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Ok, great. Let's get going then. Um Hi, everyone. Thank you so much for coming. Welcome to the event. My name is Millie. I'm, I'm Education Colea, um Stash and um I'm cos sharing today with Alice, who's the other education lead. Um Please do complete the feedback forms at the end of the event just to help support our future events. And um that will of that you'll receive your certificate of attendance. So I would just like to introduce our speaker today, Doctor Jane Caverna, who is an associate professor at UCL Medical School and a specialty doctor in Hamilton Abortion Care Service in East London. She's co-chair of Doctors for Choice UK and codirector of the charity Abortion Talk. Jane is passionate about improving abortion, education for healthcare students and about destigmatize abortion. She produced and co directed kind of women, a short documentary film about the 1967 Abortion Act. So it's really great to have you here um Get going whenever you're ready. Thank you. Great. Thanks and thank you for inviting me to give this talk today. Um I've broken it into two different sections. Uh First of all, I'm gonna talk about abortion stigma and its manifestations. And then I'm gonna talk about counteracting uh abortion stigma and how we can all do that. Uh I'm really happy to take questions as you go along. So if you have any questions, put them in the chat, um and I'm also going to be asking you questions, so it would be great if you could um respond to my questions. So II don't feel like a knobby no mates when I ask them. Um and, and tell me what you're thinking. I in the chat, I'm sorry, this platform doesn't allow you to, to speak. Um But we'll see how we uh get along with uh with doing that. So, um before I start the talk, I just want to clarify um how many women experience uh abortion in the UK? Uh And then I'm using women here because that's what, what the um that's the evidence we have. But apart from when I'm directly quoting from evidence, I will use gender inclusive language in this talk. Um So how many women experience abortion in the UK? So just have a thing. Is it one in 31 in five or one in eight? So how common actually is uh abortion? And many of you will know that actually, it's extremely common. One in three UK, women will have an abortion by the time they reach 45 years of age. And that, so that's more um than suffer from migraines and many more than will have an appendicectomy. So it's really likely as there are pro probably over 30 people um on this call that, that there will be people who have had an abortion. And that's really important to bear in mind when you talk about abortion in any group of people, right? So, abortion stigma and its manifestations. So abortion stigma is everywhere. OK? And it reinforces the idea that to have or to talk about or even to provide abortions is somehow a bad thing to do. Um And that also abortion is a less valid part of health care. Now, abortion uh stigma operates at many different levels and I'm mostly gonna talk about the individual uh level uh in this talk and how abortion stigma affects those who have abortions. Um But, but I want to start off by looking at abortion stigma at an institutional level. And so I'm gonna start off by looking at abortion stigma in medical schools. And then I'll go on to talk about abortion stigma in people who have uh abortions. I was gonna talk about abortion stigma and uh healthcare providers as well. Um But II decided that was probably too much of me talking at you. And so I've left that out. But if uh towards the end of the talk, if anyone wants to share their own experience, uh if they've worked uh in and around abortion care uh about their own experience of abortion related stigma, I would really like to hear that. Um So abortion stigma in medical schools to start with. So, um about a year ago, a UK medical student got in touch with doctors for choice and told us about an exam question they'd been asked and this is the wording they gave us. So they said that they were asked to describe three ways how a termination of pregnancy may impact uh emotionally on a patient and I'm quoting them. OK. So this was the question this student was asked, it was a formative assessment. Um So they got feedback. So the students said this uh relief, gratitude and sadness. I would have given the student full marks for this question. Um But they got, they didn't even pass the question because this was the indicative answer, anxiety, low mood and depression, guilt, regret, uh embarrassment and hideously uh it can lead to alcohol and or drug misuse. So this student failed. This question was pretty sure they were right, which is why they emailed doc doctors for choice and to and to flag up, you know, the the fact that medical schools are asking questions in this way. Now there's no evidence for this answer. This this is completely fabricated. I mean, the overarching emotion after after an abortion that people experience is relief, it can be mixed with feelings of um guilt and sadness. So that would be fine to have guilt there. Um But the rest is completely uh non evidence based. OK. Um So you can see that this is an example of the way that some medical schools uh interact with abortion um in a, in a stigmatizing way. OK. Then another medical school for another medical student, sorry, from a different medical school got in touch with us and said that they've been given um what they described as informal teaching on a on abortion by a clinical teaching fellow. And this clinical teaching, Carlo had said all of these things during their, their one hour teaching session and abortion. So she used the word murder numerous times. She talked about people killing their babies at 30 weeks. She said, uh, well, she asked them, how is this any different to women killing their husbands out of rage? Um, she talked about ripping off a leg, ripping off an arm blit up what's left and just sucking it up and said, if we saw that kind of thing going oo on anywhere else in the animal kingdom, we would think it was horrible. Uh, I mean, but I guess I can't think of a better way. Uh, she talked about, uh, um, not using painkiller for the baby. Um She said that she, that, that students would be surprised how many people they, um, she'd seen getting 17 to 18 abortions. Now I've worked in abortion care on and off for nearly 30 years and I've never seen anyone with any near, anywhere near, um, 17 abortions. So that's just not true. Um And then she said, I think they tried to put some limits on abortion when it first became legal, but that was difficult. So they scrapped them. Now we have abortion on demand again, untrue. Um And so clearly, this person was antiabortion that was teaching abortion at this medical uh school. And this is the only session this student had on abortion. They