NHS nurses and midwives should be able to approve abortions, report argues
Nurses and midwives should be able to approve perform early-stage abortions, a report has recommended.
The largest study of abortion in Britain concluded that the need for two doctors to sign off on the procedure should be scrapped.
At present, nurses and midwives are unable to prescribe abortion pills (given up to 10 weeks of pregnancy in England), with the pills instead signed off by a doctor. Abortions can only take place in NHS hospitals or in other areas designated by the Health Secretary, such as a person’s home.
But the report said that laws should change to allow trained nurses and midwives to offer abortion pills, arguing that this would cut bureaucracy and speed up women’s access to early abortions.
The need for two doctors to say an abortion can go ahead should also be scrapped, the report claimed, with nurses and midwives instead being able to stamp the paperwork for the patients they are treating.
It also calls for a change in the law so nurses and midwives can perform vacuum aspirations for abortion up to 14 weeks. Experts noted that staff are already allowed to do this for women suffering miscarriage.
The Shaping Abortion for Change (SACHA) study was led by researchers from the London School of Hygiene & Tropical Medicine (LSHTM) and based its evidence on a survey of 772 healthcare professionals, interviews with 48 women with recent experience of abortion, and consultations with 15 key stakeholders.
It found that medical abortions, in which patients typically take abortion medication at home, now account for 87 per cent of abortions in England and Wales.
While women in the study said they valued the convenience, ease, comfort and privacy and confidentiality of taking abortion pills at home, they also wanted the choice to request a surgical abortion.
The report said that relying on abortion medication could lead to loss of crucial skills and said there is a need to ensure sufficient numbers of staff are trained in surgical abortion so choice is maintained.
Kaye Wellings, SACHA co-lead and Professor of Sexual and Reproductive Health Research at LSHTM, said: “Ultimately, it seems likely that Britain will follow other countries – Ireland, Northern Ireland, Sweden, Australia and Canada – in decriminalising abortion entirely and having it subject to the professional and regulatory, rather than criminal, sanctions that apply to other aspects of health care.
“In the meantime, as abortion provision is increasingly nurse-led, it makes sense for nurses and midwives to be able to sign off abortions instead of having to pass their paperwork to two doctors, who usually have no contact with the patient.”
She added: “There is also merit in permitting nurses and midwives to prescribe abortion medications and also to carry out vacuum aspiration which they perform anyway in the management of miscarriage.
“This would ensure that sufficient cadres of professionals have the skills needed to offer women a choice and address the current risk of valuable skills being lost.”
Dr Rebecca French, SACHA co-lead and Associate Professor of Reproductive and Sexual Health at LSHTM, said that choice over the type of procedure was “important” and options for patients needed to be “available, timely and accessible”.
The SACHA study was presented to the All Party Parliamentary Group on Sexual and Reproductive Health on Tuesday.