Nicola Packer, who was arrested in the UK in November 2020 on suspicion of having an illegal abortion, was recently cleared by the jury. The details of the case show that during the Covid-19 lockdown in the UK, she called MSI Reproductive Choices following a positive pregnancy test and received and used the abortion pills-by-post. She told them she was less than 7-weeks pregnant, but was shocked when she later “passed a dead fetus estimated to be 26-weeks gestational age.”

Ms Packer was unaware of how far advanced her pregnancy was. She stated, “I just felt really bad, I didn’t know I was pregnant or that far along…If I had known I was that far along I wouldn’t have done it… I wouldn’t have put the baby or myself through it.” The case gave the impetus to Jonathan Lord, a director of MSI Reproductive Choices, to pen an opinion piece in the Guardian. In it, he wrote “[Packer] had suffered a rare complication in her abortion treatment.” However, late-term at-home medical abortions enabled by telemedicine are not rare.

Jonathan Lord previously appeared on the RTÉ “Investigates” programme of April 2024 which included highly one-sided coverage of abortion in Ireland. He was described neutrally and exclusively as a “consultant gynaecologist” (with no mention of his activism) and proceeded to make disparaging comments about a retreat for women who regret their abortions as resembling a “cult”.

The National Institute for Health and Care Excellence (NICE) states that side effects relatedto late-term at-home abortions are occurring in a range of 1 in 100 to 1 in 10 are ‘common’.

Even using the conservative estimate of 1% cited by Lord, this suggests that over 5,000 women who accessed telemedicine abortion since April 2020 may have had their gestational age incorrectly assessed. As a result, they could have been beyond the legal limit of nine weeks and six days when they took the abortion pills at home through the pills-by-post service.

The case of Ms Packer highlights the danger associated with the existing telemedicine policy and the reliance on a no-test protocol which prevents the unborn baby’s gestational age from being accurately dated.

Telemedicine abortion in Ireland has often been said to give women more “convenience” in seeking an abortion, however the impact can be dramatic for physical health. An academic article published in the Irish Medical Journal (2024) revealed how a 24-year-old woman in Limerick, who had a medical abortion, nearly died due to the presence of an undetected ectopic pregnancy. The absence of a physical examination of the patient before an abortion left open this danger.

There are additional safeguarding concerns with telemedicine. These were even acknowledged in a 3rd March 2022 letter by the HSE to Carol Nolan TD, which stated: “In- person consultations allow provision of personalised care and allow potential problems to be identified and mitigated. Meeting the woman in person increases the likelihood of the provider identifying any coercion or domestic abuse.”