Dr Sabrina Das is a Consultant Obstetrician & Gynaecologist at Imperial College Healthcare NHS Trust. She also works for Marie Stopes International as an abortion surgeon. She is the 2024-25 UK Harkness Fellow and will be spending 12 months at City University of New York School of Public Health researching abortion access and the policy landscape.
I had 15 cases on my surgical abortion list today. Team brief, “Client A is 23 weeks and is getting the train on her own to go back to Leeds after this, so we’ll do her first. Client B and C are both from Germany attending for cervical prep and their procedures will be tomorrow.”
One of the nurses told me Client B arrived the previous day, straight from the airport. Her flight was delayed and when she eventually arrived it was past 4pm and the team had finished, so she had to pay for an additional night’s stay in a hotel. She was only 20 years old and had never travelled alone before.
Client C had driven from Germany where abortion is only legal up to 12 weeks. “Apart from my best friend, who drove with me, my sister is the only other person who knows, but she’s not very happy I’m taking this decision.”
I trained as a late abortion surgeon after my first mission in Yemen working for Medecins Sans Frontieres in 2021. I realised late and complex abortion skills can save lives, especially in a context where increasing caesarean birth is killing women due to uterine rupture in subsequent pregnancies who require uterine evacuation after miscarriage or stillbirth, or during an unsafe abortion.
I realised that late surgical abortion is becoming a lost skill, with most European countries only permitting abortion up to 12 or 16 weeks. In theory, women in the UK can access an abortion up to 23 weeks and 6 days. However due to increased commissioning into the independent sector (77% of abortions occurred in the independent sector in 2021), NHS trainees and consultants do not have much exposure or experience. Waiting times for late abortion can go into weeks due to surgeon availability, which explains why many women have no choice but to travel miles (like my Client A) to access the service.
When Roe v Wade was overturned in the USA in 2022, ending the constitutional right to abortion for Americans, I was in the process of applying for a Harkness Fellowship. The first part of the application comprises a series of mini-essays articulating career achievements thus far, leadership potential and trajectory into the future on the national and global stage. The second part is a project proposal – one that demonstrates potential to address healthcare equity for the most vulnerable, in line with the Commonwealth Fund’s mission. The third part necessitates the applicant to seek references from three senior leaders who could comment on one’s potential to influence healthcare policy and practice.
I became consumed by the idea that abortion access was the only project proposal I could consider for my Harkness application. It was so clear to me that any restriction in access to abortion would disproportionately affect and traumatise already marginalised, minoritised and vulnerable communities. Many cold emails to academics, policy leaders, and reproductive justice advocates in the UK and the US led to about 50+ video calls over about 18 months to help me shape my project. I was not successful in the 2023-24 round, and reflected about what I needed to do to convince an interview panel who were not women’s health experts that abortion was an issue needing our attention. Kevin Fenton gave me great advice about using story-telling – “YOU, US, NOW” - to describe why an issue is important to me, to everybody, and why the time to act is now.
In February 2024, I was interviewed and accepted as a Harkness Fellow. This summer, I will travel to New York City, where the post-Roe climate has meant a hotbed of activity to protect a woman’s right to abortion, including late abortion, and to maintain access for a socially complex population both locally and for those who need to travel from restrictive states. I will meet inspiring healthcare leaders and reproductive rights champions. When I return in summer 2025, I will be renewed and energised to address the ongoing problems we have in the UK and Europe around fair and equitable access to abortion and wider maternal health care.
- If you are interested in learning more about applying for a Harkness Fellowship: https://www.commonwealthfund.org/apply-harkness-fellowship
- Read more about the College’s position on reforming abortion law here.