Abortion is a common procedure. In 2018, 200,608 women in England and Wales had an abortion. Almost all of these abortions were funded by the NHS, but 72% were performed by the independent sector.
Most abortions are carried out because the pregnancy was unintended, and the majority of procedures (80% of abortions in England and Wales in 2018) are conducted in the first 10 weeks of pregnancy. Abortion is a safe procedure, and can be carried out medically (taking mifepristone followed by misoprostol) or surgically.
The trend in England and Wales over the past decade has been towards increasing use of medical abortion. In 2018, 71% of all abortions in England and Wales were medical, and this rises to 83% of abortions in the first 10 weeks of pregnancy.
In recent years, there have been changes in how and where abortion services are delivered. This has resulted in variation in the type and choice of procedures available across the NHS, for example, in the offer of local anaesthesia and sedation for a surgical procedure. In addition, the procedure used for medical abortion has been refined and women in the first 10 weeks (up to 9 weeks and 6 days) may now self‑administer misoprostol at home in England and Wales. Furthermore, methods for checking whether a medical abortion has been successful have also been simplified. Some of these developments could significantly reduce costs to the NHS and be more acceptable to women.
Abortion services also provide other important sexual and reproductive health services to women, including contraceptive services. However, there is marked variation across the country, involving different types of providers and, increasingly, organisations outside the NHS. In addition, accessing abortion services may be difficult for women who live in remote areas, who are in the second trimester of pregnancy, or who have complex pre-existing conditions or difficult social circumstances. In particular, abortion care is challenging for women living in Northern Ireland who currently have to travel to other parts of the UK in order to access services.
This guideline will help ensure that abortion procedures are carried out based on the best available evidence, and that a choice of services is easily accessible to all women who request an abortion.