Make access to abortion easier, UK's top gynaecologist demands
Prof Lesley Regan wants nurses and midwives to be allowed to administer abortion pills, and only one doctor’s approval to be required
Nurses and midwives should be allowed to give women the pills that end an unwanted pregnancy as part of a relaxation of Britain’s abortion laws, the leader of the country’s specialist women’s health doctors has demanded.
In an interview with the Guardian, Prof Lesley Regan also urged MPs to amend the longstanding legal requirement for two doctors to approve any termination, reducing the number to one except in a few unusual circumstances.
Regan, the president of the Royal College of Obstetricians and Gynaecologists, said the 1967 Abortion Act was outdated and needed a shakeup because it was putting unjustified and time-consuming barriers in the way of women urgently seeking an abortion.
Amendments were needed to the 50-year-old legislation because some women, frustrated by long delays in obtaining a termination through the NHS, were instead resorting to obtaining abortion pills over the internet, she said.
Regan wants midwives to be permitted to give women the tablets, and for both nurses and midwives to be allowed to start performing abortions in the first 15 weeks of pregnancy using a technique called vacuum aspiration.
“There are a lot of women now who are finding that there are big barriers to them accessing [a] swift response to their request [for an early abortion]. Many women and girls are finding it difficult to access,” Regan said.
“The current need for two doctors’ signatures to certify that a woman is approved to undergo an abortion causes unnecessary delays in women’s access to abortion services. There are no other situations where either competent men or women require permission from two third parties to make a personal healthcare decision.
“Individual doctors should be allowed to provide the assessment in the same way as when they treat their patients without the need to consult another doctor.”
However, she said a second doctor’s opinion could still be sought if the woman was very young, or a severe foetal abnormality had been diagnosed late, or if the woman had “challenging personal circumstances” such as learning disabilities.
Nurses and midwives already obtain consent from almost all women seeking an abortion. The experience in other countries showed that women would feel more at ease if nurses, not just doctors, could prescribe abortion pills, Regan said.
Under the 1967 act two doctors have to approve a woman’s request for an abortion before it is allowed to proceed. Both doctors must agree that the woman’s physical or mental health and wellbeing are at risk if she carries on with the pregnancy.
The two doctors’ requirement was included in then backbench Liberal MP David Steel’s historic legislation to show that the request for an abortion was being taken seriously by medical professionals and the women.
Of the 190,406 terminations performed last year in England and Wales, 115,824 (61%) involved a medical abortion and the other 74,582 (39%) were done surgically. Nurses can already prescribe the same medication, and perform vacuum aspiration, in order to complete a missed miscarriage, in situations which are very similar to planned terminations.
Regan pointed to a recent academic study which found that many British women seeking an early-stage medical abortion had encountered “access barriers including long waiting times, distance to a clinic, work or childcare commitments, and prior negative experiences of abortion care”.
Abigail Aiken, the author of the research and an assistant professor at the University of Texas, said that despite termination being legal in Britain and free to access, “this research shows that some groups of women in Britain find it very challenging or even impossible to access abortion care through current service models.”
Pro-choice campaigners are preparing to mark the 50th anniversary on 27 October of the 1967 statute, which legalised abortion in England, Scotland and Wales.
“Why is Professor Regan assuming abortion is such a boon to women that it needs to be instantly available with no time for second thoughts or offers of help?” said Dr Anthony McCarthy, the communications and education director of the Society for the Protection of Unborn Children.
“If accepted, these proposals will help drive out of reproductive healthcare nurses and midwives who simply want to help women have their babies and get the support they need.
“Professor Regan’s suggestions seek to trivialise abortion and show no desire to make it more rare or any realisation that abortion is even regrettable. Easier availability is likely to lead to increased use and an undermining of positive strategies that can assist women.”
The number of women in Great Britain having an abortion has been steady for many years, and was 202,469 last year. In England and Wales, 80% occur within three to nine weeks of gestation.
Women in Northern Ireland cannot legally have an abortion, as the 1967 act did not extend there. But in June the government said that in future women from Northern Ireland could have a termination on the NHS at hospitals in England.
The Department of Health said: “Abortion is an issue on which the government adopts a neutral stance. Proposals for legislative change are a matter for backbenchers to bring forward and as it is a matter of conscience, it is a free vote in parliament.”