This Q&A page provides the O&G perspective on abortion settings. It was published by the RCOG in June 2008 to accompany the passage of the Human Fertilisation and Embryology Bill through Parliament.
What is the law regarding abortion settings?
Abortions can only be carried out in hospitals and in licensed premises such as independent sector clinics. Approval of an abortion setting is granted by the Secretary of State.
Why is there the need to expand on the types of settings providing abortion care services?
It is important that abortion care services are accessible to women who it need most. This includes women in vulnerable circumstances and those from geographically isolated communities across the country.
To improve access, services could be made available in local NHS medical settings other than hospitals. The suggestion is for GP surgeries, genitourinary medicine (GUM) and family planning clinics to offer these services, based on local needs assessment.
The results from the recently published pilot study by the Department of Health on the provision of Early Medical Abortion (EMA) in primary care settings1 are reassuring.
What are the issues surrounding allowing abortion services to be carried out in these proposed settings other than hospitals and approved settings?
Currently, the law states that abortions are carried out in settings which meet with rigorous minimum standards of care. Many GP surgeries, GUM and family planning clinics could fall into such a category of premises.
There is the issue of the expertise within these settings and recourse to further medical help when required. This includes well-trained and competent staff and the adherence to strict risk management protocols and guidelines within these settings. All community-based abortion settings would provide the same guidelines and pathways and levels of expertise as traditional settings and have emergency transfer arrangements to hospitals should complications arise.
Are there any concerns over the training and abilities of staff?
No. If offered in these settings, there would be the same skills-mix of doctors and nurses as currently provide abortion services in traditional settings. The abortions carried out in the DH pilot study were medical and not surgical, that is, abortion occurring through the administration of drugs rather than through the use of surgery, and only within the first 9 weeks of pregnancy.
Over the years, the clinical skills base of nurses have increased and many are already carrying out complex surgical procedures such as colposcopies and hysteroscopies. Nurses therefore do have the required skills needed to carry out early surgical abortions. Provided they are appropriately trained, do not themselves object to carrying out these procedures and work within a clinical team, there should be no reason why nurses are not allowed to be involved in abortion care services.
Is there any evidence on the safety aspects to support the proposal to extend abortion care services to these settings?
There is excellent international evidence to suggest that early medical abortions using misoprostol, supervised by doctors and nurses in community settings; are safe, effective and acceptable to many women. The results of the recent DH pilot study confirmed these findings. The study demonstrated that the complication rates were low, comparable with traditional settings, and staff and patient satisfaction rates with the service were high.
What is the RCOG’s view on abortion settings?
The RCOG believes that women should have better access to abortion care services. By improving access through GP surgeries, GUM and family planning clinics, it is hoped that the unnecessary delays which some women seeking abortions currently experience will be reduced. The earlier abortion is performed, the safer it is for the woman due to a choice of method and lower risk of complications.
Provided safety standards are met, staff have relevant training and competencies to carry out these procedures and appropriate information is provided to women to enable informed choice, it is entirely appropriate for abortion care services to be extended to GP surgeries, GUM and family planning clinics to serve local communities. As in traditional settings, this would include a comprehensive package of sexual health services including non-directive counselling and support, STI screening and contraception advice and provision.
1. Ingham R, Lee E. Evaluation of Early Medical Abortion (EMA) Pilot Sites : Final Report, Department of Health, 2008.
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