Quality standard
Quality statement 4: Early medical abortion
Quality statement 4: Early medical abortion
Quality statement
Women having a medical abortion up to and including 9+6 weeks' gestation are given the option to take misoprostol at home.
Rationale
Women who are having a medical abortion and taking mifepristone up to and including 9+6 weeks' gestation should be given the option to take misoprostol at home. They can then be at home when expulsion begins, rather than on their journey home. Home expulsions will reduce hospital attendance and waiting times for early medical abortions. The legal limit for the gestational age at which misoprostol can be taken at home is specified in the Secretary of State's approval order of December 2018.
In response to the COVID-19 pandemic the Department of Health and Social Care has issued temporary approval of home use for both stages of early medical abortion.
Quality measures
The following measures can be used to assess the quality of care or service provision specified in the statement. They are examples of how the statement can be measured, and can be adapted and used flexibly.
Structure
Evidence of local processes to ensure that women having a medical abortion up to and including 9+6 weeks' gestation are given the option to take misoprostol at home.
Data source: Local data collection, for example service protocol.
Process
Proportion of women having a medical abortion up to and including 9+6 weeks' gestation who take misoprostol at home.
Numerator – the number in the denominator who take misoprostol at home.
Denominator – the number of women having a medical abortion up to and including 9+6 weeks' gestation.
Data source: The Department of Health and Social Care's abortion statistics includes data on medical abortions where the second stage treatment was administered at home.
Outcome
a) Hospital attendances for administration of misoprostol for early medical abortion.
Data source: Local data collection, for example provider data returns.
b) Average waiting time for early medical abortion from initial referral to receipt of procedure.
Data source: Local data collection, for example provider annual reports.
What the quality statement means for different audiences
Service providers (such as NHS hospital trusts and independent abortion providers) ensure that processes are in place so that women having a medical abortion up to and including 9+6 weeks' gestation are given the option to take misoprostol at home. Providers ensure that healthcare professionals can give women information about the options available to help them make decisions about their care.
Healthcare professionals (such as doctors, nurses and midwives) give women who are having a medical abortion up to and including 9+6 weeks' gestation the option to take misoprostol at home. They give them information about the options available to help them make decisions about their care.
Commissioners (clinical commissioning groups) ensure that they commission abortion services that give women who are having a medical abortion up to and including 9+6 weeks' gestation the option to take misoprostol at home.
Women having a medical abortion up to and including 9 +6 weeks into the pregnancy can take the second medicine (misoprostol) at home rather than in a clinic or hospital, if they prefer.
Source guidance
Abortion care. NICE guideline NG140 (2019), recommendation 1.8.1
Equality and diversity considerations
Women should be given information that they can easily read and understand themselves, or with support. Information should be in a format that suits their needs and preferences, for example video or written information. It should be accessible to women who do not speak or read English, and it should be culturally and age appropriate. Women should have access to an interpreter or advocate if needed. For women with additional needs related to a disability, impairment or sensory loss, information should be provided as set out in NHS England's Accessible Information Standard.