A five-year review of early medical abortions in Scotland has reignited debate over England and Wales’ more restrictive policies, showing that women who terminate pregnancies at home between 10 and 12 weeks face similar risks to those in hospital settings.
The findings come from NHS Lothian’s abortion service in Edinburgh, where researchers tracked 371 medical abortions performed between 10 and 12 weeks of pregnancy from April 2020 through March 2025. While the World Health Organization has long recommended that early medical abortion at home can occur safely in the first 12 weeks of pregnancy, England and Wales currently limit at-home terminations to 10 weeks. Scotland, by contrast, permits the procedure up to 12 weeks.
The study revealed identical success rates for both settings: 97% of women achieved complete abortion whether they took the medications at home or in hospital. Among the 258 women who chose at-home abortion, only three remained pregnant after initial treatment. One decided to continue her pregnancy, while two returned for hospital procedures.
Serious Complications Remain Rare
Four serious complications occurred, all among women who chose at-home abortion: one case of hemorrhage requiring transfusion and three infections treated with intravenous antibiotics. None required critical care admission. The researchers note that hemorrhage remains rare across all abortion methods, occurring in fewer than 1 in 1,000 cases under 20 weeks of pregnancy.
“Given that those who have an [early medical abortion] in hospital will have contact with a healthcare professional throughout their procedure, it is understandable that those who have [early medical abortion] at home would be more likely to contact the abortion service with questions or concerns.”
Women who had medical abortions at home did contact healthcare services more frequently than their hospital counterparts, 23% compared to 9%. But most of these contacts involved telephone advice only. Just 11% of the at-home group needed phone consultations that could be managed entirely remotely, compared to 4% of the hospital group. Emergency hospital visits showed no significant difference between groups.
The study draws from a pool of 14,458 referrals to the abortion service during the five-year period, with 485 women assessed as being between 10 and 12 weeks pregnant. Of those, 371 opted for medical abortion rather than surgical procedures. The at-home protocol involves taking mifepristone followed 24 to 48 hours later by misoprostol, with additional doses available if needed.
Policy Implications Across Britain
What makes the Scottish data particularly relevant is that it represents real-world outcomes in a legal healthcare setting where abortion is free and integrated into the National Health Service. Previous studies from Poland, where abortion faces severe restrictions, and from countries like Vietnam and Azerbaijan, provided some evidence for safety beyond 10 weeks. But the Scottish review offers the first comprehensive look at outcomes up to 12 weeks in a setting where abortion is routine healthcare and women receive multiple doses of medication if needed.
The researchers acknowledge limitations: only 485 women in their dataset fell into the 10-to-12-week window, reflecting the relatively small percentage who seek abortions at this stage. And because many women in the at-home group didn’t have pre-abortion ultrasounds, some gestational ages were estimated by last menstrual period rather than imaging. However, previous research suggests menstrual dating proves sufficiently accurate in 96% of cases.
“In line with WHO guidance, action is needed to extend [early medical abortion] at home up to 11+6 [12] weeks to women across the rest of the UK and beyond.”
The telemedicine model NHS Lothian adopted during COVID-19 has continued since April 2020. Women self-refer to the service and receive consultations by phone unless clinical factors indicate an in-person visit. Those choosing at-home abortion receive not just the abortion medications but also dihydrocodeine for pain and cyclizine for nausea. Two weeks after taking the medications, they confirm success with a low-sensitivity pregnancy test.
England and Wales introduced temporary measures during the pandemic allowing both abortion medications to be taken at home, but maintained the 10-week limit even as Scotland extended to 12 weeks. The discrepancy creates a patchwork of access across Britain, where a woman’s legal options depend on which side of the border she lives.
The research team plans to investigate women’s experiences with at-home abortion between 10 and 12 weeks, examining not just clinical outcomes but acceptability and satisfaction. For now, they argue, the evidence supports expanding access to match WHO recommendations and Scotland’s existing practice.
BMJ Sexual & Reproductive Health: 10.1136/bmjsrh-2025-202947
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