The British 1967 Abortion Act-still fit for purpose?

The Influence of Abortion Law on the Frequency of Pregnancy Terminations-A Retrospective Comparative Study

Abortion law is one of the main factors influencing the number of abortions performed in a country. The study aimed to assess the influence of abortion law on the number of performed terminations with particular attention paid to pregnancy terminations due to fetal defects. The retrospective comparative analysis of statistical data included on the governmental websites of Poland and the UK was performed. The average of 190,733.1 terminations were performed in the United Kingdom in the years 2009–2018 with the average of 2820.9 due to fetal defects. At the same time the average of 858.6 terminations were performed in Poland with 820.7 due to fetal defects. Population size is the only significant predictor of the number of terminations in the United Kingdom. The increase in the number of deliveries and population in Poland was not linked to the increase in the overall number of terminations or terminations due to fetal defects. It might be due to the unavailability of pregnancy terminations in many places. The radicalization of abortion law exerts no influence on the decrease in the number of terminations due to fetal indications. The liberalization of abortion law promotes the increase in the number of terminations due to social indications.

Effectiveness, safety and acceptability of no-test medical abortion (termination of pregnancy) provided via telemedicine: a national cohort study

OBJECTIVE

To compare outcomes before and after implementation of medical abortion (termination of pregnancy) without ultrasound via telemedicine.

DESIGN

Cohort analysis.

SETTING

The three main abortion providers.

POPULATION OR SAMPLE

Medical abortions at home at ≤69 days' gestation in two cohorts: traditional model (in-person with ultrasound, n = 22 158) from January to March 2020 versus telemedicine-hybrid model (either in person or via telemedicine without ultrasound, n = 29 984, of whom 18 435 had no-test telemedicine) between April and June 2020. Sample (n = 52 142) comprises 85% of all medical abortions provided nationally.

METHODS

Data from electronic records and incident databases were used to compare outcomes between cohorts, adjusted for baseline differences.

MAIN OUTCOME MEASURES

Treatment success, serious adverse events, waiting times, gestation at treatment, acceptability.

RESULTS

Mean waiting time from referral to treatment was 4.2 days shorter in the telemedicine-hybrid model and more abortions were provided at ≤6 weeks' gestation (40% versus 25%, P < 0.001). Treatment success (98.8% versus 98.2%, P > 0.999), serious adverse events (0.02% versus 0.04%, P = 0.557) and incidence of ectopic pregnancy (0.2% versus 0.2%, P = 0.796) were not different between models. In the telemedicine-hybrid model, 0.04% were estimated to be over 10 weeks' gestation at the time of the abortion; all were completed safely at home. Within the telemedicine-hybrid model, effectiveness was higher with telemedicine than in-person care (99.2% versus 98.1%, P < 0.001). Acceptability of telemedicine was high (96% satisfied) and 80% reported a future preference for telemedicine.

CONCLUSIONS

A telemedicine-hybrid model for medical abortion that includes no-test telemedicine and treatment without an ultrasound is effective, safe, acceptable and improves access to care.

TWEETABLE ABSTRACT

Compelling evidence from 52 142 women shows no-test telemedicine abortion is safe, effective and improves care.