Last year 10,000 women ended their pregnancies in their own homes, using the abortion pill known as EMA (early medical abortion) that was introduced only in 2000. According to bpas, Britain’s biggest idependent abortion provider, the pill accounted for nearly a third of all 32,000 early abortions that it provided in the first nine weeks of pregnancy. This is an extraordinarily high figure for a drug that has been controversial since its introduction and may soon be banned in the United States because of safety concerns. It is likely to reignite debate over the ethics and practice of abortion, of which in 2004 there were 185,400 in the United Kingdom, compared with 181,600 in 2003.

EMA is a two-stage procedure. A woman must first go to a clinic to take the first oral dose of a drug called mifepristone (also known as RU486), which blocks pregnancy hormones. This is then followed 48 hours later by a second drug, prostaglandin, which triggers a miscarriage. Those using bpas clinics are allowed to go home so that they can miscarry in privacy. Pro-abortion groups say that this gives women a greater sense of independence and removes the stigma of having to stay in an abortion clinic.

The pill still has many critics, however. They say that it could give rise to a false impression that an abortion, even in the early stages of pregnancy, is relatively simple, without physical or psychological risk. This is not true. EMA has been linked to the deaths of ten women, and is described by the anti-abortion organisation LIFE as a “dangerous cocktail of drugs”, whose use is now being reviewed by the US Food and Drug Administration.

A decision to terminate a pregnancy is always sad. It involves loss, pain and remorse and should never be undertaken lightly or casually. But if a woman is to have an early abortion, it should be as straightforward and painless as possible. For all its vaunted medical advance, EMA is no easy procedure: the miscarriage can lead to heavy bleeding and severe cramps. All women should be given counselling, before and after taking the pills — and there should be no assumption that this has become so routine that counselling can be cut back. The NHS also uses EMA, but generally keeps women in a clinic for the miscarriage — a sensible safeguard that ought to ensure better access to proper counselling.

There is rightly concern about the high and rising number of abortions in Britain, which are linked to changing social mores, greater promiscuity and a certain thoughtlessness. One reason why EMA is popular, they argue, is that a woman who goes home for the miscarriage can mask a termination, avoiding the suspicion that would be aroused by a stay in a clinic. Whether or not this is true, such sociological observations are necessarily secondary to the important issue: a woman’s freedom to choose and the medical profession’s duty both to make that choice informed and to implement it safely. Of course, a pill that would prevent conception — even the morning after — is preferable. But the option is not always available. And beyond nine weeks abortion necessarily involves surgery and is rightly subject to intensely debated legal provisos.

The rise in EMA’s popularity may be explicable; it is not necessarily to be welcomed. Parliament has repeatedly reaffirmed a woman’s right to choose. Such a choice should never be easy. It must, at the least, be safe.

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