Pregnancy Advisory Service Research Articles

The moral and philosophical importance of abortion

Access to safe abortion has been labelled as a fundamental human right by the International Women's Health Coalition, who stated that: Despite this, abortion is illegal or difficult to access...

Outcomes with same-day cervical preparation with Dilapan-S osmotic dilators and vaginal misoprostol before dilatation and evacuation at 18 to 21+6 weeks’ gestation

BackgroundCervical preparation has been shown to reduce complications with dilatation and evacuation (D&E), but the optimal regimen is unknown. While most published reports are from North America and describe overnight cervical preparation, recent research suggests the safety of same-day cervical preparation up to a gestational age of 18 weeks. We investigated the safety and efficacy of a same-day preparation protocol using a combination of Dilapan-S and misoprostol for gestations of 18–22 weeks. Study DesignThis retrospective chart review evaluated 281 consecutive women who had a D&E from 18+0 to 21+6 weeks’ gestation at the British Pregnancy Advisory Service clinic in Richmond, London, between January and December 2010. Misoprostol and Dilapan-S osmotic dilators were used in combination for approximately 3 h prior to evacuation. Women who had induced fetal demise were excluded. We evaluated procedure success, duration and the frequency of adverse events. ResultsA total of 274 cases were included in this analysis. In 97% of cases, 400 mcg vaginal misoprostol was used, and in 85% of cases, three Dilapan dilators were inserted. Mean cervical preparation time was 3 h and 40 min (SD 41.2 min), and mean procedure time was 10 min (SD 4.2). There were two immediate complications: one cervical laceration [0.36%, 95% confidence interval (CI) 0.01–2.01] and one extramural delivery in the clinic after cervical preparation agents were placed (0.36%, 95% CI 0.01–2.01). There were no cases of uterine perforation, hemorrhage or inability to complete the procedure. ConclusionThis study suggests that same-day cervical preparation with Dilapan-S and misoprostol is safe and feasible for second-trimester surgical abortion up to 22 weeks’ gestation.

Abortion care programme for students launches in summer

The British Pregnancy Advisory Service (BPAS) is launching a programme to raise awareness of abortion care and women’s reproductive health among medical students and trainee doctors. The initiative has been introduced by BPAS in response to what Patricia Lohr, BPAS’s medical director, identifies as the “large numbers of students and trainees going through [medical school and training] without being exposed to abortion care services.” Students and trainees participating in BPAS’s Reproductive Health Externships will have the opportunity to spend two weeks observing the work in their London based Streatham and Richmond clinics. The externship is meant to provide an insight into every stage of patient care from discussing pregnancy options, to medical assessment and ultrasound, consenting for treatment, and abortion procedures. Lohr argues that undergraduate medical …

O3-S6.02 Screening for Mycoplasma genitalium, Chlamydia trachomatis and Bacterial vaginosis in a public hospital, pregnancy termination service

Garland SM1, Marceglia AH2, Tabrizi SN1Costa AM1 1 Microbiology Infectious Diseases, 2 Choices and Sexual Health Service, Royal Women's Hospital, Parkville, Victoria, Australia The Royal Women's Hospital is the largest...

Abortion is a difficult solution to a problem: A discursive analysis of interviews with women considering or undergoing abortion in Australia

There is little research on women's experience of abortion, despite its prevalence and considerable public debate. Women have abortions in a discursive environment that can pit the foetus against the woman and identifies motherhood as a woman's destiny. What does it mean to have an abortion in these circumstances? The research reported in this paper investigated abortion from the woman's perspective. Interviews were conducted with 60 women who had contacted a public pregnancy advisory service in Victoria, Australia. Discourse analysis revealed the women's primary discourse around “contemplating or having an abortion” to be “Abortion is a difficult solution to a problem”. This discourse encompassed being a responsible woman who took other's needs into account, including the potential child's. Most women found having an abortion difficult for reasons concerning the foetus, herself, and others. Women's accounts exemplified the complex personal and social contexts within which reproductive events, such as those in which the potential for abortion may play a part, must be understood.

