Abortion - Time to decriminalise?

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Under the back-drop of Mr Trump’s anti-abortion rhetoric and global onslaught on women’s reproductive rights, UK must reform it’s paternalistic and outdated abortion laws.

It may come as a surprise, that in modern day Britain abortion is still criminal act, punishable by life imprisonment. Under current english law, if a women brought abortion pills online and miscarried at home she is committing a criminal act and could be imprisoned. Under the 1967 abortion act, a women is exempt from prosecution if the procedure is carried out in a licensed premises under specific conditions; two doctors have to agree the pregnancy is greater risk than the abortion to the life or health of the mother, and she is under 24 week gestation. Many argue this law is paternalistic, out of date and not fit for purpose.

In March this year, Diane Johnson MP introduced 10 minute rule bill to decriminalise abortion, scrapping sections 58 and 59 of the Victorian Offences Against the Person Act 1861. This was supported by the Royal College of Midwives, BPAS and the British Medical Association. Dr Clare Gerada, former chair of the Royal College of GPs said: “Abortion is never an easy thing to do for any woman. But for abortion to be governed by criminal law rather than governed by healthcare regulation is nonsense”.

Opponents to decriminalisation argue it will remove safeguards needed to ensure the women’s safety. This is a false argument. Decriminalisation does not mean deregulation. Providers will continue to be regulated by the General Medical Council’s standards of good medical practice, including consent and confidentiality, like all other medical procedures. Other laws which apply to other aspects of care would continue to apply to abortion, for instance supplying abortion drugs without prescription would be an offence under the UK-wide Human Medicines Regulation 2012.

Others argue, that under current law women have access to abortion so there is no need for reform. However, abortion providers report that with 2 doctor requirement dictated by the law, it has become increasingly difficult to staff services and has led to clinic closures, making access more difficult and reducing options for women. Dr Draeger, a consultant in Lewisham, said that the current requirement for two doctors had forced the closure of the early medical abortion service, where she had worked, “Because of the way the law says that two people have to consent to a woman having an abortion, our service folded after a year because we didn’t have enough doctors. That means that the women in my borough, which is one of the most deprived in the country, have less access to termination”.

There are also fears that liberating abortion laws will lead to an increase in abortion rates. This is contrary to the evidence. Data from the World Health Organisation show that restrictive a

bortion laws do not reduce abortion rates; rather, the reduced access to contraception and safe abortion services leads to increased numbers of unintended pregnancies and, ultimately, more morbidity and deaths deaths from unsafe abortions.

In Northern Ireland, which did not pass the 1967 act, there are many stories of desperate women, who cannot afford to travel to England, buying unregulated pills online, or drinking bleach, with no support and in fear of prosecution. Last year a 21-year-old woman was given a suspended sentence after she pleaded guilty to procuring her own abortion by using a poison, and of supplying a poison with intent to procure a miscarriage, two offences under the 1867 legislation.

Globally the picture is bleak. The president of the United states, raised eye brows during his election campaign with his regressive statements; ‘women should be punished’ if they have an abortion was one of many. Since being e

lected, he has not failed to live up to his controversial rhetoric. He has pulled federal funding for Planned Parenthood; a charity that provides free or subsidised family planning services to people on low incomes. As federal funding contributes to 40% of the charity’s income, such a move would undoubtedly result in restrictions to the services it can provide and clinic closures, denying those in most need access contraception.

Sadly, the policies of this new administration has ramifications across the developing world. On his first day in office, Trump reinstated and expanded the “global gag” rule. This means that any foreign health agency that advises, performs, or advocates for abortions will lose their US funding (even if the abortions are not being directly financed by US government money). Marie Stopes, an international provider of reproductive health services, estimates that without alternative funding, the impact of this law on their services could result in 2.1 million unsafe abortions and over 20 000 maternal deaths during Trump’s first term as president.

Free, accessible, safe and legal abortion is a human right. Decriminalisation will bring UK in line with Canada and other European countries. It will also send a strong message, when globally women’s reproductive rights are under grave threat, that in Britain; we respect women, her autonomy over her body and future, and her right to choose.

