Women in England and Wales ‘feel pressured to opt for medical abortions’

Rachel Hall
Mon, 10 April 2023 

Photograph: Evelyn Hockstein/Reuters

Overstretched and underfunded abortion services in England and Wales are leaving women feeling pressured into opting for the cheaper at-home pill rather than a surgical procedure, according to research.

The proportion of medical abortions – using pills – rose from 47% in 2011 to 87% in 2021, while very few abortions are now administered surgically, finds research from the London School of Economics.

Katy Footman, the research’s author, said: “It’s a big problem in terms of the experience that patients will have of their abortions because although medical abortion is a great option and very safe and effective, there are a lot of reasons why a patient might prefer or need a surgical option.”

Medical abortions involve taking a drug that causes the lining of the womb to break down, resulting in pain and bleeding. This can make it hard to keep private for people who share their space with others. Others who may prefer surgical abortion include those traumatised by an earlier procedure or who have health reasons such as blood clotting problems.

In interviews for Footman’s research, women highlighted how the stress of having an abortion was exacerbated by feeling their choice was limited and that this was especially the case for women who lacked financial resources to travel or who were unable to advocate for themselves.

Clare Murphy, the chief executive of the British Pregnancy Advisory Service, the UK’s biggest provider of abortion services, said the “undervalued and underfunded” abortion sector was “under immense pressure” because providers were unable to increase capacity to meet the rise in demand for services because of trained clinicians.

Noting that one in three women would access abortion care in their lifetime, she said NHS England should “lead system-wide collaboration to establish abortion provision as a critical area of women’s healthcare”, and for the government to speed up publication of its sexual health strategy, which was due in 2022, to “ensure the long-term sustainability of safe, high-quality abortion services in this country”.

Louise McCudden, an advocacy and public affairs adviser at MSI Reproductive Choices UK, said the abortion provider had been calling for “more reasonable funding from commissioners for abortion services and for abortion to be made part of the standard healthcare training curriculum for years”.

The LSE research found that the competitive tendering introduced by the 2012 Health and Social Care Act had resulted in lower tariffs being paid to charities providing abortion services. This incentivises the charities to offer more medical abortions, as handing out pills takes up less space in the clinic than surgical procedures, which require a setup equivalent to a smear test.

“Because abortion is quite a stigmatised health service, there isn’t the same public accountability over the way the services are being financially squeezed. They don’t get the same public outcry when patients can’t get the access they need,” Footman said.

She said there were barriers relating to the “archaic laws” around abortion, including preventing nurses and midwives from providing surgical abortions – even though they could provide the exact same procedure for miscarriages – or requiring two doctors to sign off on an abortion.

To improve the situation, she suggested, “transparent and fair costing of abortion care” was needed. This may require separate commissioning processes for medical and surgical abortions, and stronger collaboration between charities and the NHS.

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.”