Nurses and midwives should be able to approve abortions, UK study concludes

Anna Bawden
Tue, 7 March 2023

Photograph: Evelyn Hockstein/Reuters

Nurses and midwives should be able to approve abortions, MPs have been told, in what would be one of the biggest shake-ups of regulations in more than 55 years.

If adopted, the “two-doctor rule”, which stipulates that abortions have to be authorised by two GPs, would be scrapped.

More than 20 researchers from seven countries contributed to Shaping Abortion for Change (Sacha), the largest study on abortion in the UK, surveying more than 700 GPs, midwives, nurses and pharmacists in Britain, as well as interviewing women who had recently had an abortion.


The government-commissioned study concluded that regulations should be changed to allow nurses and midwives to authorise an abortion, prescribe abortion medication and perform vacuum aspirations. Researchers found that medical abortions, in which patients take abortion medication at home, now account for 87% of terminations in England and Wales.

Although nurses increasingly supervise these abortions, two doctors are still required to authorise an abortion under the 1967 Abortion Act. In addition, nurses are not allowed to perform vacuum aspirations for a termination, even though they can conduct the same procedures for miscarriages with patients who are up to 14 weeks pregnant.

The study, which was funded by the NHS’s research arm, the National Institute for Health and Care Research (NIHR) and led by the London School of Hygiene and Tropical Medicine (LSHTM), examined international evidence, including abortion reforms in Australia, Canada and Sweden.

It found that almost a fifth of healthcare workers and a third of women were unaware that abortion is still a criminal offence unless it is signed off by a doctor.

Related: Women accused of illegal abortions in England and Wales after miscarriages and stillbirths

“Abortion legislation is more than 50 years old. Since 1967, medical and technological advances have transformed how women access their care. The law needs to be brought up to date with 21st-century opinions and practice,” said Kaye Wellings, Sacha co-lead and professor of sexual and reproductive health research at LSHTM.

In the study, 90% of healthcare professionals surveyed told researchers that they believe the decision to have an abortion should be entirely up to the woman. Medics also said anyone seeking a termination should, where possible, be offered a choice of whether to have it at home or in a clinic, what procedure they have – medical or surgical – and how they receive care and support.

The study also concluded that incorporating abortion services into other local sexual and reproductive health services could help improve access to care, but this would require the right training and resources.

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 healthcare 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”.

Responding to the findings, Elizabeth Barker, co-chair of the all-party parliamentary group on sexual and reproductive health, said: “There has never been a more important time to look at bringing abortion provision in line with modern healthcare practice.

“I hope to see the government considering how these recommendations can be reflected in abortion policy moving forward.”

Related: Google adverts direct pregnant women to services run by UK anti-abortion groups

Clare Murphy, the chief executive of the British Pregnancy Advisory Service, said: “BPAS has long campaigned for reform of abortion law across England and Wales. The current law is outdated, unnecessary and doesn’t reflect how modern services deliver care. This study reflects what we as providers know is the truth.

“Even more worryingly, the criminal law that underpins the current arrangements leaves both women and doctors at risk of prosecution. Today, two women in England are facing court proceedings for allegedly ending their own pregnancies outside the law. It’s high time politicians recognised the damage the existing law has – and decriminalised abortion care once and for all.”

Louise McCudden, MSI Reproductive Choices’ UK advocacy and public affairs adviser, said: “Abortion is a common, safe, essential healthcare service and it is unacceptable that today, women are still at risk of criminalisation under a Victorian law created in 1861. There is no reason it should require two doctors signing off every procedure and no reason it should sit within criminal law.

“It’s heartening to see such strong support for decriminalising abortion among health professionals. At this moment of renewed global focus on the importance of reproductive choice and abortion rights, now is the time to take abortion out of the criminal code.”