The NHS Must Give Women More Choice on Abortion, Says Watchdog

The ‘significant barriers’ women face when they want to terminate a pregnancy should be broken down with abortion training for all healthcare professionals and more choice for patients, a health watchdog has said.

The National Institute of Health and Clinical Excellence (NICE) urged the NHS to ensure women are given an appointment within a week of asking for one and an abortion the following week.

NICE also called for women to be given the choice between having a medical or surgical abortion at a clinic, or referred to a service that can offer this.

All hospitals should accept self-referrals from women rather than expecting them to arrive through a GP, the guidance added, tackling current inconsistency over the issue.

If approved during the consultation process, the draft reforms, drawn up with the Royal College of Obstetricians and Gynaecologists, would mark a major leap for pro-choice campaigners and for the human rights of pregnant women.

Imogen Stephens, medical director of British charity Marie Stopes, said her organisation “wholeheartedly supports” the watchdog advice, but cautioned that only so much can be done without changes to the law.

“The fact that abortion, unlike any other healthcare, sits within the framework of a Victorian criminal law is hampering best clinical practice, while the threat of prosecution is deterring young doctors from training in the field and leading to increased waiting times.”

Abortion Training For Current And Future Doctors

The RCOG said it was “absolutely vital” that all NHS staff and future doctors in medical school should be given training to understand abortion. The issue is currently missing from core curriculums for medical students at British universities.

Under the European Human Rights Convention, reproductive rights are generally thought to fall under Article 8, but abortion is not covered explicitly.

Under the convention, the human rights of an unborn baby are also attached to those of the mother rather than standing alone.

The guidance on medical abortions comes after a shift in the rules last year allowed women to start have the second of two pills in the home, after accounts emerged of miscarriages in cars and on public transport after clinic visits.

It was found last year that more than 10,000 sets of abortion pills had been seized by enforcement officers in England, destined for women who wanted to avoid the pain of miscarrying in transition.

Victorian Criminal ‘Hampering’ Efforts

Surgical abortion has become more widely accepted in England and Wales, with 193,000 surgical procedures successfully performed in 2017, but remains illegal in a law dating back to the mid 19^thCentury.

The subsequent 1967 Abortion Act, which excluded Northern Ireland, never repealed this but exempted women who ended a pregnancy with the approval of two doctors.

Stephens said the “unnecessary” legal quagmires around abortion in the UK mean that progress on abortion can only go so far.

She told RightsInfo: “The fact that abortion, unlike any other healthcare, sits within the framework of a Victorian criminal law is hampering best clinical practice, while the threat of prosecution is deterring young doctors from training in the field and leading to increased waiting times.”

Morally, the right of a mother to terminate a pregnancy remains a sensitive and contentious issue, bound up with Catholic concerns in Northern Ireland where thousands of women continue to live in fear of imprisonment over the issue.

Even as recently as February the BBC was criticised for ignoring abortion on its advice pages on the grounds of impartiality.

Stigma Must Be Tackled

But Stephens says the moral stigma and the legal limits are linked.

“The 1967 Abortion Law also means that the signatures of two doctors are needed for each abortion, which can cause delays and adds to the stigma for both women and doctors,” she said.

“Meanwhile nurses are not legally able to prescribe the medication required, despite being able to prescribe the exact same pills if a woman has suffered a miscarriage.

“Removing these unnecessary barriers would improve abortion care and allow women to access treatment more quickly.”

Paul Chrisp, director of the Centre for Guidelines at NICE, branded abortion care “essential” and added that giving women the choice over the method of terminating the pregnancy is “crucial”.

He said: “Integrating and streamlining services should help improve access for all women, leading to shorter waiting times and allowing earlier terminations. This provides multiple benefits to the woman, including being able to have a medical termination at home.”