I had an abortion – and my experience shows how broken the UK system truly is

When she found out she was pregnant, Maya Oppenheim knew that, like thousands of women, she could face difficulties trying to have a termination. But what she discovered were problems at every stage of a process that experts warn is at breaking point

More than 200,000 abortions are carried out every year in the UK (Shutterstock)

I was squatting on the floor of the toilet in Westfield Stratford shopping centre when I found out I was pregnant. Squinting at the test, I initially thought it said “progress”, but on closer inspection, the word “pregnant” was flashing in front of me. Before long, another sign popped up, reading “2 to 3 weeks”, but that turned out to be wrong. In fact, I was far further along in my pregnancy.

As soon as it dawned on me that I might be pregnant, I needed to know for sure immediately. But as I marched through Boots, frantically asking where the pregnancy tests were, in my heart of hearts I already knew. With breasts so tender they felt like they had been inflated with a bicycle pump, and my period nowhere to be seen, there were few other plausible options.

One of the first things I did after taking the pregnancy test was to call my mum. Before I’d even got the words out, she told me: “I know what you’re going to say – I could see it in your face.” A million different thoughts hurtled around my head as I tried to remain calm in the most uncalm of places. It felt surreal to be standing inside a shopping centre while struggling to come to terms with the fact that I was pregnant, though there was something almost comforting about the indifference of the sea of preoccupied shoppers hurrying around me.

Sod’s law would have it that there was no escaping the subject of pregnancy that evening: I had to go to a family gathering, which included my cousin’s wife, who was eight months pregnant. I asked how bad her morning sickness had been. “I don’t know why it’s called morning sickness when it’s constant nausea,” she replied. Those words stayed with me in the days that followed, as my normally indefatigable appetite shrank and I entered what was, for me, uncharted territory.

The decision

I had known immediately, on that toilet floor in an East London shopping centre, that I wanted an abortion. Despite being in a relationship and wanting children one day, I did not feel mentally, financially or logistically ready for a baby. For the moment, work and a career supersede the desire to have a child. This will no doubt enrage the people who do not believe women should have autonomy over their bodies, or think women’s sole purpose is to be breeding machines.

However, I am not alone, with statistics released last month showing record numbers of women were turning 30 without having had a child. The data, released by the Office for National Statistics, showed that around half of women in England and Wales who were born in 1990 did not have a child when they reached 30.

As a women’s correspondent, I am all too aware that there are still many people with retrograde views on reproduction and motherhood. As the far right has grown emboldened in recent years, so too have anti-abortion activists. Populist neo-fascism often has misogyny at its core. Take a troubling report by charity Population Matters last November, which warned that more countries were adopting policies that coerce women into having more children, with “right-wing, populist and nationalist administrations stigmatising women who choose to have smaller families as unpatriotic”. The report noted that Viktor Orban, Hungary’s far-right prime minister, promotes debt-free education for women – but only if they have at least three children.

Having written dozens of articles about countries where terminations are criminalised – even in instances of rape, incest or a threat to life – I felt both relief and guilt that I live in a place where it is legal. I assumed that the process of having an abortion would be simple, straightforward and speedy. How wrong I was.

Struggling for an appointment

The same day I found out about my pregnancy, I rang Homerton Hospital in Hackney, the hospital in which I was born, to try to book an appointment for an abortion. Nobody picked up the phone, but I was placated by an automated message that promised someone would call back within 24 hours.

Those 24 hours came and went, but no phone call came. Unwilling to wait, I rang up the British Pregnancy Advisory Service (BPAS), the UK’s largest abortion provider. “We are currently experiencing exceptionally high call volumes,” another automated voice said. I proceeded to stay on hold for 13 minutes, the soothing music playing on the end of the line having the opposite effect to that intended. In the end, I gave up and opted to send an email instead.

Two days later, I received a call from a man who told me I would have to wait three weeks for a phone consultation, meaning I would not be able to have the actual abortion until a month after requesting the procedure. This would have left me just a couple of weeks away from the 10-week cut-off point for a medical abortion, which involves taking pills. While abortions are extremely safe, it is better to have the procedure earlier on in the pregnancy.

