Abortion: The right to choose an abortion - in your lunch break

Thirty years since it was legalised in Britain, the debate still rages about abortion, and to have one or not can still be one of the most difficult decisions a woman can face. But if she decides to go ahead, there is another important choice. Which type of abortion - under general or local anaesthetic, or by taking the "morning after" pill? By Nicole Veash

When Marie Stopes launched a "lunch-time abortion" service in June this year, it was hailed by some as a medical - and even shocking - breakthrough. It is certainly popular: since June, 2,000 women have paid for this quickie procedure in one of seven specialist day-care centres around the country.

But Carolyn Roberts, operations manager at the British Pregnancy Advisory Service, says that although last year more than 160,000 women had abortions in this country, few realised they could choose how to end their pregnancy. Local anaesthetic abortions have in fact been available since the 1970s.

"GPs who refer patients to NHS trusts often have their hands tied because the local gynaecologist only offers one treatment," she explained. But women who go to non-profit making specialist services, like BPAS, are told about the different treatments available.

"We think it is important women receive this information so they can make an informed choice, but it is a fair assumption that those who go to the NHS for termination do not always get the opportunity to make that decision."

David Nolan, from the Birth Control Trust, agrees, saying most health authorities have contracts with NHS providers who offer only one method.

"In the end, women who want an abortion should be able to decide how it is done," he argues. "There are basically two different methods but vacuum aspiration is probably the most commonly used because it is over so quickly, within about five minutes. The choice here is between general and local anaesthetic. Some people don't like general because you are unconscious and it can make you feel woozy, causing a loss of control for a time. Under local, a woman can leave the centre within an hour or so, but the down side is that she remains conscious throughout the operation, and there can sometimes be a crampy pain which is quite uncomfortable."

About 10 per cent of women choose medical abortion, or RU486 as it is known, even though it has been available since 1991.

"There is a lot of ignorance about medical abortions among doctors because it has been marketed very half-heartedly," says Nolan. "The problem is the time factor. A woman needs to go to hospital three times, once for around six hours. But its great advantage is that there is no surgery at all and studies show that given the choice at least half of all women wanting an abortion would choose this method."

In their busy family planning clinic in Derby, Jackie Abrahams and Jeanette Leadbury witness this lack of choice at grass roots level.

"When we see a woman the question of which treatment method she wants is never raised," says Leadbury. "Basically, patients in South Derbyshire have the vacuum aspiration method under general anaesthetic or nothing at all. We do have a few leaflets on the RU486 method but the health authority hasn't taken the drug on so it's not available anyway." Both doctors believe treatment should be tailored to suit individual needs.

"I do think women should have choice. There are those who want to avoid the risks associated with general anaesthetic and those who want to be unconscious in the operating theatre," says Abrahams. "Unfortunately, this choice is not available in Derby at the moment, but it is something I would like to explore further. In the end, it is up to the gynaecologists and managers at the trust."

David Paintin, a retired gynaecologist and BPAS board member, says South Derbyshire is not the only place where women who want abortions have no choice about their treatment.

"In the early Seventies, almost all of my NHS abortion work was carried out under local anaesthesia. Unfortunately, a minority of women, usually teenagers, had bad experiences so we started offering a choice. The problem is that local anaesthesia takes longer and is more demanding on staff who have to give the woman emotional support. We could do around four procedures an hour compared to six under general."

"Providing a choice of both procedures can be expensive because you are paying an anaesthetist to be on hand, using him for only part of the time. In the end we moved to general anaesthesia as our standard procedure."

Most abortion providers are waiting to see how Marie Stopes' local anaesthesia day-care centres fare in the private market place.

"It is difficult to offer women choice within an NHS caseload," says Paintin, "but at some stage in the future we might see the NHS open specialist day-care facilities alongside traditional in-patient abortion methods. In an ideal world there should be choice, but many NHS gynaecologists are not trained in all procedures. And, if the truth is known, there are some consultants who are not happy doing the procedure at all."