Sonia Adesara

sonia adescara

Co-chair young Medical Women International Association

Chair Young Fabians Health Network

International Women's Day 2017 - Be Bold For Change

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internationalwomensday landscape

International Women’s Day is especially significant for MWF this year as we celebrate our centenary in 2017. Today and every day we are grateful for the hard work of the pioneering medical women who came before us and as an organisation we strive to move forward, pushing for equality and fairness for women in medicine.

The theme of this year’s International Women’s Day is ‘Be Bold For Change’, a principle that MWF was founded upon. In 1917, 190 women coming together at a time when it was difficult to have your voice heard as a woman, let alone as a woman in medicine, is nothing short of inspiring.

Today we celebrate medical women and their past achievements and we look forward to a bright future. We encourage you to nominate a friend or colleague or put yourself forward for our 100th Anniversary Prize. We are awarding three prizes, to a senior established doctor, an established doctor and an up and coming doctor to celebrate the diversity of our membership and shout about your achievements. Click here to download the nomination form.

Starting on the Shop Floor - Junior Doctor Blog

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karishma shah

Dr Karishma Shah

Academic Foundation Doctor in Orthopaedics
Oxford University Clinical Academic Graduate School
Oxford University Hospital


The Weekend Before:

The weekend before starting as an FY1 is always a flurry of emotions…

Daunting, exciting, anxiety-provoking.

It is the 'someday' you were always thinking of, and then suddenly that 'someday' is today. Your parents are probably still bubbling from the excitement of your graduation the weekend before, but you, you are just realising that gone with that ceremony is the sheepish comfort of saying “I’m just the Medical Student”, “I’ll ask the doctor”, “I think I’ll take this day off for study”!

And then, in the blink of an eye, you’re moving house and unpacking suitcases. And you’re trying to find that pretty dress to attend the Doctors’ Mess Ball- with people you've never met before. It feels like Freshers’ again!

As you begin the Shadowing Period:

This is the time the paperwork gets laid on really thick. You need to constantly check your emails because, ready or not (!), there's a landslide of emails coming your way!

Emails on contracts, on working time directives, on parking permits, on salary forms, on how to get IDs and how to use the IT systems…
And a little email on the all-important Statutory & Mandatory training.

At this point, the days have turned into nights and the nights into days and they have all amalgamated into a blur.
But, over a coffee & catch up with your dear friends from medical school, you can regain some perspective. Remember to appreciate just how fortunate you are to be able to work for the NHS- It is one of the greatest institutions in the world, and this must be a tried and tested protocol after-all.

The Shadowing Period:

Recently, the NHS has required all foundation schools to provide a shadowing period for FY1s.
This is the jump-start to your first rotation that you will always be thankful for.
Some foundation schools use time for team-building outdoor activities and others use it to simulate on-calls. But for most, this is a time to be on the wards and gain hands-on experience from the current FY1.
Medical school may have equipped you with the knowledge and techniques, but this is about getting your hands deep and dirty- learning how to answer bleeps, how to request bloods and whether to use a paper or electronic system to prescribe drugs.

Day 1:

The build-up has come and gone and Day 1 is here. 'Black Wednesday' they call it.

But, especially at a time like this, is your first day working for the NHS going to be dark and bleak?

Absolutely not.

Are the stormy clouds of political unrest surrounding the NHS going to follow you for every moment?

Not a chance!

Is that whisper tempting you to become a Management Consultant going to consume you?

No, it will just fade into oblivion.

This is the day you begin taking care of your own patients. You will have to listen to their personal stories, suture their wounded skin, empathise with their most intimate fears. And you will do this as though it were second nature- and that is why you are the people this great NHS is built on the shoulders of. You will become part of a team with the most intelligent, compassionate, dedicated and resilient people.

And as the days and weeks go on you will see that now is the time to write your own journey and all-in-all it will be more than you ever wished 'someday' will be.

So, make sure you get lots of rest and get ready for the ride!


MWF is currently offering junior doctors the chance to win £200 with our Junior Doctor Creative Prize! Submit your entry on the theme of 'The face of a doctor today' and you could be in with a chance of winning the cash prize along with the opportunity to present your entry at our conference in November. 

