Select Committee on Health Minutes of Evidence

Memorandum by Marie Stopes International (SH 97)

  As a registered charity providing sexual reproductive health (SRH) services to over 60,000 women and men in Britain in 2001, including more than 46,000 abortions, MARIE STOPES INTERNATIONAL (MSI) is pleased to present a response to "The National Strategy for Sexual Health and HIV" at the request of the Health Committee.

  In addition to service provision in Britain, MSI works in partnership with organisations in 38 countries worldwide, contributing to policy development, advocacy, training and service delivery for improved sexual and reproductive health (SRH). As an international organisation MSI monitors development in SRH in both developed and developing countries in order to build an evidence base against which services are developed in the most appropriate way for our clients.

  The development of this National Strategy is a positive step forward in encouraging debate at all levels to recognise sexual and reproductive health as a priority.

  1.  MSI is in agreement with the Strategy in highlighting access as a key issue in improving uptake of all healthcare services. In order to increase access, MSI believes that consultation with current and potential user groups is essential in order to collect the necessary data to determine critical factors such as the most appropriate location and opening hours for SRH advice and service provision. It must be borne in mind, for example, that the majority of those to be targeted through this strategy will be working, studying or responsible for childcare and therefore need services to be available outside of normal working hours.

  2.  With specific reference to NHS abortion provision, MSI applauds the intention of the Strategy to set a maximum time between first consultation with her GP or other referring doctor and an appointment with an abortion provider. However, it is arguable that the maximum, set at three weeks from 2005, remains far too long. For example, a woman having missed two menses may wait a week before such an appointment can be made. At that time she would be in the region of eight weeks pregnant. After three weeks, she may attend an outpatient appointment and be given an appointment for treatment a week later. At this point, she is on the verge of the second trimester of her pregnancy, cannot opt for early medical abortion and may even find that her local hospital is unwilling to perform abortions after the twelfth week of pregnancy.

  As is stated in the Royal College of Obstetricians and Gynaecologists (RCOG) guidelines, early termination of pregnancy is not only safer, but also allows women a wider choice—of a medical or surgical procedure and, where she has chosen a surgical procedure, local or general anaesthesia or light sedation.

  3.  There is a need for specific action to address training for doctors at all levels to secure future provision of abortion services, particularly those pregnancies where the gestation exceeds 12 weeks.

  4.  MSI wholeheartedly supports the Strategy position on widely available information for all sections of society. Such information should be appropriate to the age, gender and culture of the target audience. Access to abortion services is never easy for any woman and there is a need for open access, as is the case for Genito-Urinary Medical services. A family GP who has cared for the general health of a young woman since childhood is not necessarily the most appropriate person for her to turn to for advice about any sexual health matter.

  5.  It has been established 18 per cent of GPs, that is one in five, representing a significant minority, are opposed to abortion in principle. [13]This can have a profound effect on any woman seeking advice from her GP. She may be given the impression that she cannot legally obtain an abortion or be made to feel unnecessarily or excessively guilty about her decision, leading to harmful psychological sequalae.

  There is currently no provision to protect women in such an instance but open access in combination with improved public information (including the requirement for GPs to publish their attitude to abortion for all patients) would allow women to access supportive, non-judgmental help and advice more quickly.

  6.  There is a growing body of evidence worldwide to establish the role of nurses more directly in abortion provision. Evidence shows that doctors in training are less willing than ever before to undergo training in abortion techniques while the growing emphasis on the role of the nurse practitioner in other spheres of medical practice will pass abortion provision by, unless consideration is given to legal reform.

  Nurses now routinely fill the role of counsellor, perform ultrasound assessment of gestation, carry out a clinical examination and take the necessary blood samples prior to an abortion being performed. However, the woman still requires the opinion of two doctors before her pregnancy can be legally terminated.

  7.  In practical terms, changes in NHS commissioning have led to an increase in the proportion of abortions funded by the NHS. However there is little available evidence to determine why over 30 per cent of women choose to access abortion directly with a private or charitable provider and pay for their own healthcare. It has not been reliably established as to whether these women cannot access NHS abortion services or choose to access alternative provision for any one of a multitude of other reasons (confidentiality, speed, ability to pay, inability to access GP services etc).

  8.  MSI fully supports any and all efforts to ensure that inequalities in provision of SRH services are addressed.

  There is no question that provision of abortion services is inequitable across the United Kingdom, particularly for women from Northern Ireland where legislation relating to abortion is ambiguous and requires further clarification. Such a situation could be viewed as discriminatory, not least to those women who cannot afford to make the trip to Britain to access services as they have little or no access to NHS funded abortion in Northern Ireland.

  9.  Further, MSI recognises the need to address the increasing incidence of sexually transmitted infection, including HIV, and would like to see the specific strategy, to increase diagnosis and treatment of chlamydia, extended to include greater involvement of men in a future screening strategy. Awareness among men is even lower than among women and yet recent research has identified high rates of infection among young men. Opportunistic or strategic screening of young men would help to both increase awareness and reduce overall incidence.

  10.  MSI welcomes this Strategy as it seeks to address geographical inequalities of access and as a platform to further consider improvements in access to information and services in accordance with the wishes of users and potential users. MSI acknowledges the right of women to have children by choice not by chance and further recognises that good SRH extends beyond the absence of disease. Unplanned and unwanted pregnancy affects not only the woman herself but impacts on her family and, potentially, on society as a whole.

July 2002

13   GPs "General Practitioners: Attitudes to Abortion". MSI 1999. Back

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