Badges of Hope from HIVsport

It has been slightly difficult to find original links between sexual health and the current obsession with the Olympics. Pointing out the obvious – thousands of fit (very), young (mostly) and health (hopefully) bodies all together in a large compound in England’s green (one advantage of all that rain) and pleasant capital – seems somehow trite. Though some of us, who are less fit, might wonder how it is possible to enjoy ‘the only sport without medals’ after collapsing from the effort required to win gold, silver or bronze.

The London Olympic organisers provided 150,000 free condoms in dispensers for the 10,800 athletes at the Games, supplied by Durex which paid for the supply rights. Though it appears there may have been some intruders!

Some ‘olympic’ cities have had an increase in visitors and others a decrease – from reports here the impression is of less people in central London but that may only be commuters deciding to take leave or work from home to avoid the predicted (!) chaos who then found themselves drawn to their TVs as the hysteria and our tally of medals increased. A similar effect was seen in Weymouth where local sexual health teams struggled to find takers for their wares. Perhaps we will have another increase in the birth rate in 9 months time.

Kathy French - Olympic Ambassador on duty at Gatwick

We would like to applaud all those who took part and all those that helped to make it all run smoothly including our friend and colleague spotted wearing the lovely uniform moonlighting as an ambassador.

IVF twins: buy one get one free? (Mittal)  (published online 18 July)

The aim of IVF treatment should be to achieve a full-term singleton birth. This article explores the tensions that exist between IVF provision and the elective single embryo transfer (eSET) policy. The authors present a balanced contemporary review describing why twin pregnancies are undesirable yet may be a risk couples are willing to take. They go on to discuss the issues faced when considering strategies to reduce twin pregnancies and the tensions that exist with the eSET policy. Blanket eSET implementation appears not be a simple answer to avoid twin pregnancies. from Scott Wilkes, Associate Editor

1 in 7 couples in the UK have infertility problems

Most people growing up assume that, if and when they want children, they will be able to have them. They don’t expect to have problems with fertility, and assume that, if they do the wonders of modern fertility treatments, such as IVF and ICSI (intra-cytoplasmic sperm injection) will be able to solve them. However, in contrast to this, background figures point to 1 in 7 couples in the UK having fertility problems. This is according to new research published by the Health Experiences Research Group at the University of Oxford and available from healthtalkonline. The research team was founded by Ann McPherson (who sadly died in May 2011) and headed by Sue Ziebland and Louise Locock.

ESHRE 2012 Reports highlight fertility issues

UK still trails behind Europe in number of IVF cycles – yet it all started here.

As the number of babies worldwide born thanks to in vitro fertilisation (IVF) – breaks the 5 million barrier for the first time, figures show that the UK is still lagging behind many of its European neighbours in numbers of treatment cycles per year.  A report presented at ESHRE 2012 shows that the UK carries out 879 cycles/million inhabitants per year, which is significantly lower than many other countries including Denmark (2,726 cycles/million), Belgium (2,562 cycles/million) and Slovenia (1,840 cycles/million).

The pioneering treatment, which hit the headlines worldwide back in 1978 with the birth of Louise Brown in Oldham, has dramatically reduced the devastating burden of infertility, benefitting millions of couples both in the UK and worldwide.

However, for thousands of couples here, the dream of having a child of their own remains elusive: many are denied IVF because their Primary Care Trust or Health Board is reluctant to fund sufficient treatment. Around three quarters of all PCTs in England still don’t offer the 3 full cycles of IVF as recommended by the National Institute for Health and Clinical Excellence (NICE).

Leading national infertility charity supports new research on Single Embryo Transplant (SET)

Leading patient charity, Infertility Network UK (IN UK), has backed new research presented at the annual meeting of ESHRE, which shows that a policy of single embryo transfer reduces the risk of perinatal death in infants born after IVF and ICSI.

The report is based on analysis of more than 50,000 births recorded in the Australian and New Zealand Assisted Reproduction Technology Database from 2004-2008, where the introduction of  SET seems to have reduced overall perinatal mortality for IVF and ICSI babies.