learned nothing else about, about uh abortion. Um And so what had happened is that um the curriculum needs had cascaded abortion, teaching to clinical fellows. They hadn't trained them, they hadn't checked their values or their attitudes and they'd just been allowed to talk about abortion in whatever way they liked. Um And this student felt that they had learnt anything useful about, about um abortion. Yeah. Now this isn't uh uncommon. So studies around the world show that abortion is often not included in core healthcare student curricula. So both medical school and nursing midwifery school and that when it is, it's, it tends to be focused on the legal and ethical aspects of care so that medical students when they qualify lack knowledge on the clinical aspects uh of, of abortion care. Um And yeah, that's globally. And in the UK, we did a study a few years ago um about what medical students uh learned about abortion. And we found out that most medical schools in the UK, teach under two hours on abortion and that's mostly on the legal and ethical aspects. Um And during that study, we, we asked um curriculum these, what, you know, what, what were the barriers to teaching abortion? And these are the four barriers that most of them came up with. So a lack of curriculum, time, lack of learning, uh uh clinical learning opportunities. So the lack of um clinical settings where they could send students, lack of teachers with the relevant expertise. So the the the teacher who was teaching at that previous medical school clearly didn't have the relevant expertise. And then very interestingly, abortion perceived as a sensitive topic. And that was one of the main reasons. So in other words, they couldn't find teachers who were willing to teach this topic because it was a sensitive topic. That's in direct contrast to students um that we interviewed uh as a as a parallel to the to the to the survey of medi medical educators. Um So we interviewed 19 students from five different UK M medical schools with a range of abortion teaching. And they said that the sensitivity of the topic was the very reason that they needed good comprehensive, clinically focused education on abortion. Also the fact that it was so common and it was so stigmatized, which is not surprising. And this quote sort of sums up um most students attitudes. So this student says, I feel like if we weren't taught it properly, then that might mean that that we aren't prepared to help women who want or need abortions appropriately without stigmatizing them or making them feel guilty. So, it's a sensitive topic. I do think it's very important that we address it at, uh, at medical school. Um, and indeed every student we interviewed wanted to be able to provide competent and respectful abortion related care, um, when they qualified and they recognized the student recognized that if you, if you aren't trained, it's so easy to stigmatize people who have abortions. OK. So it's essential that this education takes um place. And again, this is not just a UK phenomenon. This is studies from across the world show that abortion is lacking um uh from uh healthcare schools, as I said, but also that students across the world recognize the need for abortion education. Um So using the examples I gave you from those two medical schools, you, you can see that, you know, if you don't get any teaching or you only focus on the ethical and legal aspects or you have antiabortion teachers or you exceptional abortion in any way or you perpetuate harmful myths, which is what that teacher uh or, or those two medical, the exam question, I'm the teacher at those two medical schools or you use stigmatizing language and I'll come back to that in the second half of the presentation. Then this is both a manifestation of abortion stigma, but it also exacerbates stigma. Um And in contrast, uh medical education that focuses on people who have abortions and the clinical competence of students. Uh And, and is inclusive and respectful of all the students beliefs and directly addresses stigma and showcases nons stigma type language could actually counteract stigma. Um And in fact, it's, it's well known that um when you're trying to reduce uh any stigma, not just abortion related stigma, then education plays a key, a key part in that along with reframing or as stigmatized in a normalizing way, contact with, with um the people are stigmatized uh and activism as well. But education is a key part of destigmatize any stigmatized topic like abortion. So what can be done about this? So, improving medical school education, abortion is absolutely essential and this can be done at, at a, at an institutional level to try and overcome those barriers I mentioned or at a national level by involving uh key stakeholders such as the British Society of abortion care providers, the Os Tog and the Faculty of Sexual and Reproductive Health. Um And that's exactly what we've been doing. So, Doctors For Choice UK and the British Society of abortion care providers have been trying to improve medical education over the last two years. So Doctors For Choice UK has run this curriculum champions project for the last two years using an eight step plan. Um And the steps are very simple. So step one is to identify any staff or student who have a really a keen interest in abortion and want to improve the curriculum. Find out what's currently taught at a local medical school, um then find out what students think of the content um and ask them what they want to be taught and then identify suitable time in the curriculum. No matter how packed the curriculum is, there are always a uh a spare few hours that you can introduce this teaching and then step by um uh involves securing that teaching time by um presenting evidence to curriculum leads um by trying to convince them how important it is to find other topics that, that medical schools teach many hours on that are far less common than abortion. Um And by then, um I've said here in steps six, designing, effective engaging, inclusive learning materials. Er, but those materials exist. So there's a list here on the right hand side uh of, of, of, of free um materials that, that you can download and you can use. Um And the Doctor of Choice UK website has the UCL where I teach resources um that you can just download and adapt for your own setting. Um And then step seven and eight just to make sure the teaching is sustainable. So to teach it with other people and to assess and evaluate it. And um certainly the abortion teaching at UCL gets really good evaluation and that's across the range of beliefs. So even students who are so called pro life rate teaching very highly. Um And that's because we make a real effort, I think to be inclusive of everyone's beliefs because we want everyone to be able to treat people who want abortions with respect. Um, and, and