Clinician-led transformation of sexual and reproductive healthcare in NI post-decriminalisation of abortion

ABSTRACT

Objective This paper outlines how, in the absence of commissioning or support from the NI Department of Health (DoH), NHS early medical abortion (EMA) services were rapidly implemented in response to COVID-19 travel restrictions. It demonstrates how clinician-led collaborative working can transform sexual and reproductive healthcare (SRH) despite considerable political resistance. Design Post-decriminalisation in October 2019, clinicians seeking to influence policy established the NI Abortion and Contraception Task group (NIACT), a multidisciplinary, multisector group with representation from clinicians, academics, service users and the charity sector. COVID-19 travel restrictions meant that women were unable to access treatment in England and local services were urgently required. NIACT established a regional central access point through Informing Choices NI (ICNI), facilitating self-referral and counselling. Non-funded EMA services were simultaneously implemented within existing Sexual and Reproductive Health services across all five Trusts. NIACT subsequently developed a strategy report, making evidence-based recommendations on better sex education, accessible contraception and the delivery of safe compassionate abortion care within high-quality SRH services. Method Since April 2020, data has been collected concurrently on the number of women self-referring to ICNI, accessibility to Trust services, waiting times, patient outcomes, contraceptive uptake and service user feedback. This data was used to provide an evidence-base for the NIACT strategy to inform the development of high-quality SRH in NI post-decriminalisation. Results EMA is currently available in all five Trusts but is not yet commissioned and relies heavily on the good will of dedicated clinicians. Demand remains high with over 40 women per week self-referring to ICNI. Waiting times are short, uptake of long-acting reversible contraception is high and service user feedback is excellent. Mifepristone is not permitted for home use in NI, which necessitates a clinic visit. Due to the temporary cessation of two Trust services, the absence of surgical services or treatment beyond 10 weeks gestation, many women still needed to travel to England during the pandemic. Conclusions NIACT have demonstrated how an integrated model of sexual and reproductive healthcare can work well within the NHS in NI. However, to ensure the sustainability of new services and develop a comprehensive abortion service, DoH commitment and commissioning are required. The NI Human Rights Commission have commenced a judicial review;it is anticipated that this will be successful in initiating the commissioning process. It is envisioned that NIACT's strategy will be utilised to inform the development of world-class sexual and reproductive healthcare in NI.