Nurses should be allowed to run abortion services up to nine weeks, charity saysBMJ 2006; 333 doi: https://doi.org/10.1136/bmj.39048.615440.DB (Published 30 November 2006) Cite this as: BMJ 2006;333:1139
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The recent call by The Chief Executive of the British Pregnancy Advisory Service (BPAS ) for a review of abortion laws on the grounds that they are “archaic” is unnecessary.1 The law as it currently stands is robust enough and fit for purpose. The main reasons for calling for a review appear to be firstly, concerns that the requirement for two doctors to evaluate the a request for abortion is restrictive. There is no evidence that such is the case. This requirement is in fact an important safety valve which ensures that there is provision for a second independent input into the decision making regarding abortion. Abortion is a difficult undertaking for women and many are appreciative of this opportunity for a second independent evaluation.
Secondly, regarding the issue of nurses providing medical terminations, this is already happening below and above nine weeks gestation under medical supervision. This must necessarily remain so for rapid medical intervention to occur when complications arise as does happen in a small number of women undergoing medical abortions.
It appears that the call for an amendment to the abortion law stem from a desire to make the abortion process “easier”. The Royal College of Obstetricians and Gynaecologists (RCOG ) has provided some guidance, which should help provide a uniformly high quality service nation wide.2 Rather than seek to amend the abortion law to make abortion “easier” we should focus our energies on reducing the numbers of unintended pregnancies, as the bulk of these become unwanted pregnancies and ultimately abortions.3
Most women seeking a termination of pregnancy are either not on contraception, using condoms or taking the contraceptive pill haphazardly.4 The issue then is that of poor or no contraception. The National Institute for Health and Clinical Excellence (NICE) has recommended long-acting reversible contraceptives (LARC) as the contraceptives of choice.5 These include sub-dermal implants, intra- uterine contraceptive devices and depo-progesterone injections, and these should be promoted and used as first line contraceptives rather than non- LARC methods. These will significantly reduce the numbers of unintended and unwanted pregnancies and therefore the requests for abortions.
1. Day M. Abortion should be made easier, says charity. BMJ 2006:333;1139
2. RCOG 2004. The care of women requesting induced abortion. Evidence –based Guideline No. 7. London. Royal College of Obstetricians and Gynaecologists.
3. Lakha F, Glasier A. Unintended pregnancy and the use of emergency contraception among a large cohort of women attending for antenatal care or abortion in Scotland. Lancet 2006; 368:1782-87
4. Esen U, Koram K, Doherty E, Orife S, Jones A.. Termination of Pregnancy in South Tyneside. Journal of Obstetrics and Gynaecology. November2006; 26(8):791-794
5. National Institute for Health and Clinical Excellence. Long –acting reversible contraception. http://www.nice.org.uk/page.aspx?o=cg030niceguideline (accessed December 8, 2006 )
Competing interests: None declared
Competing interests: No competing interests