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
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:
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
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
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:
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.
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
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.
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,
Not all NHS Trusts will be able or willing to
expand their abortion service to provide for all women needing
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
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.
1. MORI Attitudes to Abortion, October 2001.
2. National Statistics Legal abortions in
England & Wales 2001, Health Statistics Quarterly 14, Summer
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