to, and to be competent when they speak to people and to know how to answer questions. So that's a doctor choice curriculum champions project. Um, at a national level, we have involved, um, the RCO G and the Fs Rh presidents. Um along with the British Society of abortion care providers, we've written to all medical schools earlier this year, um reiterated the importance of comprehensive abortion education and recommended at least six hours of teaching on both the legal and ethical aspects, but also the clinical aspects and to focus on the clinical aspects because we're teaching future healthcare providers who will undoubtedly come across many people who are, who want or are considering or are having an abortion. Um and then signposting to the resources and support that they need to teach those. And we have a sharing uh practice meeting early next year and we, we, we will be inviting every medical school to attend that. Um And after that, we will then strategize for the next couple of years. Um and see how, whether medical schools have improved their teaching uh and how much teaching they're actually doing compared to the survey we did uh about three years ago. Ok. So there, so there are moves afoot to improve uh teaching at medical schools throughout the UK. And the curriculum champions project, the doctors choice curriculum champion project has had success in about 16 medical schools already. So we've improved teaching, not quite got to that six hours in most of them, but we have at least improved teaching in 16 medical schools. Ok. There are also moves afoot to improve abortion education in nursing and midwifery schools. So abortion talk, which is a charity that was set up to destigmatize abortion is working with a group of nurses and midwives um to try and get um comprehensive teaching in every single nursing and midwifery school in, in the country. Ok. So any questions about that before I move on to abortion stigma in people who have abortions and what we can do as healthcare providers to counteract this. If anyone has any questions, you can put them in the chat or we can invite you onto the stage if you, if you'd rather. And at the end, I'll be inviting anyone who is interested in improving um abortion education at their local medical school to get in touch with me. So I've put my email address at the end of the, at the end of the slide set. Oh, ok. So let, let's talk about abortion stigma and people who have abortions then. So the feeling of being stigmatized or even the fear of being stigmatized um can prevent people from talking about their abortion. Uh And it's ii, it's really um marked when you are an abortion provider. How many people you see, don't tell anyone about their abortion, not a family member, not a friend, not a partner. If they have one, they do it by themselves and they keep it to themselves. And that's because of abortion stigma. Abortion stigma can also make people feel justified to be judgmental of people who have or even to provide uh a um And so this secrecy and silence that people feel around their abortions can lead to isolation, increased feelings of guilt. Um and shame. Um And I'm gonna play a clip. Uh I'm gonna play an audio clip uh sooner from someone who was 18 and was just about to go to medical school who had an abortion. Um And she will explain how she felt about this even though as she says, the abortion was very straightforward, the guilt and the shame she put for years afterwards. Um was quite upsetting. Um So what can we do? So we're healthcare providers, what can we do about this? How can we um help in terms of reducing abortion related stigma? So we can talk about abortions in general, we can talk about abortions as normal health care and that really helps. So, um abortion is not really a dinnertime conversation in most circles. Um But when you do, if you do find an opportunity to talk about it, just go ahead and talk about it as if it is and it is normal health care. So that's a really easy way we can all do to um to counteract abortion stigma. But in terms of our role as healthcare professionals, we can actively dig destigmatize abortions with patients who want or are considering or are having uh an abortion. And that's what I'm gonna focus on now. So we're moving into the second um section of the talk on, on, on actively counteracting abortion stigma through respectful care. OK? But I want to start off by um asking you to um imagine you're pregnant and that you don't want to be and acknowledge that there may well be people that probably are people on the call. This has actually happened to, there may also be people on the call who have no reproductive um capacity. So that's going to be a bigger leap of, of imagination than some people. But please try and imagine this. So you're pregnant. Um You don't want to be and you tell a close brand. OK? Now I want you to think and I want you to write some suggestions in the chat, please. Um How you would want that close friend to react? OK? What specific things might you want them to say? And really what specific things do you not want them to say? OK, so have a think about that and then just write some suggestions in the in the chat. I'll give you a few minutes to do that. So we've got lots of ideas around. I'm just coming through now. Ok. So thank you. So Charlotte says to be supportive of my choices, not judgmental or rude, I think. Yeah, that's top of the list. So you don't want anyone to be judgmental. I'm glad you could tell me, let me know if I can do anything to support you. So offering support. Excellent. How can I help you? Um If I can do anything? Support. Thank you. Same there. Thank you. Yeah. Ok. Right. So we'd like them to ask how we feel about the pregnancy result as opposed to an immediate reaction of excitement. So it's really important not to presume. Yeah, if you tell someone you're pregnant, uh you don't want them to presume that you're happy about it or excited. That's really important. Thank you. Um Yep. Support any decision I make and offer help if they could. Excellent. No judgment. Great. Ok. Be supportive. Wouldn't want any opinions on my decision. That's a, that's a really good point. Yeah. So it's your decision and you want them to respect it, respected. So, non judgmental. Um uh all about it openly if I wanted to. Not Yeah, so not expressing their opinions on your situation. Fantastic. Ok. Is there anything you wouldn't want them to say apart from congratulations obviously or be excited? Uh, and you've said, don't question your decision and that's kind of what I'm getting at, don't question my decision and that can come across, er, if you say something like, why do you want an abortion? You know, so when you've explored their, you know, how they're feeling, you've not made any Presumptions um to not say something like, well, why do you want an abortion cos