Starting or ending a pregnancy: why the British Pregnancy Advisory Service is doing both

This month, the British Pregnancy Advisory Service (BPAS) announced plans to open a new clinic in London to provide fertility services. 

Here, we will be supporting individuals and couples desperate to have a pregnancy that results in the birth of a child. At our other clinics, we will continue to support women seeking to end a pregnancy. So how can a charity, known internationally for its advocacy and provision of abortion services, argue for, and offer, IVF? And how will patients feel about accessing IVF care from an organisation that also provides abortions?

Ultimately, the last question will be answered only when we start to take bookings. But we are confident enough to be making a substantial investment in a model of evidence-based, client-centred, not-for-profit care that we believe to be a beacon for the future.

If you are seeking IVF in the UK, you face a landscape of provision that mirrors that faced by women seeking abortion in the 1970s. Then abortion was legal, available and free on the NHS in theory, but only a few were able to access NHS hospitals able and willing to provide it, while the rest paid for private care. Some of the private care was excellent and reasonably priced; some was high-cost, low quality and exploited women's desperation.

BPAS was established as a charity to provide the best possible care at the lowest possible cost. It was genuinely not-for-profit – its only purpose to provide care for those with reproductive health problems and to educate society about what they need. The first clinic provided private abortion care at minimal cost. Then the NHS began to pay us to treat patients that they couldn't. Abortion commissioning started with BPAS – way before the then Prime Minister, Margaret Thatcher had dreamt of the 'internal market' in which the NHS bought services from the 'private sector'.

BPAS has never been just about abortion. We have always centred choice in our mission, and for many decades, abortion was the choice that women could not access in NHS hospitals but that we could provide. That has changed. Abortion is no longer as stigmatised as it was and many women choosing to end a pregnancy will have their abortion funded.

We will continue to fight for women's choice, building and ever-improving our termination service and advocating for its decriminalisation. But it is now time to turn the skills that we have gathered over the last 50 years to support another kind of choice, supporting those whose fertility problem is conception.

The infertility world needs BPAS. Patients need services that are evidence-based, with transparent costs and profit-free pricing. Policymakers, politicians and NHS purchasers need to hear from an ethics advocate to champion care that is needed. 

As the CEO at BPAS, I know that there are not two worlds of women – women who want to have babies (who need access to fertility services) and women who don't (who need abortion). There is one world of women who all need different things at different times. Biology plays a cruel game with us – we are at our most fertile when we are least inclined to start a family and our fertility drops when we are still more than able to raise children. As an organisation, our core value is choice: the self-determination to decide if, when and with whom to have a child. We have helped women to exercise that choice to end pregnancy, now we will help women to achieve pregnancy.

As a mother by chance, after nearly a decade of infertility and miscarriage, I know the ache, desperation and grief of failed treatment and pregnancy loss. Throughout all my treatments, I led an abortion service – never once feeling that because I could not have a child, another woman should be forced to have hers. And when I became (unexpectedly) pregnant, the joy and wonder of my own pregnancy made me appreciate all the more the distress felt by someone who just wanted to be pregnant. To feel the fluttering, and later squirming and twisting of fetal movement can be a woman's greatest joy or most dreadful nightmare. Everything is contingent, everything depends on context, and everything is personal.

Anyone who is truly committed to reproductive choice understands that our job is simply to enable our patients to act on the decision that is best for them while complying with laws and rules and to draw on the experiences of our patients and staff to advocate for the necessary improvements.

We have done this with abortion and now we will pioneer this approach in infertility. Some years ago, I was told that the profits were so great in the fertility world, that BPAS would never find people of quality to step outside the NHS and work for us. Our appointment of Dr Marta Jansa Perez, formerly Head of Embryology at the Hammersmith Hospital (Imperial College Healthcare NHS Trust), to run this service shows how wrong they were, and gives me every confidence that we will be able to work in partnership with the NHS to bring a unique service to the world of infertility care.