GPAtlas🧭 When a patient requests an abortion
Most patients present by asking, directly or indirectly, to end an unwanted pregnancy. The primary-care role is timely, non-judgemental facilitation of access – not gatekeeping. The essential tasks are to confirm the pregnancy, establish gestational age, confirm the decision is the patient's own, and screen for coercion and safeguarding concerns, then signpost or refer without delay. Earlier gestation means more options and lower risk, so speed matters.
Abortion in England, Scotland and Wales is provided within the Abortion Act 1967 (as amended by the Human Fertilisation and Embryology Act 1990). Two registered medical practitioners must certify in good faith that a lawful ground is met before treatment; most abortions are performed under Ground C (pregnancy under 24 weeks, where continuing carries greater risk to physical or mental health than ending it). Patients do not need a GP referral – they can self-refer directly to an abortion provider.
The clinical framework is driven largely by gestational age, which determines the method and setting. The key skills are to date accurately, keep ectopic pregnancy on the differential, and never miss coercion or exploitation.
| Gestation | Method options | Setting / notes |
|---|---|---|
| ≤ 10+0 weeks | Early medical abortion (mifepristone + misoprostol) or vacuum aspiration | Both pills can be taken at home (telemedicine / “pills by post”) |
| 10+1 – 14+0 weeks | Medical abortion or surgical vacuum aspiration | Clinic / hospital; cervical priming before surgical |
| 14+1 – 24+0 weeks | Medical abortion or surgical dilatation & evacuation (D&E) | Specialist service; feticide considered from 22 weeks |
| > 24 weeks | Lawful only on Grounds A, B or E (risk to life, grave permanent injury, serious fetal anomaly) | No upper time limit on these grounds |
Source: NICE NG140 · RCOG · Abortion Act 1967
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