that can come across uh as being judgmental? Ok. Um And so these are the things that I put, I actively listen and, and support the person be kind warm and nonjudgmental. Um And that you can convey that by smiling at people and making eye contact with them. Don't repeatedly ask if they're sure about their decision. This is something that that's uh come up in, in research that people say in terms of healthcare providers. Um and then avoid assumptions and stigmatizing language. OK? But um this including, of course, asking people how you can, how you can help them and support them. Ok. So this is if your friend, if you told a friend. Ok. Now, is this any different for us as healthcare providers when our patients tell us they, they're pregnant and they don't want to be. So, should we be doing all of this with our patients as well? Ok. And while you ponder that um I would like to now play the, the audio clip of the 18 year old who had an abortion before she went to medical school. So I'm gonna put myself on mute. Um And Um I think Alice or Millie is going to play it as you listen to this story, think about what the healthcare professionals she saw could have done to improve her experience. So she felt terribly stigmatized by this experience. So think about what the healthcare professionals could have done. OK, I'll just play it now. Good. So I can't hear anything. Mm um apologies everyone. Um II was playing it. I could hear it. You couldn't hear it through. No. Mm. Is that what you did previously? Just played the audio clip out loud? Yeah. And I could hear it then when it was played. Ok, let me try and play it out on my phone instead of the computer. That might be the problem. Ok. I, I've just heard the, I've just seen the other, um, addition to the chat and, yeah, absolutely. Things like you might not get pregnant again. So that's just misinformation. This might be your only chance again. That's scaremongering. Um, so you really don't want anyone to say that. And it's exactly the same if you're a healthcare provider, you know, and what research shows is that these are the things that some people, um, come across, uh, when they go to the general, their general practice or they see a GP or a practice nurse. These are the things that people do say. Ok, I'll put it out. No, if you can't hear it this time. Ok. I was 18 years old. When I found out I was pregnant four weeks before a condom had split and I'd taken oral emergency contraception the following morning. But it didn't work as I was leaving the sexual health clinic. I was told to come back if I hadn't had a period in four weeks, just to be sure I left feeling like there was nothing at all to worry about. I went back to the sexual health clinic four weeks later, but wasn't at all concerned. I was taken upstairs by a nurse who was friendly enough but not warm. I explained why I was there and she took my urine sample. She also seemed to think there wasn't any real risk of me being pregnant, which made it all the more devastating when she walked back into the room, stony faced. A few minutes later, her face told me that the pregnancy test was positive and it felt like the world had ended. I felt like the most awful person and that it served me right? Like I was being punished for having that one night stand. This was made worse by the nurse not trying to comfort me in any way. She asked me what I wanted to do and I knew immediately that I didn't want to continue the pregnancy. I had just been accepted into my dream university to study medicine. I wasn't ready to have a child. I didn't even like the person I got pregnant with. She referred me to the nearest abortion clinic. She advised me to tell a parent as I would need someone to take me to and from appointments. And the thought of telling my parents just made me feel 10 times worse. I was certain that they'd be so disappointed and feel I let them down. When I got home, I called my mum into my room. I started crying but couldn't get my words out after what felt like forever. I managed to squeak out that I was pregnant. Mum looked so relieved and said she thought I'd done something bad, like run someone over. But that this we could handle the first question. She asked, what do you want to do? I explained, I didn't want to continue the pregnancy and she said she would support me 100%. The wait between finding out I was pregnant and going to the abortion clinic was probably the hardest time in my life. Despite all the support I had from family and friends, the societal stigma, the feeling that the whole world is judging you seeps in and overwhelms. You making you doubt yourself. Finally, five long days later, I was driven by my mum to the clinic. The first thing I noticed was that the ultrasound screen was facing me. It felt like in films when smiling people are showing the wobbly figure of their wanted pregnancy. And this made me feel worse. I tried not to look back to the first consulting room where I was repeatedly asked if I was certain about my decision. I don't think it was done with any negative intentions, but it made me feel like the doctor thought I was making the wrong decision, which imparted judgment once I had continually stated that yes, I wanted to have an abortion and no, I wasn't having second thoughts. We discussed what sort of abortion I would want. I decided to have a medical abortion. I was roughly six weeks pregnant and was sent home to come back. Two days later for the first part of my abortion with leaflets and a guidance booklet. Once I had returned and taken my Mifepristone tablet, I vividly remember feeling that I had finally been able to enact the decision I had made over a week ago. It was a positive feeling and I left the abortion clinic feeling much better than when I had arrived to this day. I have not regretted my abortion at all. Two days later, we took the miSOPROStol at the clinic. I was told to get home as soon as possible to try and avoid passing the pregnancy in the car on the way home. This was my last interaction with any healthcare professional. And although they had all been non judgmental, I hadn't felt any particular warmth or support from them. Either the repeated questioning regarding my decision was pretty universal and made me feel like they thought I was doing the wrong thing. I just needed a doctor to say that I wasn't alone, that I wasn't the only one that abortion is really common. And that if I'm certain of my decision, it's just another part of reproductive health care in the eight years since my abortion, I have slowly told a few more people, but I still find it hard. This is a testament to how much stigma is still around. If I had had a knee replacement eight years ago, I wouldn't struggle to tell people about it and it wouldn't carry any of the emotional weight that an abortion does despite a brilliant support system, certainty