Said Clare Lewis-Jones, Chief Executive of IN UK and Chair of Fertility Europe: “We welcome a move towards SET, and this report gives the medical profession more evidence to encourage patients to accept SET, which reduces the risks of multiple births to both mother and babies and gives the best possible outcome – one healthy baby.

“However, it must go hand in hand with full implementation of the NICE clinical guidelines which recommend up to three full cycles of treatment, including any frozen embryo transfers (FET). Other European countries which routinely offer five and six cycles of treatment have successfully implemented SET, and it is high time that patients in the UK are offered access to the level of treatment recommended by NICE nearly eight years ago!

“Many PCTs here still fall short of the recommendations and it is totally unacceptable and unethical for some PCTs to offer only one cycle of treatment and not to include FET for patients.”

Yesterday saw the release of the report by the All Party Parliamentary Group on SRH in the UK following an investigation into restrictions to access of contraceptive services in the UK. Their report: ‘ Healthy Women Healthy Lives’ shows evidence of women being actively restricted from services and methods, with the over 25s bearing the brunt.

The Inquiry also expressed grave concerns about the fragmentation of NHS contraceptive services which, they concluded, are lacking in the effective strategic forward planning needed for when local authorities take ownership in 2013. “Many of the restrictions we found during the Inquiry shocked us,” said Baroness Gould of Potternewton, Chair of the APPG.

Evidence was submitted from service users, sexual health clinicians, sexual health charities, a GP and the Shadow Public Health Minister. Following its Inquiry, the APPG has asked the Government to consider its report and publish a response.

In gathering evidence, the Inquiry uncovered restrictions imposed by primary care trusts on contraceptive services. These include:

• Stopping the over 25s from using community contraception clinics.
• Making referrals for long-acting reversible methods of contraception (LARCs) ‘GP only’ (so women cannot self-refer as is currently common practice).
• Running contraceptive services on a residents-only basis.
• Only allowing the over 25s to get oral contraception (i.e. the pill) from a GP (not a clinic).

Several areas such as Harringey, Walthamstow, Bristol and Derbyshire were singled out in the report for placing restrictions on services.

Full report at fpa.org

The Journal of Family Planning and Reproductive Health Care’s 2012 impact factor is 1.636, a massive 32% increase on last year. The IF reflects the number of citations a journal receives and is seen as a marker of its relative ‘importance’. It is calculated by dividing the number of times articles were cited in the previous 2 yrs by the number of citable items.

The table shows how this has changed over time and compared with others in the field.

Congratulations for their hard work are due to the Editor-in-Chief (Anne Szarewski), her team of editors and Editorial Manager (Janie Foote).

International Campaign for Women’s Right to Safe Abortion

The ICMA have launched a new international campaign for women’s right to safe abortion. Individuals and organisations are invited to join the campaign in advance of 28 May, the International Day of Action for Women’s Health. To read more and to register support go to https://www.surveymonkey.com/s/CHH62F5

UNFPA announces ‘Maternal Deaths Halved in 20 Years’.

The number of women dying of pregnancy and childbirth related complications has almost halved in 20 years, according to new estimates released by the World Health Organization (WHO), United Nations Children’s Fund (UNICEF), United Nations Population Fund (UNFPA) and the World Bank.

US regulators vote for approval of PrEP by large majority.

The US Food and Drug Administration (FDA) have taken a decisive step towards approving the use of the combination pill Truvada (tenofovir/FTC) as a prevention method for HIV-negative people. Read more at NAMaidsmap. GlobalData.com reported on 11th May – In a controversial decision on May 10, the FDA antiviral drugs advisory committee backed Gilead Sciences’ drug Truvada to prevent the transmission of HIV. The committee voted in favour of prophylactic Truvada in three populations: HIV-uninfected men who have sex with men (19-3), in HIV-uninfected partners in relationships with infected partners (19-2), and for individuals at risk of acquiring HIV through sexual activity (12-8).  Although awareness of HIV and AIDs has significantly increased throughout recent decades, the disease remains a global epidemic requiring better preventative strategies. Yet the possibility that on June 15 the FDA will approve Truvada for pre-exposure prophylaxis (PrEP) has provoked strong and divided opinions from infectious disease experts and activists. Read more at globaldata.com

