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Complex medical cases: pregnancy support lacking

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bpas, abortion provision, women with medical conditions, ‘Abortion is part and parcel of women’s healthcare. It should be regulated and delivered as such’.

Women in the UK with medical conditions including epilepsy, heart problems, and cancer struggle to obtain abortion care, even though the continuation of their pregnancy poses a significant threat to their health.

A British Pregnancy Advisory Service (bpas) briefing published last month, based on 2,900 women with medical complexities who the British Pregnancy Advisory Service (bpas) helped to find abortion care during 2016 and 2017, highlights the fact that in 21st-century Britain women are being compelled to continue pregnancies they do not want due to a lack of appropriate services, or have to endure stressful, long waits for care while also coping with a health condition that may be exacerbated by pregnancy.

These are women who cannot be seen in stand-alone clinics such as those run by bpas, but must be cared for in NHS hospital settings where there is swift back-up to medical care if their condition deteriorates.

On 46 occasions in 2016 and 2017 – or generally twice a month – bpas was unable to secure suitable NHS hospital treatment for these women by the strict legal cut-off point of 24 weeks.

bpas runs a dedicated specialist placements service to find hospital appointments for these women, but as bpas does not see all women, staff believe it is reasonable to assume that at least once a week a woman with a medical condition is unable to access the care she needs.

These include very young women and women in complex situations, such as those experiencing domestic abuse, who present towards the end of the second trimester.

This may be due to late detection of pregnancy, sometimes because they are using contraception that has altered bleeding patterns so pregnancy is not suspected, or because they believed pregnancy was unlikely as a result of their condition – ill-health – affecting their fertility.

In other cases their circumstances – including their health – have deteriorated, making a wanted pregnancy no longer possible.

Here are the issues four medically complex women for whom bpas was unable to secure an appointment in 2016/17 were faced with:

A teenager who had recently left foster care. Lives alone and feels unprepared to become a parent. She has a thyroid condition (at risk of potentially fatal thyroid storm). She contacted bpas at 22 weeks. No appointment was available.

A client who had a heart condition and is currently attempting to get a non-molestation order against ex-partner due to domestic violence and has a child with a serious illness. Presented at 22 weeks. No appointment was available.

Or a client whose pregnancy was planned, but her health has sharply deteriorated. She has pulmonary fibrosis and a range of medical problems and decided to end the pregnancy as she needs to be able to care for her existing child. Presented at 22 weeks. No appointment was available.

As the 3 hospitals able to provide up to the legal limit of 24 weeks in these circumstances are all in London, distance from other areas of the country and time away from home can also prove insurmountable obstacles.

Another women contacted bpas at 15 weeks. Had recently had a heart attack. She was unable to travel far for treatment as she cares for her existing children and disabled partner. No suitable appointment was available.

In other cases women must sometimes wait many weeks before an abortion appointment can be found: in one case a mother with cancer, whose treatment could not start until the abortion was performed, waited 45 days for an appointment.

In another case, a mother with epilepsy and learning difficulties who presented at the end of first trimester was treated nearly 7 weeks later.

But work is underway to commission a specialist pathway for women who cannot be cared for in stand-alone clinics.

The Royal College of Obstetricians and Gynaecologists (RCOG) has established an Abortion Taskforce to improve women’s access to high quality abortion care; bpas will do all it can to support these initiatives.

Ann Furedi, chief executive of the British Pregnancy Advisory Service, said: “Those opposed to abortion sometimes claim there are ‘too many’ abortions, or casually declare that the time limit needs to be reduced.

“The fact is that in 21st-century Britain, there are women who are not getting the abortions they need, despite fully meeting the grounds of the 1967 Abortion Act.

“These are women for whom the continuation of the pregnancy threatens their health. These are women with existing children to care for. These are women who are often in complex social circumstances at the same time as struggling to deal with a health condition and an unwanted pregnancy.

“There is no one single solution to problems with service provision – but one thing is certain.

“While abortion remains in the criminal law, separated and stigmatised, we will struggle to provide women with the reproductive healthcare services they need and deserve.

“Abortion is part and parcel of women’s healthcare. It should be regulated and delivered as such.”

To read the full briefing paper, ‘Medically Complex Women and Abortion Care’, click here.

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