Quality statement 2: Choice of abortion procedure

Quality standard

Quality statement
Rationale
Quality measures
What the quality statement means for different audiences
Source guidance
Equality and diversity considerations

Quality statement 2: Choice of abortion procedure

Quality statement

Women who request an abortion are given a choice between medical and surgical abortion to take place up to and including 23⁺⁶ weeks' gestation.

Rationale

If clinically appropriate, medical and surgical abortion procedures are both safe and effective up to and including 23⁺⁶ weeks' gestation. A woman's experience is better if she can choose the abortion procedure to suit her individual circumstances. To support a woman's choice, it is important that women can access services as locally as possible and avoid lengthy travel times. If a provider does not offer the preferred method, the woman should be able to easily access the procedure from an alternative provider.

Quality measures

The following measures can be used to assess the quality of care or service provision specified in the statement. They are examples of how the statement can be measured, and can be adapted and used flexibly.

Structure

a) Evidence of local processes to support a discussion about the differences between medical and surgical abortion, including the benefits and risks, with women who request an abortion.

Data source: Local data collection, for example service protocol. The NICE patient decision aid on abortion care can help women discuss their options with healthcare professionals.

b) Evidence of referral pathways to alternative services that are as local as possible if a provider cannot provide an abortion by the woman's preferred method.

Data source: Local data collection, for example referral strategies and shared care pathways, including pathways for women with complex needs.

Process

a) Proportion of women who had an abortion up to and including 23⁺⁶ weeks' gestation with a record of their choice of medical or surgical abortion.

Numerator – the number in the denominator with a record of their choice of medical or surgical abortion.

Denominator – the number of women who had an abortion up to and including 23⁺⁶ weeks' gestation.

Data source: Local data collection, for example local audit of patient records.

b) Proportion of women who had an abortion up to and including 23⁺⁶ weeks' gestation who had a medical abortion.

Numerator – the number in the denominator who had a medical abortion.

Denominator – the number of women who had an abortion up to and including 23⁺⁶ weeks' gestation.

Data source: The Department of Health and Social Care's abortion statistics includes data on method of abortion. It is not expected that achievement will be 100%. Healthcare commissioners may wish to focus on variation in method for different gestational ages for their population compared with the national average.

c) Proportion of women who had an abortion up to and including 23⁺⁶ weeks' gestation who had a surgical abortion.

Numerator – the number in the denominator who had a surgical abortion.

Denominator – the number of women who had an abortion up to and including 23⁺⁶ weeks' gestation.

Outcome

Proportion of women who had an abortion who were satisfied with their abortion care.

Numerator – the number in the denominator who were satisfied with their abortion care.

Denominator – the number of women who had an abortion.

Data source: Local data collection, for example survey of women who had an abortion.

What the quality statement means for different audiences

Service providers (such as NHS hospital trusts and independent abortion providers) ensure that processes are in place so that staff give women a choice between medical and surgical abortion to take place up to and including 23⁺⁶ weeks' gestation, if clinically appropriate. Providers ensure that referral pathways are in place so that women can be promptly referred to an alternative provider that is as local as possible if the service cannot provide their preferred method.

Healthcare professionals (such as doctors, nurses and midwives) give women who request an abortion a choice between medical and surgical abortion to take place up to and including 23⁺⁶ weeks' gestation, if clinically appropriate. If any of the methods would not be clinically appropriate, healthcare professionals explain the reason why. Healthcare professionals are aware of local referral pathways for abortion care and ensure that women are promptly referred to an alternative provider if the service cannot provide their preferred method.

Commissioners (clinical commissioning groups and NHS England) ensure that they commission the range of abortion services needed, with the capacity across services so that women can choose between medical and surgical abortion to take place up to and including 23⁺⁶ weeks' gestation. Commissioners support collaboration between providers and ensure that shared care pathways are in place for women to be promptly referred to an alternative provider that is as local as possible, if the service cannot provide their preferred method.

Women who ask for an abortion to take place before 24 weeks can choose between taking medicines and having an operation to end their pregnancy. If the service cannot provide their chosen method, they are referred to a service that can. This should be in an area that is as close to them as possible.

Source guidance

Abortion care. NICE guideline NG140 (2019), recommendation 1.6.1

Equality and diversity considerations

Women should be provided with information that they can easily read and understand themselves, or with support. Information should be in a format that suits their needs and preferences, for example video or written information. It should be accessible to women who do not speak or read English, and it should be culturally and age appropriate. Women should have access to an interpreter or advocate if needed. For women with additional needs related to a disability, impairment or sensory loss, information should be provided as set out in NHS England's Accessible Information Standard.