Victories for Center for Reproductive Rights

Victory for Honduran Women

On May 17, 2012, the Center for Reproductive Rights held a demonstration on the steps of the Honduran Congress. Their mission: to stop the government from passing a bill that would have imprisoned women for using emergency contraception. Alejandra Cárdenas, Legal Adviser for Latin America and the Caribbean, had planned to personally hand-deliver 730,000 petitions to the Congress signed by activists in more than 80 countries in protest. In a surprise move, Juan Orlando Hernández, president of the Congress, declined to take the petitions—but not because he didn’t hear the massive outcry. In fact, Hernández said he no longer planned to bring the bill up for debate—and even proclaimed support for women’s self-determination. Read more:

Two Groundbreaking Victories in Oklahoma:

Medication Abortion Protected

Judge Donald Worthington permanently blocked a state ban on medical abortion when he ruled that the law was “so completely at odds” with standard medical practice that it “can serve no purpose other than to prevent women from obtaining abortions and to punish and discriminate against those women who do. Read more:

and Oklahoma Personhood defeated

With a unanimous decision by the Oklahoma Supreme Court, the Center for Reproductive Rights has won its legal challenge to strike down a ballot initiative that would have given every fertilized egg the full legal rights of a person. It is not acceptable, they ruled, to propose amendments to the state constitution that are ‘repugnant to the Constitution of the United States.’” If passed, the amendment not only would have outlawed abortion in all cases—including in cases of rape or incest, fetal anomalies, or risk to a woman’s life—but also would have banned many forms of birth control and seriously threatened fertility treatments such as IVF. Read more:

Distress of child war and sex abuse victims halved by new trauma intervention

A new psychological intervention has been shown to more than halve the trauma experienced by child victims of war, rape and sexual abuse. Researchers at Queen’s University Belfast pioneered the intervention in conjunction with the international NGO, World Vision as part of a wider programme to treat psychological distress in child victims of war and sexual violence in the Democratic Republic of Congo (DRC). Read more:

Lidegaard O, Nielson LH, Skovlund CW, Lokkegaard E. Venous thrombosis in users of non-oral hormonal contraception: follow-up study, Denmark 2001-10 BMJ 2012;344:e2990 doi: 10.1136/bmj.e2990 (Published 10 May 2012)

This is basically a companion paper to the one published last year in the BMJ, which concentrated on the Pill and was comprehensively criticised in the January issue of the Journal (Dinger & Shapiro 2012), to which readers are referred, as well as to the Rapid Responses posted on the BMJ website. This analysis, also from the Danish registry looks at the EVRA patch NuvaRing, Implanon and the levonorgestrel-releasing intra-uterine system (Mirena IUS). All the previous issues of confounding, lack of information regarding smoking, BMI, and family history, and not comparing like with like apply here.

It is important to compare new users with new users, as a well-established fact is that the risk of VTE is highest in the first 6 months of use of oestrogen-containing contraceptives. It is therefore important to look at the launch dates of contraceptive products. NuvaRing was launched in Denmark in late 2001 / early 2002, while the EVRA patch was launched there in September 2003. Meanwhile combined pills containing levonorgestrel have been in use since the 1970s, and those containing norgestimate since the mid 1980s. Thus, since the study period began in 2001, all users of NuvaRing and EVRA must have been new users, and so also more likely to be first time users / women with risk factors. Meanwhile, the users of the comparator COCs were more likely to be long term users and therefore at lower risk, since the high risk women in those groups will have been weeded out within the first 6 months of use – before the study began (ie attrition of susceptibles). The effect of duration of use is most clearly seen with NuvaRing in Table 4, where compared with non-users of hormonal contraceptives,  the relative risk becomes appreciably lower with increasing duration of use, declining from 8.36 for <1 year of use to 3.83 for use of 1 to 4 years. In addition, the numbers in each duration category are small, leading to random variability.  For the patch (6 exposed women) and the implant (5 women) not even the overall numbers are adequate.

