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Criminalised abortion in UK obstructs reflective choice and best care

BMJ 2018; 362 doi: https://doi.org/10.1136/bmj.k2928 (Published 09 July 2018) Cite this as: BMJ 2018;362:k2928

Rapid Response:

Re: Criminalised abortion in UK obstructs reflective choice and best care

I agree with the authors call to update the UK's abortion laws. The authors importantly note, decriminalising abortion provides an environment for women and girls to freely and honestly discuss their reproductive options with healthcare providers; and ensure they make the best, informed decision for them (whether that is to continue with the pregnancy, undergo an abortion, or use alternative available options).

From a medical student’s perspective, I have concerns induced abortion is only covered as part of the 'personal and professional development' component of the undergraduate medical curriculum. This component of the curriculum facilitates students to reflect upon their own views and the perspectives of others (including the legal status) by debating controversial issues, such as an abortion. Considering one in three women in the UK will have an abortion during their reproductive life, it is shocking that we are not additionally taught the basics of managing an unwanted pregnancy.

As with other health matters taught at medical school, the subject requires a holistic approach, considering appropriate counselling and support, medical and surgical management of an abortion, alternative options and complications of an unwanted pregnancy. In my opinion, the current abortion laws are complicated and as described by the author encourage "clinical contortion". Consequently, the current legal framework hinders the integration of abortion teaching into the undergraduate gynaecology programme and undermines the importance of a reproductive rights-based approach to women's health education. This results in future clinicians potentially being misinformed and under-equipped with the knowledge to manage an unwanted pregnancy.

Additionally, I suspect this may contribute to the current shortage of trained medical personnel working in abortion services, leading to long and variable waiting lists. Furthermore, in an era of safe and effective medical abortion, it is shameful the UK fails to offer a compassionate and patient-centred approach to medical abortion. It is not clinically necessary for women to attend two appointments and take misoprostol in clinic, potentially resulting in an untimely abortion on her way home.

Ultimately, undergoing an induced abortion is a medical and ethical issue rather than a criminal one. Decriminalising abortion is the necessary way forward for the UK to ensure women and girls receive high quality, safe abortion care and will enable medical students to receive adequate teaching on this subject.

Competing interests: No competing interests

13 July 2018
Rachel Burton
Medical Student
Liverpool Medical School, London School of Hygiene and Tropical Medicine
Liverpool Medical School, Liverpool, UK