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BMJ. 2007 December 15; 335(7632): 1233.
PMCID: PMC2137076

UK government sets up pilot studies to evaluate medical abortion services outside hospitals

The Department of Health is funding two hospitals to pilot medical abortion outside hospital settings, to evaluate their effectiveness and safety, the UK government announced in a recent report.

At the moment, the secretary of state has to approve places that can provide abortions, and as yet has not approved anywhere other than hospitals. In its response to a report from the House of Commons Science and Technology Committee on scientific developments relating to the Abortion Act 1967, the current legislation that covers abortion, the government said that a formal evaluation is under way to assess the safety, effectiveness and patient acceptability of providing early medical abortion services in these ‘non-traditional’ settings.

One of the pilots is in a community hospital and the other is a stand alone unit attached to a hospital, according to a Department of Health spokesperson.

In a statement, the department said, “We are formally evaluating the safety and effectiveness of providing early medical abortion services in non-traditional settings, which, in future, could be a community medical setting, such as a doctor’s surgery which has the appropriate medical expertise.” The evaluation will be completed in early 2008, and the results will be considered in making decisions about further developments in providing abortion services outside hospitals.

“If they prove successful, they could be rolled out to GP surgeries,” the spokesperson said.

Kate Guthrie, a consultant community gynaecologist with Hull and East Yorkshire NHS Trust and a spokesperson for the Royal College of Gynaecologists, said, “Some women currently have to travel long distances to a hospital to be given the pills they need for a medical abortion, and have to return two days later for the second lot of pills, even though these could safely be taken in a community based clinic.

“When a woman has already taken the difficult decision to have an abortion, this is just making it more difficult for her. I am keen to provide services closer to home—that are more women centred—as long as there is no reduction in standards.”

Experience in other countries has shown that medical abortions can be safely performed outside hospitals, she explained, adding that the essential factor would be to continue to provide the support that women need when considering and undergoing an abortion.

The government also said that the House of Commons should decide whether expanding the role of nurses and midwives to perform early medical and surgical abortions would be “safe, effective, acceptable to patients and would significantly improve access to abortion services.”

Current legislation bans anyone other than doctors from carrying out abortions. In its report, the Select Committee recommended increasing the role of nurses, with the suggestion that “subject to usual training and professional standards nurses (and midwives) could be permitted to carry out early surgical abortions.”

Nurses and midwives should be able to sign the HSA1 form required for an abortion to be performed, the Committee recommended. It also advised that nurses should be able to prescribe the drugs for a medical abortion, which currently they administer but cannot prescribe.

The government said it noted the Committee’s recommendations and considered that it was a matter for the House of Commons “to decide whether it feels there is a need for change.”

A BMA spokesperson said, “The BMA would not support a move to allow nurses and midwives to perform early medical and surgical abortion. The BMA is concerned that these changes might expose women to increased risks to their health.”

The government recommendations have been developed for members of parliament to discuss as they consider changes in the law.

Notes

Government Response to the Report from the House of Commons Science and Technology Committee on the Scientific Developments Relating to the Abortion Act 1967 is available at www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_080925.


Articles from The BMJ are provided here courtesy of BMJ Publishing Group