With regard to the two progestogen only methods under study, not surprisingly neither was associated with a significantly increased risk of VTE – progestogen only methods have not been implicated in VTE risk, since this is related to oestrogen (Reid et al, 2010). Indeed, progestogen only methods are advised for women with risk factors for VTE (Blanco-Molina et al 2012). However, in the abstract, the authors misleadingly state that ‘the relative risk was increased in women who used subcutaneous implants’ and yet their relative risk of 1.4 had confidence intervals of 0.6 – 3.4, ie not even approaching statistical significance.  For the IUS, not only was the relative risk not increased, it was significantly decreased at 0.6 (95% CI 0.4 – 0.8). This has no biological plausibility and simply highlights the lack of credibility of the analysis.

Anne Szarewski, Editor-in-Chief, J Fam Plann Reprod Health Care

Diana Mansour, Consultant in Community Gynaecology and Reproductive Health Care, Head of Sexual Health Services, Newcastle Upon Tyne,

References

Dinger JC, Shapiro S. Combined oral contraceptives, venous thromboembolism, and the problem of interpreting large but incomplete datasets  J Fam Plann Reprod Health Care 2012;38:2–6. doi:10.1136/jfprhc-2011-100260

Reid RL, Westhoff C, Mansour D, de Vries C, Verhaeghe J, Boschitsch E,et al.   Oral Contraceptives and Venous Thromboembolism: Consensus Opinion from an International Workshop held in Berlin, Germany in December 2009  J Fam Plann Reprod Health Care 2010; 36(3): 117–122

Blanco-Molina MA, Lozano M, Cano A, Cristobal I, Pallardo LP, Lete I. Progestin-only contraception and venous thromboembolism Thrombosis Research 129 (2012) e257–e262

Melinda Gates’ New Crusade: Investing Billions in Women’s Health

Melinda Gates this week pledged billions of dollars to be spent on improving access to contraception. In her many travels she repeatedly met women who were unable to gain access to something which most of the rest of the world take for granted. In an interview with Newsweek she recounted stories from the women many of whom were unable, for example, to get repeat injections of Depo Provera. In July she is teaming up with the British government to cosponsor a summit of world leaders in London, to start raising the $4 billion the Foundation says it will cost to get 120 million more women access to contraceptives by 2020. And in a move that could be hugely significant for American women, the Foundation is pouring money into the long-neglected field of contraceptive research, seeking entirely new methods of birth control. Ultimately Gates hopes to galvanize a global movement. “When I started to realize that that needed to get done in family planning, I finally said, OK, I’m the person that’s going to do that,” she says. More from the Gates Foundation website.

Paper confirms EC IUD failure rate less than 1 per 1000

Authors of the first ever systematic review of all available data from the last 35 years argue that IUDs should be routinely offered and available to those requesting emergency contraception. They found that the failure rate was less than 1 per 1000 when they analysed data from 42 studies involving 7034 women using 8 different IUDs. They also found that 85% clinicians in one study never offered this as an option. In a press release this week one of the authors, Professor James Trussell, said:

“This is an extremely difficult problem to deal with, especially as in many countries women can just go to their local pharmacy to obtain the ‘morning after pill’, but virtually no women know to ask for an IUD and many family planning clinics and surgeries do not offer same-day insertion. Offering same-day insertion would remove a huge barrier to the greater use of IUDs.”

Online First – Postnatal contraceptive choices in HIV-positive women [Duncan et al.]

Gillian Robinson (Associate Editor) writes:

“This paper describes an exciting example of how an integrated contraception and sexual health service can work to provide holistic care for women. This clinic provides women living with HIV with prenatal, antenatal and postnatal care in a community setting. The paper is a retrospective case note review. Uptake of postnatal contraception was high yet more than 20% of women were not seen postnatally. The authors suggest that the reasons for this are explored to ensure all women with HIV receive contraception in the early postnatal period to prevent unwanted pregnancy.”

NAT calls for new health bodies to tackle late diagnosis of HIV

“Halve It”, a broad coalition of leading experts and advocates in HIV and AIDS, welcomes the renewed call by the National AIDs Trust (NAT) for the urgent prioritisation of HIV testing in its new ‘HIV testing action plan’ which provides vital strategic guidance to health bodies on tackling the serious issue of late HIV diagnosis in the UK.

