A prescription for bad care: How the criminalisation of abortion can undermine trust in sexual and reproductive health services.

Manna Mostaghim is a PhD Candidate in the Health Policy Department at the LSE. Her PhD thesis is on the provision of publicly subsidised IVF for women with a high BMI in the UK.

Nicola Packer was told by medical staff that they would take care of her, “that her safety was their priority and that whatever happened they were there to support her”.

Nicola confided in her healthcare team that she had abortion pills to self-manage a pregnancy termination. She trusted medical professionals to look after her.

In reply to her disclosure, she was told, “…the police would be called and the corner would have to be informed”.

Abortion as a crime and healthcare practitioners

Abortion is lawful in England, Scotland and Wales. But a self-managed abortion, without the permission of two doctors and after ten weeks gestation, is still subject to criminal prosecution under the Offences against the Person Act 1861.

Self-managed medical abortions, up until 12 weeks’ gestation, are also considered safe by the World Health Organisation. As the Center for Reproductive Rights states, “Abortion pills have been found to be safer than common medicines such as penicillin, Tylenol and Viagra”.   

However, the prosecution of abortions in 2023-2024, since 2002, has increased by almost 200%. In May 2023, Carla Foster was found guilty and imprisoned for her abortion; in December 2024, Sophie Harvey was found guilty of an abortion. In the recent instances of the criminal prosecution of abortions, “police may have been contacted by the healthcare team”.

But handcuffs are not a form of medication. Police investigations do not improve your gut health. A criminal prosecution is not a miracle cure for an unwanted pregnancy. National media attention on an individual’s sexual and reproductive health choices are not a public health awareness campaign.

People who seek healthcare after a pregnancy termination need healthcare, not handcuffs.  

The continued criminalisation of abortion facilitates an inherently combative relationship between healthcare providers and patients. It makes a conversation with a healthcare practitioner possible fodder for court transcripts.

Do medical professionals have an obligation to report a self-managed abortion?  

A medical professional has no statutory obligation to report a suspected abortion to law enforcement.

Per the British Medical Association in 2024, “In England, Scotland and Wales, there is no legal or professional obligation or duty on doctors to report suspected or actual crimes associated with abortion to the police”.    

In 2024, guidance issued by the Royal College of Obstetricians and Gynecologists, alongside the Faculty of Sexual and Reproductive Healthcare, and the British Society of Abortion Care Providers:

“Healthcare professionals working in women’s health rarely need to liaise with the police. Unless a statute requires it (for example with female genital mutilation), a healthcare must abide by their professional responsibility to justify any disclosure of confidential patient information or face potential fitness to practice proceedings”.

It therefore remains unclear the reasons why a healthcare practitioner would report an abortion. Morality? Concern? Determent?  

Google searches as evidence

Tip offs by healthcare practitioners also expose patients that seek aftercare after pregnancy loss to serious privacy invasions.

To determine whether a patient has had a self-managed abortion, or a miscarriage, police have often seized phones and laptops to collect evidence. For example, web searches by Carla Foster – on how to “conceal her pregnancy” “about miscarriages” “how to obtain abortion pills” and “how to have an abortion at home” – were used as pieces of evidence to justify her prison sentence.  

Pregnant people who have had miscarriages have also been subject to years-long criminal investigation based on singular internet activity. For example, a woman shared with the BBC that she had abortion pills in an online shopping basket – and although she never purchased the pills – it was the basis of the years-long criminal investigation she was subjected to about her miscarriage.

(More information on the use of digital data as evidence in the criminal prosecution of abortion).  

Underresourced sexual and reproductive health providers 

Nicola Packer’s prosecution is another incident amongst a worrying trend of increasing prosecutions of abortions. We need even more solidarity with healthcare providers on abortion.  

The NHS is increasingly underresourced – with sexual and reproductive healthcare services especially under pressure to produce herculean results under arduous circumstances. 

Healthcare providers across England, Scotland and Wales are committed to the wellbeing of patients. However, the continued criminalisation of abortion places undue stress on healthcare providers to cultivate trust with patients. 

The decriminalisation of abortion would not only protect patients but, also, healthcare providers.