Safeguarding in abortion care: Protecting vulnerable patients through research and transformation

Safeguarding promotes the welfare and safety of adults and children who may be at risk of abuse, neglect, or exploitation. In England and Wales, all providers of funded health services registered with the Care Quality Commission (CQC) are required to maintain safeguarding leadership and robust systems to identify and respond to harm (RCN, 2019; HM Government, 2023). Within abortion care, however, safeguarding presents unique complexities requiring specialist approaches, continual adaptation, and ongoing research.

Safeguarding within abortion care presents a unique challenge. Many individuals accessing abortion services are physically well and may have limited or no routine contact with healthcare services or professionals. For many patients, contact with BPAS may represent the first time they disclose a pregnancy to anyone.

Importantly, it may also be the first time individuals disclose experiences of abuse, coercion, exploitation, or vulnerability. Confidential, compassionate services delivered by skilled practitioners create a unique opportunity for individuals to discuss pregnancy choices openly and seek support in a safe environment.

Evidence demonstrates that domestic abuse frequently begins or escalates during pregnancy and the postnatal period (Women’s Aid, 2019). Safeguarding concerns including domestic abuse, coercive control, reproductive coercion, mental ill-health, sexual violence, honour-based abuse, trafficking, exploitation, and barriers to healthcare can all become more complex within the context of pregnancy and abortion care (NICE, 2020; Rowlands et al 2022; Hestia, 2018; Karma Nirvana, 2025).

Recent data from Karma Nirvana identified 3,079 honour-based abuse cases through its national helpline in 2024/25, representing a 35% increase since 2021/22 (Karma Nirvana, 2025). The most frequently identified barriers preventing individuals from seeking support included fear of repercussions and mistrust of professionals, reinforcing the importance of professional curiosity and creating psychologically safe environments that enable disclosure (Karma Nirvana, 2025).

Within abortion care, where patients may only have a single interaction with healthcare services, opportunities to identify hidden vulnerability become particularly significant. Practitioners therefore require the skills and confidence to recognise less visible indicators of risk and create environments where patients feel safe to disclose concerns.

Around 12% of BPAS patients require safeguarding support, equating to almost 16,000 patients annually. Within BPAS, many safeguarding disclosures relate to domestic abuse and mental health concerns; however, safeguarding complexity extends far beyond these categories.

Many individuals accessing services may be experiencing hidden harms not immediately visible during routine healthcare interactions. For example, a young person experiencing family or cultural pressures relating to pregnancy may face significant risks should their pregnancy or abortion become known. Others may be experiencing reproductive coercion, exploitation, trafficking, homelessness, or significant social isolation (Rowlands et al, 2022).

The evolution of telemedical abortion pathways has transformed access to care and reduced barriers for many patients. However, telemedicine has also required safeguarding approaches to evolve. Practitioners increasingly require enhanced communication skills, professional curiosity, and robust escalation pathways to identify vulnerability and assess risk within remote consultations (RCOG, 2022).

Consequently, staff within abortion care settings often have significant exposure to challenging and emotionally demanding subject matter. Practitioners regularly manage disclosures involving abuse, trauma, exploitation, and hidden harm. Organisations therefore have a responsibility not only to safeguard patients but also to support workforce wellbeing and resilience through robust training, specialist safeguarding supervision, psychologically safe support structures, and accessible escalation pathways.

BPAS has undergone a significant period of safeguarding transformation to strengthen both patient experience and staff support when managing safeguarding concerns.

The BPAS safeguarding transformation programme has included implementation of bespoke evidence-based safeguarding risk assessments, enhanced restorative safeguarding supervision, earlier intervention processes, strengthened escalation pathways, and improvements designed to support vulnerable patients through earlier identification and intervention.

BPAS has also made significant investment in education and professional development. All staff receive specialist training in the use of the Domestic Abuse, Stalking and Harassment and Honour-Based Violence Risk Assessment (DASH) to support recognition of domestic abuse risk factors and strengthen responses to patients experiencing abuse and coercion. BPAS has also introduced a bespoke Level 3 Safeguarding programme, specifically designed around the complexities and unique safeguarding presentations encountered within abortion care. Investment in specialist training and supervision strengthens both practitioner capability and organisational assurance that vulnerable patients receive safe, informed, and compassionate care.

The organisation has also prioritised workforce wellbeing through specialist safeguarding supervision and reflective support structures, recognising that practitioners working within safeguarding and abortion care are frequently exposed to complex and emotionally demanding subject matter.

Research within safeguarding and abortion care remains critically important and continues to be under-developed. Individuals accessing abortion services often include groups whose experiences are traditionally underrepresented in research, including children and young people, victims of abuse, and those experiencing hidden harm or marginalisation.

As abortion care evolves, there is a risk that pathways continue to develop without sufficient evidence regarding patient outcomes, practitioner experiences, or effectiveness of interventions.

Research evaluating safeguarding pathways within abortion settings would strengthen understanding of what works well and where further development is needed. Incorporating patient voice into safeguarding research would provide essential insight into the lived experiences of vulnerable groups and support meaningful service improvement.

Research involving staff experiences would also improve understanding of the emotional impact of safeguarding work and identify how organisations can best support resilience and workforce wellbeing.

Safeguarding transformation is not a one-time intervention but an ongoing process requiring continuous horizon scanning, adaptation, and innovation. As the complexity of abortion care evolves, safeguarding systems must continue to adapt alongside changing patient needs and emerging risks.

Through partnership working, meaningful research, strong governance, and patient advocacy, organisations such as BPAS play a vital role in ensuring people can access reproductive healthcare safely and receive support that enables them not only to avoid harm, but to thrive.