Termination of pregnancy services should be able to offer women a choice of medical or surgical procedures to terminate their pregnancy and if not, they should promptly refer the woman to a service that can, according to a draft termination of pregnancy guideline published by the National Institute for Health and Care Excellence (NICE).
Developed with the Royal College of Obstetricians and Gynaecologists (RCOG), the draft termination of pregnancy guideline aims to improve the organisation of termination of pregnancy services and make it easier for women to access them.
This includes aiming to provide women with an initial appointment within one week of requesting one and undertaking the procedure within one week of the appointment.
It also says that commissioners should allow women to self-refer to termination of pregnancy services, a practice that is common in the independent sector and is growing in NHS provided services. This removes an unnecessary step in the process, allowing women to access treatment more quickly.
The draft guideline also states that termination of pregnancy training should be undertaken by all healthcare professionals who have it as part of their core curriculum, unless they opt-out due to a conscientious objection.
The vast majority of terminations in England and Wales are carried out in the first 10 weeks of pregnancy. Women have the option of terminating their pregnancy either medically (taking mifepristone followed by misoprostol) or undergoing a surgical procedure. Although the number of terminations undertaken annually in England and Wales has decreased in the last decade, it remains a common procedure with just under 193,000 being performed in 2017.
NHS organisations should compare their current practice with NICE’s recommendations and consider what changes may need to be made to put them into practice. In considering any changes, they will need to take into account any extra costs and savings involved. The speed at which these recommendations are adopted by local NHS services will depend on the resources they have available and the other priorities they are dealing with.
Paul Chrisp, Director of the Centre for Guidelines at NICE, said: “Choosing to terminate a pregnancy is an important part of reproductive health for many women, which is why it’s essential that providers are able to offer consistent support and advice.
“Integrating and streamlining services should help improve access for all women, leading to shorter waiting times and allowing earlier terminations. This provides multiple benefits to the woman, including being able to have a medical termination at home.”
Iain Cameron, Chair of the Guideline Committee and Emeritus Professor of Obstetrics and Gynaecology at the University of Southampton, said: “The evidence suggested that a shortage of staff trained in termination of pregnancy services was making it harder for some providers to offer all procedures. Giving trainee healthcare professionals the opportunity to gain experience in termination of pregnancy services should enhance access to this essential aspect of women’s care.”
Professor Lesley Regan, president of the Royal College of Obstetricians and Gynaecologists, said: “Abortion care is an essential area of women’s healthcare and it is crucial that women are given a choice of medical or surgical treatment options and have access to safe, timely and compassionate care.
“These guidelines will help to address significant barriers that women experience across the country, by reducing waiting times and making it easier for them to access services. It’s also absolutely vital that more healthcare professionals are trained in this key area of women’s healthcare to ensure services are sustainable in the long-term.”