In the coming months, MPs will have the best chance in a generation to modernise UK abortion law. The 40-year-old Abortion Act was framed in a different era of medicine and a time of different social expectations. While other areas of health care have been able to develop over time to permit doctors and nurses to modernise their practice, the law has kept abortion services trapped in the past.
Only doctors can take clinical responsibility for abortion although nurses perform far more complex procedures in other areas of medicine; two doctors must confirm that a woman meets the legal requirements in addition to the normal consent procedures; early medical abortion is subject to the same constraints as surgery; and women who live in Northern Ireland are still denied access to this basic aspect of reproductive health care.
The British Medical Association and the Commons Science and Technology Committee have supported the removal of the legal requirement for two doctors' signatures, as this may be causing delays in access to abortion services. The Royal College of Nurses argues that nurses with suitable training and professional guidance should not be prevented by law from carrying out all stages of early medical and early surgical abortion, noting that there is no evidence that this would compromise patient safety or quality of care. Specially trained nurses provide such care in the United States and South Africa, why not here?
Greater involvement of nurses in early abortion care would also increase national capacity for abortion at early gestations and so reduce treatment delays.
The abortion time limit must remain at 24 weeks; there is no need to reduce it. Research does not support claims that the gestational age of viability has reduced since 1990. Doctors are better at keeping alive those babies born at and after 24 weeks; but not those born before. Yet there is ample evidence that women need access to abortion up to the current gestational limit. The women who request the latest abortions are those who would be least able to cope with their pregnancy.
Changes to the law should remove the unnecessary barriers that frustrate so many women and their doctors. A woman should be able to end a pregnancy because it is unwanted. Abortion should be regulated by the same principles and standards as other clinical procedures.
We can all agree that it would be better if unintended pregnancies were prevented, and that increased use of long-acting reversible methods of contraception may contribute to this end. However, the rising number of abortions demonstrates that abortion remains necessary.
The author is chief executive of the British Pregnancy Advisory Service