FDA Approves first pill for Heavy Menstrual Bleeding (HMB)

Natazia is a combination oral contraceptive (COC) consisting of estradiol valerate and estradiol valerate/dienogest. The US Food and Drug Administration (FDA) first approved Natazia in May 2010 to prevent pregnancy. On March 14, 2012, the FDA also approved Natazia to treat heavy menstrual bleeding (HMB), making it the first and only OC indicated for this purpose. One interesting thing is that until now we have known Natazia, in the UK, as Qlaira and until now it has not been widely used. More details at Medscape.

UK women misdiagnosing genital infections

To mark National BV Day on 18th April a study found that one in four British women has misdiagnosed themselves on the internet. Researchers found Dr Google is now the first port of call for women with genuine health concerns who are almost twice as likely to check online before consulting a doctor or even talking to Mum. But searching their symptoms online and self-medicating has led a tenth of the country’s women to endure unpleasant side effects as a result of their misdiagnosis.

Morning after pill courier service launched

A new service allows women (living in London) to order emergency contraception on the internet, so it arrives within two hours, rather than having to see their GP to obtain the drugs. For £20, women can order the drug by filling out an online form through the internet medical practice DrEd.com. The forms, which ask users to confirm they are aged over 18, will be assessed by doctors before pills are dispatched by courier. Currently they only offer Levonelle®, which can also be purchased in advance and by buying 2 packets for £24.00 at a saving of 37%.

Pharmacists should provide oral contraceptive services, says NHS report

As reported by Jacqui Wise in the BMJ:
“A report from NHS South East London has recommended that trained community pharmacists provide oral contraceptive consultation services after a successful pilot scheme to widen access to contraception.  The part of the report that has received the most media coverage is a recommendation to “consider providing the service to women under 16 years where appropriate.” The report said that this may help reduce numbers of teenage pregnancies.”

Brook and fpa respond to proposal to introduce contraceptive pill in pharmacies

Responding to the proposal that the contraceptive pill should be available from pharmacies without a prescription to young people, including those under 16, the chief executives of Brook and FPA, Simon Blake and Julie Bentley said: “The majority of young people under 16 are not having sex, however we must ensure that those who are can access support and services when they need to. “Although Brook and FPA welcome proposals which could increase young people’s access to sexual health services and information, all the necessary safeguards must be in place to ensure young people can get the information and support they need. “This includes pharmacists having the appropriate clinical knowledge about contraception, being able to communicate effectively with young people, having the right type of environment including a confidential space, as well as the appropriate support and referral networks.”

Egg-Sharing in Fertility Treatment

Evaluating egg-sharing: new findings on old debates – as reported in BioNews
Egg-sharing refers to a scheme where a woman undergoing fertility treatment donates a portion of her eggs to an anonymously matched recipient in exchange for a reduction in treatment costs. As a very specific form of egg donation, egg-sharing has generated heated debate since its introduction in the UK in 1998. While proponents argue it provides a win-win solution, allowing two women to help each other conceive, critics talk of the potential ethical and psychological consequences. Until recently, there has been very little empirical data to inform these discussions. However, new research conducted by Gurtin and Golombok at the University of Cambridge Centre for Family Research, in collaboration with the London Women’s Clinic, hopes to redress this balance.

Men’s health expert presents to Members of European Parliament

A leading men’s health expert presented a report detailing the health challenges facing men across Europe MEPs and key European decision-makers at the European Parliament in Brussels.