about my decision and the ability to access safe and free abortion care. I still felt completely overwhelmed by the surrounding stigma. I can only imagine how much more difficult abortion access is for those who don't have that support system or live in a country where abortion is less readily available. That's the end of the clip. Thank you. Um So just have a think, what did she say? So the her abortion was quite straightforward. Um She had the support of friends and family, but she felt terribly stigmatized uh about it and she said she felt alone and she mentioned a few things that healthcare providers could have done. Um And so she said, what she said is, yeah, they were non judgmental but they weren't warm. Um And that's why as a healthcare provider, when you see people, you really need to convey the fact right from the start of the consultation that you are a warm and kind and nonjudgmental um person. She was asked repeatedly whether she's sure about the decision. So um we really shouldn't do that. It is important to, to check the people are sure. But 11 healthcare provider can do it once and document, document it and nobody needs to repeat that. And then she said, she wished somebody had said how common uh abortion is because she felt alone. And that's something that we can really easily do in consultations is to say that um uh abortion is really common. Um So adding those to the things that we've already talked about. Uh uh there are many things we can, we can do um during our consultations to actively uh counteract abortion stigma and I've called this respectful care. OK? And in terms of how, how common abortion is, it really, it takes literally 10 seconds to say that. One in three women, I don't know whether you know this, but one in three women have an abortion, you're not alone. This is, this is routine health care as far as we're concerned. And when you say that to people, you see the sort of relief in their, in their face when you s when you say it. Um and then also encouraging people to talk to someone they trust and not keep this a secret. And then if they don't have anyone and some people do not have anyone. Um Then they can be signposted and encouraged to talk to a uh to talk to a counselor because what we don't want is people keeping this a secret which reinforces the stigma and, and the shame. OK. So these are the things that we can do to people. Um I'm not, I'm not gonna spend a bit of time on this giving clear accurate information, including how common a abortion is. And then I'm gonna finish off the presentation by talking about contraception and uh and stigmatizing language. OK? I am going to attempt now to do something on meter. So if you could log in on your uh phones or, or um laptops to ment.com um and use the code 82073659. I'm going to go through a few key stats around abortion that can be used to destigmatize abortion in consultations. They're really handy, you know. So and so you know what you're talking uh about as well. So I'll just give you a minute to log into ment and put in the code and I can't switch screens. So I'm gonna try and do it on my phone. So II hope this works. So you should see a slide that says what percentage and I'm now going to move it to the first question. So, and I'm gon I've broken this down into 25%. 33 50 65 and 90%. So all percentage of pregnancies in this country are unplanned. Ok, so you just have a have a punch. Oh, so I can see a lot of you here do not have faith in people using contraception or stopping an unwanted pregnancy, which is interesting. Ok, thank you. Thank you for that. So actually um it it is around 50%. So we're better at at at stopping unplanned pregnancies than you thought. Which is good. So that's the, the second there. So you so, right, just under 50% of pregnancies in, in this country are unplanned. Ok. So what percentage of pregnancies in this country end in abortion? Do you think if 50% are unplanned? What percentage end in, in abortion? Yeah, some people here think that planned pregnancies end in abortion and undoubtedly some do. Yeah. So yeah, most people have roughly got it. So it's actually 25% of all pregnancies end in abortion, but it's a third of births that are either unplanned or people feel ambivalent about. So, for those of you who do antenatal clinics that's really important to bear in mind is you should never say congratulations to someone who's pregnant before, you know how they feel and you should still explore people's feelings around pregnancy um in antenatal settings and certainly in general practice gum and, and srh settings. Ok. So that's a lot of pregnancies that end in abortion a quarter in total and a third of all births uh are unplanned. Ok. So next question, um what percent of individuals state the financial factors had an impact on their decision to end a pregnancy. And this, you know, being someone who's provided abortions for years, this is really fascinating because it goes up when tories are in government and then once the labor party have had time to, to to bed in their policy, it actually goes down. Um So, yeah, it's, it's in a recent um British pregnancy advisory survey, it was a 57% of 1300 respondents said that that financial factors were had played an important part in their decision to end a pregnancy. And in individuals in the most deprived areas of the country are twice as likely to have an abortion than those living in the least deprived areas. And this is really sad because lots of these individuals would continue the pregnancy if they could um afford it. Ok. Next question, what percentage of individuals having an abortion have had one or more previous abortions? And this is a really key fact to, to convey to people who are, are having a second or third uh abortion because we generally speak about abortion in the singular. And that can be stigmatizing to people who've had more than one abortion. OK. So the majority think 25% thank you is actually 41%. So again, just under 50% of uh of people in the UK have had more than one abortion. Ok. Um and yeah, I'll explain how to use that in a, in a few minutes. So what percentage of individuals having an abortion already have Children? Yeah. So the, so the people, the common myth is that the people who have abortions are in their early twenties, they're Footloose and fancy free. They're not thinking about contraception. Um and that's just not true. Ok. That's just not true. Ok, so this is a really good spread of opinion on this. Thank you. And it's actually over 50%. There's nothing like having one child or two Children or three Children to help you to understand, uh, your, your feelings about another child. Ok. So, yeah, over 50% of people having abortions in the UK have already, uh, have one or more Children. Ok. And, uh, the last question and I'm gonna skip those, uh, what percentage of abortions