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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