Professor Alan White, Director of the Centre for Men’s Health at Leeds Metropolitan University was commissioned by the European Commission to produce a report which gives the first complete picture of the breadth of issues affecting men’s health across Europe.  Professor White brought together 36 leading researchers from 34 countries across Europe to undertake the research which highlights the state of men’s health in Europe as a serious public health concern. more info

Faculty Consultations

The CEU Guideline on “Barrier Methods-Contraception and STI prevention” is for consultation until 21st May. see FSRH website:

BASHH Mentoring Group is currently seeking new members:

BASHH would like new representatives to support coordination of mentors and mentees within North West regions and Wales. The successful candidates would also be involved in the activities that the Mentoring Group is currently taking forward nationally. Closing date for applications: 16^th May 2012.  see BASHH website for more details

And finally – we hear reports that Virgin Care have obtained ‘preferred bidder’ status in the tender to run West Sussex sexual health services .

new audit reveals shocking truth as 3.2m women face restrictions in access to contraceptives or services

A new audit of the commissioning of contraceptive and abortion services in England has revealed a stark picture of inequality in women’s healthcare, with a third of women of reproductive age unable to choose from the full range of contraceptives or services in their local area.

The audit was carried out by the Advisory Group on Contraception – a coalition of leading experts and advocacy groups interested in sexual and reproductive health – through Freedom of Information requests made to Primary Care Trusts (PCTs). The report of the audit findings, Sex, lives, and commissioning: An audit of the commissioning of contraceptive and abortion services in England demonstrates that:

As many as 3.2 million women of reproductive age (15-44) are living in areas where fully comprehensive contraceptive services, through community and/or primary care services, are not provided

• Those PCTs restricting access to contraceptives or contraceptive services had a higher abortion rate than the national average
• Over a quarter (28%) of PCTs responding to the audit did not have a strategy in place or under development to address unintended pregnancy and the need for abortion or repeat abortion

The audit also uncovered evidence of PCTs introducing access restrictions based on cost rather than choice or quality:

• NHS North Lancashire confirmed one method of contraception was not prescribed “due to lack of funding/training for staff”
• NHS Brighton and Hove confirmed that its “GP-led health centre will only prescribe Long Acting Reversible Contraceptive (LARC) methods to residents of Brighton and Hove.  Non-residents attending with a filled prescription for LARC will be provided with a fitting”
• NHS Haringey Teaching said that from the 1 October 2011 “women aged over 25 do not receive contraception pills from the local CaSH [Contraception and Sexual Health] Service; they receive this service from their GP”
• NHS Barnet stated that “In 2010 the PCT introduced a restriction on over 25’s accessing integrated services for generic contraceptive advice… Only patients within this age group who have complex needs can be seen by an integrated service”

Dr Connie Smith, Consultant in Sexual and Reproductive Healthcare, said:

“Contraception is a very personal issue.  What is right for one woman may not be right for another.  That is why the national NICE guidelines on contraception are built around the importance of choice. 

 “PCTs that are restricting choice are getting worse outcomes.  As a result of flouting national guidance, women are paying a big personal cost and the NHS is bearing a huge financial cost.  Unintended pregnancy costs the NHS more than £755 million every year.  For every £1 spent on contraception the NHS saves £12.50, so restricting access and choice is a complete false economy, harming women and the NHS.  Those PCTs with restrictions in place need to have an urgent rethink.”

Dr Anne Connolly, a GP with a special interest in sexual health, added:

“As a GP I know how important it is to get contraception right.  We must take a personal approach to meeting women’s needs and operating a blanket ban on some services or contraceptives goes completely against this. 

 “It is very concerning that so many PCTs have no strategy in place to address unintended pregnancy and that some are introducing restrictions on contraceptives or services.  The Department of Health should urgently publish a sexual health strategy showing how the needs of women of all ages can be met, alongside clear standards about the quality of service women have a right to expect.”

The AGC has made a series of recommendations for how sexual health and contraceptive services could be more effectively planned, commissioned and delivered.  These include:

• The Department of Health should publish its planned sexual health policy document without further delay and ensure that it sets out clearly the expectation for commissioners to commission comprehensive, open access services that reflect a life-course approach for people of all ages
• NICE should prioritise the development of the quality standard on contraceptive services
• Contraceptive services must be commissioned based on the principles of the NHS Constitution. Commissioners should remove any policies or contracts in place which limit an individual’s access to contraceptive services based on reasons of age or place of residence
• Commissioners should ensure that up-to-date strategies are in place to reduce unintended pregnancy, and the need for abortion and repeat abortions, and these strategies should focus on addressing the needs of women of all ages

This report from Jennie Bristow (editor, Abortion Review)

23 March 2012

UK: Health Secretary launches shock wave of inspections on abortion clinics

The Health Secretary, Andrew Lansley, yesterday announced to the UK media that the Care Quality Commission (CQC) would be carrying out a series of ‘unannounced inspections’ on abortion clinics throughout the UK to ensure that doctors are complying with the ‘spirit and the letter’ of the 1967 Abortion Act. Jennie Bristow reports.

