- Dozens of British women denied abortion care before 24 weeks in 2016 and 2017, even though the pregnancy threatened their health
- Women with uncontrolled epilepsy, blood disorders, and heart conditions particularly affected
- Numbers of women with medical complexities growing in the population, this is reflected in women needing abortion care
- Continuing criminal framework that surrounds abortion can deter doctors from entering this area of women's health
- Abortion up to 24 weeks must be decriminalised to ensure best service delivery framework
Women in the UK with medical conditions including epilepsy, heart problems, and cancer struggle to obtain abortion care, even though the continuation of the pregnancy poses a significant threat to their health.
A bpas briefing published today based on 2,900 women with medical complexities who bpas helped to find abortion care during 2016 and 2017 highlights the fact that in 21st Century Britain, women are being compelled to continue pregnancies they do not want due to a lack of appropriate services, or endure stressful, long waits for care while also coping with a health condition that may be exacerbated by pregnancy. These are women who cannot be seen in stand-alone clinics such as those run by bpas, but must be cared for in NHS hospital settings where there is swift back up to medical care if their condition deteriorates.
On 46 occasions in 2016 and 2017 - or generally twice a month - bpas was unable to secure suitable NHS hospital treatment for these women by the strict legal cut-off point of 24 weeks. bpas runs a dedicated specialist placements service to find hospital appointments for these women, but as we do not see all women, we believe it is reasonable to assume that at least once a week a woman with a medical conditions is unable to access the care she needs.
These include very young women and women in complex situations, such as those experiencing domestic abuse, who present towards the end of the second trimester. This can be due to late detection of pregnancy, sometimes because they are using contraception that has altered bleeding patterns so pregnancy is not suspected, or because they believed pregnancy was unlikely as a result of their condition affecting their fertility. In other cases their circumstances – including their health – have deteriorated, making a wanted pregnancy no longer possible.
Medically complex women for whom bpas was unable to secure an appointment in 2016/17:
- Teenager who has recently left foster care. Lives alone and feels unprepared to become a parent. She has a thyroid condition (at risk of potentially fatal thyroid storm). Contacted bpas at 22 weeks. No appointment available.
- Client has a heart condition and is currently attempting to get a non-molestation order against ex-partner due to domestic violence. Has a child with a serious illness. Presented at 22 weeks. No appointment available.
- Client’s pregnancy was planned, but her health has sharply deteriorated. She has pulmonary fibrosis and a range of medical problems. Has decided to end the pregnancy as she needs to be able to care for her existing child. Presented at 22 weeks. No appointment available.
As the 3 hospitals able to provide up to the legal limit of 24 weeks in these circumstances are all in London, distance from other areas of the country and time away from home can also prove insurmountable obstacles.
- Contacted bpas at 15 weeks. Has recently had a heart attack. She is unable to travel far for treatment as she cares for her existing children and disabled partner. No suitable appointment available.
In other cases women must sometimes wait many weeks before an abortion appointment can be found: in one case a mother with cancer whose treatment could not start until the abortion was performed waited 45 days for an appointment. In another case, a mother with epilepsy and learning difficulties who presented at the end of first trimester was treated nearly 7 weeks later.
Work is underway to commission a specialist pathway for women who cannot be cared for in stand-alone clinics. The Royal College of Obstetricians and Gynaecologists (RCOG) has also established an Abortion Taskforce to improve women’s access to high quality abortion care. bpas will do all it can to support these initiatives.
However we ultimately believe abortion must removed from the criminal law and the unique threat of prosecution of healthcare workers involved in abortion care lifted, enabling abortion to be regulated in the same way as other comparable healthcare procedures.
The criminal law acts as a deterrent to doctors training in this area, and has inhibited the development of integrated women's reproductive healthcare services - meaning many young medics are not exposed to abortion care nor offered the opportunity to train. The 1967 Abortion Act did not decriminalise abortion – it only made it legal when 2 doctors authorise the procedure on specific grounds. Any abortion performed outside of the Act carries the threat of life in prison and in recent years those opposed to abortion have called for the sanctioning of doctors – not for failing to provide high quality clinical care, but for failing to fill in the legal paperwork that is unique to abortion correctly. This has had a chilling effect on practice.
Ann Furedi, chief executive of the British Pregnancy Advisory Service, said:
“Those opposed to abortion sometimes claim there are ‘too many’ abortions, or casually declare that the time limit needs to be reduced. The fact is that in 21st Century Britain, there are women who are not getting the abortions they need, despite fully meeting the grounds of the 1967 Abortion Act.
“These are women for whom the continuation of the pregnancy threatens their health. These are women with existing children to care for. These are women who are often in complex social circumstances at the same time as struggling to deal with a health condition and an unwanted pregnancy.
“There is no one single solution to problems with service provision – but one thing is certain. While abortion remains in the criminal law, separated and stigmatised, we will struggle to provide women with the reproductive healthcare services they need and deserve. Abortion is part and parcel of women’s healthcare. It should be regulated and delivered as such.”
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Notes to Editors:
The full briefing paper, Medically Complex Women and Abortion Care, is available online here.
bpas is a charity which sees more than 70,000 women a year and provides reproductive healthcare services including pregnancy counselling, abortion care, miscarriage management and contraception, at clinics across the UK. It supports and advocates for reproductive choice. More information can be found at bpas.org.
The campaign to decriminalise abortion
bpas launched the We Trust Women campaign to decriminalise abortion in 2016 alongside a coalition of other healthcare and women’s rights organisations including the Fawcett Society and Women’s Aid. Since then, a range of expert medical bodies have voted to support decriminalisation, including the BMA and the Royal College of Obstetricians and Gynaecologists.
In March 2017, Diana Johnson MP presented a bill seeking to decriminalise abortion up to 24 weeks of pregnancy. This was supported by MPs across the political spectrum, and passed its first stage by 172 votes to 142. Due to the general election, this bill was not able to progress any further. Bpas supports the re-introduction of a bill to the same effect.