Contrary to media claims, we are readily available during the day for concerns and complications, and we have out-of-hours emergency cover well arranged.
What do we offer?
Home Abortion offers online abortion care for women who are less than 9 weeks pregnant and do not wish to be. This care falls under (the additional provision of) general practitioner care, medical abortion. We provide this service between 8:00 AM and 6:00 PM on weekdays.
We offer women:
- detailed information on our site
- Option to ask questions via email, reply within 48 hours, usually within 24 hours
- If necessary, telephone contact with patients from Monday to Friday from 08:00 to 18:00.
- 24/7 access to Fiom's phone or chat service for psychosocial support
- prescription for the abortion pill via your own pharmacy
- embedding within regular GP care for complications and aftercare in line with other forms of additional provision
We offer GPs:
- (Telephone) consultation for GPs who self-prescribe the abortion pill
- Cooperation: GP wants to support woman, we will prescribe.
- GPs who wish to call us with a question: please send message and we will call back
- Refresher training
How do we work?
Following a careful review of the application form by a staff member, the form is re-examined by the prescribing doctor (four-eyes principle) when prescribing. If there are any questions, we will contact the woman for a telephone consultation, a brief email response, or for example, a request to have an ultrasound scan. This can then be provided to us.
We will send the prescription to the pharmacy that the unintentionally pregnant person has provided. In addition to the prescription, the pharmacist will also receive a link to the The KNMP's abortus dossier and to the Guideline for General Practitioners on Unintended Pregnancy. By the end of 2024, all pharmacists will have been informed.
Transfer letter to own GP
The pregnant person then receives a message from us stating that the prescription has been sent to the designated pharmacy, and we will once again provide the link to the patient information leaflet developed by GPs and pharmacists. They will also receive a referral letter for their GP. The pregnant person can decide whether to forward this letter to their GP or not. This procedure is the same as that used by abortion clinics.
Aftercare
During the day, between 08:00 and 18:00, we can answer questions by email from women who are unexpectedly pregnant and have taken the medication. We email women after 4 weeks, asking them again to repeat the pregnancy test. For her contraceptive use, we refer her to her GP.
Outside of these hours, meaning in the evenings, at night, and at weekends, any complications will be handled by an out-of-hours GP service. In autumn 2024, these services received instructions on how to handle questions and complaints after using the abortion pill.
In this regard, we don't work any differently from a regular GP practice. Even a GP who prescribes the abortion pill doesn't provide the out-of-hours care themselves, but can rely on the GP out-of-hours service.
Based on the prevalence of complications from medical abortion, we expect approximately 160 cases per year, distributed across 111 out-of-hours GP clinics.
For general practitioners who encounter a patient who has taken the abortion pill during their daily practice or out-of-hours service, it is important to know that the care is no different than for a patient experiencing a miscarriage, see NHG Standard Miscarriage
Patients who have visited an abortion clinic or a fellow GP and have been given the abortion pill can also report in (at the day practice or) during out-of-hours services. Not all abortion clinics have arranged 24-hour care. They therefore refer patients to their GP for aftercare.
The most important information that the GP on duty needs to know has been sent to all GP out-of-hours centres as a protocol in autumn 2024 and is presented below. This advice comes from the Guideline on Unintended Pregnancy.
GP Out-of-Hours Protocol
Every GP – regardless of whether they prescribe medication for a medical abortion themselves – can offer assistance during out-of-hours services for questions about, or complaints or complications from, a medical abortion. GPs have likely been doing this unknowingly for a long time, as women who receive this medication via a gynaecologist or abortion clinic sometimes present with heavy blood loss, whether or not they disclose the reason. Complaints from a medical abortion are comparable to those of a (medically treated) miscarriage. The advice from the NHG Standard Miscarriage is therefore leading. The most important items are:
• If no bleeding occurs 6 hours after using misoprostol, the woman can insert four additional 200 microgram misoprostol tablets vaginally. We routinely prescribe a repeat prescription for misoprostol.
• Advise an NSAID as a first choice for pain relief, for example, ibuprofen up to a maximum of 2400 mg/day, supplemented with paracetamol at the maximum dosage.
• Be alert and invite a woman for a consultation if she has the following complaints:
- 4 full sanitary pads per hour for 2-3 hours, or
- fever above 38 degrees for more than 4 hours, or
- increasing abdominal pain and foul-smelling vaginal discharge.
• Refer to a gynaecologist in cases of persistent heavy bleeding (> 4 full sanitary pads/hour for 2-3 hours) to rule out an incomplete abortion.
• Consider an ectopic pregnancy for unexplained pain, especially if there are risk factors. In case of suspected ectopic pregnancy, consult with the gynaecologist.
• Refer to a gynaecologist for persistent fever, especially in combination with abdominal pain and unpleasant discharge. This may indicate PID. The GP can treat PID themselves, or suspected PID, provided that ultrasound has ruled out any remaining products of conception in the uterus that could be causing the inflammation.
• Women who report a positive pregnancy test after an abortion can make an appointment with their GP during working hours on weekdays.
Evidence-based practice
Online abortion care is as effective and safe as in-person care, a study shows Cochrane systematic review from 2025. The American College of Obstetricians & Gynaecologists (ACOG) has determined that the abortion pill is as safe as an NSAID and less deadly than an erectile dysfunction pill.
We operate according to the Guideline mentioned above, which was developed through collaboration between abortion specialists, gynaecologists, GP trainers, a lawyer, a representative of a women's organisation, and a pharmacist. Several of us contributed to this guideline and provide training on it to other GPs.
In addition, we rely on the Directive Counselling when considering termination of pregnancy of the Dutch Society of Abortionists, on the WHO Guideline and the NICE Guideline.