Select Committee on Health Minutes of Evidence

Memorandum by British Pregnancy Advisory Service (SH 96)


  BPAS welcomes the National Strategy for Sexual Health and HIV (the Strategy) and the inclusion of standards and targets for abortion that positions this service as an accepted and necessary component of reproductive healthcare.

  BPAS evidence will focus on those features of the Strategy and other issues, which could improve the accessibility, and provision of abortion services in this context.


  BPAS is a charitable organisation established in 1967 with the primary objectives to:

    —  promote the availability of publicly funded abortion services;

    —  provide high quality, affordable services to women who cannot obtain care through the NHS;

    —  offer a model service that is client-centred and evidence-based, and which can be set a standard for other providers; and

    —  encourage research and advancement in understanding in matters of fertility regulation.

  In 2001, BPAS responded to over 272,000 enquiries to our abortion helpline and provided 43,532 abortions to residents of England and Wales, a quarter of the total required. The NHS paid for 67 per cent of these procedures under commissioned arrangements.


  BPAS believes that the following changes to the legal framework and to policy development would have a beneficial impact on women and on the potential to achieve the target objectives of the Sexual Health Strategy:

To Policy

  3.1  BPAS recommends that the target objective of all women who meet the legal requirements will have access to an abortion, consistent with RCOG guidance on waiting time, should be made explicit for all commissioning bodies.

  This objective should be included within the NHS performance assessment framework, subject to performance indicators and reporting mechanisms.

  3.2  BPAS recommends that funding is made available to the level necessary to meet the identified target objectives and remove the inequalities that currently exist.

  3.3  BPAS recommends that a review of the evidence and research be conducted into the provision of early medical abortion and what is required to provide a safe and effective service.

  3.4  BPAS recommends that emphasis is given to the development of professional education and training in abortion, including examination of the enhanced role that nurses could play in the delivery of services.

  3.5  BPAS recommends that commissioners should make full use of the independent, charitable sector in developing effective working partnership to meet the Strategy target objectives.

To the Law

  3.6  BPAS believes that abortion should be decriminalised.

  We understood that the political and legislative changes necessary to bring this about might be unacceptable at present but policy makers should accept the reality, made explicit within the Strategy, that abortion is a necessary and normal component of reproductive healthcare.

  3.7  BPAS believes that provision should thus be made for abortion to be provided and regulated like other forms of healthcare and reproductive medicine.


  Amongst others, there are four critical areas that impact on the provision of abortion services and contribute to the inequalities in access to those services:

4.1  Prioritisation

  Historical reluctance to address the issue of abortion means that it has been accorded a lower priority than other areas of sexual healthcare.

  Concerns about provoking controversy have led to debate about whether abortion services should be provided. Public opinion1 and the Government's acceptance in the Strategy that abortion is an integral component of sexual healthcare is timely and welcome.

  A mature exploration of how those services should be provided is now therefore possible.

4.2  Funding

  Abortion care is unique in the reliance placed on the independent sector and on individual women's willingness and ability to pay for their treatment.

  Commissioning arrangements and collaboration with, particularly, the charitable sector has enabled the NHS to fund 76 per cent of abortion in 20012. This still left 24 per cent (41,739) women who had to pay for their own care in the independent sector.

  The Strategy is explicit in that ". . . services should be developed to provide NHS funded abortions . . ."! and "From 2005, commissioners should ensure that women who meet the legal requirements to have access to an abortion . . ."

  The Implementation Action Plan however is only implicit in respect of when it refers to this target.

  The additional cost to the NHS of funding the care of all women who present for treatment will be considerable, in the order of £16 million—£20 million each year3. However, this must also be compared to the vastly increased costs of maternity care and other costs associated with the continuance of an unintended/unwanted pregnancy.

  With abortion care, there is a defined spend and the quantum is readily calculable to the level indicated. There is little likelihood of significant changes in trend and thus central funding and local commissioning strategies can be planned with some certainty, compared with other areas of healthcare, even within the Strategy.

4.3  Inequality

  The Strategy illustrates the wide variation in NHS support for providing and/or funding abortion in different areas which is clearly inequitable when set against the principles of the NHS Plan4 and a national health service.

  Freedom to allow health commissioners to prioritise abortion services in line with the targets of the Strategy and provision of adequate funding to implement those plans will be the major drivers to achievement.

  What remains are the practical barriers to overcome, namely, capacity.

4.4  Capacity

  Not all NHS Trusts will be able or willing to expand their abortion service to provide for all women needing the service.

  It is widely recognised that there is a shortage of doctors prepared and trained to undertake abortions and many who restrict their caseload to arbitrary personal limits.

  To meet the Strategy target within the NHS alone would require an increased capacity of over double the rate of current provision which caters for only 43 per cent of the total caseload2.

  The remaining treatments are provided through the Independent Sector, either on a commissioned basis from the NHS (33 per cent) or privately (24 per cent).

  It is clear that it would not be feasible to increase capacity within the NHS alone to the Strategy target without compromising clinical standards and/or the provision of other necessary services.

  Implementation will thus need to examine alternative models of service delivery, which would impact less on capacity constraints and also explore the continued benefits of collaborative and innovative partnership with the independent sector.

  In this instance, BPAS is unique as a specialist provider, combining two elements that increase acceptability to those who doubt the appropriateness of public-private partnerships in healthcare. BPAS is a not for profit Registered Charity and with a non-virement financial policy which ensures that all funds are solely and wholly devoted to the development of abortion services in the UK.

July 2002


  1.  MORI Attitudes to Abortion, October 2001.

  2.  National Statistics Legal abortions in England & Wales 2001, Health Statistics Quarterly 14, Summer 2002.

  3.  Parliamentary Question, Hansard. Volume 301. No 75. Column 423. 24 November 1997.

  4.  Department of Health. The NHS Plan, A plan for investment, a plan for reform: CM4818, Stationary Office July 2000.

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