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Women's health

Womens health: termination of pregnancy

The RCN aims to support its members in providing the very highest standards of compassionate care possible for women who choose to have a termination of pregnancy, and are committed to providing considerate/empathetic support to those nurses, midwives and healthcare assistants who work to provide safe and quality care. 

Whether pregnancy is planned or unplanned, the RCN believes that every woman should have the right to choose how to deal with this life event, within current legislation. The RCN believes that termination of pregnancy and contraception are necessary and integral to the provision of a comprehensive sexual and reproductive healthcare service, and support the current legislation. See: RCN Termination of Pregnancy (Induced Abortion) position statement.

We equally acknowledge and respect those nurses, midwives and healthcare assistants who have a conscientious objection within current legislation.  

The original Abortion Act was 50 years old in 2017, this has led to considerable discussion about the legislation, which was updated by the Human Fertilisation and Embryology Act 1990 amended 2008, and which excludes Northern Ireland.

It is recognised that there are differing points of view on the issues surrounding Termination of Pregnancy (the preferred term agreed by DH some years ago, however abortion remains a commonly used term). In the midst of these debates are women, men, nurses, midwives and healthcare assistants who are involved in termination of pregnancy, and /or who have varying views on the subject.

The decriminalisation of abortion is the current debate taking place across the UK, It rests on the ideal that society has moved forward in 50 years, and there is no longer a requirement for this ‘medical condition’ to be enshrined in a legislative framework, that some consider to be outdated and inappropriate. The campaign We Trust Women was launched by BPAS (the largest independent provider of TOP services across England and Wales (including NHS Contracts) in 2015-16.

It was followed by the Royal College of Midwives declaring its support in May 2016, however this was not without controversy for them.

The British Medical Association (BMA) published a detailed report in February 2017, which provides a comprehensive overview of the various arguments for and against, but did not change its position. The BMA conference in June 2017 saw a call by some doctors for the BMA to change its position – links below for further details.

In October 2017, the Royal College of Obstetricians and Gynaecologists (RCOG) released a statement lending their support to the campaign with parameters similar to the BMA, including the need for:

  • regulation and professional standards and ongoing quality monitoring
  • requirement for conscientious objection to be maintained
  • to maintain viability limits to remain.

The Faculty of Sexual and Reproductive Health (FSRH) published a statement outlining its support in November 2017. In February 2019, the Royal College of General Practitioners' (RCGP) announced their support for the decriminalisation of abortion, saying that the procedure should be governed by medical regulatory frameworks, not the criminal justice system.    

In May 2018, the RCN published its member response to a consultation of the full membership, see: Decriminalisation of Termination of Pregnancy. RCN Membership Response

In December 2018, the RCN published their position statement on decriminalisation. See: Decriminalisation of Termination of Pregnancy Position statement.

Advanced Nursing Skills

There is also a consideration and ongoing discussion about the need to extend nursing skills in care (this is partly driven by the lack of medical staff available to perform Termination of Pregnancy and related to a recognition that this is an area for advanced nursing care to expand). A recent publication by Sheldon & Fletcher outlines the advantages of this move, and the NNP meeting agreed that RCN would support advanced practice if the individual was adequately skilled, however this needs further work. It would also require a change to current legislation. The RCN is currently in discussions with FSRH about advancing nursing skills to support quality care.

In 2022, the RCOG has an Abortion Care eResource, where there are eight eTutorials available to help health workers, healthcare students and clinical educators gain practical and applicable knowledge about safe abortion care across global contexts.

Nursing Education and Development

In 2020, RCN is committed to supporting best practice, and with a view to considering how we can best support nursing practice and leadership in TOP service provision. We have now published the results of a survey to consider the educational standards of nurses, midwives and healthcare assistants working across direct and indirect services where woman are cared for. Our report RCN Nursing Education in Termination of Pregnancy Services identifies the current range of education qualifications and the considers a career pathway and further educational needs in the service. 

Key RCN resources

Further RCN resources

Termination of Pregnancy. An RCN nursing framework (2020). This updated guidance incorporates expert and evidence-based practice. It has been produced to support registered nurses and midwives working within the NHS and independent sectors, across the UK. It considers the legislative frameworks in place in 2020 across the UK, alongside clinical guidance for those working in termination of pregnancy services.

Clinical Nurse Specialist in Early Pregnancy Care (2017). The role of the clinical nurse specialist in early pregnancy care is intended to enhance the care for women who may be concerned about a complication in early pregnancy. This document outlines the key skills and knowledge required to develop the role of this specialist nurse/midwife and should provide clear direction for commissioners and managers when creating roles to support best practice in local service provision for women and their families. 

Managing the disposal of pregnancy remains (2021). This publication is intended to provide clear guidance for all health care professionals to have in place sound systems and processes to ensure the safe and appropriate disposal of pregnancy remains, where the pregnancy has ended before the 24th week of gestation. This includes following an ectopic pregnancy, early intrauterine fetal death, miscarriage, or a medically or surgically induced termination of pregnancy.

Further resources

Current legislation

On 30 March 2020 the Government has approved temporarily (In England) telemedicine for abortion consultations and home use of mifepristone, the first course of early medical abortion treatment. For more information, see: Temporary approval of home use for both stages of early medical abortion

In March 2020, Northern Ireland enacted new legislation and guidelines, see: A new legal framework for abortion services in Northern Ireland

Advanced nursing skills

Sally Sheldon, Joanne Fletcher (2017) Vacuum aspiration for induced abortion could be safely and legally performed by nurses and midwives. J Fam Plann Reprod Health Care 2017;0:1–5. doi:10.1136/jfprhc-2016-101542 

Further reading

Aiken, Lohr, Lord, Ghosh, & Starling (2021).  Effectiveness, safety and acceptability of no-test medical abortion (termination of pregnancy) provided via telemedicine: a national cohort study. British Journal of Obstetrics and Gynaecology

British Medical Association (BMA). How will abortion be regulated in the United Kingdom if the criminal sanctions for abortion are removed?

Commons Women and Equality Committee (2019). Abortion law in Northern Ireland: Government response to the Committee’s Eighth Report of Session 2017–19

Department of Health and Social Care (2019) Abortion: further clarification of time limit

FSRH & RCOG statement (2022).  FSRH and RCOG welcome the Welsh Government’s decision to permanently allow telemedicine for early abortion care

Guidelines for Nurses. Women's health. Guideline summaries and featured articles on women's health

NICE quality standard (2021) Abortion care. This quality standard covers care for women of any age who request an abortion. It describes high-quality care in priority areas for improvement

NICE guideline (2019) Abortion care. This guideline covers care for women of any age (including girls and young women under 18) who request an abortion

Royal College of Obstetricians and Gynaecologists. Coronavirus (COVID-19) infection and abortion care. This guidance contains a table at the beginning that summarises updates. The page also links to a useful decision aid to help assist clinicians and women decide when a scan is required

World Health Organization (2018). Medical management of abortion

World Health Organization (2022). Abortion care guidelines

Page last updated - 13/04/2022