Should Nurses Be Authorised To Approve Abortions?

“The wellbeing and safety of women accessing abortion services has been, and will continue to be, our first and foremost priority.”

A study for Shaping Abortion for Change (SACHA), led by the London School of Hygiene and Tropical Medicine (LSHTM) has concluded that nurses and midwives should be able to approve abortions. If ratified, this would constitute one of the most fundamental changes to abortion laws since the Abortion Act came into force in 1967.

What The SACHA Study Says

The study, which was funded by the National Institute for Health Research, advised that regulations be amended to allow nurses and midwives to authorise an abortion, prescribe abortion medication, and undertake vacuum aspirations.

These amendments would bring abortion legislation into line with current healthcare practice, the study’s authors argued.

What Would This Change?

As the law currently stands, abortions must be approved by two doctors and abortion procedures are only permitted in either an NHS hospital or another setting approved by the Secretary of State. Nurses are not permitted to perform Vacuum Aspirations (VA) for abortions even though they can do so for patients who suffered miscarriages within 14 weeks of pregnancy.

Do you think there is an important distinction, both ethical and health-related, between the aftercare of a miscarriage and the termination of a viable pregnancy? And if so, would allowing nurses and midwives to approve abortions without reference to a doctor compromise the legal protections currently in place to protect both pregnant women and unborn babies?

Nurses’ New Role In Provision

Kaye Wellings, Professor of Sexual and Reproductive Health Research at LSHTM and one of the SACHA study co-leads, argues that ‘as abortion provision is increasingly nurse-led, it makes sense for nurses and midwives to be able to sign off abortions instead of having to pass their paperwork to two doctors, who usually have no contact with the patient.

"There is also merit in permitting nurses and midwives to prescribe abortion medications and also to carry out vacuum aspiration which they perform anyway in the management of miscarriage" she continued.

If the move to allow nurses to approve abortions is rejected, should a requirement for the approving doctors to have personal consultation with the patient prior to making the decision be legislated for instead?

What The Evidence Says

Evidence from the National Institute for Health and Care Excellence (NICE) has previously illustrated that women favoured nurse-delivered services. The research from SACHA had now “confirmed the current law that compels abortions to be performed by doctors is preventing best practice [and] compassionate care in the UK” Professor Wellings declared.

87% of terminations in England and Wales were medical abortions, in which patients typically take abortion medication at home, according to the study’s researchers. They also found that nurses are increasingly supervising medical abortions.

The study also reported that nearly a fifth of health workers and a third of women surveyed were unaware that abortion, unless authorised by a doctor remains a criminal offence in Britain.

"The wellbeing and safety of women accessing abortion services has been, and will continue to be, our first and foremost priority". A Department of Health and Social Care spokesperson

Why Education And Training Is Vital

The loosening of the abortion rules put in place during the COVID-19 pandemic which allowed patients access to pills for early medical abortion via a teleconsultation ended in August 2022. Do you think this change, albeit temporary, demonstrated the need to extend the ability to make abortion approval decisions to a wider pool of healthcare professionals than just doctors?

The study’s researchers stated that including abortion content in education and training programmes was critical to “equip new cadres of healthcare professionals to contribute to abortion care and support”.

Another recommendation was that abortion provision be integrated into community sexual and reproductive health services.

“Abortion is one of the most common health procedures, likely to be experienced by one in three women in their lifetime…Yet, in our study nearly nine out of 10 health care professionals working outside of specialist abortion services said lack of training was a barrier to providing care’ said Dr Rebecca French, the other SACHA co-lead, and Associate Professor of Reproductive and Sexual Health at LSHTM.

Could The NHS Make These Changes?

Does the NHS have sufficient staffing capacity to accommodate such an integration? Or will a lack of personnel and training mean nurse-led abortions could be potentially less safe than current arrangements?

A spokesperson for the Department of Health and Social Care said: "We are committed to improving women’s access to reproductive health services and published the Women’s Health Strategy for England in August 2022.

The ambitions set out in the strategy include creating a system-wide approach to women’s reproductive health that supports individual choice and ensures better access to services through the creation and expansion of women’s health hubs" they explained.

Please let us know what you think in the comments. Should nurses and midwives be able to approve abortion procedures on their own, or is the involvement of a doctor, even if that doctor has not personally met the patient, a necessary safeguard for both patient and professional?

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