Reasons women give for contemplating or undergoing abortion: A qualitative investigation in Victoria, Australia

Objective To increase understanding of women’s perspectives on considering or undergoing elective abortion. Design Qualitative study. Setting A large public women’s hospital in the state of Victoria, Australia. Sample Sixty women who had contacted a public pregnancy advisory service in Victoria, Australia, seeking information, advice, or appointments in relation to an unplanned or unwanted pregnancy. Methods Qualitative telephone interviews. The iterative qualitative analysis employed the five stages of a thematic framework approach. Main outcome measures Themes in women’s accounts of considering or undergoing elective abortion. Results Women’s accounts emphasized their reasons for considering or seeking abortion. Decisions were made in the context of their lives as a whole; influences were usually contingent and multiple. Reasons related to the woman herself, the potential child, existing children, her partner and other significant relationships, and financial matters. Conclusions This research used qualitative methods to produce the only recent study of its kind in Australia. Women’s accounts reveal the complex personal and social contexts within which reproductive events must be comprehended and the thoughtfulness with which they make decisions. Results of this research will assist health-care professionals to increase their insights into women’s reproductive experiences.

Women with Cognitive Impairment and Unplanned or Unwanted Pregnancy: A 2-Year Audit of Women Contacting the Pregnancy Advisory Service

Little is known about the experience of women with cognitive impairments (intellectual disability and acquired brain injury) in relation to unplanned or unwanted pregnancies. Records of the Pregnancy Advisory Service (PAS) at the Royal Women's Hospital across a 2-year period were examined. Details of 20 women with cognitive impairments, who had contacted PAS for support with an unplanned or unwanted pregnancy, were found. Many of these women had faced significant barriers to reproductive choices. The majority of the women had needed someone to facilitate their first contact with PAS; one quarter had contacted PAS too late for the option of the abortion they were seeking; one quarter were in significant conflict with their support people over the pregnancy; almost half of the women contacted PAS significantly late in their pregnancy; and one quarter (more than half of those who already had children) were currently involved with child protection services. The audit suggests that women with cognitive impairments need more accessible information on sexual and reproductive health, and assistance to access pregnancy information and services. It is important that social workers and other professionals who work with women with cognitive impairments be aware of their greater vulnerability and often complex social situations, and adopt a proactive as well as supportive approach when working with these women.

Considering abortion: a 12‐month audit of records of women contacting a Pregnancy Advisory Service

To characterise the demographic and psychosocial circumstances of women contacting Victoria's largest public pregnancy advisory service (PAS). Audit of PAS electronic records for the 12 months from 1 October 2006 to 30 September 2007. De-identified data were extracted from a comprehensive electronic database used for recording consultations. Summary statistics and measures of association. During the 12 months, 5462 women contacted PAS; records were created for 3827 women, and data were available in more than 80% of records for 77% (13/17) of items. Over half of the women receiving pregnancy support from PAS (60%) were 18-29 years old; 12% lived outside the metropolitan area; 51% held a health care card, and smaller percentages faced housing, financial, or drug and alcohol problems; 16% reported violence, but 71% described partners as involved and supportive. Most (79%) made contact within 2 weeks of discovering pregnancy, and 72% were referred by a general practitioner. Later gestation at contact was associated with younger age (P < 0.001), having a health care card (P < 0.001), and living outside the metropolitan area (P < 0.001). The most common reasons for seeking abortion were the desire to delay pregnancy (23%) and family completion (18%); 42% already had at least one child. Twenty-three women reported that the pregnancy was the result of rape. Ten per cent had mental health problems, and smaller numbers faced access barriers and had special needs. This PAS responds to demand from women with diverse social and personal circumstances. Findings provide evidence for policy, prevention and service development.

Giving more support to teenagers

The British Pregnancy Advisory Service (BPAS) is to give out emergency contraception freely over the Christmas period (Guardian, 2008a). The initiative is aimed at teenagers and women who can't afford to pay for it—in these credit crunching times an unplanned £26 is a lot to shell out. The BPAS hasn't forgotten the risk of sexually transmitted infections and is including condoms with its pack. The idea is to have a safety net in the bathroom cabinet (or chest of drawers if you're a teenager) and it's being compared to keeping pills for a headache ‘just in case’. But once the condoms are gone isn't such a measure simply giving permission for casual, unsafe sex?

Latest news and product developments

Latest news and product developments

Webwatch

The wide availability of contraception in Britain can mask the fact that pregnancy for many women is an unanticipated and sometimes unwelcome event. Those who believe, or find, themselves to be unexpectedly pregnant may look to internet sources for further guidance. Two sites that women may use under such circumstances are the Family Planning Association (FPA) and the British Pregnancy Advisory Service (BPAS): www.fpa.org.uk www.bpas.org

Provision of chlamydia testing in a nationwide service offering termination of pregnancy: with data capture to monitor prevalence of infection

Objectives: To establish a methodology by which all women attending for termination of pregnancy (TOP) at British Pregnancy Advisory Service (BPAS) branches may be approached to participate in Chlamydia trachomatis...

