Joint RSM/BSACP Conference on ‘Excellence in Abortion Care’ at the Royal Society of Medicine, London, UK on 11 October 2017

On Wednesday 11 October 2017, I attended the joint conference organised by the British Society of Abortion Care Providers (BSACP) and the Royal Society of Medicine (RSM) with the theme ‘Excellence in Abortion Care’. I was particularly excited to attend, as I am currently the President of the Society of Medical Students for Choice in QUB, as well as a volunteer with Alliance for Choice, an activist group based in Belfast, and I have a keen interest in abortion care and women’s health.

The day was packed with informative sessions, split into six main sessions: Update on Abortion Statistics; Clinical Update in Abortion Care; Using Telemedicine to Increase Access and Satisfaction of Abortion Care; Inspection and Regulation; Access and Management of Abortion After the First Trimester; and Nurses and Midwives in Abortion Care. With such a varied and mixed day, I believe that the conference was accessible and interesting for people involved in many different areas of abortion care.

The abortion statistics session contained many interesting points about the implications of Northern Irish and Irish pregnant women and people travelling to Britain for abortion access. The point was made that the numbers of women and people travelling from Northern Ireland and Ireland to undergo abortions in Britain are always underestimates, on account of stigma and fear leading to people not providing accurate addresses and postcodes.

The session around clinical updates in abortion care was very interesting with regard to the woman-centred aspects of abortion care, and demonstrated how the patient experience is useful in improving clinical practice. This session focused on early medical abortion (EMA) and pain management during manual vacuum aspiration. I found the EMA session particularly informative about the benefits versus the negatives of EMA in terms of patient satisfaction and reducing the stress of unexpected pregnancies and the risks of EMA, including missed ectopic pregnancies.

Telemedicine is an area of medicine that is often underutilised; however, it has an important role to play in abortion provision, facilitating the care of patients living in remote areas or those who cannot attend clinics for a variety of reasons. It was stressed in this session how important the decriminalization of abortion care is in facilitating the provision of better access to abortion services to those patients who cannot access care within a clinic or hospital setting. This is an example of the Inverse Care Law being seen in action, namely those who are most in need of care being unable to access it, including those in controlling relationships or those with childcare or work responsibilities that they cannot abandon in order to attend a clinic or hospital for a day. Despite the National Health Service (NHS) being set up to reduce health inequalities, travelling for abortion care can result in many inequalities for those who are unable to travel for the reasons given above. This is also important to remember in respect of pregnant women and people in Northern Ireland and Ireland – free abortion services and funding in Britain is not a long-term solution for many women, and abortion services must be accessible within local care facilities or even at home. Unfortunately, however, legislation often stands in the way of providing high-quality, patient-centred care.

This focus on legislation continued into the afternoon, with the session on Nurses and Midwives in Abortion Care commenting on the limits of the 1967 Abortion Act, which we are celebrating 50 years of in Britain. This Act, which was extremely welcome in 1967, as women were dying or left with lifelong disabilities after unsafe and illegal abortions, is out of date for 2017. With developments such as ‘Women on Web’ and ‘Women on Waves’, that provide abortion pills to people who cannot access healthcare facilities, access to abortion can be as close as a mouse-click away. Similarly, legal limitations on who can provide abortions restricts abortion care provision to doctors and excludes nurses and midwives, despite them being highly trained members of the healthcare team, when their involvement in abortion care provision might sometimes be preferable in terms of resource allocation.

The day ended with a documentary film showcase led by Dr Jayne Kavanagh, a clinical teaching fellow at University College London. This film was incredibly powerful and emotional, and featured interviews with doctors who worked both before and after the 1967 Abortion Act; activists and politicians who were instrumental in bringing about changes in abortion legislation; and, of course, women who accessed abortion services before the Act was introduced. I personally found the film particularly moving because this year not only represents 50 years since the 1967 Abortion Act was introduced in Britain, but also because it represents 50 years of denial of abortion care to pregnant women and people in Northern Ireland.