in the UK are carried out at less than 10 weeks of pregnancy? Uh, good range of opinion on this as well. So we're buying between 66 and 90%. Um, it actually is nearly 90%. Ok. So in 2022 which is the last, um, set of data we have from the department of health, 88% of abortions carried out under 10 weeks, uh, and this has increased year on year. It shot up in, during COVID, um, when, uh, well, before that. So you can see 77% in 2010 82% in 2019. And then in 2020 it shot up to nearly 90%. Ok. So that, that's been increasing year on year actually for, for o over 10 years. But now we're up to 90%. So the majority of people in this country um use pills to, to end their pregnancy um under 10 weeks. Ok. So that's the majority of abortions. However, and this th th th this graph here is experienced globally. So, whilst the majority of people who access abortion do so in the first trimester across the world where abortion is legally available, there will always be a small number of people who access and need abortions later on in pregnancy. So after 12 weeks. Ok. And, and these are the people who are most stigmatized by abortion. And I think it's important to understand why people have abortions later in pregnancy because it's not because they can't be bothered to access an abortion in early pregnancy. Ok. There are very specific reasons why people uh present for an abortion in the second trimester or even the third. So, would you like to write in the chart some reasons why you think someone might present uh for an abortion later than 12 weeks? And I identified six specific reasons here. Yeah. Great. Yep, health complications, finding out later denial. And that's more common in young people. Yeah. Change in circumstances. Very good. So, domestic violence is a common reason. So, fetal anomaly, that's a common reason. They, they might not have made a decision yet and they find it really difficult to make a decision. Some people, small, um, minority people, but still significant, just don't know what's best for them, you know. Um, and certainly if they have a change in circumstances they might have started off with a, with a wanted pregnancy and because of the circumstance change, their partners gone off with their best friend or, or they've developed a, a serious medical condition. Um The situation changing has made them change their mind. Ok. Um Yeah, irregular cycles. They don't find out until 20 weeks. Um They might be on the pop, the progesterone only pill, they don't have periods on the pill and then they notice that their abdomen is a bit bigger than usual. Um And they're 20 weeks uh pregnant and we, we, we, we see, we see that in clinic. Um it's harm. So we're talking probably uh accident, domestic uh abuse. Yes. Change of circumstances. Great in including financial circumstances. So you've lost your home, you know, you, you've, you've, you've, you've broken up with your partner. Indeed. Um coercion from, from partner. Yep. So, uh that, that is a, a reason why or, I mean, I say coercion, it might not even be coercion. So, so I saw someone last year who got to 23 weeks because she desperately wanted to continue the pregnancy and her partner desperately did not want to, to continue the pregnancy. And ultimately, he said I'm going to leave you if you continue the pregnancy. Um, and she got to 20 th three weeks before she made up her mind. So these are normally, yep, then they're pregnant. Yep. Unable to access services earlier on in the pregnancy. So, yeah, people who have barriers to accessing service. So they could, um for example, people with um say psychiatric conditions, aphia people trapped in um abusive relationships. So they, they can't get out of the house gui guilt. Actually, that, that's absolutely true. So that's a barrier. So people who just feel so bad about wanting to have an abortion that they just delay or they deny their pregnancy. And I said, including young people, I think you've got them all. Absolutely. Um So, so these are not people who are taking this decision lightly. There are really significant reasons why and you've identified all of them so well done. Um And I think that's important uh when you're talking to other people about abortions because people find it very difficult to understand why are they having an abortion at 20 weeks? Um And for me, 100% of the time, it's because of one of these reasons. Ok. So you have to think what, what's the significance of all these, uh this data for you as a healthcare provider and that is you can use it. So first of all, what it shows is that abortion care is important. It's necessary, it's normal and ordinary people have abortions. Um But the info can also be used to destigmatize abortions. So the, the first um bullet point there is one I've already said, which is, you can say to people, one in three women in the UK have an abortion and then if it's the person's second or third abortion or fourth, you can say, and many, many people have more than one abortion cos that's true. You know, many people do uh if someone's struggling because they've already got kids and you know, they're struggling to make to, to come to terms with it. You can say, well, look over 50% of the people having an abortion already have kids. This is something that people with kids, it's is a very common thing to do. Um And then the last one is like, not being sure about whether to end or continue the pregnancy is a common reason people have an abortion after the first three months of pregnancy because people feel terribly guilty about not being able to make their, their mind up. So you can see the, these stats um help you to, to provide uh evidence based um data for people that, that, that can help to destigmatize uh abortion and it, and it, it really works. Ok. And lastly, bringing up contraception and avoiding assumptions as stigmatizing language. So, um some people think that it is inherently judgmental to bring up contraception in a consultation about abortion and people do not want to do it. I strongly disagree with that. I think it's a really um constructive thing to do and people are generally grateful as long as you bring it up in a sensitive way. So what is a sensitive way to bring up contraception when you are talking to someone about abortion? And there are, there are some rules of thumb here. Um And in fact, I spoke to uh a colleague today who said that they um they lost a patient uh when they brought up contraception early on in an abortion consultation, they could see she wasn't with them anymore. And so that's one of the rules of thumb is you never bring this up at the start of a consultation. You always bring it up right at the end of a consultation when you have either if, if you're in general practice or gum or srh, you've referred that patient for an abortion and then you can bring this up at the end of the consultation, you