Dr Caroline Scherf is a Consultant Gynaecologist and has supported the RCOG’s Leading Safe Choices programme in South Africa and Tanzania.
Why is the availability of abortion care important for women?
An unwanted pregnancy is a common complication in women’s reproductive lives. If we accept that early pregnancy complications such as miscarriages or ectopics are a normal part of reproductive life, an unwanted pregnancy also presents such a complication. It should be dealt with as matter-of-factly as other early pregnancy issues and this needs to happen in the local Gynaecology or sexual health department.
Abortions are equally common and will be accessed regardless of legality or safety as many women are desperate enough to take huge risks when being faced with an unwanted pregnancy.
Illegal abortions are often unsafe and always lead to feelings of guilt. Access to post-treatment contraception is more difficult and thus the risk of subsequent abortions very high.
Thus provision of legal, safe abortion is vital to support women and minimise adverse outcomes.
What drew you to working in abortion care (UK/Global)?
My supervising consultant colleagues provided abortion as a routine part of Gynae services during my training. It had not been taught in my undergraduate course and I was keen to learn.
When applying to consultant posts, one including abortion care came up which I was happy to provide and move forward.
Since you became an O&G how has the landscape around abortion changed?
Yes, the subject has become even more scarce in undergraduate and postgraduate medicine and the community of colleagues providing specialist abortion care has shrunk a lot. The UK population still seems to think that ‘#needing an abortion’ is a rare event. Public opinion might support the need for access but the issue of patient’s guilt and lack of professional recognition for those working in this area continues to obstruct efforts to lift abortion care out of its Cinderella existence.
As an abortion care provider/advocate have you experienced stigma within the healthcare system? If so, what steps do you think would address this?
Lots of stigma: no other very common treatment in medicine is open to ‘conscientious objections’ when the need to provide care seems outside GMC codes of care. Thus very few doctors (especially those working in O&G) accept the necessity to provide abortion care as part of their job. ‘Conscientious objection’ amongst O&G staff is unchallenged and may often mean different things, such as ‘I am uncomfortable with this situation as I don’t understand it’ or even ‘I don’t really agree with certain women’s life choices and want to leave the work for others to do’.
Both statements are in conflict with the GMC codes of practice but since not challenged remain acceptable.
What do you think are the key priorities to ensure abortion services are sustainable today and into the future?
The Health Ministers of each UK country need to direct every single O&G unit to provide abortion care, just as they are commissioned / obliged to provide early pregnancy units and care.
What impact do you think the decriminalisation of abortion would have on abortion care services?
Decriminalisation of abortion would simplify treatment with less hospital contacts, better access to abortifacient medicines and more time for specialists to deal with complicated cases. It may also help to de-mystify abortion care and normalise it as part of mainstream O&G. Finally it will move the issue of abortion firmly into medical domains with ethical implications (similar to fetal medicine).
Let’s look at the Canadian example much more closely to alleviate politician’s anxiety regarding decriminalisation of abortion.
What role is there for post abortion family planning in abortion care services?
The two are very closely linked and suitable effective future contraception should be identified and provided for each women during her abortion treatment.
This interview has been condensed and edited.