Women driven to end pregnancies amid row over £28 drug

Chris Haines, ICNN Senedd reporter

A doctor who facilitated abortions for two women with much-wanted pregnancies was not allowed to prescribe a £28 anti-sickness drug due to cost-effectiveness rules in Wales.

The stark warning came as petitioners called on the Welsh Government to place Xonvea, the only licensed medication for severe pregnancy sickness, on the routine prescription list.

Georgina Forbes, a specialist doctor in Gwent, revealed she facilitated terminations for two women who were suffering from hyperemesis gravidarum (HG) in a single week. HG, which affects about 3% of pregnancies, leads to extreme, persistent nausea and vomiting.

“Both pregnancies were very much planned and wanted,” she wrote. “Both had multiple admissions and were on other medical treatments which were not giving adequate relief.

“For the sake of their physical and mental health, they felt their only option was to terminate their much-wanted pregnancies – inevitably having a further impact on their well-being.”

‘Not allowed’

She warned of distress for the patients and staff involved because Xonvea “may well be the medication that provides symptomatic relief but departments are not allowed to prescribe it”.

Dr Forbes, chair of the College of Sexual and Reproductive Healthcare’s Wales committee, noted Xonvea costs £28 for a 10-day supply – “far less than the cost of admission”. She urged Welsh ministers to ensure women are not “left behind compared to other UK nations”.

In 2019, the drug was rejected for routine use by the All-Wales Medicines Strategy Group (AWMSG) – which advises ministers – due to “insufficient” evidence of cost-effectiveness. Scotland reached a similar conclusion while access in England is inconsistent.

But campaigners argue the decision is a false economy. Data submitted to the Senedd’s petitions committee highlighted a two-night hospital admission to rehydrate a woman with severe sickness costs the NHS £850, with ambulance call-outs costing a further £238.

Petitioner Sarah Spooner, from Monmouthshire, argued the “myopic approach” ignores the costs of untreated sickness such as perinatal mental health support.

‘Postcode lottery’

Ms Spooner, whose pregnancy sickness was so severe she had to have a termination, warned of inequality in access to treatments. She recalled having to travel to an abortion clinic in Bargoed to get medication, a process she described as “immensely difficult”.

While the Welsh Government has insisted health boards have discretion to prescribe the drug “when other treatments… are ineffective”, staff and patients report a different reality.

Ms Spooner’s 947-name petition warned women face a “postcode lottery” for care, with only two Welsh health boards making Xonvea more widely available.

She was contacted by Heather Kosick, a Canadian doctor, who was horrified by her story.

Dr Kosick wrote: “Here in Canada Xonvea, also called Diclectin, is readily available to all pregnant women. In fact, it is considered the first-line agent for nausea and vomiting in pregnancy due to its extensive safety data.”

‘Hospitalised’

Ms Spooner volunteers for the Pregnancy Sickness Support charity which pointed out that Xonvea has been prescribed globally for years, with an estimated 30 million women treated.

The charity highlighted that 57% of patients are forced to cycle through three or more ineffective drugs before being offered Xonvea, which 83% of women found effective.

One patient reported being hospitalised seven times during a pregnancy without Xonvea but zero admissions during a subsequent pregnancy when she was prescribed the drug.

About 5% of women with HG end a wanted pregnancy due to the severity of symptoms, according to a 2021 study, which found 52% considered termination.

The study, from the Obstetric Medicine journal, found 25.5% of respondents occasionally experienced suicidal thoughts while 6.6% reported frequent suicidal ideation.

‘Horrendous’

Writing to the petitions committee, Wales’ health secretary Jeremy Miles said the 2019 AWMSG appraisal remains the “most up-to-date and comprehensive evaluation”.

He told the committee health boards can make Xonvea available in certain circumstances, with more than 1,140 prescriptions issued between January and July 2025. He added that the manufacturer was “unable” to provide updated information to support a reappraisal.

Mr Miles wrote: “We must ensure our health service treats all conditions and diseases fairly. Taking an evidence-based approach helps us to do this, whatever the disease, by ensuring resources are targeted at where the evidence indicates people will gain the most benefit.”

During today’s (December 8) meeting, Senedd members paid tribute to women for sharing their “horrendous” experiences before deciding to ask the AWMSG to reconsider its position.

Plaid Cymru’s Lindsay Whittle said: “I don’t think you can put a price on young families, young couples who wish to start a family and have undergone such traumatic decisions.”

He stressed: “Cost should simply not be the issue – families are suffering.”