Mind the gap: voluntary sector pregnancy advice service

This article describes a voluntary pregnancy advisory service in a deprived inner city area and summarizes some descriptive statistics kept relating to one year (2000). The evidence suggests that this service was acceptable to women in the local area and frequently used by them. Possible reasons why the service may be acceptable are discussed, followed by an attempt to explore how such voluntary sector organizations could work in partnership with the health services, both by supplementing them, and also by providing an interface between the local community and the health services to encourage appropriate and effective use of the statutory services by more marginalized members of the communities which they serve.

The new ethics of abortion

The papers included in this supplement were first given at a meeting, The New Ethics of Abortion, organised by the British Pregnancy Advisory Service (BPAS) in Senate House at the...

Evaluation of near patient testing for Chlamydia trachomatis in a pregnancy termination service

AimTo identify and evaluate advantages and disadvantages of a near patient test (NPT) for Chlamydia trachomatis, using Clearview Chlamydia MF (Unipath Ltd) in a British Pregnancy Advisory Service (BPAS) clinic.MethodThe...

Public hospital pregnancy termination services: are we meeting demand?

ObjectivesTo identify the socio-demographic characteristics of women seeking termination of pregnancy through a public hospital service and explore issues of accessibility to the service. MethodAn audit of the Pregnancy Advisory Service (PAS) at the Royal Women's Hospital in Melbourne from January to March 1996. Data were collected from 1,088 intake forms of women seeking an abortion. ResultsThe women were of low socio-economic status, with 437 (40.2%) living on a government pension or benefit and 55.6% holding a Health Benefits Card. However, only 33.8% were given an appointment for an abortion in the public clinic, with most (63.7%) referred to private services. ConclusionsThe demand for this public hospital abortion service exceeds its capacity and economically disadvantaged women are required to seek abortion in private services. ImplicationsThere is a role for regional health authorities to ensure adequate distribution of public hospital pregnancy termination services.

Small area analysis: abortion statistics.

Small area analysis has developed over the last two or three decades as a useful tool in health services research, as it allows the identification of areas within health or local authority districts with high rates of morbidity and mortality, and thus provides a useful base for planning the delivery of health services. A profile was compiled for Liverpool Family Health Services Authority on planned parenthood in the Liverpool District, with the aim of identifying where resources are needed most - which parts of the City, and which groups of women, are most in need. The profile included an analysis of various outcome measures, including abortion statistics, which can be used as a guide to the apparent effectiveness of services. Using a combination of statistics on NHS abortions for electoral wards, and private abortions by postal district, it became apparent that, on the whole, areas of high NHS induced abortion rates also have high private (British Pregnancy Advisory Service; BPAS) induced abortion rates, and vice versa. The maps for NHS and BPAS abortion rates suggest that total abortion rates are high in City centre wards, and low in areas south of the City. This would suggest that there are differences in social factors, family planning provision, and other factors which are influencing abortion rates. Although available indicators would suggest that City centre wards are in greatest need of improved family planning provision, these are the wards which are relatively well provided with health authority family planning clinics.(ABSTRACT TRUNCATED AT 250 WORDS)

PROBLEM PREGNANCY, PERSONAL PRIVACY AND PERSONNEL POLICY

Frequency of problem pregnancy and abortion is not always recognised – the British Pregnancy Advisory Service aims to liaise and advise large‐scale employers of women. The nature and scale of this health care problem are outlined; it is a problem for personnel managers who may need to supply counselling and employee support, confidentiality, information and access and benefits, professional agencies and facilities. Managers′ own attitudes may require modification.

Wrong view.

Ms B Nolan attempts to continue her attacks on the British Pregnancy Advisory Service through your columns (Nursing Standard week ending June 24, letters page). However, unlike the readers of many of the newspapers she writes to, your readers have professional knowledge and experience that show them how wrong she is.

Setting the facts straight

Some readers may think that the 'cosy commercial links between doctors and abortion clinics' alleged by 'anti-all abortion' MP, Nicholas Bennett, exists in the British Pregnancy Advisory Service which provides around one third of non-NHS abortion operations for residents of England and Wales. However, this is not true.