Rebecca Meiksin

Young people in England experience higher rates of sexually transmitted infections (STI) than other age-groups (Migchelsen et al. 2024), and despite a 20-year decline, England and Wales still have ...

Aim: To explore the views of healthcare practitioners in Britain regarding the role of midwives and nurses in the delivery of medical and surgical abortion. Design: An observational study of the Shaping Abortion for Change study healthcare practitioner survey (2021–2022). Methods: Relationships between healthcare practitioner type, participant characteristics, knowledge of and attitudes towards abortion, and views about nurses' and midwives' role in abortion care were examined using Pearson's Chi‐squared tests of association and multivariable logistic regression. Results: Amongst 763 participants including doctors, nurses, midwives and pharmacists, 71.6% supported specialist nurses in sexual and reproductive health and abortion clinics and hospitals, expanding their roles to include prescribing abortion medications and surgical abortion methods. Support was lower for midwives (35.8%) and primary care nurses (32.5%). There was considerable support for all nursing and midwifery groups to be involved in adjacent tasks of abortion care. Differences in support by healthcare practitioner type persisted after adjustment for exposure variables. Conclusion: There is strong support for specialist nurses to expand their role in abortion care. This change could be implemented following clarification of the legal position. Some healthcare practitioner groups are more reluctant to support broader involvement of nurses and midwives in abortion provision. Implications for the Profession and/or Patient Care: Expanding specialist nurses' role in abortion care could increase service capacity and improve patient access and experience. Understanding and addressing the concerns of healthcare practitioners opposing this change is critical for successful implementation and patient safety. Impact: This study addresses the potential for nurse and midwife role expansion in abortion care. The findings highlight broad support for specialist nurses whilst identifying barriers to wider role expansion. The research informs policy discussions on workforce optimisation and access to abortion services across Britain. Reporting Method: This study adheres to the STROBE guidelines for reporting observational studies. Patient or Public Involvement: In the SACHA study, patient and public involvement was included at all stages to inform study design, recruitment, data collection and analysis.

There is little research on sexual harassment among younger adolescents or on how rates vary by gender and other student/school characteristics. Drawing on data from 50 English schools, we explored the prevalence and patterning of victimization in the past year among students aged 12–13. Of 7,060 participants, almost a tenth had experienced sexual harassment. Girls, non-binary students, and sexual-minority students reported the highest rates. Student commitment to school was associated with reduced victimization, particularly among straight students and in higher-attaining schools. Sexual harassment is a priority area for intervention, particularly for students facing the highest risk.

Objectives Therapeutic, regulatory and technological changes have contributed to new directions in abortion care. We aimed to gather views of healthcare professionals on current and future regulation and provision of abortion in Britain. Design Cross sectional, stratified cluster sample survey with additional free text comments. Setting Healthcare settings in Britain Participants Healthcare professionals (nurses, doctors, midwives, pharmacists) working in a range of healthcare services, including dedicated abortion services. Measures Knowledge of and attitudes towards the regulation and provision of abortion. Results 771 healthcare professionals from all areas of Britain responded to the survey. Support for abortion being a woman’s choice was high, more than nine in ten saw it as such and a clear majority favoured abortion being treated as a health rather than a legal issue. Only 6.2% saw abortion at any gestational age as contrary to their personal beliefs and a similarly small minority (6.7%) were against abortion after 12 weeks gestation. One in five of all healthcare professionals and a third of those aged under 30 were unaware that the law in Britain requires two doctors to authorise an abortion. Free text comments revealed opposition to the need for this legal requirement. Support for an extended role for nurses in abortion care was high; two thirds (65.3%) agreed that nurses should be able to prescribe abortion medication. Little more than a third of all healthcare professionals (37%) agreed that abortion should be standard practice in their service; the proportion was highest among those in sexual and reproductive health services (58.4%) and lowest among those in general practice (18.7%). Conclusions Health care professionals in Britain are generally supportive of abortion being treated in the same way as other health issues and would be likely to support any moves to decriminalise abortion. Strengths and limitations of the study The study describes the views of a range of healthcare professionals in different specialities and settings on the current and future regulation and provision of abortion. The use of a stratified cluster sampling strategy increases the generalisability of findings. Additional qualitative data from free text comments helps in understanding the survey responses. The main limitation stems from the timing of the study. Scheduling fieldwork at the height of the COVID-19 pandemic and its immediate aftermath may have introduced both participation and reporting bias. Healthcare professionals most actively involved in coping with the pandemic may have declined to participate because of time pressures and/or provided responses influenced by awareness of the current constraints of their workload. What is already known on this topic The 21^st century has seen major changes in the landscape of abortion. Therapeutic and technological advances have led to an increase in the prevalence of medication abortion which can be safely managed by women at home and have provided the innovative telemedical interventions enabling them to do so. The trends have prompted reflection on the appropriate regulation of abortion in Britain, on the role of different cadres of healthcare professionals; and on the appropriate healthcare settings in which abortion can be provided. Little is known about the views of health care professionals on these issues. What this study adds The law on abortion is not widely known. One in five of all health care professionals and one in three aged under 30 are not aware that for abortion to be legal in Britain two doctors must certify that certain grounds have been met. There is near universal support among healthcare professionals for abortion being a woman’s choice and a widely held view that abortion should be treated no differently from any other health condition. Enthusiasm for incorporating abortion into existing practice is high among healthcare professionals employed in sexual and reproductive health services but most of those in general practice see abortion provision as out of scope for their service. An extended role in abortion for nurses commands considerable support among healthcare professionals, including prescribing abortion medication and, whilst the legal requirement to do so remains, to authorise abortions. How this study might affect research, practice or policy Should there be political will in Britain for a legal reform that removes specific criminal prohibitions against abortion, our data suggest that it would encounter strong support amongst healthcare professionals.

Introduction: Use of telemedicine in abortion care is safe and effective. Patient satisfaction with telemedically supported abortion is high, but as use expands in Britain, little is known about patients’ or health professionals’ views on how it is best used. We sought the views of both groups on telemedicine's role in abortion provision and how its use might be optimised. Methods: We administered a structured survey with an additional free-text response option to a range of health professionals from services identified via clustered random sampling. We conducted semi-structured interviews with patients with recent experience of abortion, purposively sampled from abortion services. Participants were recruited from England, Scotland and Wales. We analysed qualitative data using thematic analysis alongside framework analysis. Results: Support for telemedicine was high among participants, which included 771 health professionals from a range of services and 48 patients. Among health professionals, 23% opposed the use of telemedicine in abortion provision. Opposition was highest among those uninvolved, or who did not feel skilled, in remote provision. Reported benefits included patient convenience and comfort. Patient concerns centred on adequate provision of emotional support. Participants made suggestions for augmenting and extending the use of telemedicine to meet some patients’ needs, including combining telemedical consultation with in-person care and providing information and follow-up via digital methods. Conclusions: Acceptability of telemedically supported abortion, which offers logistical and emotional benefits to patients, is high in Britain. Novel ways of providing telemedical support should be explored to enhance remote abortion provision. In-person care should remain an option for patients.