Correspondence to: J Lord j.lord@exeter.ac.uk
Abortion is still a criminal offence in England and Wales, with access to abortion permitted under specific circumstances defined in the Abortion Act 1967. One of us (Nicola Packer) was recently acquitted after standing trial in England having been accused of an illegal abortion.1 The high profile case has highlighted deficiencies in the current legal framework, underscoring the need for decriminalisation.2
Packer was the sixth woman to have appeared in court since December 2022 charged with ending her own pregnancy, although around 100 have endured the trauma of criminal investigation in the past five years.34 In November 2020 she took abortion medication (mifepristone and misoprostol), prescribed over the phone during covid-19 lockdown. The gestation limit for most abortions in England is up to 24 weeks of pregnancy, and 10 weeks for self-administered medical abortion at home. Packer delivered the fetus at home unaware that she had been beyond 10 weeks’ gestation, with the head circumference and an examination by an obstetrician suggesting it was 22-24 weeks.
She first attended Charing Cross Hospital from where she was redirected to Chelsea and Westminster Hospital. Despite both emergency departments noting she was tachycardic, which in the context of a retained placenta should warrant immediate action to address a potential concealed haemorrhage, staff seemed distracted by the stillborn fetus and exploring the circumstances of the delivery.5
After Packer had surgery to remove the placenta, the head of midwifery called the police.6 At the time, the hospital’s and the community safeguarding leads said that “nobody had done anything wrong” and that all actions were “completely in the best interests of Nicola.”7 Subsequent multiagency guidance reminds healthcare staff of their professional responsibilities of confidentiality.8
Packer was arrested and discharged into police custody over two days. During her incarceration she was denied access to painkillers and anticoagulation medication.1 The case took four and a half years to come to trial. During the proceedings medical records, security camera footage from hospital, intimate photos, and sensitive details about her personal life were presented.1
Reforms required to abortion law
Although taking a case to trial is on the extreme end of proceedings, women in England have been investigated after experiencing miscarriage and premature labour,9 had contact with their children barred (in some cases forcing immediate cessation of breastfeeding), and needed panic alarms installed after receiving death threats; three have served prison sentences.3 Multiple organisations have called for urgent action to stop these horrific investigations that are causing so much harm.10
The harm that criminalising abortion causes to women and health systems is well described.11 In South America women presenting with miscarriage risk long prison sentences.12 Evidence of increasing harm to women has been described in the US.13 Conversely Canada, where abortion has been completely decriminalised since 1988, has not seen the rise in abortion rates recorded in most other countries have.14 New Zealand also removed abortion from criminal law in 2020,15 as have all Australian states.16
As debate intensifies in the UK, opponents will raise two main objections. Firstly, they will suggest that the later gestation cases are the result of permitting remote consultation and prescribing (“telemedicine”), even though all four women who have been convicted obtained medication through the internet (one also obtained a second set from an abortion provider).17 One of the major advantages of telemedicine is that it enables the most vulnerable to access regulated healthcare, meaning they can be identified and safeguarded.1819 The rate of women seeking abortion medication illicitly substantially reduced in the UK after telemedicine was introduced.18
The proposed legal reform would apply only to England and Wales and would mean women no longer face the threat of prosecution for any abortion of their own pregnancy. This would give women the same protections as they have in countries such as Northern Ireland, Ireland, France, Canada, Australia, and New Zealand.10 Secondly, therefore, opponents will allege this permits “abortion up to birth.” It is exceptionally rare for women to reach a later gestation and need an abortion—cases occur in the most harrowing of circumstances, such as in the context of abusive relationships,20 which as the Court of Appeal stated need “compassion, not punishment.”21 The current law will not deter these cases, but it may deter others, including those who have miscarried naturally but are fearful of falling under suspicion, from seeking medical help.4 In Canada, after 30 years of decriminalisation there has been no detectable increase in later gestation abortions.1422
The main reason so many individuals and organisations acted with suspicion toward Packer—and in other similar cases—is that the law itself directs and encourages such responses. On 17 June members of parliament will vote on an amendment to the Crime and Policing Bill 2025 to remove women from the threat of prosecution for ending their own pregnancy.23 In the UK parliamentary system amendments are limited in scope, so this will not deliver the reform that has been achieved in other countries.15162224 However, it would prevent other women from enduring Packer’s horrific experience, which is why we, along with over 50 organisations,25 are calling for “Nikki’s law.”23
Footnotes
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Competing interests: We have read and understood BMJ policy on declaration of interests and declare the following interests: JL is the co-chair of the Royal College of Obstetricians and Gynaecologists (RCOG) abortion taskforce; NP was subjected to a 4½ year police investigation and trial for an alleged illegal abortion for which she was acquitted; TA tabled the amendment NC1 to the Crime and Policing Bill 2025. Her register of interests is at https://members.parliament.uk/member/4623/registeredinterests. LR is chair of the RCOG abortion taskforce, past president of RCOG, and women’s health ambassador for England
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Provenance and peer review: Commissioned; not externally peer reviewed.
