The SACHA Study is the largest research project on abortion to be carried out to date in the UK. More than 20 researchers from seven countries have come together forming the SACHA Consortium.
Changes are taking place in the abortion landscape that will impact patients, practitioners and policymakers. Around three in four abortions carried out in the UK are now done by taking pills, and only one in four by surgery. Early medical abortion, involving taking mifepristone and misoprostol, can now be managed as part of routine healthcare in the first 10 weeks of pregnancy.
The SACHA Consortium is a large group of practitioners, policymakers and researchers, united by the common aim of ensuring that new directions in abortion care are soundly based on robust empirical evidence. Their expertise encompasses healthcare, including nursing and midwifery, sexual and reproductive health, general practice, commissioning, public health and policy, social science, epidemiology, information technology and the law.
Institutions collaborating on the SACHA Study, led by Prof Kaye Wellings and Dr Rebecca French at the London School of Hygiene and Tropical Medicine, include the British Pregnancy Advisory Service, the Karolinska Institute (Sweden), King's College London, Lambeth Local Authority, University of British Columbia (Canada), University of Edinburgh, University of Kent, University of Melbourne (Australia), University of Oxford and University of Plymouth. Between them, the team members have provided the evidence base for most of the large national sexual and reproductive health interventions in the UK in the last three decades.
Study background
Changes are taking place in the abortion landscape that will impact patients, practitioners and policymakers. Around three in four abortions carried out in the UK are now done by taking pills, and only one in four by surgery. Early medical abortion, involving taking mifepristone and misoprostol, can now be managed as part of routine healthcare in the first 10 weeks of pregnancy. Since 2018, women have been able to take the second abortion pill, misoprostol, at home, and manage the abortion themselves. During nationwide lockdowns, abortion services have mainly been delivered through telemedicine and self-managed by patients, who have been able to administer both pills themselves.
Moves are afoot to change the law on abortion provision. The 1967 Abortion Act in Britain legalised, but did not decriminalise, abortion. It is still a criminal offence to have an abortion unless two doctors have signed to confirm certain conditions have been met. Many are now calling for the law to be changed, arguing that, since the procedure is safer than continuing the pregnancy, it should be governed by healthcare regulations and not the law. Both the UN and the WHO have called for abortion law reform. In Northern Ireland, the law was changed in 2019, so that women and healthcare workers no longer face prosecution if they end a pregnancy without medical approval. The same may well happen in the rest of the UK.
At the same time, the drive for abortion provision to be brought in line with modern healthcare practice is gathering pace. Clinical pathways and models of abortion care being considered reflect the need for patient-centred approaches, shared decision-making and supported self-management - all of which are supported by increasing use of telemedicine and digital resources. Thought is being given to what support is needed by women self-managing abortion and what role can health professionals such as GPs, pharmacists, nurses and midwives play in provision.
The changes could have real benefits. Patients would have more control over what happens to them. Research from other countries has shown that effective, safe and acceptable abortion care can be provided by non-abortion specialist healthcare workers. But reliable evidence is needed to underpin the reforms in the UK. Efforts are being made to develop new ways to improve abortion care in other parts of the world, but more needs to be known before deciding what is the right fit for the UK. The SACHA Study has been funded by the UK's National Institute of Health Research to gather information that will have a direct impact on clinical policy and practice, and will help shape abortion care for the future.
Kaye Wellings
Professor
Prof Kaye Wellings is a social scientist and known, nationally and internationally, for her research into sexual and reproductive health. She is Professor of Sexual and Reproductive Health at LSHTM and was founding head of the Centre for Sexual and Reproductive Health Research from 1995 to 2017. Kaye founded the National Survey of Sexual Attitudes and Lifestyles with Natcen in 1987 and co-led the study until 2015. Kaye is an elected Fellow of the UK Faculty of Public Health, the Faculty of Sexual and Reproductive Health, the Royal College of Obstetricians and Gynaecologists and of the Academy of Social Sciences. She sits on a number of advisory committees in Europe and North America, works closely with the WHO, and is a trustee of the Population Council. Co-leading Work Package 4.
Rebecca French
Associate Professor
Dr Rebecca French Associate Professor, LSHTM. Public Health specialist brings experience of public health and policy-related research and evaluation including research in sexual and reproductive health service delivery and use of new technologies. Chair of the RCOG Clinical Studies Group on Sexual & Reproductive Health. Responsible jointly, with Prof Kaye Wellings, for overall management and strategic direction of the study. Co-leading Work Package 3.
Melissa Palmer
Assistant Professor
Dr Melissa Palmer, Assistant Professor at LSHTM. Brings experience of both quantitative and qualitative research, including evaluation of E-Health interventions, analysis of routine data and large-scale survey data. Will contribute across the study to fieldwork, data analysis and reporting. Co-leading Work Package 2.
