Membership Call: Thursday, May 23rd, 2013 at 2PM EST/11AM PST
Later abortion care in the UK and other European nations: Experiences and challenges
British law on abortion and gestational age, the law doesn’t differentiate between pregnancy earlier in gestation and pregnancies up to 24 weeks. In Britain, women can obtain abortions through the National Health Service (NHS), which theoretically makes access to first trimester abortion easier.
bpas provides 1/3 of abortions in Britain across all gestational ages, but over 50% of all second trimester abortions, because British hospitals have difficulty handling later abortion procedures.
Although some women do have to travel significant distances to reach a provider, this is less of an issue in Britain than in the US. The primary access issue in Britain is the location of clinicians who provide later abortion procedures. Most later abortions in Britain are done in stand-alone clinics, not in hospitals. Abortion is relatively easy to access for uncomplicated cases, but becomes much more difficult to access for women with medical issues, a higher BMI (40+), or is in need of a hospital facility because of the complexity of the procedure.
Physician training and specialization in later abortion is a significant barrier. There is a prejudice against D&E on procedures past 14 weeks, and instead a reliance on medical induction. Although many women might prefer a D&E, most hospitals can only provide induction procedures. There exists a misconception that because women can obtain abortion through NHS at earlier gestational ages, later abortion is not as necessary, and therefore less urgency in addressing access issues around it. The establishment of Medical Students for Choice in the UK has been very important for the promotion of abortion care training in the UK. There seems to be a disconnect for many medical students about why women need later abortion in a place where contraception and first trimester abortion are readily available.
What the UK can learn from the US about abortion provision & access
UK abortion is seen as a medical treatment, the issue is framed as doctors permitting abortion, where in US legislation the focus is on the concept that abortion is a woman’s decision related to choice and privacy. Most countries in Europe provide liberal access to abortion in the first 10-12 weeks of pregnancy, usually up to 14 weeks, but it is often unavailable after that, and prompting many women to travel to Britain for a later abortion. Current debate in the UK centers around whether certain fetal abnormality conditions should be determined to be serious enough to warrant an abortion; yet, if abortion were seen as a woman’s choice, this argument would be moot. UK advocates can learn from the ways that American advocates have dealt with travel obstacles and variance in state legislation. The differences among European countries are less challenging to overcome with some creativity, e.g., support for telemedicine and the use of social media to provide additional information to women about their options. The focus should be on determining what a good later abortion provision model looks like, and how to overcome impediments to that.