The competition is open to all and you don't have to be a member to enter! 

Submit your entry (whether it be an essay, poem, photo etc) to This email address is being protected from spambots. You need JavaScript enabled to view it. 

Travel Broadens the Mind

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In March 2016 Dr Heidi Doughty was awarded the MWF Dorothy Ward International Travel Fund. Based in Birmingham, Heidi works as a part time Consultant in Transfusion Medicine and describes her professional passion as ‘Good Blood in Bad places’. She travelled to Bergen, Norway in August 2016 to research the use of whole blood in massive haemorrhage.

Why Bergen?

I chose to visit Bergen because the hospital based blood service there had recently introduced the provision of whole blood for the local Air Ambulance. The project is part of a larger programme of transfusion innovation due to the collaboration between Haukeland University Hospital, the pre-hospital community including the military, and the University. The visit gave me an opportunity to build on my own work as well as visit a transfusion system that is very different from the UK. I wanted to look at their transfusion support for haemorrhage and consider the implications of re-offering whole blood alongside component therapy in the UK. 

I was extremely fortunate to secure professional leave from NHS Blood and Transplant. However, Norway is relatively expensive. Two cups of coffee and a cookie in a café may cost over £20. So, I needed to carefully consider the living costs. I used a combination of special offers for the flight and my sponsor, Prof Tor Hervig, had secured well-priced student hostel accommodation near the hospital. It was to be a 10 m² room with: duvet but no bedding; wash basin but shared bathroom; and internet but no Wi-Fi. I needed to rethink my packing list. So I took essential eating utensils, Ethernet cable and radio. However, I confess that I arranged to borrow local hospital bedding. The room may have been small but the hostel gave me a room with a wonderful view and an introduction to the most hilarious group of international students.

bergen fish marketBergen fish market

Getting down to work

I recommend arriving before a weekend to orientate. I had been met at the airport by one of the female consultants, Torunn. Her kindness and support really made the difference. We spent the Friday on formalities, Saturday – baking at her home and on Monday I was ‘good to go’. The most important time in any new project is the first face to face meeting with the ‘boss’. It provides the reality check. Tor had been injured. Many staff were away for their summer holidays or getting ready for conferences. I have MS and although well at the moment, I get tired. However, we had Tor’s small research team including the computer genius, Joar, who immediately secured Wi-Fi connectivity for both my laptop and Smart Phone. This meant I could remotely access my work emails and documents. The Bergen team asked me to review the impact of their Acute Transfusion Package introduced in 2007. They had extracted 13 years of data but offered it to me for analysis to provide a new perspective and lead on publication.

I reviewed the data in the context of the international literature. This was really interesting as I was not familiar with the early Nordic papers and guidelines. They were really early adopters of the new paradigm of massive haemorrhage management. In the blood bank, I followed the journey of the ‘whole blood’ from the donor, through platelet sparing white cell filtration to quality control. Most of the procedures were written in Norwegian so I learnt to use Translation software. I was also introduced to their new Multiplate Analyser ® designed to analyse platelet function. During the second week I visited some of the areas dealing with massive haemorrhage including Emergency department, ITU and the Air Ambulance. The most novel activity for me was writing a travel blog for MWF. It was a really interesting combination of reflective note writing and capturing the moment.


Looking across the waterfront to the historic Bryggen area

Capture the moment

One of the things that have learned during my travels is to ‘capture the moment’. This includes collecting and dating evidence such as policy documents, procedures, your own notes and photographs. In addition, back-up all electronic records. I found it useful to summarise my initial thought and findings in a PowerPoint presentation for the project team. I also integrated some of the findings into my presentation on UK practice given to the whole Department. This generated a more dynamic exchange and ideas. An unexpected area of interest was my experience of transfusion support for the Olympics because they were preparing for a 2017 sporting events.

