One woman a week in the UK struggles to obtain an abortion through the NHS before she reaches the legal 24-week limit due to strains on services, a charity has warned.
In a new report, the British Pregnancy Advisory Service (BPAS) said women with medical conditions including epilepsy, heart problems and cancer particularly struggle to access abortion care, even though the continuation of the pregnancy “poses a significant threat to their health”.
Women with such health conditions cannot be seen in stand-alone abortion clinics such as those run by BPAS, but must be cared for in NHS hospital settings where there is swift back up to medical care if their condition deteriorates.
On 46 occasions in 2016 and 2017 - or generally twice a month - BPAS was unable to secure suitable NHS hospital treatment for these women by the strict legal cut-off point of 24 weeks. These figures are just the women who contacted BPAS for help. The charity said “it is reasonable to assume that at least once a week a woman with a medical condition is unable to access the care she needs”.
The review, based on 2,900 women with medical complexities who BPAS helped to find abortion care during 2016 and 2017, highlights the fact that in 21st Century Britain, women are being compelled to continue pregnancies they do not want due to a lack of appropriate services.
Even for those who are able to obtain an abortion, the wait for an appointment is sometimes long and stressful and prior health conditions may be exacerbated by pregnancy, BPAS warned.
These include very young women and women in complex situations, such as those experiencing domestic abuse, who present towards the end of the second trimester, or those whose health condition affects their fertility and periods.
The report includes heartbreaking case studies of women with prior medical conditions who were unable to secure an appointment before 24 weeks between 2016 and 2017.
One teenager who has recently left foster care now lives alone and says she feels unprepared to become a parent. She has a thyroid condition and is at risk of potentially fatal thyroid storm. She contacted BPAS at 22 weeks, but no appointment became available before she passed the 24-week limit.
Another woman had planned her pregnancy, but her health sharply deteriorated. She has pulmonary fibrosis and a range of medical problems. She decided to end the pregnancy because she needs to be able to care for her existing child. Again, she could not access an abortion before 24 weeks.
The report also flags some woman are only offered unsuitable appointments before they reach the 24-week limit, such as appointments a long distance away from their home.
A woman who has recently had a heart attack contacted BPAS for help at 15 weeks pregnant. She is unable to travel far for treatment as she cares for her existing children and disabled partner but was only offered an appointment in London - some distance from her home.
In other cases women must sometimes wait many weeks before an abortion appointment can be found: in one case a woman with cancer whose treatment could not start until the abortion was performed waited 45 days for an appointment. In another case, a woman with epilepsy and learning difficulties who presented at the end of first trimester was treated nearly seven weeks later.
Ann Furedi, chief executive of BPAS, said: “The fact is that in 21st Century Britain, there are women who are not getting the abortions they need, despite fully meeting the grounds of the 1967 Abortion Act.
“These are women for whom the continuation of the pregnancy threatens their health. These are women with existing children to care for. These are women who are often in complex social circumstances at the same time as struggling to deal with a health condition and an unwanted pregnancy.”
In the report, BPAS points out the 1967 Abortion Act did not decriminalise abortion – it only made it legal when two doctors authorise the procedure on specific grounds.
Furedi continued: “There is no one single solution to problems with service provision – but one thing is certain: while abortion remains in the criminal law, separated and stigmatised, we will struggle to provide women with the reproductive healthcare services they need and deserve. Abortion is part and parcel of women’s healthcare. It should be regulated and delivered as such.”
Work is underway to commission a specialist pathway for women who cannot be cared for in stand-alone clinics. The Royal College of Obstetricians and Gynaecologists (RCOG) has also established an Abortion Taskforce to improve women’s access to high quality abortion care. BPAS said it will do all it can to support these initiatives.
In response to the BPAS report a Department for Health and Social Care spokesperson said: “We are working with NHS England and the Royal College of Obstetricians and Gynaecologists to improve abortion services for women with health co-morbidities – ensuring that NHS hospitals can expand their capacity and that staff have the right skills to provide appropriate care for these complex cases.”