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Wasting Time on the Time Limit: The Real Issues in Women's Reproductive Healthcare

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The Conservative MP Nadine Dorries has requested a parliamentary debate on a reduction in the time-limit from 24 to 20 weeks. As was widely reported after the women's minister Maria Miller expressed her support for such a reduction, there have been no medical or scientific advances in this area since parliament last looked at this issue in 2008.

Moreover when it comes to the small number of women who need access to services after 20 weeks, their circumstances and reasons remain as compelling as ever. There is no need to revisit this issue: but the tragedy is that the energy spent discussing it detracts time and attention from genuine problems in women's reproductive healthcare. Were the MP for mid-Bedfordshire really as 'pro-woman' as she claims, here are some of the themes she could be tackling which affect women across the spectrum of reproductive needs.

Access to contraception
Some 40% of women using BPAS' contraceptive counselling service following an unplanned pregnancy report problems accessing contraception. Clinic closures or opening times inconvenient for working women or women with childcare commitments are frequently reported by the women we see, with women over-25 often getting a particularly raw deal as services are geared towards younger women. We have seen a rise in the number of women seeking advice about unplanned pregnancy not long after giving birth: our recent post-natal contraception survey found one in four women wanted more advice and support with contraception after a baby, and overall very few were given access to their choice of contraception from the full range of options.

Miscarriage management
One in four pregnancies end in miscarriage, which can be a particularly traumatic episode in a woman's life. Many of these women will experience "missed miscarriage", in which the pregnancy has ended but the womb has not expelled it - often meaning medical intervention is necessary. A recent campaign by the parenting website Mumsnet highlighted a range of problems women experiencing miscarriage can face - from inconsistent access to counselling services to a lack of choice in the medical methods available to manage the miscarriage. An Early Day Motion supporting the campaign was signed by dozens of MPs, although not everyone joined in.

Improving access to early abortion
Early Medical Abortion - "the abortion pill" - has transformed abortion services around the world. Two forms of medication are taken about two days apart. Akin to a natural miscarriage, it means women can avoid surgical intervention and any accompanying risks, and it can be used at some of the earliest gestations, when surgical methods may not be possible - so it has contributed to an increase in the proportion of early abortions. In the developing and developed world - including in France, Sweden and the US - women who meet the legal requirements for abortion can use the medication to expel the pregnancy in the privacy of their own home.

This is in keeping with recommendations from the World Health Organisation, which believes being able to do so contributes to confidentiality and comfort. But in the UK, regulations stipulate that women having abortions can only take the medication in a clinic or hospital, before being able to travel home. This increases the risk that they will miscarry before they get home. For many women, this combined with the sheer number of separate appointments makes this method impossible for them, particularly if they are working or live long distances from the nearest clinic - or need to keep their visits very private. A small change in the regulations could make a big difference to the many thousands of women' experience of abortion every year. (Nadine is not keen).

Reductions in midwife numbers
The Royal College of Midwives says 5,000 more full-time midwives are needed to ensure women and their babies receive the care they need. The shortages affect every region of England, according to the RCM. A recent report by the Care Quality Commission found one in seven of the 141 hospital trusts that provide maternity and midwifery services in England do not have the recommended one midwife for every 28 births. A recent survey showed that nearly a fifth of women polled said they felt unsupported during labour and birth.

So there are lots of areas a pro-woman MP with an apparent interest in reproductive healthcare could be usefully focusing on. Picking on overwhelmingly vulnerable women who need access to later abortion services really isn't one of them.

Around the Web

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