Objectives To assess the impact of the December 2018 approval of home administration of misoprostol in England on access to medical abortion. Design Time series analysis Setting British Pregnancy Advisory Service (BPAS), independent-sector abortion provider in England Participants 145,529 abortions carried out by BPAS across England between 2018 and 2019. Intervention Approval of home administration of misoprostol in early medical abortions (EMA) in December 2018 Main outcome measure Gestational age at abortion and EMAs as a proportion of all abortions. The analysis was stratified by key sociodemographic characteristics to assess differential impacts of the approval Results 99,008 abortions took place in the period before the approval or during its implementation phase (January 2018 - June 2019) and 46,521 took place after (July 2019 - Dec 2019). Compared to if former trends had continued, the actual proportion of EMAs was 4.2% higher in December 2019 and the mean gestational age 3.4 days lower. Conclusion Following the approval of home use of misoprostol, we saw an acceleration in the trends towards increasing proportion of all abortions that were EMAs and decreasing gestational age at abortion, especially in more deprived areas of England. Some inequities remain across race/ethnicity groups that require further investigation. Policymakers should take the positive results of this study into consideration when reviewing rules for home management of medical abortions, including with home use of mifepristone.
Examining impacts of approval of home use of misoprostol in England on access to medical abortion