Fetal tissue donation, STI screening, and improving contraception

Abigail Fitzgibbon, BPAS press and public policy officer, reports on the recent Medical and Nursing Conference.

The BPAS Medical and Nursing Conference, which took place in London on Friday 12 December, brought together doctors and nurses from across London and the South of England for BPAS’ first multi-disciplinary training and research event. BPAS developed this approach to give clinical staff the opportunity to learn together, and to give both doctors and nurses the chance to hear the latest news and research in sexual and reproductive health.

Clinical updates on post-abortion ultrasound, Implanon insertion and removal, and pain medication, were followed by a number of presentations from experts in the field. Professor Naomi Pfeffer, Professor of Social and Historical Studies of Health at London Metropolitan University, discussed abortion, fetal tissue and medical research. Dr Martyn Walling, General Practitioner and Fellow of the Royal College of GPs and Fellow of the Faculty of Sexual and Reproductive Health, discussed Long Acting Reversible Contraceptives (LARCs). An expert panel discussed the relationship between abortion services and screening for HIV and Chlamydia.

Abortion and fetal tissue donation

Naomi Pfeffer raised issues around fetal tissue and the potential for tissue from aborted fetuses to be used in stem cell research.

Professor Pfeffer argued that women having an abortion should be approached to donate fetal material medical research. She also took the opportunity to outline the findings of small scale focus group research undertaken into the views of women who have had abortions about donating fetal tissue. Many began with the view that donation could be a positive thing to come out of their unintended pregnancy - however, concerns were quickly raised. One concern was that, as stated by the Polkinghorne guidelines, women are not allowed to know in detail what the tissue they donate would be used for. According to Pfeffer, some women felt that this would be important in their decision whether to donate, as they felt a ‘duty of care’ to the fetus. 

Guidance in this area was last updated when the Polkinghorne guidelines were published in 1989. The Department of Health recognised the need to update this guidance in 2004 but as yet there have been no moves to update it. Professor Pfeffer called for a full review, public discussion and regulatory guidance in order to address the concerns clinicians feel about asking women having an abortion about fetal tissue donation, and assist researchers who need such tissue in order to carry out medical research.

STI screening

Ruth Lowbury, Executive Director of the Medical Foundation for AIDS and Sexual Health (MedFASH) joined Dr Mary Macintosh, Director of the National Chlamydia Screening Programme, in arguing the case for abortion services increasing STI screening in clinics. Ms Lowbury focused on HIV testing and noted that because of the improvements made to anti-retroviral therapy, many people with HIV can have a very good prognosis. It is not the case, therefore, that specialist pre-test counselling is required before a healthcare professional can offer patient testing. According figures she quoted from London studies, there is a higher prevalence of HIV infection in women terminating their pregnancies compared with those giving birth. Since 1998, HIV testing has been universally recommended in antenatal care (resulting in a mother-to-child transmission rate of below 2%). MedFASH is arguing for an increase in HIV testing across wider healthcare settings, as 25% of people living with HIV are not aware of their infection and late diagnosis is the biggest factor in HIV-related morbidity and mortality.

Dr Macintosh explained that in order to reduce Chlamydia prevalence, 30-50% of the target population (15 – 24 year olds) need to be screened. Currently most Primary Care Trusts (PCTs) are a long way off reaching this target and inclusion of Chlamydia screening in abortion services could help address this deficit, as abortion services currently account for 3-4% of screening and see many women for the target age group for screening. 

Dr Simon Barton, Clinical Director of HIV/Sexual Health at the Chelsea and Westminster Hospital, closed the session by addressing various practical concerns that doctors and nurses may have about HIV and Chlamydia screening. The point was made by delegates that, as a non-profit organisation, BPAS is limited in what it can do with regard to screening as a PCT must be willing to fund patients for it. Many PCT contracts do not incorporate this agreement. Dr Barton suggested that one option would be to encourage PCTs who are reluctant to offer HIV testing by including it in agreements as standard, and if they are unwilling to fund this when commissioning services, for staff to flag it up with the Independent Advisory Group on Sexual Health and HIV.

LARCs

PCTs are blocking access to LARCs because of the cost implications of funding these methods of contraception, Dr Martyn Walling told the conference. LARCs are far more reliable than ‘traditional’ methods such as the contraceptive Pill, and are ultimately cost-saving. However, local health trusts are reluctant to give women choice in this area because of the higher initial cost. This is contrary to guidance from the National Institute of Clinical Excellence (NICE) and is contributing to the unplanned pregnancy rate in the UK, he argued. 

Dr Walling argued that GPs are not able to offer women the best chance to prevent unintended pregnancies because PCT funding rations the full choice of contraception, so women do not have the option of selecting the most suitable method for their lifestyle. However, he did note that the Department of Health’s additional investment into LARCs, announced in the summer of 2008, was a positive sign, and that the new funding would increase LARC use and improve the options available to GPs and therefore patients.

Dr Walling also reported on the development of a new LARC, the NuvaRing. This is a vaginal contraceptive ring that is a oral contraceptive pill in ring form and can last up to 35 days. Dr Walling noted that there was an issue in the first trial of NuvaRing with irregular bleeding: however the method is now better than the Pill in this area. He felt this method would be effective and popular once the benefits were ‘sold’ to women.

For more information about the Medical and Nursing Conference, see the BPAS press release, 12 December 2008