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Photography Gayatri Malhotra (via Unsplash)

Why is it so hard get an abortion in the UK right now?

Women in the UK are being made to travel long distances and wait several weeks to access abortion care

Katie* was in a public toilet last summer when she found out she was pregnant, despite being on the contraceptive pill. Still a teenager, she knew that getting an abortion was, in her words, “the best decision” for her and her partner. But it wasn’t as easy as she’d hoped.

Three whole weeks passed between her initial visit to the GP and the time she was finally able to register for a termination with the British Pregnancy Advisory Service (BPAS). In that time, her pregnancy progressed past the point where she would have been able to have a medical abortion, which involves taking pills, often in the comfort of your own home. She then had to wait another week and travel 15 miles, during college hours, to the nearest clinic for her initial scan. Things got worse from there.

“I was told that, because of how far along I was, I wouldn’t be able to have a medical abortion,” she tells Dazed. Not only did Katie now have to undergo a surgical abortion, but she also was given the choice between travelling 40 miles away to have the procedure under either local anaesthetic or conscious sedation, or travelling 100 miles to London to be put under general anaesthetic. “I would have chosen general anaesthetic as I feel this would have minimised the trauma I experienced and reduced the pain,” she tells Dazed. “But the distance to travel was much greater. London is about two hours away from me.”

Although abortions are completely safe and differ for everyone, Katie says the experience was “horrible”. For conscious sedation, benzodiazepines are administered to help patients relax, and according to the BPAS website, patients will be awake but drowsy and may have no or limited memory of the procedure once it’s over. But Katie says she remembers everything. “During the surgery, emotionally I just felt numb yet overwhelmed at the same time,” she says. “My anxiety was the highest it has ever been, I was shaking and crying throughout the whole procedure, unable to speak due to fear and shock. The pain was inexplicable and it continued for the rest of the day.”

Katie isn’t alone. Last year, journalist Maya Oppenheim wrote about her abortion experience in the Independent. High demand and a lack of appointments meant she had to wait a month to have the procedure, despite the NHS website saying that no one should have to wait more than two weeks for an abortion. She was told that if she wanted something sooner, she’d have to travel from London to either Doncaster or Liverpool for an appointment. In the end, the earliest procedure she could get was at a clinic in Kent, and she was made to take a five-hour round trip to get the healthcare she needed.

This chimes with Sarah’s experience. She tells Dazed that, due to a lack of appointments at the MSI Reproductive Choices UK clinic in Manchester in December 2021, she was forced to travel 40 miles to Leeds for a medical abortion, two weeks after her initial call. Unfortunately for Sarah, this two-week wait also fell during the Christmas period. “It was really difficult,” she recalls. “Christmas was weird that year. Your brain is going through so much with the hormones and everything.”

The hour-and-a-half drive to Leeds was nerve-wracking, and, due to Covid restrictions, Sarah had to go into the clinic alone. “I remember being pretty scared going into the building,” she says. “It felt pretty unfamiliar as it was in a city I’ve only visited a few times and in an industrial estate quite a walk from the city centre.” Then because the person at the front desk forgot to sign her in, it took Sarah two hours to be seen. Eventually, she had a scan and was given the pills to take home. “I was glad that everything was in my control again,” she says.

“People might have childcare commitments, or what if they have to miss work and can’t get paid, or they’re dismissed if they don’t show up?” – Sarah Salkeld

Women having to travel for abortion healthcare isn’t a new story. Women from Northern Ireland have historically had to travel to England for abortion healthcare, and in many cases still do. Last year it was revealed that 2,057 women living in Scotland had abortions carried out in England or Wales between 2010 and 2020 due to a lack of provision for abortion services after 15 weeks of pregnancy, despite Scottish law allowing abortion up to 24 weeks.

According to Sarah Salkeld, associate clinical director at MSI UK, the issue in England and Wales is the result of independent abortion providers, which provide 77 per cent of abortions in the country, receiving “below tariff” funding from integrated care boards (ICBs). In fact, a spokesperson for the charity told Dazed that, on average, it receives 50 per cent of the national tariff, which is around £500 for a medical abortion between nine and 14 weeks and over £1,000 for a surgical abortion. The problem appears to be widespread: last year iNews revealed that BPAS was receiving, on average, 48 per cent of the tariff for surgical abortions up to 15 weeks and that MSI was “making a loss on every surgical procedure” they do.

