Fifty years ago today the Abortion Act 1967 came into effect, making it possible for women to access safe and legal abortion in Britain on the NHS.
Yet half a century later, a shortage of doctors trained in abortion care means women sometimes face long delays in securing an appointment, when the legal cut-off for a procedure is marked at 24 weeks.
The British Pregnancy Advisory Service, BPAS, one of the leading abortion providers in the UK, has said a lack of doctors “who are willing or able” to provide terminations means women are unable to access the care they need on a regular basis.
Though the Royal College of Obstetricians and Gynaecologists (RCOG) has offered an Advanced Training Skills Module in abortion care since 2007, reports suggest fewer than 1% of trainees completing such modules have taken it.
The RCOG says that between 2007 and 2017, only 44 trainees out of about 5,000 junior doctors completed the abortion care module – a necessary qualification to develop the high-level skills required for a consultant post in abortion, a key area in women’s healthcare.
BPAS said: “There are many young medics interested in abortion care, but in recent years there have been problems with getting exposure and training.
“On a regular basis BPAS is unable to find appointments for women who are left with no choice but to continue an unwanted pregnancy that can in fact put their health at risk.”
With a renewed focus on training young medics to specialise in the procedure, a new generation of family planning doctors are hoping to prompt change – and are encouraging their colleagues to specialise in abortion care too.
Alice Howe, 29, is currently a practicing GP in Dartford, and is planning to specialise in sexual health from next year. As a teenager, she said several of her friends had abortions and she was struck by how difficult it was to secure the procedure, and how far they had to travel – the nearest abortion centre was more than two hours away from their village in south Wales.
“A couple of my friends had really traumatic experiences, they were hassled outside by campaigners. They were made to feel like it was a really awful, wrong thing to do. I’ve never got to grips with why people think it’s bad.”
An ardent supporter of access to abortion, Howe said she is concerned by how few medical students actively want to become providers of the service. “Most of my friends and (medical) colleagues would say ‘Yes, I’m pro-choice’, but then wouldn’t want to do anything about it. That’s why provision is so low.
“Even in obstetrics and gynaecology, there are so few trainees who are willing to do the abortion module and become abortion providers.”
Howe believes training to specialise in this field is difficult in the NHS, because there are so few abortion care providers in senior positions.
“If you want to become an abortion care provider you may have to go outside of the NHS to BPAS or Marie Stopes to be able to train. There are a lot of barriers for doctors who even want to do it,” she said.
It’s really exciting to think I am going to be one of the future doctors ensuring women do have access to these sorts of services
Sean Rees
But she is hopeful things are changing for the better. On the 50th anniversary of the act, she said she feels proud of the UK’s provision for women. “The last two or three years has been huge movement, and we’ve really seen a shift in political stance on pro-choice movements. I think that’s slowly eating away at the stigma of abortion.”
There are currently calls to review the law, to make it easier for women to access abortions, by allowing nurses and midwives to administer the abortion pill – and for only one doctor’s permission to be required to approve the termination.
It is something Sean Rees, a fourth-year medical student at UCL, feels strongly about. “It’s a legal requirement (to have two doctors), not required for any other medical or surgical procedure in the UK at all.
“It’s not necessary because there are so many regulations and frameworks in place already that adding this extra burden onto services for women doesn’t really make sense clinically,” he said.
Rees is hoping to specialise in abortion. “It’s really exciting to think I am going to be one of the future doctors ensuring women do have access to these sorts of services. It’s an expanding field of medicine, it’s definitely changing in terms of how we will create services for women, especially if we are successful in decriminalising it,” he said.
A spokesperson for the British Pregnancy Advisory Service, BPAS, said it is “incredibly heartening” to see the next generation of doctors step forward to specialise in terminations, but said more work also needs to be done to further legalise abortion.
In England, Scotland and Wales, the legal grounds for abortion are set out in the 1967 Abortion Act, and outlines the procedure is legal if a woman is less than 24 weeks pregnant and two doctors agree that continuing the pregnancy and having a baby would be worse for the woman’s physical or mental health than ending the pregnancy by having an abortion.
However if these conditions are not met, a woman can be prosecuted under criminal law. BPAS says it is time to change this – and for abortion services to be regulated in the same way as all other medical procedures.
In a letter published in today’s Times newspaper, women’s organisations including BPAS, the Fawcett Society and End Violence Against Women called on the Health Secretary, Jeremy Hunt, to follow his counterparts in Wales and Scotland and enable women to use abortion medication at home once lawfully prescribed, in line with guidance from the World Health Organisation.
Women in England can already use these pills at home for treatment of an incomplete miscarriage, and signatories asked for the “same dignity to be extended to women requesting an early abortion”.