opportunity was missed to make some limited amendments to the Abortion Act 1967 via the Human Fertilisation and Embryology Act 2008, in particular to extend the range of locations where abortions can take place to primary care, to extend the role of nurses and to permit women the choice to be at home to complete early medical abortion. Regrettably, the use of misoprostol at home has still not been approved, despite a powerful evidence base for its safety. A challenge to this stance of the Department of Health before Mr Justice Supperstone failed. Unless the Secretary of State sees fit to create a new class of place for medical abortion, it appears that a stalemate has developed on this point. Nevertheless, barriers to access to abortion can be overcome by working within existing legal frameworks.
The law in most countries has now become out of step with scientific progress. In order to prevent women in distress with unwanted pregnancies and those who assist them being prosecuted and running the risk of custodial sentences, such laws need modernising. The repeal of criminal laws, as has been done most recently in Victoria, Australia, is an example of the way forward. Also, there is no solution that will stop the traffic in mifepristone and misoprostol, so avoidance of draconian regulatory responses is needed.
English law on abortion is now decidedly archaic and over-medicalised. To protect women who experience unwanted pregnancies we should attempt to modernise the law and have in sight an ideal position to aim for. Abortion should be regulated in the same way as any other health intervention; to achieve this the criminality of abortion for doctors and pregnant women should be removed. Sections 58 and 59 of the Offences Against the Person Act 1861 should be repealed, along with the Infant Life (Preservation) Act 1929 in its entirety, the Abortion Act 1967 in its entirety and Section 37 of the Human Fertilisation and Embryology Act 1990, which was not amended by the 2008 Act. A new section of the Offences Against the Person Act would make it an offence for anyone other than a registered health care professional to perform an abortion; this would deal with clandestine abortionists and the likes of Magira and Erin.
Beyond this decriminalisation of abortion in general, however, it is the author's opinion that British women should have the freedom to self-administer mifepristone and misoprostol to induce their own abortions at up to 9 weeks' gestation. The wherewithal for this is now freely available, so this would be a pragmatic advance, in line with contemporary attitudes of many sections of the population. The role of health professionals in early medical abortion would then solely be to disseminate information on dosage and routes of administration and to provide follow-up in case of complications. Any role for drug regulators, customs officials and the courts in self-induced early medical abortion would be abolished.
Some may say that this proposal is unrealistic in view of the political controversy that would be likely to surround such a radical change in the law. But such modernisation has scientific backing as a public health measure and could be used as a model in countries where its benefits to women's health would be even greater.