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In the UK there is inadequate provision of hospital-based abortion services, causing delays, difficulties, and denial of care for women with medical problems seeking to access a termination of pregnancy.
Surgical abortion by dilatation and evacuation is frequently the optimal method of abortion for women in the second trimester with complex medical problems, but availability of this procedure is especially limited.
We demonstrate the feasibility of expanding a hospital-based abortion services to accept referrals from across the UK. Other units, with the support of commissioners and the relevant national bodies, should consider doing the same, to ensure women are able to access care and are not forced to continue unwanted pregnancies that endanger their health.
Abortion services in the UK are increasingly commissioned within the independent sector. This has improved accessibility and lowered costs for the care of women who have no significant medical problems, but creates access problems for women requiring hospital-based abortion care, as hospital-based National Health Service (NHS) units lose funding and cease to operate. To indicate the scale of need for hospital-based abortion care, The British Pregnancy Advisory Service (bpas), an independent-sector abortion provider, has reported that in 2016 and 2017 it arranged referrals to NHS providers for 2900 women. Due to the shortage of hospital-based services, particularly those offering care in the second trimester, these patients often have to wait several weeks for a referral to be accepted and may face a further wait until their appointment. They also may need to travel large distances. A significant minority of these women are unable to access abortion at all and are forced to continue pregnancies they would almost certainly be eligible to terminate within the UK legal framework1. These ongoing pregnancies will furthermore be complicated by the same condition that complicates their abortion. Given …
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