Travel not only broadens the mind, it enlarges your professional and personal networks. The travel fellowship has built upon my past knowledge and should inform future developments. It was only 2 and half weeks and I wish it had been longer. However, I am confident that I will continue to work with the Bergen team and revisit. This visit was designed for my benefit but I hope I added value for them as a mature practitioner from the UK. Such travel fellowships continue the strong tradition in Medicine of taking a European and global outlook. All of us, but especially our patients, benefit. I strongly recommend my colleagues to apply because to quote “You will travel to learn and return to inspire”.

air ambulance

Air ambulance coming into land

Dorothy Ward Travel Fund Winner - Travel Journal 2016

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In March 2016 Dr Heidi Doughty was awarded the MWF Dorothy Ward International Travel Fund. Based in Birmingham, Heidi works as a Consultant in Transfusion Medicine and is travelling to Bergen, Norway to research the use of whole blood in massive haemorrhage.  As she embarks on her trip, we follow her travel journal. 


Heidi26th July 2016 - Taking Transfusion Forward

On Friday 29th July, I leave Heathrow early in the morning to fly to Bergen on the Western Coast of Norway. Today though – I'm trying to do my packing supervised by my kitten Sophie and I'm really excited.

I'm traveling to Bergen to investigate the role of whole blood in massive haemorrhage. Massive haemorrhage or bleeding is a medical emergency and an immediate threat to life. Common causes of bleeding include childbirth, major surgery and gastrointestinal bleeding. My particular interest is the use of blood in trauma. During the last decade the management of massive bleeding has radically changed. The emphasis is to stop the bleeding as soon as possible and to resuscitate using blood instead of saline.

Military and civilian clinical guidelines now recommend the use plasma and platelets as well as red cells, to help the patient’s blood to clot better. An alternative way of doing this would be to give whole blood however, this is rarely offered by modern blood services. They take a pint of whole blood and then divide it up into the separate elements. This approach means more patients can be treated and it is much better for most patients. So it will really take a big change to reintroduce the use of whole blood.

Bergen is one of the few centres in Europe working on the modern evaluation of the use of whole blood. There is a unique partnership between the military, civilian and academic communities working on both the clinical and the laboratory aspects of whole blood collection, storage and use. The aim of my visit is to review the recent clinical and laboratory work with a view to informing a program for the UK.

So what to pack? I am only going for 18 days but Bergen is meant to be the wettest place in Norway…

30th July 2016 - A Good Night's Sleep


A good night's sleep makes an enormous difference now that I'm pretty well settled into my room. I’m staying in a student hostel near the Haukeland Hospital sitting on a hill above Bergen. It's very international with students and staff from all over the world and I have a small room with shared facilities. It is basic but I am really lucky that I have a fantastic view that looks out over the city.


Bergen was founded by King Olav Kyrre in 1070 AD, and became Norway’s first capital in the 13th century. Until the 1830s Bergen was the biggest town in Norway and was for a while in the Middle Ages, the largest town in Scandinavia.
I didn’t know much about the Hanseatic League until I briefly visited Bergen last year, but I was reminded again when I visited Kings Lynn last month. Kings Lynn is also a Hansa port and shows how our international links have been so important to the UK. The links are not just limited to commercial trade but also the exchange of culture and knowledge.

I visited Kings Lynn to exchange some of the current thoughts around the management of massive haemorrhage and it was really interesting not just to meet the clinical teams, but to seee how the laboratory services are underpinning the developments. I will be doing something quite similar here in Norway.

The plan today is confirm the walking route to the hospital and meet up with friends.

Saturday 30 July: Coffee and Cakes

Travel is a wonderful thing and you can meet incredible people. Many have fascinating stories to tell and I think the best way to hear these stories is over coffee and cakes.

Today I met Danny in the hostel. He arrived from Spain 3 weeks ago and is working on fatty acids. We worked together in the kitchen making breakfast and chatted about working as doctors and researchers. We may complain about the NHS, but you should hear some of the international stories!

A South African friend is working in Bergen for a short period of time and both of us are interested in training colleagues to collect whole blood. It is the sort of thing you may have to do if you're working in places without lab support. He showed me his new favourite coffee shop, BKB in Thormøhlens Gate. It is a small place, slightly hidden away and has a really good feel. Most things in Norway are expensive by international standards so it is important to take advantage of the refill system for coffee! Although one refill is usually enough because Norwegian coffee is turbo charged! Don’t forget to enjoy your coffee with a bun too, the baking tradition is great in Bergen.

