Nurses and midwives should be able to approve abortions, a UK study has concluded, in what would be the one of the biggest changes to abortion legislation since 1967.
The findings of the Shaping Abortion for Change (SACHA) report, which was led by the London School of Hygiene and Tropical Medicine, has recommended significant changes in abortion healthcare law to bring legislation in line with current practice.
Current law, under the 1967 Abortion Act, requires abortions to be approved by two doctors. The way this law is currently interpreted means that nurses are not allowed to perform Vacuum Aspirations (VA) for abortion even though they can conduct the same procedures for miscarriages with patients who are up to 14 weeks pregnant.
However, the study, funded by the National Institute for Health Research, suggests that regulations should be changed to allow nurses and midwives to authorise an abortion, prescribe abortion medication and perform vacuum aspirations.
Kaye Wellings, SACHA co-lead and Professor of Sexual and Reproductive Health Research at LSHTM, said that ‘as abortion provision is increasingly nurse-led, it makes sense for nurses and midwives to be able to sign off abortions instead of having to pass their paperwork to two doctors, who usually have no contact with the patient.
‘There is also merit in permitting nurses and midwives to prescribe abortion medications and also to carry out vacuum aspiration which they perform anyway in the management of miscarriage. This would ensure that sufficient cadres of professionals have the skills needed to offer women a choice.’
The study’s recommendations were based on evidence from around the world as well as in Britain, and involved a survey of 772 healthcare professionals, interviews with 48 women with recent experience of abortion, and consultations with 15 key stakeholders.
The researchers found that medical abortions, in which patients typically take abortion medication at home, now account for 87% of terminations in England and Wales. They also found that nurses are increasingly supervising medical abortions.
It was also found that that almost a fifth of healthcare workers and a third of women were unaware that abortion is still a criminal offence unless it is signed off by doctors.
Dr Rebecca French, SACHA co-lead and Associate Professor of Reproductive and Sexual Health at LSHTM, said: “Abortion is one of the most common health procedures, likely to be experienced by one in three women in their lifetime.
‘Yet, in our study nearly nine out of 10 health care professionals working outside of specialist abortion services said lack of training was a barrier to providing care. Abortion is a health issue and should be covered in health professional training.’
A Department of Health and Social Care spokesperson said: ‘We are committed to improving women’s access to reproductive health services and published the Women’s Health Strategy for England in August 2022.
‘The ambitions set out in the strategy include creating a system-wide approach to women’s reproductive health that supports individual choice and ensures better access to services through the creation and expansion of women’s health hubs.
‘The wellbeing and safety of women accessing abortion services has been, and will continue to be, our first and foremost priority.’