The wait I was facing was at loggerheads with the NHS website, which stipulates: “You should not have to wait more than two weeks from when you (or a doctor) first contact an abortion provider to having an abortion.” The National Institute for Health and Care Excellence (NICE), which provides evidence-based recommendations for healthcare in England, says providers should “ensure minimal delay in the abortion process, and ideally provide the assessment within one week of the request and provide the abortion within one week of the assessment”.

We’ve had reports from across the board of unprecedented demand

The man on the phone admitted BPAS was grappling with massive delays, telling me they were receiving 1,000 requests for abortions a day. I stated the obvious – that this was a time-sensitive procedure and I wasn’t willing to wait that long – and he said I could have a phone consultation for an abortion a week later. However, if I wanted something sooner, I was told I would have to travel hundreds of miles to Doncaster or Liverpool for an in-person appointment. This was beginning to feel like a nightmare.

For me, someone in stable employment, it’s possible to travel that distance, but still difficult to juggle alongside a full-time job and the rest of my life. However, this would not be at all feasible for young women hiding their pregnancy from abusive parents. Or women facing domestic abuse. Or those trapped in precarious, low-paid work with an unforgiving boss. BPAS says access is a common issue across the UK, with some women even having to travel from Scotland to London for surgical abortions later in their pregnancy.

Katherine O’Brien, of BPAS, said the surge in women needing abortions was likely to be linked to the struggle to access contraception in the wake of the pandemic.

A recent study found that almost a third of women seeking long-acting contraceptives, such as coils or implants, were unable to do so during the Covid crisis. “Women are returning to normal life, but contraceptive support has not returned to normal,” Ms O’Brien explained. “At the same time as the surge in demand, there are unprecedented numbers of staff off sick, isolating, or ill with Covid, and this is an issue across the whole NHS.” One of BPAS’s abortion services was hit with a 700 per cent rise in staff absence due to coronavirus in the first week of January, when compared to the same period last year.

A gruelling journey

As crippling exhaustion left me struggling to do day-to-day tasks, the prospect of continuing with a pregnancy I didn’t want felt like torture. I found another leading abortion provider, MSI Reproductive Choices UK, which managed to get me a telephone consultation that evening.

During my telephone consultation, I explained I’d had a minuscule amount of discharge, which triggered a request to come in for an in-person appointment and a scan, rather than simply sending the abortion pills in the post. I was offered a consultation in Waterloo in central London a week later, but ended up opting for an appointment in the small Kent village of Aylesham, which meant I would be seen a few days earlier. My granny had unexpectedly died a couple of days before I’d found out I was pregnant, and I couldn’t face the prospect of being in too much pain to attend her funeral.

Even the journey from London to this unremarkable village in the home counties became a gruelling five-hour round trip. Fortunately, I had my boyfriend there to support me. As we sat in the waiting room, another woman vented on the phone about the fact that she had travelled for four hours for an abortion, yet would not be seen that day.

I was called in, and the nurse and midwife tried to carry out an ultrasound, but initially did not have any luck detecting a pregnancy. My immediate thought was, “Oh God, I’m not actually pregnant. What a waste of time and stress.” But deep down I knew this could not be the case. There was no mistaking the fact that I was pregnant, my mind feeling like it was trapped in someone else’s body. After doing another, substantially more intimate scan, they told me I was about six and a half weeks pregnant – far further along than I had realised.

Services on the brink

Having a medical abortion involves taking two tablets. Prior to the pandemic, getting the first tablet, mifepristone, required a visit to an abortion clinic. But after Covid hit, the government allowed the medication to be sent by post to be taken at home after a phone consultation, a system referred to as “telemedicine”. Those rules were due to run out on 25 March, with ministers taking a long time to clarify whether they would be extended. The government finally declared a six-month extension for at-home early medical abortion last week. But providers were incensed that they did not make the provisions permanent. About half of all abortions are delivered via telemedicine. BPAS notes that if the system reverted to how it was before, the service would be likely to see a 43 per cent rise in abortions being carried out after 20 weeks of pregnancy.

Jonathan Lord, of MSI Reproductive Choices UK, said abortion services are in disarray. “The whole sector is really struggling at the moment,” Mr Lord, who is also the co-chair of the British Society of Abortion Care Providers, told me. “We’ve had reports from across the board from all the NHS trusts we know of, and all charities, of unprecedented demand. As soon as things get a little less efficient, the gestation of women goes up, and more have to get surgical abortions, which are harder to provide.”

