Reflections on the RSM/BSACP Online Conference ‘Excellence in Adversity: Abortion Care in the Coronavirus Pandemic’, 12 October 2020
18 November 2020
Any person, lay or medical, would be unlikely to disagree that the past 8 months have seen enormous disruption in healthcare, in work and in social relations. Much of this disruption has been negative, and in healthcare it has had a tremendous effect on both healthcare workers and patients. But disruption can also be a tool to jump-start innovation, and so this year’s joint Royal Society of Medicine (RSM)/British Society of Abortion Care Providers (BSACP) conference entitled ‘Excellence in Adversity: Abortion Care in the Coronavirus Pandemic’ looked both at how the demands of the pandemic have led to liberalisation in some areas of service provision, and have possibly pointed the way towards longer-term change.
The ongoing need for social distancing provoked innovation in the format of this year’s event, resulting in it being BSACP’s first experience of a ‘virtual’ conference held online using videoconferencing. Despite the odd technical gremlin, as the participants explored how to manoeuvre through both small group workshops and larger plenaries, the consensus was that not only did the online format make possible an event that would have had to be cancelled, it also enabled people to access the conference who might otherwise have struggled to participate for reasons of geography, caring responsibilities or competing work commitments.
It became apparent early in the pandemic that the traditional structures which dictated where and by whom reproductive healthcare could be both offered and accessed would need to be adapted. But what has proven so interesting this year for those interested in reproductive health is that rather than simply trying to approximate old practices in new circumstances, real reform has taken place, with both practical and social implications.
Outcomes for which those in the abortion care community have long campaigned, but which have been ensnared in academic debate, became political reality. As was set out by Rachael Clarke, Public Affairs and Advocacy Manager at British Pregnancy Advisory Service (BPAS), in her account of some spectacularly confused decision making by the government, after a “double U-turn” the first wholly telemedicine abortions became available in England, Wales and Scotland. For the first time, women at early gestation can be prescribed mifepristone and misoprostol after a telephone consultation, and then either have that medication posted to them or alternatively collect it themselves from the clinic. This change, which both the conference speakers and participants agreed granted women far greater autonomy over their choices, has not yet been confirmed by the Department of Health as a permanent change. News therefore that some of those present at the conference are currently undertaking comprehensive statistical research using data arising from the majority of UK abortions undertaken during the first lockdown period, with the aim of demonstrating that this is a change in practice that should remain in place after the pandemic, is encouraging.
Yet for all these changes, abortion in most of the UK remains governed by the Abortion Act 1967. With this in mind, Dr Janet Barter, a Consultant in Sexual and Reproductive Health at Barts NHS Trust and Dr Charles Musters, Consultant Perinatal Psychiatrist at East London NHS Foundation Trust, gave an illuminating presentation on the part of the Act that renders legal at any gestation an abortion where there is risk to the life of the pregnant women or risk of grave permanent injury to her physical or mental health. Although such cases are fortunately few in number annually, Drs Barter and Musters made it clear that these cases are likely to be time-critical, and therefore it is essential for sexual health and obstetrics/gynaecology professionals to have established networks with colleagues in other medical specialties such as psychiatry for when such emergencies occur.
As doctors and politicians consider the future direction of the UK’s abortion laws, research comparing the outcomes under different legal regimes in different parts of the UK and overseas will become ever more important. One of the great advantages of an online conference is the ability to connect in real time with overseas speakers, and so Professor Abigail Aiken was able to speak from Texas about a ground-breaking comparative qualitative study of remotely-managed early medical abortion across eight European countries. Strikingly in England, Wales and Scotland, some 86% of medication abortions provided during the first Covid-19 protocol were fully remote telemedicine, indicating the popularity of this model with service users.
In both the morning and afternoon sessions, time was set aside for smaller, focused workshops, which enabled attendees to learn more about how the changes are relevant to their own clinical practice. Thus there were a range of seminars for those seeking to establish services, on the logistics for those setting up services, for those involved in training or teaching abortion care at both graduate and undergraduate level, as well as other specialty- or location-specific workshops. In the free communications sessions, some of the new generation of doctors and scholars, who had pre-submitted abstracts for judging, were given an opportunity to present their research to wider audience. Congratulations to Drs Clara Duncan and John Reynolds-Wright whose short presentations were judged the winners in the online participant polls conducted during the morning and afternoon sessions, respectively.
In her closing keynote presentation, Professor Lesley Hoggart took a step back in order to place the current changes in the context of her wider social science research into cultural and ethical issues about women self-managing abortion. Abortion continues to be deeply stigmatised, and Professor Hoggart made it clear that building upon the shifts towards self-management of abortion by women, and using experience gained from the adversities of the current pandemic to lobby for normalised, legalised abortion, will only be possible if the deep-rooted social issues of shame, gender and sexuality are addressed.
Charlotte Kelly, Patient and Public Involvement Representative on BSACP Council