Authors' objectives: Significant changes to the nature and context of abortion provision are taking place in the United Kingdom. Empirical evidence is needed to guide efforts to respond to these changes. To provide an evidence base to inform optimal configuration of health services and systems in response to current and future changes in abortion provision in the UK.

Authors' results and conclusions: Patients and health professionals were found to be broadly in favour of relaxation of current laws on abortion in Britain: specifically, to dispense with the requirement for two doctors to sign authorising an abortion; to permit healthcare professionals other than clinicians to prescribe abortion medication and perform vacuum aspiration; and to allow abortion to be provided in additional suitable resourced and equipped facilities, notably community sexual and reproductive health services. Training was considered necessary to equip health professionals for an extended role in abortion provision as were permissions to licence premises other than those currently approved. Patients’ assessment of abortion services in Britain was positive. Suggestions for further improvement included increasing the timeliness of care, resolving disparities between expectations and reality, providing emotional and psychological support, and offering choice to patients. Evidence from other countries cautioned against assumptions of direct transferability of models of care. Considerations of competence, capacity and resources are important to policy and practice decisions. The needs of abortion patients are well met by abortion services in Britain. Options in terms of how abortion is carried out, by whom and where, need to be made available to take account of different circumstances.

Authors' recommendations: Evidence from the study supports recommendations relating to abortion regulation and provision: The regulation of abortion: further consideration should be given to how abortion services are best regulated. The current regulatory framework for abortion serves to limit potential evidence-based service innovations that would be likely to benefit service users. It is poorly understood by service users and many service providers and commands little support among either group. Authorisation of abortion: patients should not need to give justification of their reasons for wanting an abortion and health professionals other than doctors should be permitted to consent abortions for patients they care for. Approval of premises: abortion provision could beneficially be integrated into – given levels of support revealed in the study – adequately resourced community SRH services to improve access to clinical settings in areas underserved by the independent sector and facilitate an integrated approach to SRH care. Extension of roles: appropriately trained nurses and midwives should be allowed to prescribe abortion medication and perform vacuum aspiration for abortion to ensure sufficient cadres of professionals with the skills needed to offer choice and address the current risk of skills being lost. Professional training: undergraduate training and professional education to equip new cadres of HCPs to contribute to abortion care and support. Training is needed to ensure a full range of services available, for example, provision of surgical abortions and the fitting of contraceptive implants and intrauterine devices post abortion. Patient choice: patients seeking abortion should, where possible, be offered options in terms of procedure and premises: commissioning should ensure availability of options, and health professionals should provide information to facilitate informed choice. Improving patient care: interventions should be developed across the patient journey, to support decision-making, procedure management and after care, including contraception. A strong policy steer: greater visibility of abortion in strategies relating to women’s health and SRH, with corresponding action plans, is needed. Facilitating and resourcing continued research into abortion provision: including patient and professional perspectives on abortion care and support, routine monitoring of trends in abortion procedures and the development of novel interventions to improve abortion care and support.

Authors' methods: Observational study comprising five integrated components: (1) a realist review to generate evidence to guide optimal abortion provision and a scoping review of interventions aimed at preparing non-specialist health professionals to provide abortion care and support; (2) country-based case studies identifying transferable lessons for policy and practice in the UK; (3) a Knowledge, Attitude, Behaviour and Practice survey among healthcare practitioners; (4) qualitative research with women with recent experience of abortion to explore their experiences of care and support; (5) consultations with key stakeholders on the implications for policy, practice and research of findings from the research. Data collection period April 2020–January 2023. Primary setting: Britain. Data-gathering sites: Canada, Sweden, Australia. Forty-eight recent abortion patients recruited via independent providers and National Health Service hospitals in England, Wales and Scotland; 771 health professionals (doctors, nurses, midwives; pharmacists); 31 stakeholders with expertise in abortion in Canada, Sweden and Australia; 15 key stakeholders with expertise in abortion research, policy and practice in Britain. Abortion-related knowledge, attitude and practice among health professionals, including inclination to provide abortion, and competence and capacity to do so. Selected trends in abortion rates and their correlates, and the views of health professionals with expertise in abortion, in Sweden, Canada and Australia. Accounts of experience and preferences among women with recent experience of abortion. The study may suffer the inherent weaknesses of observational studies in terms of the potential for bias. It was carried out during the exceptional period of the COVID-19 pandemic with implications for the ease with which it could be conducted and for the generalisability of the findings. In the component exploring patients’ perspectives, we did not capture patients who disclosed experiencing an abusive relationship, and the number of women aged under 20 was small. Our inability to capture the views of patients in Northern Ireland, despite strenuous efforts to do so, was a source of regret. Multicomponent, mixed-method observational study, comprised five work packages (WPs): WP 1: reviews of the literature Research question: what does the literature tell us about how best to provide abortion? Design and method: realist review to generate evidence to guide the choice of effective approaches to abortion provision; scoping review of interventions aimed at preparing health professionals for a role in abortion care and support. Conducted in April 2020–December 2022. WP 2: evidence from other countries Research question: what has been the experience of countries that have fully or partially decriminalised abortion, and what are the transferable lessons for policy and practice in Britain? Design and method: case studies in three countries (Canada, Australia, Sweden) comprising (1) documentary searches of country-specific evidence on the process and impact of decriminalisation; (2) time series analysis of routine abortion data; (3) in-depth interviews with 31 key stakeholders in abortion policy and practice. Conducted in June 2020–September 2021. WP 3: the views of health professionals in Britain Research question: what are the views of health professionals on the regulation and provision of abortion in Britain? Design and method: stratified cluster sampling survey of services; 771 health professionals in England, Scotland and Wales. Fully scheduled questionnaire with optional free-text box exploring receptivity to and preparedness for changes in abortion provision. Conducted in November 2021–July 2022. WP 4: the views of abortion patients in Britain Research question: what are patients’ experiences of and preferences for models of abortion care? Design and method: semistructured, in-depth interviews with 48 patients aged 16–43 with recent experience of abortion recruited via independent and NHS sites in England, Scotland and Wales. Conducted in July 2021–August 2022. WP 5: the views of key stakeholders in Britain Research question: which approaches to abortion provision might be most appropriate and feasible in Britain? Design and method: stakeholder consultations: 15 attendees representing statutory, academic and the third sector at 2 full-day residential round table discussion groups focusing on key themes identified in the findings and implications for policy and practice. Conducted in January 2023.

Project Status: Completed

URL for project: https://www.journalslibrary.nihr.ac.uk/programmes/hsdr/NIHR129529

Year Published: 2026

URL for published report: https://www.journalslibrary.nihr.ac.uk/hsdr/ASGW2227

URL for additional information: English

English language abstract: An English language summary is available

Publication Type: Full HTA

Country: England, United Kingdom

DOI: 10.3310/ASGW2227

Organisation Name: NIHR Health Services and Delivery Research programme

Contact Address: NIHR Journals Library, National Institute for Health and Care Research, Evaluation, Trials and Studies Coordinating Centre, Alpha House, University of Southampton Science Park, Southampton SO16 7NS, UK

Contact Name: journals.library@nihr.ac.uk

Contact Email: journals.library@nihr.ac.uk