Abortion care is a key part of women’s health services. Nurses and midwives support people through this process in both NHS and independent settings. Here at the RCN, we recognise that not all who become pregnant identify as women, so this guidance is inclusive of gender-diverse individuals.

The term ‘termination of pregnancy’ is used interchangeably with ‘abortion’ and refers to induced abortion, not miscarriage.

Nurses must be well-informed, skilled and supported. Their role includes clinical care, safeguarding, counselling and service development. They must understand and work within the legal framework.

In England, Scotland and Wales, nurses cannot authorise abortions but can provide care under a doctor’s supervision. In Northern Ireland, nurses and midwives have more autonomy, including prescribing medication and performing procedures.

In England, Scotland and Wales, the Abortion Act 1967 (amended with the Human Fertilisation and Embryology Act 1990) sets out when abortion is legal. Two doctors must agree that one of the following applies:

• The pregnancy is under 24 weeks and continuing it poses a greater risk to the woman’s health.
• Ending the pregnancy prevents serious, lasting harm.
• Continuing the pregnancy risks the woman’s life.
• There’s a high chance the baby would be born with serious disabilities.

Abortions must be approved using a legal form (HSA1), except in emergencies. They must take place in approved settings, though early medical abortion (EMA) can now be done at home in most of the UK.

In Scotland, both EMA medications can be taken at home up to 11 weeks and six days. From 2023, mifepristone can be taken at home at any stage, if clinically appropriate.

In Wales, EMA at home is allowed up to 10 weeks.

In Northern Ireland , abortion is allowed:

• Up to 12 weeks on request, certified by one health professional.
• Between 12 and 24 weeks if continuing the pregnancy poses a greater risk, certified by two professionals.
• After 24 weeks, if the woman’s life or health is in danger, or the baby has a severe abnormality.

In Northern Ireland, all medical and surgical abortions must be carried out at a Health and Social Care (HSC) site or at premises registered for this purpose by the Department of Health.

Nurses and midwives in Northern Ireland can prescribe abortion medication and perform manual vacuum aspiration (MVA). This is not yet confirmed as legal for nurses elsewhere in the UK.

All abortions must be reported to the Chief Medical Officer. Nurses in England, Scotland and Wales cannot sign legal forms or prescribe abortion drugs, but can support care under a doctor’s responsibility.

Under Section 4 of the Abortion Act 1967, nurses and midwives in England, Scotland and Wales have the right to conscientiously object to participating directly in abortion procedures, except in emergencies where the woman’s life or health is at serious risk.

This means they can opt out of hands-on involvement but must still provide routine nursing care before and after the procedure. In Northern Ireland, this right is covered under separate legislation. Nurses who object must inform their employer early and should be supported to avoid conflict in care settings.

Nurses increasingly lead abortion services, especially with EMA and telemedicine. Their responsibilities may include:

• counselling
• STI screening and treatment
• ultrasound assessments
• contraception advice
• discharge and follow-up
• supporting vulnerable patients
• leading service development.

Advanced roles require training, supervision and legal understanding. Nurses should also have access to clinical supervision and leadership development.

Patients must give informed consent, understanding the procedure, risks, alternatives and their right to withdraw consent.

Young people under 16 can consent if deemed competent. Confidentiality must be respected, including for under-18s, unless there’s a safeguarding concern.

Abortion services should be easy to access, with options for direct referral and remote consultations. Most people have already made their decision, but some may need support.

The decision lies with the pregnant person. Health professionals must ensure it’s free from coercion and assess safeguarding risks.

There are two main types:

• Medical abortion: Uses medication. EMA is usually done before 10 weeks and can be done at home.
• Surgical abortion: Removes the pregnancy from the uterus. The method depends on gestation and may need cervical preparation.

Both are deemed safe, but earlier abortions carry fewer risks. Pain relief should always be offered.

Aftercare should support recovery and reduce risks. Patients should receive clear information, including:

• what to expect physically and emotionally
• when to seek help
• contraception options
• STI testing
• a 24-hour contact number.

Routine follow-up isn’t usually needed unless there are complications. EMA patients should take a pregnancy test two weeks after treatment.

Patients should be informed about disposal options, such as burial, cremation or incineration. Their wishes must be respected and documented. If no decision is made, remains are usually disposed of after 12 weeks.

Nurses must be alert to safeguarding risks, especially for under-18s and vulnerable patients. Risks include abuse, exploitation, trafficking, female genital mutilation (FGM) , forced marriage and honour-based violence.

Care must be inclusive and respectful. Services should be adapted for LGBTQI+ patients, people with disabilities and those with mental health needs. Professional interpreters should be used when needed.

Nurses and patients have the right to access and provide care without fear. Buffer zones around clinics are being introduced to protect against protests.

Unregulated pregnancy advice centres may give misleading information. Nurses should guide patients to regulated services.

The full PDF explores this topic in more detail. The publication may include case studies, images, tables, good practice checklists, glossaries and suggested questions to ask patients. You’ll also find a concise list of references and links to useful organisations and websites.