This action, which Lansley confirmed in a statement to Parliament today, 23 March, is allegedly a response to concerns that doctors are ‘pre-signing’ the HSA1 abortion forms. ‘The process of pre-signing certificates where the doctor does not know who the woman is for whom that certificate may be used in relation to that abortion is in itself illegal. I am not prepared to tolerate a failure to respect the law,’ Lansley said in a press statement yesterday.

He further stated: ‘The CQC has agreed to undertake unannounced inspections to identify the scale of this problem and we will set up a special team comprising of all the necessary regulators… to look at how we stamp out bad practice in abortion clinics.’

The BBC gives a more measured explanation of the law regarding the HSA1 form. ‘Except in emergencies, the law says two doctors must certify an abortion. However, there is no requirement for them to have actually seen the woman – only that they should have seen and assessed the necessary clinical information about her case, which could have been taken by another doctor or nurse.’

Lansley’s concern is that this ‘second signature’ is being provided before the doctor has reviewed the relevant notes. This is not the practice of most abortion providers, including British Pregnancy Advisory Service (BPAS). However, launching a wave of CQC inspections on the basis of forms potentially being pre-signed in some other clinics is a strange and heavy-handed action, for three reasons.

First, the second doctor’s signature has been long understood to be a legal, rather than a clinical, safeguard; arising from attempts in the 1960s to pass a controversial new law in the form of the Abortion Act. As such, many politicians – including Lansley himself – have questioned whether it is necessary to retain this cumbersome and clinically irrelevant requirement in the 21st century.

As the BBC explains, ‘The requirement for two doctors’ signatures was criticised as long ago as 2007, when a report by MPs on the Commons science and technology committee recommended it be removed because of the potential for abortions to be unnecessarily delayed.’ And Andrew Lansley himself, during the debate about the abortion law that took place in 2008, said:

‘If a woman needs an abortion in terms sanctioned by the Abortion Act 1967, it must surely be better for it to be an early, medical abortion than a later, surgical one. I therefore hope that the House will consider whether the requirement for two doctors to consent to an abortion being performed, and the restrictions on nurses providing medical abortions, need to be maintained.’

So it is strange indeed that the Health Secretary, busily engaged as he is in controversial reforms of the entire health service, should now view strict adherence to the ‘two doctors’ requirement as a sudden issue of major clinical concern. His quote in yesterday’s press statement could not be more different from the temperate approach that he took four years ago. On 22 March 2012, Lansley argued:

‘I am shocked and appalled to learn that some clinics – which look after women in what are often difficult circumstances – may be allowing doctors to pre-sign abortion certificates. This is contrary to the spirit of the Abortion Act. The rules in the Abortion Act are there for a reason – to ensure there are safeguards for women before an abortion can be carried out.’

The second peculiarity of this shock wave of inspections is that the ‘evidence’ upon which they have been launched seems remarkably thin. It seems to have come out of police investigations launched on the back on the Daily Telegraph’s investigation into ‘sex selection’ abortions last month, which itself found little evidence that such abortions were carried out.

There may be more basis Lansley’s concerns than a flimsy newspaper investigation – but we do not know. And this is the third and most striking peculiarity of today’s Parliamentary statement: that the media were briefed about it before any of the clinics whose work it might concern.

Ann Furedi, chief executive of BPAS, said: ‘Abortion doctors provide an important service to women who are often in difficult circumstances. Their work is already intensely scrutinised, with clinics regularly inspected by the CQC.

‘Mr Lansley says he is shocked and appalled by the practices he has uncovered. BPAS is shocked and appalled that Mr Lansley has found it necessary to inform journalists of alleged breaches of the abortion law before he has informed those responsible for providing the services that have been investigated, and before the investigation is concluded.’