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; firstname.lastname@example.org
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.