Funnily enough, I spent the evening baking homemade pizzas and Norwegian specialities, Skillingsboller (penny buns) and Kanelknuter (cinnamon knots). What a great end to the day.

Baking lightened

1st August - Networking

Today was my first day in the office, Or to be technically correct, my first day in the ‘Avdeling ved immunologi og transfusjonmedisin’ (Bergen Blood Bank or BBB for short).
I said ‘Hei!’ to all and then settled down in Tor’s office to look at the various projects they are working on. Tor is my sponsor here and sadly injured himself shortly before I arrived but he bravely made his way on crutches into the hospital to see me - what an incredible personal commitment!

One of the first things I did was ask to test the ‘network’. It helps to have a young person (Joar) to do this. My first question; could I connect my work laptop from Birmingham to the Bergen WiFi? Secondly, could I then remotely dial-up and access my accounts in the UK? And the answer was yes to both! (Not only that, but I could was able to connect my smart phone to the WiFi which gave me access to my beloved digital radio).

I am just astonished at such things (this probably reflects my age). The digital era has revolutionised the way we can do business. Professionally, it allows us to collaborate in ways we could not have imagined. Last year I was using Dropbox with colleagues in Sierra Leone. I use broadband telephones not only talk face to face with colleagues, but also to contact my family and friends.
It reminds me of how much we value being connected. However, I believe that in the digital age that the best form of networking should be about real human connections. (like being a blood donor). I really value my networks but exchanging emails is not the same as sharing bread in the hospital canteen. 

3rd August - A sense of perspective

I got up at 6am this morning. It was already bright in the sky but the street lights were still on in Bergen. I started to work and think about the discussions from the last two days. The local team have invited me to review their data for massive transfusion for the last 13 years. They are keen to have an international perspective on the impact of introducing an Acute Transfusion Pack. It is quite a privilege.

Massive haemorrhage is a medical emergency and it affects many clinical specialities. The management includes haemorrhage control and resuscitation, often with blood if available. Since 2006 there has been a paradigm shift in transfusion support with the introduction of Transfusion Packs containing a balance of blood components. The aim is to try and provide the equivalent of whole blood. Bergen introduced their pack in 2007.

One of my problems is how best to sort the data to tell their story. I needed perspective and time to think. So at 10.30, as the sun was shining, I decided to go up Mount Ulriken. Ulriken is the largest of the mountains around Bergen and the cable car station is close to the hospital. I always believe you should grab opportunities when you can. From the top you can see Bergen and the surrounding area. In short you get a different perspective.

I went for a walk on the top of the mountain. The Norwegian definition of an ‘easy round route’ needs to be considered with care. The route was tough and perhaps a little ambitious as my balance is not too good these days. There was a risk of getting fixed on the details of the path as it was very uneven and still slippery from the recent rain. However, I took my time. Looking up and around me I could begin to see the bigger picture.

It was fantastic.

Looking down at bergen


Tuesday 9th August - Time for a change

I am now in my second week and need to pull together everything I've learnt in Norway. We are still crunching data, but I think we now have a story to tell about their change in transfusion support for massive bleeding. As part of my review, I have started read more of the Scandinavian literature including the multi-disciplinary Nordic guidelines. It is fascinating to see how teams in different countries have addressed the same problem during the last 10 – 15 years.

Today was my turn to present to the Bergen department as part of their professional development program. I chose ‘Transfusion support for Massive Haemorrhage: a UK perspective’. I started with the lessons learnt from both civilian and military experience and focussed on some of the practical and organisational issues. I related it to what I have read recently and the implications for their local emergency planning.

One of my favourite Scandinavian titles is ‘Time for a Change’. Change in this area is happening in the UK and elsewhere, but it has taken a decade. Recently, there have been a number of revised guidelines which cover the management of haemorrhage. However, we now need to translate these into effective patient care in a timely manner using resources wisely. It will take locally sensitive organisation, teamwork and clinical leadership.


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