However, to end on an optimistic note, I do believe that continuing activism and advocacy from leading healthcare organisations, including the British Medical Association, Royal College of Obstetricians and Gynaecologists, Royal College of Midwives and, of course, the BSACP, are helping to bring about a change of opinion and ensuring access to essential abortion care services to all pregnant women and people, regardless of their address or postcode. Similarly, the hard work and success of the British Pregnancy Advisory Service’s #WeTrustWomen campaign and Alliance for Choice’s #TrustWomen campaign are bringing abortion to the forefront for politicians to discuss, and are raising public awareness about this important healthcare and human rights issue.

Jill McManus, Third-year Medical Student, Queen’s University Belfast, Belfast, Northern Ireland; jmcmanus27@qub.ac.uk

Note on the Author

Jill McManus is president of the QUB chapter of Medical Students for Choice, and is an activist with Alliance for Choice, a pro-choice activist and advocacy group based in Northern Ireland. She also has a blog, where she writes about current events and information on abortion.

‘Doctors, Conscience and Abortion Law and Practice’ Workshop, University of Kent, Canterbury, UK, 29 June 2017

On Thursday 29th June I attended a conference at the University of Kent entitled ‘Doctors, Conscience and Abortion Law and Practice’ organised by Dr Ellie Lee and Professor Sally Sheldon as a collaboration between the Centre for the Interdisciplinary Study of Reproduction (CISoR), the Centre for Parenting Culture Studies (CPCS) and the British Pregnancy Advisory Service (bpas). This conference was part of a series of events for the 50th Anniversary of the 1967 Abortion Act and aimed to promote critical reflection on this legislation. There were four main sections to the day: ‘Doctors and the Abortion Act 1967,’ ‘Abortion Providers: Doctors Who Do’, ‘Conscientious Objection: Doctors Who Don’t’ and finally closing remarks from Ann Furedi (bpas Chief Executive).

Overall this conference was extremely interesting with scholars from around the world giving fascinating talks on the issue of conscience. One of the most memorable comments of the day was made by Professor Malcolm Potts (University of California at Berkeley) who said the abortion procedure is the only one in America where “the surgeon is more likely to die than the patient”. This comment was striking for me as it really drew attention to the fantastic, yet dangerous jobs medical professionals across the globe do in providing safe abortions to women. A further interesting point raised at this conference was regarding the conscientious objection clause and the current debate surrounding the position of abortion in medicine. There were many different opinions on the conscientious objection clause of the 1967 Abortion Act at the conference. Some people attending the conference believed that abortion should be considered a routine aspect of obstetrics and gynaecology, and if any doctor conscientiously objects to abortion then they should specialise in a different field of medicine. This is widely linked to debates on the position of abortion within medicine in Britain and is definitely a discussion that needs to continue.

Finally, I would like to highlight the ‘My Abortion Experience’ project led by Dr Lesley Hoggart. During the conference we were shown several films of young women describing their experience of abortion. The stories these young women told were inspirational and showed the importance of the work that medical professionals who are involved in the provision of abortion do on a daily basis. There is an upcoming 2-day conference in London as part of this series on 24–25 October 2017 entitled ‘The Abortion Act 1967: A Promise Fulfilled?’, which aims to address a range of important socio-legal, historical, political and clinical practice-based questions, focusing on the hopes and strategies of the broad coalition (made up of disparate constituencies) in favour of liberalising change and the extent to which they have been realised.

Hannah Pereira

ESRC PhD Candidate in Social Policy, School of Social Policy, Sociology and Social Research, University of Kent, Canterbury, UK; hp273@kent.ac.uk

 

Scottish Abortion Care Providers Meeting – The Highlights!

Overview

The 7th Annual Scottish Abortion Care Providers meeting was held in Edinburgh on 27 January 2017.

Over 100 delegates attended from all over Europe, representing many different disciplines. It was a fantastic opportunity to meet enthusiastic colleagues and share new information and visions, helping to improve abortion care in Scotland, through talks, discussions and poster presentations. A wide range of thought-provoking topics were presented within the main meeting themes, including current care within Scotland, and the challenges and new initiatives associated with improving a women’s journey through abortion.

