Womens health: termination of pregnancy

The RCN aims to support its members in providing the very highest standards of compassionate care possible for women who choose to have a termination of pregnancy, and are committed to providing considerate/empathetic support to those nurses, midwives and healthcare assistants who work to provide safe and quality care. 

Whether pregnancy is planned or unplanned, the RCN believes that every woman should have the right to choose how to deal with this life event, within current legislation. The RCN believes that termination of pregnancy and contraception are necessary and integral to the provision of a comprehensive sexual and reproductive healthcare service, and support the current legislation. See: RCN Termination of Pregnancy (Induced Abortion) position statement.

We equally acknowledge and respect those nurses, midwives and healthcare assistants who have a conscientious objection within current legislation.  

The original Abortion Act was 50 years old in 2017, this has led to considerable discussion about the legislation, which was updated by the Human Fertilisation and Embryology Act 1990 amended 2008, and which excludes Northern Ireland.

It is recognised that there are differing points of view on the issues surrounding Termination of Pregnancy (the preferred term agreed by DH some years ago, however abortion remains a commonly used term). In the midst of these debates are women, men, nurses, midwives and healthcare assistants who are involved in termination of pregnancy, and /or who have varying views on the subject.

The decriminalisation of abortion is the current debate taking place across the UK, It rests on the ideal that society has moved forward in 50 years, and there is no longer a requirement for this ‘medical condition’ to be enshrined in a legislative framework, that some consider to be outdated and inappropriate. The campaign We Trust Women was launched by BPAS (the largest independent provider of TOP services across England and Wales (including NHS Contracts) in 2015-16.

It was followed by the Royal College of Midwives declaring its support in May 2016, however this was not without controversy for them.

The British Medical Association (BMA) published a detailed report in February 2017, which provides a comprehensive overview of the various arguments for and against, but did not change its position. The BMA conference in June 2017 saw a call by some doctors for the BMA to change its position – links below for further details.

In October 2017, the Royal College of Obstetricians and Gynaecologists (RCOG) released a statement lending their support to the campaign with parameters similar to the BMA, including the need for:

• regulation and professional standards and ongoing quality monitoring
• requirement for conscientious objection to be maintained
• to maintain viability limits to remain.

The Faculty of Sexual and Reproductive Health (FSRH) published a statement outlining its support in November 2017.

In May 2018, the RCN published its member response to a consultation of the full membership, see: Decriminalisation of Termination of Pregnancy. RCN Membership Response. 

In December 2018, the RCN published their position statement on decriminalisation. See: Decriminalisation of Termination of Pregnancy Position statement.

Advanced Nursing Skills

There is also a consideration and ongoing discussion about the need to extend nursing skills in care (this is partly driven by the lack of medical staff available to perform Termination of Pregnancy and related to a recognition that this is an area for advanced nursing care to expand). A recent publication by Sheldon & Fletcher outlines the advantages of this move, and the NNP meeting agreed that RCN would support advanced practice if the individual was adequately skilled, however this needs further work. It would also require a change to current legislation. The RCN is currently in discussions with FSRH about advancing nursing skills to support quality care.

In 2022, the RCOG has an Abortion Care eResource, where there are eight eTutorials available to help health workers, healthcare students and clinical educators gain practical and applicable knowledge about safe abortion care across global contexts.

Nursing Education and Development

In 2020, RCN is committed to supporting best practice, and with a view to considering how we can best support nursing practice and leadership in TOP service provision. We have now published the results of a survey to consider the educational standards of nurses, midwives and healthcare assistants working across direct and indirect services where woman are cared for. Our report RCN Nursing Education in Termination of Pregnancy Services identifies the current range of education qualifications and the considers a career pathway and further educational needs in the service.