should always avoid conveying any urgency or using words like we need to sort this out. Um That is stigmatizing and comes across as judgmental. Um But you can present it as something that you can help this person with if needed. So um yes, and always avoid Presumptions about patients need for contraception. So by asking permission to discuss it and by never putting pressure on people to accept the most effective or or any other methods. Uh so you don't, you know, you don't pressurize people into having an implant or a coil just because they um have an unwanted pregnancy. So these are some words that you can use when, when you're talking to people who uh in an abortion consultation, wherever it is about contraception. So, for example, we have access to many different methods of contraception here, we can talk about that. Now if you like. So it's really important to give um people um to give them the chance to say yes or no to get permission to talk about contraception. Um We offer a conversation about contraception. Is that something you'd like to do now? You know, so no pressure at all, right, at the end of the consultation. Um and if you present contraception like that, the, the majority of people really want to talk about it uh or tell you if they don't need it. OK. So that's contraception. Um and lastly stigmatizing language, avoiding Presumptions and stigmatizing language. So, first of all, when you're speaking to someone about abortion, uh I'm sure none of you on this call would ever say to someone. Do you have a boyfriend or are you married or what does your husband think you would never do that? It's really easy if you think about it to, um, to be open in and not make any Presumptions about relationship status or gender of, of, of a partner if someone has a partner, so you can open up conversations like this. Are you in a sexual relationship at the moment? Is this the person you got pregnant with? Do they know about the pregnancy? So you're not making any Presumptions there that this person has a partner because many people do not have a partner when they're pregnant. Um er, and er, that even if they do have a partner, they might be pregnant with uh got pregnant with someone else. Um And then you, this, this, do they know about the pregnancy then leads into a conversation about um how the partner feels about the pregnancy and whether they're supportive. Um and if they do have a partner and they haven't told uh them, then that leads to more questions, questions in terms of safeguarding issues, cos sometimes that's a red flag when someone won't tell their partner, that's a, a red flag in terms of safeguarding issues. Ok. So that's um avoiding Presumptions about uh relationships and gender of partners. Um Now, in terms of stigmatizing language itself. So this, this is uh a consultation that an ex UCL medical student had in uh in one of our local um emergency departments. Summary cars had IUD in pregnant. Uh the patient was with her partner, the um fy two, wanted the consultant, the consultant to scan the patient because that she had a coil in. So she knew that that increased her ectopic pregnancy list. So she just wanted to check the pregnancy was in the uterus. And when the consultant came in, this is what she said. She said hello, mummy. Um we won't be looking at baby in any detail. The specialist team will explain it all to mummy when they do the detailed baby scan. Now, I hope most of your reaction is like uh cos that is nauseating and it is stigmatizing as well. Um And the, the F I two said that um when the consultant said that the faces of both of the patient and their partner dropped, um you know, and they were really upset uh uh about, about this. I mean, I find using the term mummy anyway, completely patronizing and I would never do that, but in this context, it's totally unacceptable. So you don't need to say the word mother when you're talking about a person who's pregnant and potentially doesn't want to be or definitely doesn't want to be. You can use the word pregnant woman or pregnant person instead instead of saying baby, you can use uh pregnancy or fetus. And father is an interesting one and, and a lot of people fall f of this. So just as a pregnant person is not a mother, so the person they got pregnant with is not the father, they are the person you got pregnant with. So try and avoid terms like mother and father and baby when, when you see people who do not want to continue their pregnancy. Um and also repeat abortions sounds really like repeat offense, repeat offenses. So it's so easy to just say more than one abortion instead of repeat abortions, differentiating late abortions as well can be stigmatizing. And as I said, this group of people uh already uh are the most stigmatized people in terms of abortion care. So you can say the pregnancy duration uh which they are. So abortion at 18 weeks or abortion later in pregnancy or abortion after the three months, uh uh later than three months in pregnancy. Um and just don't call them late abortions and then this, this differentiation uh social terminations is something you'll probably hear, especially if you do go. Um and again, that just signals good and bad abortions. So, you know, if you're having it for medical term, uh medical reasons such as fetal anomaly or uh um complex medical issues, uh That's OK. And I've actually heard a midwife say that that's a valid reason for abortion implying that if you have an abortion because you don't want to be pregnant is not valid. OK. So, so be careful around your uh your language uh in, in social medical termination and then crisis pregnancy. Ok. Mm For most people, this is not a crisis, you know, it's an unwanted or unplanned or a pregnancy, the person is unable to continue for whatever reason. So whether the pregnancies experiences a crisis or a disaster or simply an unwanted accident, abortion is an option and a solution to that situation. Ok. So it is not a crisis for the majority of people. Um And lastly, uh I've said don't use these terms, but there are exceptions to, to this. Um And that is when the patient uh is facing uh uh a prenatal diagnosis, a fetal anomaly with a wanted pregnancy. And what research shows is that these patients actually want to be referred to as patients, uh sorry, parents. Um and they want their fetus, the pregnancy to be referred to as a baby and they would prefer not to use the word uh abortion. So the term used generally is termination of pregnancy for medical reasons. And you might see that TPF R and that's what these patients want. And so in this situation, it's very, it, it is different to those who, who are choosing to end a pregnancy because this is a wanted pregnancy. Um And this is often the worst thing that's ever happened to, to patients. So you want to be as sensitive as possible and take the lead from them um and