Surgical abortions also require operating theatres and staff, which have been hard to secure with resources diverted for the pandemic.

I took the first abortion pill on a train hurtling back to London, and was relieved to experience no side effects. If you throw up within an hour, you have to let the doctors know, as the pill may not be effective. That evening I did feel a little strange, but it was when I took the second abortion pill 24 hours later that the all-consuming agony hit: the worst pain I remember feeling in my life.

Intense pain

I chose to put the second pill in my mouth for 30 minutes, rather than the other (substantially scarier) option of inserting it into my vagina. The pill pretty much wholly dissolved in my mouth in 20 minutes. Before long, I was writhing on the floor in pain, with paracetamol and ibuprofen scattered around me. No matter how I positioned myself or where I placed a cushion, there was no way to get comfortable or escape the cramps. I must have gone to the toilet about 30 times in the space of three hours – partly as a way to distract myself from the deep, roaring pain.

While the nurse and midwife had been kind, gentle, supportive and calm, they had failed to properly explain how painful an early medical abortion would be. This is something friends who have had abortions tell me they also experienced.

One in three women in the UK has an abortion yet it is so stigmatised

Crawling out of the toilet on all floors, groaning and too plagued by pain to sit up and drink water, I kept wondering if what I was experiencing was normal. What’s more, the nurse and midwife’s warning that I must be on guard for severe bleeding had me a little on edge, after they said I must go to the hospital if I soak through two sanitary pads in an hour and blood is “pouring out like urine”. I even had a nightmare in which this happened. Fortunately, it did not happen in real life, but that did not stop me from incessantly checking to ensure I was not about to bleed to death.

But after three hours, the pain did abruptly subside; the feeling was reminiscent of a sea of calm after a violent storm. Despite the pain having gone, the next two weeks were to be devoid of fun, and filled with rules and a fair amount of bleeding. The advice isn’t consistent – I was told by MSI that there must be no sex, baths, sports or heavy lifting for two weeks. As well as no tampons or mooncups until the next period.

After the abortion, when I asked MSI if this was consistent with their wider advice, they said the guidance on baths was inaccurate and you only have to wait 48 hours. MSI also explained that they have no official, generic advice on how long to wait until you exercise, and their guidance on waiting to have sex has been reviewed and is currently being updated to “whenever you feel ready”.

While their advice felt perfect for me, it was completely out of sync with advice on the NHS website, which does state that you can “have sex as soon as you feel ready” – adding that “you can usually return to normal activities as soon as you feel comfortable to, including having a bath or shower, using tampons, exercising (including swimming) and heavy lifting”. BPAS, on the other hand, though it says you can have sex as soon as you feel ready, does not offer any specific advice on how long to wait until you exercise.

The aftermath

So how do I feel now, a few weeks after having had an abortion? Deeply relieved I am no longer pregnant, and massively grateful I live in a country where abortions are legal. But this relief is bittersweet due to my frustration, disappointment and shock at how poor abortion provision is in the UK, due to this critical aspect of healthcare being neglected by the powers that be.

The lack of attention abortion care appears to receive from politicians makes even less sense when you bear in mind how common abortions are. A record number of women in England and Wales had a pregnancy terminated in 2020, with the increase sharpest among women aged 30 and older. In 2020, just over 209,900 abortions were recorded, an increase from around 207,400 the year before.

“One in three women in the UK has an abortion, yet it is so stigmatised,” Ms O’Brien, of BPAS, said. “It is a standard part of women’s healthcare. Everyone will know someone who’s had an abortion. There isn’t a concerted effort to make the service the best it can be for women. The taboo and the stigma, and almost a view that women undergoing abortion do not deserve the best care, is part of the reason the government sidelines this issue. If telemedicine was a clear benefit to one in three men, do you think we would be having this constant debate?”

If you have been affected by the issues raised in this story, the NHS signposts to support through this page. Or you can speak to someone in confidence at the British Pregnancy Advisory Service, the UK’s largest abortion provider, by calling 03457 30 40 30 or emailing info@bpas.org. Or you can ring MSI Reproductive Choices, another leading abortion provider, on 0345 300 8090.