Scottish Abortion Care

Dr Rachael Wood from National Services Scotland opened the proceedings by providing some background to the current abortion statistics for Scotland. We learnt that there has been an increase of 2.6% in the number of abortions performed in Scotland from 2014 to 2015. This is not thought to be due to non-Scottish residents or women travelling for abortion. The increase has been seen mainly in women living in areas of deprivation, particularly women aged 35–39 years. Almost 80% undergo a medical abortion, with approximately 60% in 2015 occurring by 8 weeks (compared with 33% in 2006).

Difficulties in Abortion Care

Dr Caitriona Henchion from the Irish fpa (@IrishFPA) highlighted the difficulties faced by women and healthcare professionals in both the North and South of Ireland.

We then learned of Portugal’s journey following the legalisation of abortion from Dr Teresa Bombas.

Dr Lisa McDaid (@mcd_li) from the University of Glasgow provided an interesting insight into women’s experience of more than one abortion.1 She explained that there are often complex and overlapping issues, which demonstrate a range of potential vulnerabilities among women seeking more than one abortion. Terms such as ‘late’ and ‘repeat’ abortion are stigmatising in themselves for women. She suggested rather than a policy focus on trying to reduce ‘repeat’ and ‘late’ abortions, instead we should shift the focus towards preventing unintended conceptions and supporting those women who need subsequent abortions.

Latest Initiatives

Dr Philippe Faucher (@PhilFaucher) gave a stimulating talk on the management of early medical abortion (i.e. pregnancy of unknown location). He presented research to highlight that this is an option for many women and something that is now offered in his service in France. Provided risk factors for ectopic pregnancy are excluded, mifepristone can be administered, following a serum human chorionic gonadotrophin (hCG) result on that day. Women should be followed up within 7 days where an 80% decrease in serum hCG level would be expected (50% at Day 4).

Dr Faucher provided evidence to suggest that mifepristone was not dangerous for an ectopic pregnancy, which could well be missed on an early pregnancy scan. In fact, he proposed that managing abortion in this way would lead to earlier detection of ectopic pregnancies.

This is not yet routine practice in the UK. Currently high-sensitivity urine pregnancy tests are used rather than successive serum hCG levels to confirm complete abortion. However, this research suggests another option for women not wishing to delay their pregnancy management.

Dr Patricia Lohr (@lohrpa) shared bpas’ experiences when altering the timing between mifepristone and misoprostol from 24–48 hours to same-day administration. Both options were found to be acceptable to women. While there may be a slightly reduced efficacy with same-day administration, this was often the preferred option for women due to their own personal circumstances.

 Professor James Trussell presented reassuring work on the experiences of women seeking at-home medical abortion through ‘Women on Web’ from both Eire and Northern Ireland.2 Over a 5-year period (January 2010–December 2015) 5650 women requested at-home medical abortion. Just over 1000 women were surveyed, with 97% feeling they had made the right decision and 98% recommending the method to others. The feelings women most commonly reported after completing TOP were ‘relieved’ (70%) and ‘satisfied’ (36%).

We then heard about Scottish initiatives to improve women’s journey through abortion. Leanne Rockingham (@learock76) and Jill Wilson from NHS Lothian and Greater Glasgow and Clyde presented a recently developed animated film entitled ‘Let’s Talk About Abortion’ (https://youtu.be/KksPuM5cokc). This work led on from research carried out by the Centre for Research on Families and Relationships on young people’s views and knowledge about abortion. This short film addresses the gaps highlighted by the research findings and provides the information that young people themselves have asked for, in a format with which they will engage.

The meeting provided lots of food for thought, and prompted discussions and networking between groups to take some of these ideas forward. I’m looking forward to next year’s meeting already!

Janine Simpson, Specialty Registrar Community Sexual and Reproductive Health, Sandyford, Glasgow, UK; janine.simpson2@nhs.net

References

  1. Purcell C, Cameron S, Caird L, et al. Access to and experience of later abortion: accounts from women in Scotland. Perspect Sex Reprod Health 2014; 46: 101–108. DOI: 10.1363/46e1214.
  2. Aiken ARA, Gomperts R, Trussell J. Experiences and characteristics of women seeking and completing at-home medical termination of pregnancy through online telemedicine in Ireland and Northern Ireland: a population-based analysis. BJOG 2016; DOI: 10.1111/1471-0528.14401.