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Major UK study recommends extending abortion powers to nurses




Nurses and midwives should be allowed to authorise and perform abortions, the largest-ever UK study on abortion has recommended.

The Shaping Abortion for Change (SACHA) study has been funded by the government through the National Institute for Health and Care Research and is being led by the London School of Hygiene and Tropical Medicine.

“It makes sense for nurses and midwives to be able to sign off abortions instead of having to pass their paperwork to two doctors” Kaye Wellings

While a full report is yet to be published, some of the findings and recommendations were presented yesterday to MPs and peers from the All Party Parliamentary Group on Sexual and Reproductive Health.

One of the key recommendations was for a change of the law in Britain to allow appropriately trained nurses and midwives to sign off abortions, prescribe abortion medication, and perform procedures.

They noted how abortion care was increasingly becoming nurse-led and yet under the 1967 Abortion Act two doctors were still required to authorise an abortion.

The study recommended that powers to prescribe medication for abortions and to perform vacuum aspiration (VA) procedures should be extended to nurses and midwives.

At present, nurses can conduct VA for miscarriages for patients who are up to 14 weeks pregnant, but only doctors can perform them for abortions.

The study looked at international evidence and, in Britain, surveyed nearly 772 health professionals, interviewed 48 women with recent experience of abortion, and consulted 15 key stakeholders with expertise in abortion provision.

The SACHA team comprises 22 researchers and practitioners in six countries.

They found that medical abortions, in which patients typically take abortion medication at home, now accounted for 87% of abortions in England and Wales.

Meanwhile, under the current law, abortion procedures can only be performed in an NHS hospital or a place approved by the secretary of state.

However, the researchers said it was key that women and pregnant people continued to have choice over where and how they had their abortion, including the option to have a surgical abortion if they preferred.

They said it would be key for education and training programmes to include abortion content in order to “equip new cadres of healthcare professionals to contribute to abortion care and support”.

Among their other recommendations was for abortion provision to be integrated into community sexual and reproductive health services.

The study also revealed that almost 20% of health workers surveyed and a third of women interviewed were unaware that abortion was still a criminal offence in Britain unless it is signed off by a doctor.

“We are committed to improving women’s access to reproductive health services” Government spokesperson

Meanwhile, 90% of health professionals involved in the research believed that the decision to have an abortion should be entirely that of the woman.

Professor Kaye Wellings, SACHA co-lead and professor of sexual and reproductive health research at the London School of Hygiene and Tropical Medicine, said that “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 two doctors, who usually have no contact with the patient”.

She added: “There is also merit in permitting nurses and midwives to prescribe abortion medications and also to carry out vacuum aspiration which they perform anyway in the management of miscarriage.

“This would ensure that sufficient cadres of professionals have the skills needed to offer women a choice and address the current risk of valuable skills being lost.”

She claimed that evidence from the National Institute for Health and Care Excellence (NICE) had already shown that women preferred nurse-delivered services.

The research from SACHA had now “confirmed the current law that compels abortions to be performed by doctors is preventing best practice, compassionate care in the UK”, warned Professor Wellings.

Baroness Elizabeth Barker, co-chair of the All Party Parliamentary Group on Sexual and Reproductive Health, said she hoped to see the government considering how the recommendations from the report could be reflected in abortion policy moving forward.

A Department of Health and Social Care spokesperson said: “We are committed to improving women’s access to reproductive health services and published the Women’s Health Strategy for England in August 2022.

“The ambitions set out in the strategy include creating a system-wide approach to women’s reproductive health that supports individual choice and ensures better access to services through the creation and expansion of women’s health hubs.

“The wellbeing and safety of women accessing abortion services has been, and will continue to be, our first and foremost priority.”

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