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We welcome research about safeguarding under-18s in early telemedical abortions. Telemedicine can be a useful adjunct to in-person care. The Royal College of Paediatrics and Child Health safeguarding guidance for under-18s accessing early medical abortions requires that providers aim to see under-18s in-person ‘at some point in the EMA care pathway’. This guidance will be included in the new NHS Standard Contract from April 2023.
Romanis and Parsons don’t address the prevention of mid-term abortions (the central reason why under-18s should be seen in-person) focusing their analysis on abortion care providers’ views of access to abortion care.
Abortion deliveries beyond 10 weeks are inevitable if not preceded by clinical examination and/or ultrasound scans,[3-5] and the psychological consequences of a mid- or late-trimester home delivery can be severe.[6,7] Under-18s lack brain maturity[8-10] and are more vulnerable to effects of trauma.[11,12] The law imposes particular responsibility to prevent foreseeable trauma in this age group.[13,14]
Under-18s are also vulnerable to child sexual exploitation and abuse. Virtual consultations enable unseen and unheard coercive adults to overhear and intercept the patient's conversations.[15,16] Ensuring they are seen in-person enables rapport and guarantees privacy. Following no-test medical abortions, under-20s, compared to others are more likely to report wanting a face-to-face abortion in the future...
Under-18s are also vulnerable to child sexual exploitation and abuse. Virtual consultations enable unseen and unheard coercive adults to overhear and intercept the patient's conversations.[15,16] Ensuring they are seen in-person enables rapport and guarantees privacy. Following no-test medical abortions, under-20s, compared to others are more likely to report wanting a face-to-face abortion in the future.
Access difficulties for in-person assessment should be addressed by service design such as outreach or transport provision rather than forgoing in-person assessment with the significant consequences this could have for young people.
The debate around safeguarding in abortion care has become polarised including suggestions that those who raise concerns about child safeguarding are doing this from an anti-abortion standpoint. Whilst we respect all viewpoints, we are not anti-abortion and in our many plenary discussions no members of the National Network of Designated Healthcare Professionals for children have expressed anti-abortion views.
1 Royal College of Paediatrics and Child Health. Safeguarding guidance for children and young people under 18 accessing early medical abortion services. Available at: https://childprotection.rcpch.ac.uk/resources/safeguarding-guidance-for-... (Accessed: February 5 2023)
2 Romanis, EC. and Parsons, JA. (2023) Early telemedical abortion, safeguarding, and Under 18s: A qualitative study with care providers in England and Wales, BMJ Sexual & Reproductive Health. British Medical Journal Publishing Group. 27/01/2023 doi 10.1136/bmjsrh-2022-201762
3 Raymond EG, Grossman D, Mark A, et al. Commentary: No-test medication abortion: A sample protocol for increasing access during a pandemic and beyond. Contraception. 2020;101(6):361-366.
4 Royal College of Obstetricians and Gynaecologists (RCOG). Coronavirus (COVID-19) infection and abortion care. Information for healthcare professionals. V3.1. Royal College of Obstetricians and Gynaecologists, 2020. Available at: https://www.rcog.org.uk/media/bbhpl2qa/2020-07-31-coronavirus-covid-19-i... (Accessed: February 5 2023)
5 Aiken A, Lohr PA, Lord J, et al. Effectiveness, safety and acceptability of no-test medical abortion (termination of pregnancy) provided via telemedicine: a national cohort study. BJOG. 2021;128(9):1464-74
6 Raymond EG, Bracken H. Early medical abortion without prior ultrasound. Contraception. 2015;92(3):212-214.
7 Kirkland F. Clinics call for at home abortions to continue. BBC News [Internet]. 2022 Mar 30. Available at: https://www.bbc.co.uk/news/health-60912656 (Accessed: February 5 2023)
8 Steinberg L. Commentary: A behavioral scientist Looks at the science of adolescent brain development. Brain Cogn. 2010 February ; 72(1): 160–164.
9 Cohen AO, Breiner K et al. When is an adolescent an adult? Assessing cognitive control in emotional and non-emotional contexts. Psychological Science 2016;27: 549–562.
10 Diekema DS, Adolescent Brain Development and Medical Decision-making. Pediatrics 2020; 146:S18
11 Miller AB, Prinstein MJ Adolescent Suicide as a Failure of Acute Stress-Response Systems. Annual Review of Clinical Psychology 2019;15(1):425-50
12 Eiland L, Romeo RD. Stress and the developing adolescent brain. Neuroscience 2013;249:162–71
13 Her Majesty's Government, 1989. Children Act 1989 sec 1 (1). Available at: https://www.legislation.gov.uk/ukpga/1989/41/contents (Accessed: February 5 2023)
14 Department for Education 2018. Working together to safeguard children. Available at: https://www.gov.uk/government/publications/working-together-to-safeguard... (Accessed: February 5 2023)
15 Bateson DJ, Lohr PA, Norman WV, et al The impact of COVID-19 on contraception and abortion care policy and practice: experiences from selected countries. Editorial. BMJ Sexual & Reproductive Health 2020;46:241-243.
16 Moore N, Bucknall A. Safeguarding annual report 2020.MSI Reproductive Choices UK. Available from: https://www.msichoices.org.uk/media/3599/msi-reproductive-choices-uk-saf... (Accessed: February 5 2023)
17 Porter Erlank C, Lord J, Church K. Acceptability of no-test medical abortion provided via telemedicine during Covid-19: analysis of patient-reported outcomes. BMJ Sex Reprod Health. 2021;47(4):261-268.