Abortion briefing

Background

The RCN represents over 390,000 registered nurses, midwives, health visitors, nursing students, health care assistants and nurse cadets in the UK. This makes the RCN the largest professional union of nursing staff in the world. The College promotes patient and nursing interests on a wide range of issues by working closely with government, the UK parliaments and other national and European political institutions, trade unions, professional bodies and voluntary organisations.

The RCN has hitherto supported the availability of abortion under the current legislation and supports the BMA's position developed in the 1970's that the Abortion Act is a 'practical and humane piece of legislation'.

Summary

  • We support the current law that enables abortion up to 24 weeks gestation
  • We believe that the requirement for two doctors to agree that a woman can have an abortion should be removed
  • We recommend a change or clarification in legislation to allow nurses and midwives to be allowed to perform early surgical abortions and to be able to prescribe Mifespristone for early medical abortions as part of a clinical team
  • We would like to see clear standards of care for all women seeking abortions to minimise the differences in care in different locations
  • The RCN would like to see that in every provider unit, all women seeking abortion have access to screening for STIs and treatment, if indicated, before their procedure in order to reduce the incidence of pelvic inflammatory disease (PID) post procedure

Position Statement

The Abortion Act 1967 was originally passed to end illegal and dangerous abortions and set out a range of conditions and safeguards for women which included specifying where abortions could take place, and under what circumstances. The Act does not relate to Northern Ireland and therefore this briefing does not refer to the current arrangements in place there.

Nurses and midwives are currently providing high quality, patient centred nursing care by offering physical, emotional and social care and support to women and their families. Nurses working within these services wish to improve access and ensure women receive a safe, effective and seamless service with the least delay.

The RCN aims to support its members in providing the very highest standards of care possible for their patients and clients. We acknowledge and respect those nurses who have a conscientious objection to providing abortion care but are committed to providing support to those nurses who work in abortion to provide safe and quality care.

Our view of abortion services was achieved through consultation with the relevant RCN forum members who work in the clinical field of abortion.

The 24-week time limit for legal abortion

We support the current law that enables abortion up to 24 weeks gestation. It is the RCN’s view, based on the peer-reviewed published data currently available, that there is no evidence of significant improvements or advances in neonatal care, or understanding of foetal development, to suggest reducing the 24-week limit under the Abortion Act. The major development since 1990 has been an improvement in the survival of babies born at 24 weeks and over, but not below this gestation.

The RCN is mindful of the Royal College of Obstetricians and Gynaecologists’ comments that should the time limit be reduced there will be greater demands on neonatal services. With neonatal services already under pressure the greater number of pre-term babies placed in intensive care could lead to those born at later gestation with greater chances of survival being deprived of care. 

The requirement for two doctors’ signatures

We believe that the requirement for two doctors to agree that a woman can have an abortion should be removed. There is no other medical or surgical procedure which requires the consent of a medical practitioner or the signature of two doctors before it is carried out. The current requirement of two medical practitioners’ signatures is not only out-dated but can lead to delays in the referral process.

The RCN believes that a competent woman seeking an abortion is able to give informed consent to any procedures carried out (except in medical emergencies that may arise where this is not possible). Her consent would be based upon an explanation and understanding of the available methods of abortion including complication rates and follow-up care.

Extending the role of nurses and midwives

The RCN believes that registered nurses and midwives with appropriate training and who are appropriately accredited in abortion care should be allowed to perform early surgical abortions and to be able to prescribe Mifespristone for early medical abortions as part of a clinical team.

When the Abortion Act was passed in October 1967 it was not common practice for nurses and midwives to perform surgical procedures; however nurses and midwives have expanded on their practice and now perform a range of complex procedures including colposcopies and hysteroscopy’s, and fitting intrauterine devices (IUDs) and sub-dermal implants. Moreover, while nurses are able to prescribe Mifespristone, as listed in the BNF for Nurse Independent Prescribing (NIP), they currently cannot prescribe it in abortion cases.

Serious abnormality

The RCN believes that the current grounds to terminate a pregnancy on the basis of serious foetal abnormality within the Abortion Act 1967 should remain (sections 1(1)(d) and 5(2)(a) of the Act). 
The Act currently does not give any guidance about how “serious handicap” should be defined and nor have the courts given any guidance as to how this phrase should be interpreted. We believe that it is difficult to provide a clear definition of serious abnormality, or produce a definitive list of conditions, and would advise caution in attempting to do so. There needs to be sufficient flexibility to take account of individual cases. 

Standards of care

The RCN would like clear standards of care for all women seeking abortions to minimise the differences in care in different locations.

Ensuring access to sexual health services is vital in reducing the number of unwanted pregnancies and repeat abortions. School nurses play a pivotal role in supporting and advising young people about sexual health. Unfortunately the number of school nurses was badly hit by NHS deficits and there are approximately only 3000 school nurses, or one nurse to every ten schools, in the UK. The RCN believes this number needs to be doubled in order for school nurses to be effective in tackling the wide range of issues affecting young people. In 2004, the Government said there should be one full-time nurse for every secondary school and its cluster of primary schools in England by 2010. However, it is highly likely the Government will not reach this target.

We would also like to see that in every provider unit, all women seeking abortion have access to screening for STIs and treatment, if indicated, before their procedure in order to reduce the incidence of pelvic inflammatory disease (PID) post procedure.

Royal College of Nursing
7 May 2008