pick up on their language preferences and how they wish to identify themselves and, and mirror that. But for the majority of people having abortions, uh do not want to be pregnant. Um And so, yeah, try and think about how to use a language that's not stigmatizing and it's 1956. And I think I've said enough, um apart from, to summarize, which is that, you know, we can all counteract abortion stigma no matter what we do by talking about it as uh normal healthcare by giving clear accurate information. Like using the data, I've told you by using nons stigmatizing language by improving healthcare teaching uh on abortion and by providing respectful care when we see people who have uh uh or are considering abortion. Um And then finally, if you're interested in improving abortion and teaching at your local medical school or you're interested in being trained to facilitate evidence based workshops on abortion in local schools. Please do get in touch with me and there's more information about those, both those projects on the Doctors For Choice UK website. OK. I do believe that might be my last s No, it's not if anyone's interested in in learning more about the clinical aspects of abortion. The RCO G has a, an online free er um program uh ele program on the clinical aspects of abortion. Um interactive. Uh You can download the slides, there's quizzes, there's videos. Um Yes. So, so for those who probably didn't get taught this at medical school, um then you can learn more about the clinical uh um aspects there. So if someone wants my email, I'll just go back if you just Google, my name. You'll, you'll get it, uh, an UCL and that's it. So, I think we've got like, what three minutes for questions? I Yeah, thank you so much for that. It's really, really interesting, really important. I'm sure everyone would agree. Um Would you like me to read the questions out? Yes, please. Um So the first one, is it preferable to directly ask a patient for preferred terminology or to gather an idea by listening to their language? Yeah. So if, if, if the pregnancy is unwanted, then you just stick to pregnant pregnant woman person you got pregnant with um and the fetus or the baby, it's the fetus or the pregnancy. If someone uses the word baby, II, then you have to make a call about whether you mirror their language or or not, but to start off with you use those what we call them value neutral terms. Um And, and nobody will be offended by, by that. Whereas if you use mother and baby, some people will be, will be upset by that. So you start off with those terms and then it, then you need to make a decision about mirroring patient's language. Um That's up to you. I I'll read the next one. Yeah. Thank you. Um Someone has asked, have you got any advice for being a medical student in a termination of pregnancy clinic? Yeah. So, so II think as far as I know UCL is the only medical school in the country that offers students placements in um, abortion clinics, but you can contact the independent provi so you can, first of all find out if you, you have an NHS abortion uh service in your, any of your local hospitals. Um, and if you, if you have, you can email the, the, the clinical lead directly because abortion providers are always happy to have people sitting in their services. Um, if you don't have a local, er, service, you can email BPAs British Pregnancy advisory service. They have, they provide, um, nearly half the abortions in the country and they have what they call a student externship where you can go and sit in, in clinics with them. So it's always possible to get, uh, to get a placement if you live in London, email me and I'll bring you along to Hoer. So we have, we have people in our clinics, um, pretty much constantly and I manage the ROTA so I can slot you in if there's a space, uh, if you live in London. But, yeah, be pass to the people to, to contact outside of your local area. Um, and then the final question probably, um, someone's asked, do we need to ask patients their reason for wanting an abortion in terms of legal paperwork? Yeah, that's really, really good question. No, you don't. Ok. So if you think about, um, I don't know whether you know the grounds for abortion but the, the most common ground is, is called clause C and that is that risk to the physical or mental health of the pregnant person would be greater, uh, if the pregnancy continued, er, compared to having an abortion. Now, if you look, if you look at the physical evidence that always pertains so it's always physically safer to have an abortion under 24 weeks. So that's a clause where you, you, that's um, the, the clause that the majority of people have an abortion for. Um, so it's always in this country because we provide safe abortions. It's always, um, less risky to have an abortion than it is to give birth. Always 100%. Um, and physically. Er, so that's physically, sorry, psychologically, it is always, uh, safer for people to have an abortion if that's what they want. Ok. So what, so you can justify clause C as long as, um, it's the, the abortion is what the person wants. So, legally, it's more, it's much more important to find out if this person's being coerced into an abortion, um, than it is to ask any reasons why we, we don't need to know why people want an abortion. We need to know that they're sure it's right for them and they're not being coerced into it legally. But I would argue morally as well. Ok. So, so, um, II have never asked a person ever why they want an abortion. I, II would explore feelings about, about, um about how they feel about their pregnancy. And I can talk about how I open up that if that would be useful, that conversation. But asking someone directly, why do you want an abortion? So imagine it was you who was pregnant? And someone said, why do you want an abortion? How judgmental that that comes across? And we, we don't need to know and I'm not interested. I just need to know that this is what the the person wants and that they're not being coerced into it. And then I can legally justify signing um what's called the HSA one form, which is the legal documentation that you need to certify that the person's met the grounds of the abortion act. Great. Thank you so much. Sorry, we don't have time for any more questions, but I really, really appreciate you being here and everyone um fill out the feedback form when you get a minute for your certificates. Um So thank you all. See you all on the next one. Thank you for coming and yeah, do please get in touch if you have any other questions? I'm really happy to, to answer. And uh yeah, if you, if you're, if you're interested in being a sort of abortion advocate and getting involved in projects, do email me and join doctors for choice is 5 lbs for students, 25 lbs for trainees cheap ish depending. Ok. Thanks. Thanks for inviting me. Thank you. Hi everyone. Bye.