Background

Dilatation and evacuation, or D&E, is the safest method of second-trimester surgical abortion. It has a lower rate of immediate complications than the alternative of medical induction, causes less pain and bleeding, and is also faster, cheaper, and preferred by the majority of women.1 In addition to elective pregnancy termination, D&E has a role to play in the effective management of second-trimester miscarriage and pre-viable preterm pre-labour rupture of membranes.

However, access to D&E in the British National Health Service (NHS) is inadequate. Although no recent published data is available, it is common knowledge amongst abortion service providers that only one hospital in the country provides D&E to 24 weeks’ gestation, and only a very small minority of hospitals provide any D&E service at all. As a result, many women are not offered this option for termination, particularly women choosing a termination because of a seriously abnormal antenatal fetal diagnosis,2 or those with complex medical problems that require inpatient care.3

Barriers to improved access to D&E

There are probably multiple barriers to improved access to D&E in the NHS, but in my experience many doctors are concerned about the potential for damage to the cervix, which could result in reduced cervical integrity for subsequent pregnancies. D&E requires …