Rachel Scott
Assistant Professor
Dr Rachel Scott Assistant Professor at LSHTM. Brings qualitative and quantitative expertise and experience, including comparative research on abortion (Britain vs France; US vs Britain); representations of abortion (West Africa) and an intervention trial of the effect of post-abortion contraceptive counselling. Will contribute across the study to fieldwork, data analysis and reporting. Co-leading Work Package 2.
Rebecca Meiksin
Research Fellow
Rebecca Meiksin Research Fellow in Social Science at LSHTM. Experience of qualitative and quantitative research as well as practice experience in supporting women seeking abortion. Brings experience of conducting qualitative and quantitative systematic reviews and of realist methods. Contributes to study fieldwork, data analysis and reporting.
Maria Lewandowska
Research Assistant
Maria Lewandowska is a Research Assistant in the Department of Public Health, Environments and Society at LSHTM. She completed her MSc in Reproductive and Sexual Health Research at the School and wrote her thesis looking at the impact of the approval of home administration of misoprostol in medical abortions in England, using quantitative methods. Involved in the quantitative and qualitative components of the study.
Natasha Salaria
Research Assistant
Natasha Salaria is a Research Assistant in the Department of Public Health, Environments and Society at LSHTM. She completed her MSc in Reproductive Science and Women’s Health at UCL and brings quantitative and qualitative experience along with strategic communications and dissemination of research. Will be involved in the quantitative and qualitative components of the study including fieldwork, data analysis and reporting on Work Packages 3 and 4. Natasha is also a mental health first aider at the School.
Paula Baraitser
Consultant
Dr Paula Baraitser Consultant in sexual health at King’s College Hospital, Senior Lecturer in Global Health, KCL. Director of community interest company, SH:24. Brings experience in the development and evaluation of sexual health services, particularly online; extensive experience of use of new technologies to improve SRH. Co-leading Work Package 1.
Sharon Cameron
Consultant Gynaecologist
Prof Sharon Cameron Consultant Gynaecologist NHS Lothian & Lead for Abortion Care & Sexual and reproductive Health. Editor in chief BMJ Sexual & Reproductive Health. Brings research experience in conducting and evaluating initiatives to improve women’s SRH, including expansion of health care provision outside existing models of service delivery, self-management of abortion, development of effective methods of follow up after medical abortion and SRH services from community pharmacies. Co-leading Work Package 5.
Caroline Free
Professor
Prof Caroline Free Professor of Primary Care and Epidemiology, LSHTM, General Practitioner and Honorary Consultant in SRH at KCH. Brings research and development experience in primary care interventions, particularly M-health and sexual and reproductive health. Co-leading Work Package 1: Realist Review.
Louise Keogh
Professor
Prof Louise Keogh Professor, Health Sociology, Melbourne School of Population and Global Health. University of Melbourne. Experienced qualitative researcher who has studied the impact of decriminalisation of abortion in Victoria and has recently received funding to explore a new model for the regulation of conscientious objection to abortion in Australia. Louise will be actively involved in facilitating fieldwork in Australia, in the recruitment of participants, the identification of published and grey literature on abortion in Australia and in carrying out fieldwork.
Patricia Lohr
Medical Director
Dr Patricia Lohr Medical Director, British Pregnancy Advisory Service (BPAS) and Director, Centre for Reproductive Research and Communication. Advisor on abortion education to British Society of Abortion Care Providers and Royal College of Obstetricians and Gynaecologists. Direct clinical abortion service experience and extensive experience of trialling interventions to improve provision. Patricia will advise on all service-related aspects of the study. Co-leading Work Package 4.
Clare Murphy
Chief Executive Officer
Clare Murphy Chief Executive Officer at British Pregnancy Advisory Service. In addition to contributing to Work Package 4, Clare will work with the LSHTM lead on dissemination of study findings and public engagement and will manage lay involvement in the study.
Wendy Norman
Professor
Dr Wendy Norman Associate Professor, and Public Health Agency of Canada Chair in Family Planning, Faculty of Medicine, University of British Columbia. Family Physician. Brings extensive expertise in innovation approaches to abortion provision and pivotal experience in shaping policy and practice post-decriminalisation in Canada. Wendy will facilitate and guide the fieldwork and desk research in Canada.
