APPG press release: Parliamentary cross-party group hears proposed changes to abortion regulation and provision

The All Party Parliamentary Group on Sexual and Reproductive Health (APPG SRH), a group of cross-party MPs and Peers, will hear findings and recommendations from SACHA (Shaping Abortion for Change), the largest study on abortion to be carried out in Britain to date at a meeting held in Parliament on March 7th 2023.

The findings of the Study, funded by the National Institute for Health and Care Research (NIHR) and led by the London School of Hygiene & Tropical Medicine raise policy questions such as the appropriate location for performing an abortion, the opportunity to extend the roles of nurses and midwives, the support needed by women, and whether changes are needed to the regulation of abortion. 

Findings from the Study include: 

• Almost 20% of healthcare workers are unaware that abortion is still a criminal offence unless it is signed off by a doctor. 
• 90% of healthcare professionals believe that the decision to have an abortion should be entirely that of the woman.
• A third of the women interviewed were unaware that abortion is still a criminal offence unless it is signed off by a doctor. 

Recommendations from the Study include: 

• Healthcare professionals other than doctors should be able to sign off on abortions for patients they are caring for.
• Incorporating abortion provision into other sexual and reproductive health services within the community could help improve access to care. 
• Appropriately trained nurses and midwives should have their roles extended to enable them to, for example, prescribe abortion medication. 
• Women seeking abortion should, where possible, be offered options in terms of where they have their abortion (ie at home or in a clinic), the procedure they have (ie medical or surgical) and how they receive care and support. 

Baroness Barker, Co-Chair of the All Party Parliamentary Group on Sexual and reproductive Health, said: 

“With the recent policy changes in abortion care, such as the telemedicine pathway for early medical abortion being made permanent, and following the publication of the Women’s Health Strategy in England there has never been a more important time to look at bringing abortion provision in line with modern healthcare practice. 
 
The findings of the SACHA Study demonstrate the importance of listening to women’s views and experiences in order to ensure they have full control over their reproductive healthcare. I hope to see the Government considering how these recommendations can be reflected in abortion policy moving forward”. 

Kaye Wellings, SACHA co-lead and Professor of Sexual and Reproductive Health Research at LSHTM, said: 

“Ultimately, it seems likely that Britain will follow other countries – Ireland, Northern Ireland, Sweden, Australia and Canada – in decriminalising abortion entirely and having it subject to the professional and regulatory, rather than criminal, sanctions that apply to other aspects of healthcare. In the meantime, as abortion provision is increasingly nurse-led, it makes sense for nurses and midwives to be able to sign off abortions instead of having to pass their paperwork to a doctor, who may have had no contact with the patient.” 

Dr Rebecca French, SACHA co-lead and Associate Professor of Reproductive and Sexual Health at LSHTM, said: 

“Abortion is one of the most common health procedures, likely to be experienced by one in three women in their lifetime. Yet, in our study nearly nine out of 10 health care professionals working outside of specialist abortion services said lack of training was a barrier to providing care. Abortion is a health issue and should be covered in health professional training”. 

ENDS 
For further information please contact Catrin Hughes at chughes@fsrh.org or 07950 435 846.

Notes to editors 

• The SACHA study, funded by the National Institute for Health and Care Research (NIHR), looked at international evidence from published literature and from countries that had decriminalised abortion, interviewed 31 stakeholders in Sweden, Canada and Australia; and in Britain surveyed nearly 772 health care professionals, interviewed 48 women with recent experience of abortion, and consulted 15 key stakeholders with experience and expertise in abortion provision. The SACHA team comprises 22 researchers and practitioners in six countries. 
• The SACHA Consortium is a large group of practitioners, policymakers and researchers, united by the common aim of ensuring that new directions in abortion care are soundly based on robust empirical evidence. Their expertise encompasses healthcare, including nursing and midwifery, sexual and reproductive health, general practice, commissioning, public health and policy, social science, epidemiology, information technology and the law. 
• Institutions collaborating on the SACHA Study, led by Prof Kaye Wellings and Dr Rebecca French at the London School of Hygiene and Tropical Medicine, include the British Pregnancy Advisory Service, the Karolinska Institute (Sweden), King's College London, Lambeth Local Authority, University of British Columbia (Canada), University of Edinburgh, University of Kent, University of Melbourne (Australia), University of Oxford and University of Plymouth.
• Between them, the team members have provided the evidence base for most of the large national sexual and reproductive health interventions in the UK in the last three decades. 
  The Study has taken place in the context of significant changes in the abortion landscape – impacting women, practitioners and policymakers. More than four in five abortions are now carried out by women themselves, at home, by taking pills (mifepristone and misoprostol) with telemedical support. Government approval of this practice during the COVID-19 pandemic was made permanent in April 2022.  
• More information on the SACHA Study can be accessed here.
• The mission of the National Institute for Health and Care Research (NIHR) is to improve the health and wealth of the nation through research. It does this by: 
  - Funding high quality, timely research that benefits the NHS, public health and social care; 
  - Investing in world-class expertise, facilities and a skilled delivery workforce to translate discoveries into improved treatments and services; 
  - Partnering with patients, service users, carers and communities, improving the relevance, quality and impact of our research; 
  - Attracting, training and supporting the best researchers to tackle complex health and social care challenges; 
  - Collaborating with other public funders, charities and industry to help shape a cohesive and globally competitive research system; 
  - Funding applied global health research and training to meet the needs of the poorest people in low and middle income countries. 
• NIHR is funded by the Department of Health and Social Care. Its work in low and middle- income countries is principally funded through UK Aid from the UK Government. 
  
  Key recommendations 
• Evidence from the study supports recommendations relating to abortion regulation and provision to reflect changes in the way healthcare is delivered.  
• Authorisation/certification of abortion: Health care professionals other than doctors should be permitted to sign off abortions for patients they are caring for. 
• Integration of abortion provision into routine health care: Abortion provision could beneficially be integrated into – given levels of support revealed in the study – in community sexual and reproductive health services with adequate resources and appropriate commissioning.  
• Extension of roles: Appropriately trained nurses and midwives should be allowed to prescribe abortion medication and perform vacuum aspiration in the context of abortion provision. 
• Provision of training: attention is needed to provision of both undergraduate training and professional education to increase knowledge and awareness and to equip new cadres of health care professionals to contribute to abortion care and support. 
• Patient choice: Women seeking abortion should, where possible, be offered options in terms of where they have their abortion, which procedure to have, and how they receive care and support, (ie remotely by telemedicine or in person in the case of medical abortion).  
• Patient support: Interventions to improve abortion care should be clearly positioned across the patient journey, eg to support decision-making about where and how, to manage expectations and pain relief, and to facilitate contraceptive care.  
  
  About the APPG SRH 
  The All Party Parliamentary Group on Sexual and Reproductive Health in the UK (APPG SRH) is a group of MPs and Peers seeking to raise awareness in Parliament of the needs of women seeking abortion and the importance of improving the sexual and reproductive health of people in the UK. 
  
  The APPG brings together Parliamentarians, experts and campaigners to examine issues within sexual and reproductive healthcare in the UK, and to explore options to improve healthcare through policy and legislative change. The Group is chaired by Dame Diana Johnson DBE MP and co-chaired by Baroness Liz Barker.