Abortion service usage

Original Request

For each month since April 2019, how many women have sought Isle of Man NHS abortion services (a) on-Island and (b) off-Island.

Data Tables (4)

Full Response Text

Abortion services carried out on the Isle of Man since May 2019

Document prepared 10 July 2021

0 2 4 6 8 10 12 14 16 18 20 Abortion services carried out on the Isle of Man since May 2019

Abortion services carried out on the Isle of Man since May 2019

Document prepared 10 July 2021

Abortion services carried out on the Isle of Man since May 2019 May-19 2 Jun-19 3 Jul-19 6 Aug-19 9 Sep-19 15 Oct-19 13 Nov-19 10 Dec-19 10 Jan-20 12 Feb-20 10 Mar-20 14 Apr-20 10 May-20 12 Jun-20 6 Jul-20 13 Aug-20 5 Sep-20 10 Oct-20 9 Nov-20 14 Dec-20 14 Jan-21 14 Feb-21 6 Mar-21 11 Apr-21 15 May-21 19 Jun-21 9

BPAS helps provide high-quality abortion care to clients from the Isle of Man – operating the booking line, providing telephone and video consultations, providing pre- and post-abortion counselling, and caring for women who travel to England. We welcomed the change in law in the Isle of Man in 2019 – abortion happens regardless of the legal framework, and the change in law finally enabled safe, free, and accessible care to be available to Manx residents We support the development of on-island abortion care – recognising that local care increases accessibility, minimises the burden of travel, improves experience of abortion services, and normalises the provision of abortion care. Changes to abortion regulation and clinical guidelines have increased the ability to provide telemedical care and reduce the need for invasive testing prior to Early Medical Abortion procedures BPAS provides abortion as community healthcare from standalone clinics, and supports a community-based approach to on-island provision The British Pregnancy Advisory Service (BPAS) is a reproductive healthcare charity that offers pregnancy counselling, abortion care, miscarriage management, contraception and testing for sexually transmitted infections (STI) to 100,000 women each year. We are the largest abortion provider in the UK, operating around 60 clinics across Great Britain. 98% of the care we provide is NHS-funded. We also provide funded care for women from the Isle of Man, and we have historically cared for privately funded clients from the island prior to the change in law.
In addition to our service provision, we advocate for the ability of women to access safe, legal, high-quality abortion care, and to ensure that the law does not stand in the way of accessible care and clinical developments. To this end, we provided advice and guidance to MHKs during the passage of the Abortion Reform Bill. The Abortion Reform Act 2019 – when passed – was the most progressive abortion legislation in the British Isles. In the two years since its passage, Northern Ireland has undergone similar legal reforms, and Guernsey has approved new legislation which will decriminalise women and service providers. The Isle of Man should rightly be seen as leading the way in this development of modern abortion law.
As an organisation, BPAS supports the decriminalisation of abortion and its classification as a healthcare procedure like any other. We therefore support the legislation as a whole.
There are also several aspects of the law which we consider particularly important:

The complete decriminalisation of women obtaining abortions, whether or not that is within the provisions of formal healthcare; The ability of nurses, midwives, and pharmacists to provide legal abortion care without direction by a registered medical practitioner; The availability of abortion throughout pregnancy on certain grounds; and The introduction of access zones – the first in legislation across the British Isles – to protect providers and clients from anti-abortion harassment. We do not believe that any changes are necessary to the underlying legislation. BPAS has worked with the Isle of Man Department of Health and Social Care and providers at Nobles Hospital to support provision of abortion services both on- and off-island. We have shared our clinical procedures and guidelines, and provide advice and information. At the current time, BPAS provides: A dedicated booking line service for clients from the Isle of Man (01624 642521); Telephone and video consultations for clients, including a pregnancy options discussion covering abortion, adoption, or parenting, determination of gestational age, procedure choice, taking of medical history, and safeguarding assessments; Where on-island care has been requested, the sharing of consultation notes with providers at Nobles Hospital; Off-island abortion care, primarily surgical care beyond 10 weeks’ gestation, from our clinics in England; Where requested, funding of travel, accommodation, and an escort for clients travelling to England for care; and Where requested, pre- and post-abortion counselling. At the current time, we do not believe that the Isle of Man government has published abortion statistics. As the provider for DHSC-funded services, the best estimates of the numbers of Manx women requiring care are therefore likely to come from BPAS’s data.
However, women from the island may still opt to receive care privately from other providers in England or elsewhere, or be referred by BPAS into NHS hospitals if they are in need of specialist care – accounting for numbers that are not included in BPAS statistics. The figures included here account for 2018 (before the change in law, where BPAS accounted for 57/95 of the abortions recorded as provided for Manx women in England and Wales), 2019 (covering the period of change, where BPAS provided 51/57 abortions), and 2020 (covering the pandemic, and where complete England figures are not yet available).
It should be noted in the statistics below that the figures related to travelling are an accurate representation of number of abortions, but that consultations are not. As a provider, we usually see a proportion of women who change their mind about proceeding with an abortion post-consultation – and these figures are therefore likely to be an overrepresentation of the number of procedures obtained.

