Calls to overhaul ‘fragile’ UK abortion services as women face ‘untenable’ waits and huge distances

Exclusive: Amelia Louli had to travel over 100 miles for an abortion or face a three-week wait

Demonstrators gather outside the United States embassy in Vauxhall, south London to protest against the decision to end constitutional protections for abortion in the US (PA Wire)

Women seeking abortions are having to travel hundreds of miles to access care as “untenable” waiting times put unsustainable pressure on services.

Those seeking surgical and late-stage abortions in the UK are being forced to cross the country for care because of availability gaps in their area, while “messy” NHS systems are forcing private providers to turn women away, The Independent has been told.

The already “fragile” situation was made worse during the pandemic, leading medics, experts and charities to call for an overhaul of the system and for NHS trusts to take up services.

MP Stella Creasy, who has called for the decriminalisation of abortion in the UK, told The Independent she was “terrified” for women making journeys to have an abortion.

The politician, who is an outspoken campaigner for abortion rights, said the problem lies in the fact abortion is still criminalised in the UK. It is only allowed if approved by two doctors, who must agree having the baby would pose a greater risk to the physical or mental health of the woman than a termination.

“At the moment, abortion starts from a criminal perspective and so provision is made that much more complicated,” she said. “This is a healthcare and a human rights matter.”

One woman told The Independent she was forced to travel over 100 miles from Penrith to Liverpool for her abortion and had to stay in hospital far away from home when the procedure went wrong.

Medics said the hole in surgical services was driven by a “vicious cycle” of a lack of training for doctors to perform the procedures and warned future services could be at risk if there is no one to take them over.

‘The final straw’

Leading providers have also said NHS contracting rules mean women who need a medical abortion face restrictions on who they can choose to have an abortion with.

Data gathered by leading abortion provider MSI Reproductive Choices UK, seen by The Independent, revealed women in 15 areas across England can only use the abortion provider which has the contract in their local area.

Jonathan Lord, medical director of MSI Reproductive Choices UK, said this meant access to services was a “postcode lottery” and ongoing difficulties to access terminations had been further compounded by the pandemic.

Mr Lord, who is also co-chair of the British Society of Abortion Providers, said: “There has been pressure on waiting times because of the pandemic,” he said.

“People don’t want to wait, so they have to travel long distances. People are so desperate to get treatment they will travel long distances rather than waiting. Covid was the final straw.”

He said the commissioning of abortion services “is very much a mess”, adding there was a culture of “cost-cutting” rather than a focus on quality and sustainability of care.

Katherine O’Brien, of the British Pregnancy Advisory Service (BPAS), said that women should have the right to go to another provider if there were long waiting times, but noted they were routinely blocked from doing so.

Ms O’Brien said it was “devastating” being forced to turn women away when they knew they could treat them.

She revealed one provider had to turn down NHS contracts for abortion services because the costs were too low to provide quality services.

Lack of NHS-run services

About 75 per cent of NHS abortion services are carried out by independent providers.

Professor Kaye Wellings said that while access to medical abortions has vastly improved since a rule change that now allows women to take two pills at home, the picture is very different for surgical and late-stage abortions, with only five NHS trust-run services offering them.

In 2021, NHS England published a contract for late-stage and complex abortions, in which it admitted that the use of private services meant there had been a “reduction in provision and expertise in the NHS sector over time”.

Dr Tracey Masters, a consultant in sexual and reproductive health in London and spokesperson for the Royal College of Obstetricians and Gynaecologists, said patients at her local service were regularly travelling from Manchester, Scotland and Wales to get an abortion.

She said the banning of most abortions in the US following the Roe vs Wade ruling should be a “wake-up call” to recognise that while some UK abortion services were good, others weren’t working well.

She added: “You know, think about how terrible it is for women in America to have to travel hundreds of miles but here we have, you know, very similar things happening for women in Scotland.

“In my mind, that feels pretty inadequate, really, that someone should have to travel that sort of distance to get some care.”

Dr Masters explained that not enough NHS hospitals can provide surgical abortions, partly because of a lack of medical training.

Professor Lesley Regen, chair of the RCOG abortion taskforce, said the situation got worse during the pandemic when there was an increase in late abortions as many women were being told “no you can’t have anything” by local services.

She said: “It’s very important for this country not to become complacent about it [access to abortion services]. Things can move quite quickly, as you can see in the States, when the anti-choice lobby are involved, and I think that’s quite important that we understand that women should have reproductive choices, in my opinion.”

Talking about the lack of trained doctors, she warning there would be few replacements when her generation retires.

A ‘daunting’ journey

In several reports from 2021 and 2022, the Care Quality Commission raised concerns over independent abortion provider BPAS, which included long waiting times, women having to travel long distances and a lack of staff in some clinics.

Amelia Louli, who is based in Penrith, said she was forced to make the 100-mile journey to Liverpool in 2020 for a surgical abortion.

The mother-of-three, who is a single parent, decided to get her abortion through BPAS, as she was told she would have to wait for three or four weeks for an initial appointment if she went through a hospital.

Ms Louli, 36, added: “I was just so sick. For all of my pregnancies, I suffered from really extreme sickness.

“I’m a working single parent with three kids so every day that I was sick, it was debilitating and too difficult to cope with, so I chose to travel.”

Ms Louli, who is doing a PhD about abortions, said she had to get a friend to look after her children while she was away – adding that her appointment was at 10.30am in the morning but she did not make it into the theatre for the procedure until 4.30pm as it was so busy.

It was “daunting” knowing she was “a long way from home” in case anything went wrong, she added.

“It was tiring,” Ms Louli said. “It was expensive. I didn’t get reimbursed for costs and the hard thing is I did have complications a couple of weeks after and I ended up in hospital for five days in Carlisle.”

A Department of Health and Social Care spokesperson said: “Ensuring women can access abortion services in a safe, secure way is essential.

“We continue to work on plans to improve sexual and reproductive health services, including access to long acting reversible contraception, and will publish a sexual and reproductive health action plan later this year.”