UK: New evidence-based guideline on abortion published

Women who have an abortion should not be forced to undergo mandatory counselling before the procedure, the Royal College of Obstetricians and Gynaecologists (RCOG) has said in new guidance.

The RCOG published its revised guidelines on the care of women requesting induced abortion on 23 November 2011.

The clinical guidelines are for all healthcare professionals and aim to ensure that all women considering induced abortion have access to a high quality service based on national standards. The recommendations cover commissioning and organising services, possible side effects and complications, pre-abortion management, abortion procedures and follow up care.

The RCOG’s press release highlights a number of new recommendations, including:

- Services should identify issues which make women particularly vulnerable, for example child protection needs and domestic abuse, and refer them on to appropriate support services in a timely manner.

- Services should provide women with information about the physical symptoms and sequelae that may be experienced after abortion such as pain and bleeding and gastrointestinal symptoms.

- Service providers should inform women about the range of emotional responses that may be experienced during and following an abortion.

- Providers should be aware that women with a past history of mental health problems are at increased risk of further problems after an unintended pregnancy.

- During pre-abortion assessment women should be offered screening for STIs and there should be a system for partner notification and referral to a sexual health service.

- All appropriate methods of contraception should be discussed with women at the initial assessment and a plan agreed for contraception after the abortion.

- Women should have access to counselling and decision-making support, however, women who are certain of their decision should not be subjected to compulsory counselling.

- A 24-hour telephone helpline number should be available for women to use after abortion if they have any concerns.

- Doctors should also discuss ongoing contraception and offer screening for sexually transmitted infections.

Aspects of the new guidance were reported by the Daily Telegraph newspaper and by the news agency PA.

PA reports that ‘a Royal College has explicitly said women who are sure they want an abortion should “not be subjected to compulsory counselling“‘, and that this ‘follows a row in September over the issue of counselling, with Tory backbencher Nadine Dorries and Labour’s Frank Field losing a Commons vote on the issue. They wanted to prevent non-statutory abortion providers such as Marie Stopes and BPAS from offering counselling.’

PA also reports that the new guideline ‘supports the safety of taking pills at home to induce an abortion. This is illegal in the UK and was the subject of a High Court challenge by British Pregnancy Advisory Service (BPAS) earlier this year.’

Ann Furedi,chief executive of BPAS, said the ‘rights and wrongs of abortion are subject to opinion, but clinical risks are a matter of fact’.

She added: ‘We welcome the clear guidance on the offer of counselling. We alsonote the conclusion that home use of misoprostol in early medical abortion is safe andsupported by the evidence but currently not permissible within the law.

‘We trust the necessary steps will be taken soon so that this can be offered to women in Britain,thus allowing us to provide a service in line with international best practice.”

Julie Bentley, chief executive of the Family Planning Association (FPA), said:

‘We believe these are sensible guidelines which will improve women’s experience of abortion services and care. We are pleased to see that they confirm the evidence that abortion is not a direct cause of poor mental health and that there isn’t a link between abortion and breast cancer.

‘We also welcome the recommendation that women can complete the second stage of medical abortion at home if they choose and it’s safe to do so.’

The Care of Women Requesting Induced Abortion: Evidence-based Clinical Guideline Number 7. RCOG, 23 November 2011

RCOG release: Revised guidelines on women seeking induced abortion published. RCOG, 23 November 2011

Women having an abortion ‘should not be forced’ into counselling. Daily Telegraph, 23 November 2011

Call to limit abortion counselling. PA, 23 November 2011

Source: http://www.abortionreview.org