Comment

Michael Nevill: Access to abortion after 20 weeks must be protected

Nurses need to understand why women present for later abortions and be prepared to advocate for them, says the British Pregnancy Advisory Service’s Michael Nevill.
Access to abortion

Nurses need to understand why women present for later abortions and be prepared to advocate for them, says the British Pregnancy Advisory Services Michael Nevill

Very few terminations take place in the final weeks of the second trimester: in 2016 less than 2% of all abortions undertaken in England and Wales were at over 20 weeks (the total number of abortions at all gestations was 185,596).

Women present late in pregnancy for many reasons. Some will have had a heartbreaking diagnosis of a fetal anomaly, while others will be in different yet equally challenging circumstances.

The British Pregnancy Advisory Service (BPAS) recently published a report highlighting some of the later cases we have seen. Catriona found out she was pregnant at 22 weeks.

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Nurses need to understand why women present for later abortions and be prepared to advocate for them, says the British Pregnancy Advisory Service’s Michael Nevill


Less than 2% of all abortions undertaken in England and Wales in 2016 were over 20 weeks
Picture: iStock

Very few terminations take place in the final weeks of the second trimester: in 2016 less than 2% of all abortions undertaken in England and Wales were at over 20 weeks (the total number of abortions at all gestations was 185,596).

Women present late in pregnancy for many reasons. Some will have had a heartbreaking diagnosis of a fetal anomaly, while others will be in different yet equally challenging circumstances. 

The British Pregnancy Advisory Service (BPAS) recently published a report highlighting some of the later cases we have seen.  Catriona found out she was pregnant at 22 weeks. She had no pregnancy symptoms and had a contraceptive implant insitu so was not expecting to have regular periods. Hormonal contraceptives can cause side effects that hinder pregnancy identification, including irregular or suppressed menstrual bleeding.

Combined pill

Jo had irritable bowel syndrome and irregular periods, and also used the combined pill. Her lack of periods did not cause her concern and it was only when she noticed that her stomach was more prominent than usual that she decided to take a pregnancy test. She had a scan at 19 weeks.

Many women have irregular periods, so the absence of a monthly bleed may not alert them to a possible pregnancy; conversely the presence of a light bleed may lead them to believe they have had a period and cannot be pregnant.

‘No woman aspires to have an abortion, even less so a later abortion’

Some young people access abortion services late because they have been concealing their pregnancy, fearing the response from parents and partners. Other factors include domestic violence and crisis situations such as homelessness, illness and relationship breakdown during the pregnancy. 

These are women who may have initially decided to continue a pregnancy, but as their circumstances became more challenging they felt it was no longer right to do so. The women we see at BPAS often have children and consider the impact a further child will have on their already struggling family.

Legal limit

Some MPs are calling for the legal limit for abortion to be reduced to 12 weeks. Cases of ‘miracle’ babies who with intense interventions in specialist units have survived at 23 weeks are often used to support calls for a reduction in the abortion limit.

We should not play women’s needs off against each other. There is no contradiction in celebrating the survival of a much-wanted baby born long before he or she was ready, and ensuring the small number of women who need to end pregnancies at a similar gestation can do so.

It is important that nurses understand the reasons why women sometimes present later for abortion, and act as their advocates.

There is not a single woman in our waiting room right now who wants to be there. No woman aspires to have an abortion, even less so a later abortion. But when a woman finds herself in that situation, she deserves our compassion and support to access the services she needs.

Further information

Why women present for abortions after 20 weeks 


 

Michael Nevill is director of nursing at the British Pregnancy Advisory Service

 

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