BPAS’s provision means that every woman who calls the booking line for an abortion from the Isle of Man receives a consultation with us. Recent figures are therefore likely to be a good representation of the number of women seeking abortion care. Since the change in law, we have seen an increase in the number of women receiving consultations. We have also seen a sizeable change in the funding route used by these women – and in 2021 have not yet provided a consultation to a Manx resident who has opted to self-fund.
This is in stark contrast to 2018 where we provided 151 consultations to self-funded women, where the England and Wales abortion statistics show only 95 women ultimately received abortion care (with any provider). This indicates a high proportion of women who had hoped to access formal care but been unable to travel to access it. Ultimately, there is no way to know whether these women were able to access care via illicit medications locally, or if they were forced to continue with an unwanted pregnancy. BPAS provided consultations for similar numbers of women between 2019 and during the pandemic – indicating that access to care was being maintained.
The number of clients opting to travel to BPAS has been significantly lower than the number 151 70 8 127 173 39 2018 2019 2020 2021 (TO A P RI L) Private Isle of Man DHSC 57 30 20 9 2018 2019 2020 2021 (TO A P RI L) Private Isle of Man DHSC

consultations provided in all years. In 2018 and the first part of 2019, it can be expected that this was as a result of an inability to travel. In the second part of 2019, 2020, and 2021, this can be seen to be the direct impact of formal on-island provision.
The need for and benefit of on-island provision has been particularly acute during the pandemic. BPAS provided 181 consultations for abortion care during 2020, with only 9 clients travelling to England for a surgical procedure. Since the beginning of June 2019, no client from the Isle of Man has paid privately for an abortion with BPAS.
The provisions for funding travel, accommodation, and – where required – an escort have also been used by approximately 70% of all Isle of Man clients travelling to England. BPAS has welcomed and supported the advent of routine abortion provision on-island, while ensuring that clients who are unable to receive the care of their choice locally have had the ability to access funded care in England. This is a hugely positive change for Manx women, and a testament to the work done by campaigners, politicians, and providers.
Going forward, BPAS remain happy to support the care pathway in the Isle of Man, but recognises that ultimately the provision of care as close to home as possible and as part of the broader healthcare provisions on-island will be best for women.
We therefore suggest that: On-island Early Medical Abortions should continue, and serious consideration should be given to providing in line with Scottish practice which is self-managed care at home up to 12 weeks’ gestation – minimising the number of clients needing to travel. No-test telemedical care should be available permanently for Early Medical Abortions. This includes the provision of mifepristone and misoprostol to take at home, and a removal of blanket requirements to undergo an ultrasound scan which are invasive and often distressing to clients, and not part of best practice care. This provision is in line with guidelines from the Royal College of Obstetricians and Gynaecologists, and has been shown to be safe, effective, and accessible by a recent large cohort study covering more than 50,000 abortions in England and Wales (https://obgyn.onlinelibrary.wiley.com/doi/10.1111/1471-0528.16668).. Consideration should be given as to the sustainability of services and include training of a wider range of healthcare professionals who could provide medical abortion care at all stages of pregnancy. This is particularly important for women seeking later stage medical terminations on the grounds of foetal anomaly. Funding and pathways should be retained for travel off-island where required – this is primarily the case for later gestation surgical cases where population size would pose a difficulty to on-island clinicians retaining necessary skills. Abortion should be delivered as part of a community-based sexual health and contraception service – preserving confidentiality but minimising barriers to access. The DHSC should better advertise the service and the provisions available to ensure that all women who need abortion care are aware that they can obtain it without personal cost and in a convenient and confidential way.

Manx Care Noble’s Hospital, Strang Braddan, Isle of Man IM4 4R (01624) 650 000

Our ref: 1863857 21st July 2021

Dear ###

We write further to your request which was received on 23rd June 2021 and which states:

"For each month since April 2019, how many women have sought Isle of Man NHS abortion services (a) on-Island and (b) off-Island."

Our Response

(a) For each month since April 2019, how many women have sought Isle of Man NHS abortion services on-Island Please see Appendix 1 – Abortions on IOM, attached (b) For each month since April 2019, how many women have sought Isle of Man NHS abortion services off-Island While our aim is to provide information whenever possible, in this instance Manx Care is unable to provide the information that you have requested. This is in line with Section 11(3)a of the Act, as a practical refusal reason applies; namely we do not hold or cannot, after taking reasonable steps to do so, find the information that you have requested. However you may wish to re-submit your request to Public Health within the Cabinet Office who may be able to help you. To provide advice and assistance, you may also find Appendix 2 - BPAS (attached), “The Isle of Man Abortion Reform Act 2019 Review” by the British Pregnancy Advisory Service helpful. Please quote the reference number 1863857 in any future communications.

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