Lily is religious and says abortion wouldn’t usually be an option for her.

But when she became pregnant during the coronavirus pandemic, she felt “panic and stress”. “I am 41, I have two sons and I absolutely did not plan to have another child,” she said.

Lily has shared her story about taking prescribed abortion pills at home because she’s thankful for the service, which made “this most difficult time of my life as easy as it could possibly be”.

The pandemic was the only reason Lily could legally take her abortion pills at home: ordinarily, she would have been forced to travel to a clinic. The at-home service is due to end in August following a key consultation that was flooded with responses from anti-abortion groups – but a last-ditch vote tomorrow could offer a lifeline.

In March 2020, the government passed an emergency measure to approve mifepristone and misoprostol, the two pills used in a medical abortion, for home use across England, Scotland and Wales. The process also requires a telephone consultation with a clinician.

Kerry Abel, chair of the campaigning group Abortion Rights UK, told openDemocracy that she and her colleagues have been calling for this for years. The 1967 Abortion Act was written before the introduction of abortion pills, when in-clinic surgical abortions were the only option.

“There was this ridiculous situation where people were going into the clinic to be watched taking pills. These are pills that are used following miscarriages, but because they were being used for the purpose of abortion, people were being treated like children,” said Abel. She described the introduction of home abortions as one of the few successes of the pandemic.

‘A political decision’

Abortion is a devolved issue, so while Wales has chosen to continue at-home abortions, England has decided to end services from 29 August 2022.

This followed a government consultation into telemedical abortion in England, which was flooded with copycat submissions from anti-abortion groups. Of the four campaign groups linked to the most consultation responses three oppose abortion – Right to Life (8,424 entries), the Society for the Protection of Unborn Children (SPUC, 288), and Christian Concern (84) – and one, the British Pregnancy Advisory Service (BPAS, 240), is pro-choice.

Abel is concerned that vocal anti-abortion groups have influenced the outcome of the consultation, adding “the situation has become incredibly politicised”.

“This is a medical procedure and we should judge the failure or success of a medical procedure or changes to a medical practice by using medical evidence or, at least, peer-reviewed sociological evidence,” she said. “There’s absolutely tons of evidence showing that this is working, that it’s popular, that it reduces wait times, and reduces socioeconomic barriers.”

Katherine O’Brien from BPAS agreed: “The Royal College of Midwives, Royal College of Obstetricians and Gynaecologists, Royal College of GPs and the British Medical Association all submitted evidence that this was a safe and effective service that benefited women and benefited the NHS.”

She added: “The government hasn't explained why they came to this decision [to end at-home abortion] because they know it’s indefensible and doesn't make any medical sense.”

Consultations will often draw coordinated responses, said O’Brien, “but the government should use a consultation to gather evidence, rather than opinions”.

Ultimately, O’Brien believes that Maggie Throup, the minister in charge of abortion, and Sajid Javid, the health secretary, made a “political decision”.

An unnamed Westminster source told US feminist news site Refinery29 they were concerned about the voting records of the two ministers: both have either abstained on, or voted again, key abortion legislation. Javid has also been linked to the Heritage Foundation, a US anti-abortion group, after being invited to one of their events as a guest speaker.

However, last week, when the Health and Care Bill was going through the House of Lords, Conservative peer Liz Sugg tabled an amendment to make telemedical at-home abortion permanant.

The House of Commons will vote on the amendment this week.

“If MPs vote down the amendment, then, at the end of August, the abortion service that we’re currently providing will become a criminal offence – any woman having an abortion at home with pills, that will become a criminal offence,” said O’Brien.

O’Brien added: “MPs get scared when it comes to abortion, they think it’s this incredibly controversial thing. This is just about keeping a service that a Conservative secretary of state bought in.”

Louise McCudden, advocacy and public affairs adviser for MSI Reproductive Choices UK, agreed: “Our hopes now sit with our elected MPs.”

“We call on people to write to or tweet their MP, reminding them that this is a pro-choice country and that the overwhelming majority of women want this service to stay. We call on MPs to listen to the evidence, the guidance of medical bodies and to women, and vote in favour of the amendment,” she said.

Use of ‘abortion pill reversal’

UK anti-abortion groups saw another significant win recently when restrictions imposed on Dr Dermot Kearney, a Christian doctor who offered so-called ‘abortion pill reversal’ (APR) treatment, were lifted after he took his case to the High Court.

APR was invented by a controversial anti-abortion doctor in California. High doses of progesterone, a hormone, are taken after the first of the two pills used for a medical abortion.

O’Brien told me that this is the anti-abortion response to telemedical abortions, particularly during the COVID-19 pandemic. British anti-abortion group SPUC said the Abortion Pill Reversal network’s 24/7 helpline has “surged with emergency calls amidst [the] coronavirus lockdown”.

The General Medical Council (GMC), the main regulatory authority for doctors in the UK, originally placed “interim conditions” on Dr Kearney last year after a complaint from MSI UK.

Dr Eileen Reilly was placed under investigation by the GMC at the same time after she offered to prescribe the treatment to an openDemocracy undercover reporter. (She has not appealed the decision and is still under investigation.)

Kearney was represented by the Christian Legal Centre, the legal arm of Christian Concern, a UK evangelical organisation that has worked previously with US Christian Right legal giants, such as Alliance Defending Freedom, on culture-war cases from sex education to assisted dying.

Dr Jonathan Lord, MSI UK’s clinical director, said that there was “no evidence” to suggest that APR worked and some evidence that it may even be harmful.

He added: "In the extremely rare event that someone does change their mind having taken abortion medication, it’s vital that they are fully supported by a non-judgemental team who can provide impartial information and independent counselling about all the options.”

He explained that neither the GMC nor its expert witness endorsed the use of progesterone in this way – their role was to simply determine whether there was a realistic prospect of establishing if a doctor prescribing it is fit to work as a doctor.

O'Brien from BPAS says this ties in with the issue of home abortions. "It is going to be profoundly disappointing if a GP is able to prescribe this dangerous, unproven treatment to vulnerable women while we can’t provide a service that is safe and effective."

She added that one of the ways women are drawn to APR services is through the leaflets distributed outside abortion clinics. “I worry that if MPs vote telemedical abortion down and women return to clinics, we’ll see this again.”

‘Amazing impact’ of telemedical abortions

Venny Ala-Siurua, executive director of online abortion service Women on Web, says that the UK has long been seen as a world leader in abortion rights, and “introduced home abortions really swiftly when the pandemic started and right away created amazing impact for the NHS and women.”

Before the pandemic, Women on Web saw several barriers to abortion care in the UK, from abusive relationships to long wait times to difficulty in travelling. But then: “We saw pretty much all requests disappear the moment telemedicine was introduced, so it was clearly a popular intervention.”

Evidence from the UK was even used to inform last December’s decision by the US’s Food and Drug Administration (FDA) to make telemedical abortion available permanently – perhaps a surprising move, given the upcoming challenges to Roe v Wade, the 1973 case that legalised abortion in the States.

Meanwhile, the Welsh government recently ruled to make at-home abortion permanently available, as did Scotland, New Zealand and some parts of France.

“When we started 15 years ago, telemedical abortion was such a controversial thing to do and now we’re seeing that our service is becoming a standard form of care in many countries,” said Ala-Siurua.

She added: “We fully expect that women in England will start reaching out to us again for research and support if the vote [in the House of Commons] doesn't go their way – and we will be there for them.”