Gynaecologists' abortion practice

To ascertain the relation between gynaecologists' opinions on the provision of abortion and the service provided by the Health Service in their district and to investigate the methods used for second trimester abortion.

A postal questionnaire sent three times to a 50% random sample of gynaecologists practising in the National Health Service (NHS) in 1989 in Great Britain.

343 of 396 practising gynaecologists, 87% of those selected.

Proportion of gynaecologists holding views or reporting practice.

Although only 11% actually performed abortions beyond 20 weeks, 57% approved later operations in cases of rape and 85% for a threat to the woman's health; only 47% approved late abortion for schoolgirls under 16 years. Dilatation and evacuation was used by only 1% of NHS gynaecologists even though from 13 to 16 weeks it is a safe and efficient method. Although Government statistics report that vacuum aspiration is used in over one third of second trimester abortions, this is technically unlikely and was not confirmed by this study. Less than 50% of abortions in England and Wales are performed in the NHS yet fewer than 40% of gynaecologists reported problems in providing an abortion service. Overall 21% thought they were providing abortions for over 90% of the women resident in their districts, whereas only 2% of districts achieve this proportion in their home regional health authority. Overall 60% supported separating abortion work from general gynaecology, and 45% would like regional abortion units. Only 27% supported fertility control acquiring the status of a subspecialty.

Accepting these suggestions would improve the service, reduce regional variations in provision, provide opportunities for research and could have an important effect in helping slow the world population increase.