Jennifer Reiter
Lead Commissioner for Sexual Health
Jennifer Reiter is Lead Commissioner for Sexual Health (including abortion services) at London Borough of Lambeth. She has also commissioned sexual and reproductive health services for London Borough of Camden and HIV Prevention England. In the UK she previously served as Secretary for Abortion Support Network. In the US she delivered education, outreach and training for Planned Parenthood chapters in Wisconsin and Illinois. For the SACHA study, she will provide guidance into the commissioning of services and will facilitate the participation of commissioners in the study and enlist their support in disseminating the outputs. Co-leading Work Package 5.
Sally Sheldon
Professor
Prof Sally Sheldon Professor of Law at Kent Law School. Brings health care law and ethics, with specific reference to reproductive health/abortion. Sally will provide the necessary perspectives on legal aspects of abortion provision across the study. Co-leading Work Package 5.
Jill Shawe
Professor
Prof Jill Shawe Professor of Maternal and Family Health School of Nursing & Midwifery, University of Plymouth. Sexual & Reproductive Health Nurse and Midwife. Brings experience of research into women’s health care and the role of nurse/midwife in sexual and reproductive health and inequalities in access. Co-leading Work Package 3.
Geoff Wong
Associate Professor
Dr Geoff Wong Associate Professor in Primary Care at the Nuffield Department of Primary Care Health Sciences, University of Oxford and GP in London. Brings extensive expertise in realist synthesis and its application to understand implementation to complex health and social interventions.
The SACHA Study is the largest research project on abortion to be carried out to date in the UK. More than 20 researchers from seven countries have come together forming the SACHA Consortium with the aim of building a comprehensive evidence base for new directions in abortion care. Five interlinked work packages make up the study:
- Reviews of existing evidence on novel models of abortion care that are being tried and tested;
- Case studies capturing the experience of abortion provision reforms in Australia, Canada, and Sweden, and transferrable lessons to be learnt for the UK.
- A survey of health care practitioners such as GPs, midwives, nurses and pharmacists, to assess the potential for extending their role in abortion provision;
- In-depth interviews with women with recent experience of abortion to find out how best abortion services might be organised to meet their needs and preferences for different models of care;
- Roundtable discussion groups with key stakeholders to examine which innovations in abortion care would be most likely to work in the UK.
The study findings will be tailored to different audiences - the general public, the media, healthcare professionals, academics, policymakers and commissioners.
Items in the media citing SACHA:
- Major UK study recommends extending abortion powers to nurses (Nursing Times)
- UK abortion law should change to reflect current practice, study suggests (Medical Xpress)
- NHS nurses and midwives should be able to approve abortions, report argues (Yahoo News)
- Nurses and midwives should be able to approve abortions, UK study concludes (The Guardian)
- Need for two doctors to approve abortion ‘should be scrapped' (Irish News)
- Everything you need to know about having an abortion, according to a reproductive health expert (Glamour Magazine)
- Abortion is safe, supported, and available in the UK. Why is the law so complicated? (The Guardian)
- Scotland 'must act quickly' on abortion services as new study shows women 'overwhelmingly support' telemedicine provisions (The Scotsman)
- Women support home-use of abortion pills and telemedical model of care (News-Medical.Net)
- Scotland urged to continue at-home abortions (BBC)
We presented the findings of the SACHA Study at the All-Parliamentary Party Group on Sexual and Reproductive Health on the 7th of March 2023.
Our team presented the following research at the conference of the International Federation of Abortion and Contraception Professionals in September 2022:
- COVID-19: abortion and contraception - impetus or impediment? Wellings Kaye, London School of Hygiene & Tropical Medicine, Public Health and Policy, London, UK,SACHA Consortium, LSHTM, London, UK.
- Decriminalising abortion in Britain: what do patients and providers think? French RS, Salaria N, Lewandowska M, Meiksin R, Palmer M, Scott R, Lohr PA, Shawe J, Wellings K,The SACHA Study Team. London School of Hygiene & Tropical Medicine, Department of Public Health, Environments and Society, Faculty of Public Health and Policy, London, UK.
- Perceptions of stigma among women receiving abortion care in Britain. Dr Rachel Scott, LSHTM, London, United Kingdom; Maria Lewandowska, LSHTM, London, United Kingdom; Dr Patricia Lohr, British Pregnancy Advisory Service, London, United Kingdom; Rebecca Meiksin, LSHTM, London, United Kingdom; Jennifer Reiter, Lambeth Council, London, United Kingdom; Dr Rebecca French, LSHTM, London, United Kingdom; Dr Melissa Palmer, LSHTM, London, United Kingdom; Professor Kaye Wellings, LSHTM, London, United Kingdom.
Read more about our research at the conference.
The results of the first research paper published by SACHA, based on qualitative interviews with women with recent experience of abortion, presented by Maria Lewandowska at the conference of the European Society of Contraception and Reproductive Health, May 2022.