The funding crisis is being compounded by rising demand, which Salkeld puts down to multiple factors. “A big factor is that, year on year, the funding for contraception services is going down. So people can’t access the contraception they need when they need it,” she says. It’s true: across England, spending on STI testing, contraception and treatment decreased by 17 per cent between 2015/16 and 2020/21, as a result of the public health grant used by local councils to fund sexual health services being slashed. On top of that, Salkeld continues, “with the cost of living crisis, people are really, really tight on money and having a family costs a lot of money and that people can’t necessarily afford to have another child. Plus, we’re mixing again after Covid and the more people socialise, the more likely it is that people will have unplanned pregnancies.” Demand isn’t slowing down, either: in the first two weeks of January this year, MSI UK treated 47 per cent more people than in the same period last year, and gave 51 per cent more phone consultations.

A key issue, as is also the case in Scotland and Northern Ireland, is a lack of commissioning of certain abortion services, particularly in the NHS. “[Independent providers] will usually go up to the legal limit, whereas a lot of the NHS services will not, particularly over 14 weeks,” says Salkeld. “So then you get the situation where, because we are not in a hospital setting, if someone’s a high-risk patient and they have to go to hospital to have their abortion because that’s the safest thing for them, but their local service doesn’t provide it past a certain point, then they will have to travel.”

She says that northern regions and extremely rural areas, in particular, face the brunt of these issues. Below tariff funding also means that independent providers aren’t always able to offer a full range of treatments in certain areas, leaving women like Katie without a real choice. Although the introduction of the Pills by Post scheme during the pandemic – which minimises the need for travel by allowing people in the early stages of pregnancy (up to ten weeks) to have the two pills required to end a pregnancy delivered to their door, following a telephone or e-consultation with a doctor – has helped, says Salkeld, these issues usually affect those who are further along in their pregnancies, or who need specialised care.

All of this can have a profound effect, both emotionally and materially. Having to travel for an abortion is time-consuming and expensive and, although some services like the Abortion Support Network (ASN) and MSI UK will help people to fund their journeys, the burden disproportionately affects people from lower socioeconomic backgrounds – the same people who are more likely to impacted by dwindling contraception services and more likely to get an abortion. “It’s very disruptive to your life,” says Salkeld. “People might have childcare commitments, or what if they have to miss work and can’t get paid, or they’re dismissed if they don’t show up? People who are deprived are much more likely to be in jobs that are less flexible and they’ll be worse off in this situation.”

There’s also the issue of safeguarding. As Salkeld says, “it's very difficult to explain why you’re gone for that long.” Due to the extensive travel, Katie was forced to tell her mum – who was very much against the idea of her being sexually active – about her abortion. “I couldn’t tell her I was just popping down to the next city,” she says. “It was very shocking to hear that I would have to have surgery, as this limited my options of fewer people knowing.”

All of these issues are culminating in a lack of bodily autonomy for women. Some, like Katie, have no real choice over the procedure they’re able to have; others are even unable to get access to abortion at all (in a very small number of cases, Salkeld says, some people are forced to continue with their pregnancy). One in three women in the UK will get an abortion at some point in their lifetime, and so without real autonomy, the current crisis is leaving many women in uncomfortable and even traumatic situations. For now, abortion healthcare providers are desperately trying to plug the gaps, but as Salkeld says, adequate funding is an urgent necessity.

A spokesperson for MSI Reproductive Choices UK told Dazed: “Once someone is sure of their decision, it is our priority to ensure they can access care as soon as possible. As in all parts of the health service, the Covid pandemic and the need for people to self-isolate caused a temporary increase in waiting times. But thanks to the dedication of our frontline teams, on average in 2022, we were able to treat 97 percent of people for a face-to-face medical abortion, and 99 percent of people via telemedicine, within ten days. In some cases, people prefer to opt for a later appointment due to existing childcare or work commitments, so we always offer a choice, including the earliest and nearest options.”

A spokesperson for BPAS said: “At BPAS, we are absolutely committed to providing high-quality, compassionate abortion care to all those who need our support. Unfortunately, due to staff shortages, we are currently unable to provide surgical services at [the clinic Katie visited], but we are working to re-establish this treatment pathway as soon as possible. Guidance from the Royal College of Obstetricians and Gynaecologists makes clear that general anaesthetic is not recommended for routine use in abortion procedures due to the associated higher rates of complications for patients, which is why we do not have services set-up to provide abortion care under GA at all our surgical locations.”

They added that below tariff funding “affects our ability to offer the full range of choice of treatment methods in certain locations, which means that some women will be forced to travel significant distances to access the care that they need”.

They continued: “Women deserve access to the highest quality abortion care available – but services need to be adequately funded.”

A Department of Health and Social Care spokesperson said: “We are committed to improving sexual and reproductive health in England, including improving access to abortion services, and published the Women’s Health Strategy for England last August. We have given more than £3 billion to local authorities in England to fund public health services this financial year, including sexual and reproductive health services.”

*Name has been changed