• Barrier methods (e.g. condoms) and FABM may be used but the latter requires appropriate counselling, as fertility signs can be unreliable immediately post-abortion. Service delivery considerations • Healthcare providers must ensure valid consent is obtained and documented. • If a woman’s preferred method is not immediately available, a bridging method should be offered, and timely referral arranged to access her chosen option. • Clear care pathways should be in place for those with complex needs or requiring specialist support. Context and background Over the past decade, the UK has experienced a substantial shift from surgical to medical abortion. In 2011, 47% of abortions in England and Wales were medically induced; by 2021, this figure had risen to 87%. 108 This trend accelerated following the 2018 approval for home use of misoprostol, allowing women to complete early medical abortions (EMA) at home, enhancing privacy and accessibility 109 and continued further with approval for home-use of mifepristone and associated approvals for telemedicine abortion care. 110 These innovations in abortion care made medical abortion easier to access but also coincided with structural barriers to providing surgical abortion and have impacted how contraception is provided and received. 111 In traditional clinic-based abortion care, uptake of contraception was high when methods were provided on-site. A study of 2011 – 2014 data from the British Pregnancy Advisory Service (BPAS) clinics in England and Wales found that 85% of women accepted post-abortion contraceptive counselling, and 51% chose a method at the time of their abortion. Of those, over half selected an implant or intrauterine device, and 91% received their preferred method before discharge. 112 With the shift to telemedicine, access to long-acting methods changed significantly. The lack of routine in-person visits meant that procedures like implant or IUD insertion required a follow- up appointment. In NHS Lothian (Scotland), 35% of patients requested LARC after telemedicine EMA, but only 46% of these received it within six weeks. 113 Follow-up data showed that only 30% of patients who received the POP post-abortion were still using it at 3–6 months, though proactive outreach – such as telephone or text follow-up, and fast track services – may enable some to initiate an effective method. 114
Commissioning and Challenges In England, abortion services are commissioned by ICBs with much of the care delivered by independent providers such as BPAS, National Unplanned Pregnancy Advisory Service (NUPAS), and MSI Reproductive Choices. Contracts typically include contraceptive counselling and provision. However, access to certain methods, such as subcutaneous injectable contraception (DMPA), the vaginal ring or patch, or newer oral contraceptives, may be limited by local commissioning decisions. NHS England’s 2025 abortion commissioning guidance reinforces the expectation that services offer the full range of clinically appropriate contraceptive options, while allowing for local flexibility. 115 In Wales, Local Health Boards are responsible for commissioning abortion services, with majority of care delivered through the NHS. This is primarily via Early Medical Abortion at Home (EMAH), similar to Scotland. Independent providers like BPAS support the provision of abortion services across all regions, though access to surgical abortion remains limited, affecting patient choice. Contraceptive provision is integrated into the abortion pathway and generally mirrors the range offered in England. In Scotland, abortion services are provided directly by NHS health boards, mainly in hospital settings but also through community sexual and reproductive health clinics. Contraception is routinely offered as part of care. However, access to later abortion (post- 20 weeks) is limited, and women often travel to England for care provided by independent clinics, where Scottish health boards also cover the cost of contraception. Abortion services in Northern Ireland are commissioned through NHS Trusts and continue to develop, though provision remains fragile. Where local access is unavailable, travel and accommodation for care in England are funded, with referrals coordinated by BPAS. Contraception is included in commissioning, but access, particularly to LARCs, varies across Trusts. The Northern Ireland Abortion and Contraception Taskgroup (NIACT) has recommended integrating abortion into a wider sexual and reproductive health services, with seamless pathways from community and primary care to hospital-based services, to ensure consistent access to contraception. 116 Despite strong clinical support for post-abortion contraception, several barriers affect its consistent and effective delivery. The expansion of telemedicine and self-managed medical abortion has been a major advance in abortion care, improving access, privacy, and convenience for many women. However, it has also reduced in-person contact, limiting opportunities for contraceptive counselling and immediate provision. To ensure individuals can still access the full range of methods, services must be supported to adapt. This requires flexible commissioning models and close collaboration between providers to meet women’s needs across both in-person and remote care settings.
108 Department of Health and Social Care. Abortion statistics, England and Wales: 2021. London: DHSC; 2022. 109 Lewandowska M, Carter DJ, Gasparrini A, Lohr PA, Wellings K. Impact of approval of home use of misoprostol in England on access to medical abortion: An interrupted time series analysis. Int J Gynaecol Obstet. 2024 Jan;164(1):286-297. 110 McNee R, McCulloch H, Lohr PA, Glasier A. Self-reported contraceptive method use at conception among patients presenting for abortion in England: a cross-sectional analysis comparing 2018 and 2023. BMJ Sex Reprod Health. 2025 Jan 13: bmjsrh-2024-202573. 111 Footman K, Revolution in abortion care? Perspectives of key informants on the importance of abortion method choice in the era of telemedicine. Sex Reprod Health Matters. 2023 Dec;31(1):2149379. 112 Aiken A, Lohr PA, Aiken CE, Forsyth T, Trussell J. Contraceptive method preferences and provision after termination of pregnancy: a population-based analysis of women obtaining care with the British Pregnancy Advisory Service. BJOG. 2017 Apr;124(5):815-824.
113 Dixon A, Reynolds-Wright JJ, Cameron ST. Uptake of long-acting reversible contraception after telemedicine delivered abortion during Covid-19. Eur J Contracept Reprod Health Care. 2022;27(4):284–8. 114 Vianello M, Reynolds-Wright JJ et al. Self contraceptive use and satisfaction among women accessing telemedicine medical abortion at the onset of the COVID-19 pandemic at 3-6 month follow-up. BMJ SRH. 2023 Jan;49(1);21-26; Reynolds-Wright JJ, Cameron ST, A post-abortion contraception text-and-call service to support patients to access effective contraception after telemedicine abortion. BMJ SRH. 2025;51(1);51-53; Boydell N, Buijsen S, Reynolds-Wright JJ et al. Abortion patients’ perspective on enhancing a telemedicine model of post-abortion contraception: a qualitative study. BMJ SRH. 2024; doi:10.1136/bmjsrh-2024-202428. 115 NHS England, Principles for commissioning abortion services. 116 Northern Ireland Abortion and Contraception Taskgroup (NIACT). Improving abortion and contraception services in Northern Ireland: a review and recommendations.
36
Made with FlippingBook Digital Proposal Creator