Abortion Delays for BMI 40+?

I was surprised to discover today that being larger doesn’t only affect your maternity and antenatal care. It can lead to abortion delays too.

The British Pregnancy Advice Service (the UK’s leading abortion care service) released this briefing paper. It highlights the number of women forced to continue pregnancies, some of which are against medical advice. The women remain pregnant against their will because of a lack of capacity in the system.

On 46 occasions in 2016 and 2017 – or generally twice a month – BPAS was unable to secure suitable NHS hospital treatment for women by the strict legal cut-off of 24 weeks.

In other cases, there was significant delay between the woman presenting for treatment and being able to access that treatment. One mother with cancer, whose treatment could not start until the abortion was performed, waited 45 days for an appointment. In another case, someone with epilepsy and learning difficulties, presenting at the end of first trimester, waited nearly 7 weeks.

But where does high BMI come into this?

Three of the cases for whom BPAS could not find an appointment in time are described thus in the paper:

BMI over 40. Existing children.
Pregnancy is the result of a sexual assault.
Presented at 22 weeks.
No appointment available.

19 years old with three young children. BMI>40. Her ex-partner has recently been released on bail following a prison sentence for domestic violence.
Presented at 19 weeks. No suitable appointment available.

BMI over 40. 18 weeks pregnant. Daughter was recently violently assaulted and raped; she feels unable to cope with both a new baby and supporting her daughter through this experience. Cannot stay overnight and leave her other children. No suitable appointment available.

Why is this?

Most abortions in the UK are performed outside the NHS by the not-for-profit sector, in stand-alone community clinics run by organisations like BPAS. However, women with co-morbidities must be managed within a hospital setting, where there is swift access to backup care and specific clinical expertise, in case of emergency.

BMI is included in these co-morbidities, with the cut-off being a BMI of 40, and in fact, according to BPAS’s statistics, it’s the fourth most common reason for referral for treatment.

The briefing goes on to show that many of the clinics they can refer into will only treat women up to a certain gestation. The the later someone presents for treatment, the fewer locations available. There are just 35 sites across the entire UK country offering this service. If you don’t discover you’re pregnant until several weeks along, this can drastically reduce your options.

I can’t imagine coming to the very difficult decision of terminating a pregnancy, only to find you are compelled to continue with it anyway, because of a lack of appointments.

So, where does this leave us?

One in three women will have an abortion in her lifetime. According to government statistics, 3.6% of women have a BMI greater than 40.

So, at a rough guesstimate, around 1% of the population may find themselves in exactly this situation.

If you’re considering a termination, and you have a high BMI, it looks like the sooner you approach a provider for treatment, the more likely you are to be able to access it, and access it in a location convenient to you. Perhaps in this instance it’s better to approach the provider even while you’re in the process of making up your mind, in order to buy you time to arrange a suitable appointment.

But according to this study of 4968 women in 2016,

Benson LS, Micks EA, Ingalls C, Prager SW. Safety of Outpatient Surgical Abortion for Obese Patients in the First and Second Trimesters. Obstet Gynecol. 2016

abortion clinics needn’t be restricting access to women with high BMI at all? Is this yet another thing we should be fighting to be treated the same as any other women?

We’re damned if we do, and damned if we don’t.