Comment

Abortion reform: it makes sense to trust nurses with more responsibility

It is nurses who support women through the abortion process, and the law should reflect this

It is nurses who support women through the abortion process, and the law should reflect this


Picture: Alamy

In a landmark parliamentary debate in June, MPs announced their intention to table an amendment to the forthcoming Domestic Violence Bill‎ to decriminalise consensual abortion up to 24 weeks. This would be done through repeal or reform of the 1861 Offences Against the Person Act, which made it a criminal offence, punishable by life in prison, for any woman to induce her own miscarriage and for anyone to assist her in doing so.

The 1967 Abortion Act did not repeal these provisions, rather it created exemptions to prosecutions if two doctors gave legal authorisation and the procedure was performed by ‎a doctor in specifically licensed clinics or hospitals. Today many of the provisions are seriously out of date.


Sarah Wollaston

Potential role of nurse practitioners

One of the ‎proponents of change is MP and chair of the health select committee, Sarah Wollaston, who has spoken of the ‘amazing’ nurse practitioners, who she would like to see take a greater role in abortion care if the law changed to enable them to do so.

Would this be appropriate? Absolutely.

Nurses up and down the country support women through their whole abortion pathway, including discussing pregnancy options and determining the gestational age by ultrasound. 

‘In practice, more often than not, doctors are determining that the woman meets the grounds of the abortion act based on the assessment the nurse alone has undertaken’

In practice, more often than not, doctors are determining that the woman meets the grounds of the abortion act based on the assessment the nurse alone has undertaken. Although the law prohibits it, there is no good reason why a nurse prescriber could not prescribe and administer the drugs used for early medical abortion. As for surgical abortions, there are nurses providing this safely and effectively in countries where the law is less restrictive, or where the procedure is free of any kind of legislation.

Some nurses and midwives in this country provide the surgical procedure known as manual vacuum aspiration for managing miscarriage. This proves it is safe for them to do so – yet providing exactly the same procedure for the purpose of abortion could land them in prison.

Diverse caseloads

As the director of nursing for the British Pregnancy Advisory ServiceI get to see first-hand the wonderful work of the nurses in our organisation. Some cases are straightforward, others are quite complex. There are young people too scared to talk to their parents, woman fleeing domestic violence, and those who are pregnant as a result of rape or child sexual exploitation. Nurses are ready and prepared to deal with them all.

Would a change in legislation negate the need for doctors in abortion care? No. There are women who have complex medical conditions requiring care and advice from medical practitioners. Nevertheless, many women would welcome a change in the law that would allow them to be seen and treated by nurses alone.


Michael Nevill is director of nursing, British Pregnancy Advisory Service
 

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