‘Only one Scottish doctor is trained in surgical care to legal limit’,

There are two types of abortions; medical, which involves taking pills, and surgical, which involves a minor operation. However, in Scotland, all later stage abortions provided, including those due to a fetal anomaly diagnosis, are currently medical abortions.

This means women have to go through a labour-like experience in Scotland if they are 13 weeks and over into a pregnancy.  Medical experts have told The Herald a surgical abortion would avoid this experience and would often involve less prolonged discomfort. 

At the moment, Scottish doctors can only gain training for later surgical care if they travel down to England and there is no facility in Scotland providing surgical abortions past 13 weeks. 

The legal limit for an abortion in the UK is 24 weeks into a pregnancy, however, all abortion care in Scotland is currently limited to 20 weeks due to a lack of provision here. To access care after this time, women have to travel to England.  

Although the majority of women in Scotland have an abortion under 12 weeks, recent figures show Scottish women travelling down south for surgical care has reached a record high. Up to the end of September, 57 women made the journey down south this year. This compares to 50 women in the same period last year, according to recent figures from the British Pregnancy Advisory Service. 

Ed Dorman has been an abortion provider throughout his 40 plus career in the NHS in England and is the co-chair of the Royal College of Obstetricians and Gynaecologists abortion task force.

Speaking exclusively to The Herald about training for surgical abortions, he said: “It’s a crazy situation where if Scottish doctors want to train they would have to travel to England as John Reynolds-Wright from Edinburgh has done. He’s really an advocate for getting things up and running in Scotland and providing choice."

Asked if Dr Reynolds-Wright was the only doctor he knew of who had the training, Dr Dorman said: “Yes, that’s right. I think there’s only one doctor in Scotland who has completed the training. I don’t think any of the older doctors have done this training for many years so they couldn’t really say that they are competent.” 

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Dr Dorman said his biggest concern for abortion care across the UK is the lack of NHS staff who are able to carry out a late surgical abortion procedure. 

“What happens in hospitals in England, never mind in Scotland, is that obstetricians and gynaecologists have largely lost the skills to do uterine evacuation which is what we are talking about with later surgical abortions. This means women end up really sick and there have been maternal deaths.” 

Working as a surgeon at a BPAS clinic in London, Dr Dorman sees at least one Scottish woman for abortion care every two weeks. Dr Dorman said there are some exceptions but almost all women from Scotland who he has cared for receive surgical abortions. He believes this care should be made available in Scotland to ensure women have autonomy when it comes to their healthcare. 

According to NICE (National Institute of Care Excellence ) guidelines women should be offered a choice of method of abortion up to the 24 week limit. 

Dr Dorman said: “It gives women a choice of something other than late, horrendous, prolonged and difficult medically induced abortions which some can be like…they would prefer to avoid the more than 24 hours of a potentially traumatic experience of having to labour and deliver a later gestation foetus.” 

The Scottish women who pass through the clinic’s doors in England have some “incredibly harrowing stories”, the doctor said, such as the need for a procedure after being in an abusive relationship, those unable to continue a pregnancy after the loss of a partner and those who did not realise they were pregnant as a result of other medical conditions. 

Dr Dorman said attitudes towards surgical abortions have changed over the years. From an audit of the hospital he works in back in 2017, only 20 % of women who had a foetal abnormality wanted a surgical abortion. By 2021, 91% had opted for the surgical route. 

Dr Dorman said the reason for an upsurge in surgical choices is likely down to not needing to “endure the emotional trauma of labouring and delivering a dead baby".

The doctor also said there are studies which show it is safer to have a surgical abortion for women between 14 and 24 weeks pregnant as “the amount of bleeding is often less and risk of infection is less”. 

Dr Dorman says it is up to authorities across the UK to deliver surgical care and even suggested there should be a “a threat of penalties” for hospitals “who are dragging their feet”. 

“I think it’s the only way things are going to change”, Dr Dorman added. 

Lucy Grieve co-founded the campaign group Back Off Scotland which ensured the successful introduction of buffer zones last month. These zones prevent anti-abortion protestors from being within a 200 metre radius of a hospital. Now, her attention is firmly set on improving abortion care in Scotland. 

Agreeing with Dr Dorman on the need for surgical care in Scotland, Ms Grieve told The Herald: “These women at the moment can’t access care they should be legally entitled to and they should have the choice between medical and surgical.” 

Ms Grieve said the establishing a facility offering surgical care for an abortion would help women across Scotland. 

“This is a cornerstone of women’s rights and I can’t for the life of me understand why more isn’t being done to establish a surgical service. I’m scared about possible ramifications of continuing to not provide surgical care. I’m scared for women’s safety.

“Women in Scotland who are ending a pregnancy because of a foetal abnormality or foetal anomaly diagnosis have to go through this experience.” Ms Grieve said: “It can’t be right that from a government that claims to care so much about a women’s right to choose that this is the only option.”

Ms Grieve, does however welcome what she describes as “revolutionary” changes to abortion care in Scotland. 

One of these changes was Scotland offering telemedical appointments for women in the first 12 weeks of pregnancy. This was a measure which was initially introduced during the Covid pandemic and was then made permanent. This allows any woman to have a telephone or video consultation with a qualified nurse or midwife and – where eligible – abortion medication is posted so that a woman can pass her pregnancy at home. 

“Scotland has in many ways been revolutionary with the introduction of telemedicine abortion, in particular early medical abortion and there’s been so much work done,” Ms Grieve said. 

Termination services in Scotland have seen a 10% increase in demand. There were an additional 1,600 terminations in 2023 (18,207) compared to 16,607 in 2022,  according to the most recent data from Public Health Scotland. 

The Scottish Government has said the NHS National Services Scotland has done “significant work” to consider the available delivery options for abortion care, and a short-life working group has been established to consider these options with NHS Boards.

Public Health Minister Jenni Minto said: “Patient safety is always our highest priority, and I completely understand concerns raised by women forced to travel to access abortion services. That is why, we are working with NHS Boards and other key stakeholders to support women having later stage abortions in Scotland.

“The Scottish Government expects the Boards to meet the Healthcare Improvement Scotland’s standards relating to abortion as a minimum. This means where an NHS Board cannot offer abortion services locally, they must provide an appropriate and person-centred care pathway for patients and support patients with travel and accommodation costs covered if patients do need to travel to England for treatment.”