Assessing the Impact of a Routine Requirement for In-Person Abortion Care for Adolescents in England and Wales: A
Hannah McCulloch1, Sarah Salkeld2, Melissa J Palmer3
1Centre for Reproductive Research & Communication, British Pregnancy Advisory Service (BPAS), London, United Kingdom.
Purpose:
No-test medication abortion involves a teleconsultation, gestational age dating by last menstrual period (LMP), and home-use of medicines. In England and Wales, British Pregnancy Advisory Service (BPAS) and MSI Reproductive Choices UK (MSIUK) began offering no-test medication abortion to patients of all ages with pregnancies ≤69 days' gestation in April 2020. In May 2021, BPAS changed policy; adolescents aged 15 years and less could initiate care via teleconsultation but must have an in-person safeguarding assessment review (screening for harm/abuse/neglect), and an ultrasound. We assessed the impact of this change on accessibility, safeguarding, and gestational age estimation.
Methods:
We compared waiting time from first contact to abortion, abortions conducted at ≤6 and ≤10 weeks' gestation, and safeguarding referrals to support organizations using routine data from BPAS or MSIUK for abortion patients aged 15 years and less over 5 months before and after BPAS' policy change. For BPAS patients postpolicy change, we determined safeguarding referral source (teleconsultation/in-person) and diagnostic accuracy of LMP and other menstrual history features versus ultrasound for determining gestational age.
Results:
Between December 1, 2020 and September 30, 2021, 614 adolescents were treated. Postpolicy change, median waiting time from the first contact to abortion at BPAS significantly increased (7 vs. 11 days, p < .001) and proportion of abortions provided within 1 week of contact decreased (52.7% vs. 25.9%, p < .01). Both were stable at MSIUK (9 vs. 9 days [p = .59]; 38.2% vs. 39.2% [p = .99]). At BPAS, all indicated safeguarding referrals were identified at initial teleconsultation. Ten of 201 BPAS patients (5.0%) became ineligible for medication abortion (gestation > 69 days) while waiting for routine ultrasound; both LMP and ultrasound dating suggested eligibility (gestation ≤ 69 days) at first contact.
Discussion:
Requiring in-person adolescent consultation is associated with reduced access to medication abortion without enhancing safeguarding.
