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Human Fertilisation and Embryology Bill [Lords]
] As amended (in the Standing Committee), further considered.
1967
The Abortion Act 1967 shall be amended as follows :--
In section 1(1) after the word "practitioner" insert
"(a) when a registered medical practitioner has certified in good faith that the pregnancy has not exceeded its twelfth week, or (b) in any other case,".'.-- [Ms. Harman.]
Brought up, and read the First time.
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Ms. Harriet Harman (Peckham) : I beg to move, That the clause be read a Second time.
Mr. Speaker : With this, it will be convenient to take the following : New clause 6-- Amendment of the Abortion Act 1967-- .-- In section 1 of the Abortion Act 1967 (medical termination of pregnancy) after subsection (2) there is inserted
"(2A) The opinion of a single medical practitioner shall be sufficient for the purposes of subsection (1) of this section providing that that practitioner is also of the opinion that the pregnancy has not exceeded its twelfth week.".'.
Amendment No. 31, in clause 34, page 19, line 41, at end insert-- (1A) After section 1(1) of that Act there is inserted-- "(1A) The opinion of one medical practitioner is sufficient for the purposes of subsection (1) of this section if he is also of the opinion, formed in good faith, that the pregnancy has not exceeded its twelfth week.".'.
New clause 5-- Conscientious objections --
The Abortion Act 1967 shall be amended as follows :--After section 4 insert --
"4A--(1) Any registered medical practitioner who has a conscientious objection to participating in any treatment authorised by this Act who relies upon or intends to rely upon a provision of section 4 above shall be under a duty to notify either--
(a) The Chief Medical Officer of the DHSS, or if they work in Scotland,
(b) The Scottish Home and Health Department.
(2) The Secretary of State shall by Statutory Instrument make regulations to provide--
(a) for requiring any such notification as mentioned in subsection (1) above to be in such form and at such time as may be prescribed by the regulations ; and
(b) for the keeping and maintaining of a register of the names of all those persons who have given notification and such register shall be open to public inspection.
(3) Any Statutory Instrument made by virtue of this subsection shall be subject to annulment in pursuance of a resolution of either House of Parliament.'.
Government amendment No. 54.
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New clause 7-- Application of Abortion Act 1967 to Northern Ireland --In the Abortion Act 1967 in section 2(1) after the word "Scotland" there shall be added the words "and in respect of Northern Ireland" ; the reference in section 2(2) to Chief Medical Officers shall include a reference to the Chief Medical Officer of Northern Ireland ; the references to the National Health Service Acts shall include references to any Acts and Orders which have the like effect in Northern Ireland ; and for section 7(3) there is substituted "This Act extends to Northern Ireland." '.
Ms. Harman : I shall confine my comments to new clause 1, new clause 6 and amendment No. 31, which deal with easier access to early abortion. I know that my hon. Friend the Member for Barking (Ms. Richardson) will seek to catch your eye, Mr. Speaker, to address the issues raised by new clause 5.
New clause 1, new clause 6 and amendment No. 31 address the problem of late abortion. There will always be some late abortions when, for example, it is only late in the pregnancy that the pregnancy begins to pose a health risk to the mother, when there is only a late diagnosis of foetal abnormality or when the woman does not realise that she is pregnant until late in the pregnancy. Many late abortions could be carried out earlier. I am sure that all hon. Members will agree that early abortion is better than late abortion.
Prompt abortion spares the woman unnecessary stress and anxiety caused by delay and red tape. Early abortion is easier for the doctors and nurses involved because the foetus is less developed, it poses less of a health risk to the woman, there is less likelihood of post-operative complications, and it can be carried out as day surgery so that the woman does not occupy a scarce in-patient bed. Late abortion is to be avoided wherever possible. One important way to avoid late abortion is to improve access to early abortion, and there should be no disagreement about that in the House because the sad facts are well documented.
In its report, "Late Abortion in England and Wales", the Royal College of Obstetricians and Gynaecologists found that one in five women who had an abortion after the 28th week of pregnancy, where there was no foetal abnormality, had been referred before the end of the 12th week of the pregnancy. It is inexcusable to make a women wait a further eight weeks into the pregnancy and to have an abortion after 20 weeks when she could have had that abortion before the 12th week of the pregnancy. The royal college's report simply backs the findings of earlier studies by the Lane commission, as far back as 1974, and the Policy Studies Institute's reports commissioned by the Department of Health and Social Security and published in 1979. The reports have piled up and the numbers pile up. It is estimated that every year, over 2,000 abortions are performed at over 20 weeks where there is no foetal handicap. It is time that something was done. The new clauses and amendments offer the House a choice. New clause 1 would make abortion legal up to the 12th week of pregnancy on the woman's request. New clause 6 and amendment No. 31--which are in almost identical terms--would avoid late abortion by allowing abortion with the approval of one doctor instead of the current requirement of the approval of two doctors. The grounds on which the doctor would certify the abortion
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would remain the same as under the current law. Those grounds are that the continuation of the pregnancy would pose a threat to the life or to the mental or physical health of the woman, or to her existing children, or that there is serious foetal abnormality. The key point about new clause 6 and amendment No. 31 is that, up to 12 weeks, only one doctor instead of two would be required to certify. If that step is taken tonight--as I hope that it will be--we shall be moving in line with public opinion. According to the Jowell report on British social attitudes, public support for allowing abortion has increased significantly in the past four years. The report shows that a clear majority are in favour of abortion being allowed by law when the woman decides "on her own" that she does not wish to have the child. A majority now back abortion on request. We should be following the pattern of many other European countries, such as France, Italy, Sweden and Holland, if we allowed easier access to early abortion.Easing the law and allowing abortion in early pregnancy would enormously help reduce the delay that leads to late abortion. Improving abortion services on the national health service is also important. The law makes abortion legal in this country, but whether a national health service abortion can be obtained depends on where one lives. There is an enormous and unjustified regional variation in the provision of abortion services on the national health service. I should like the Minister to look at these figures.
Mr. David Alton (Liverpool, Mossley Hill) rose --
Ms. Harman : I shall not give way. I know that the hon. Member for Liverpool, Mossley Hill (Mr. Alton) will speak later and I do not want to take too much time.
I should like the Minister to look at these figures, which come from her own Department. In north Devon, 95 per cent. of the abortions performed were carried out by the national health service ; only 5 per cent. of women who have abortions in north Devon have to seek, or choose to seek, private sector abortion. In south Birmingham, only 1 per cent. of the abortions carried out are performed by the national health service ; 99 per cent. are carried out in the private sector. That regional variation cannot be justified because inability to obtain a national health service abortion contributes to the delays that lead to late abortions. We need a prompt NHS abortion service in every region.
I know that, although some hon. Members will be anxious to avoid late abortions, they will be worried that easier access to early abortions will result in more abortions and increase the abortion rate. I do not believe that women use abortion as a casual alternative to contraception. In my view, the new clauses will not affect the abortion rate or the number of abortions that are performed. The abortion rate is largely the result of unwanted pregnancies. The way to cut the abortion rate is to help women to avoid unwanted pregnancies.
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I hope that all hon. Members who share my concern about the abortion rate will join our campaign for better sex education in schools and for a public information campaign about contraception. We must also see an end to the cuts in family planning services. Those are the measures that will cut the abortion rate. The new clauses,
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which seek to ease the legal requirements for early abortion, will cut the number of avoidable late abortions. I urge the House to support them.Sir David Price (Eastleigh) : I am happy to follow the hon. Member for Peckham (Ms. Harman). I specifically commend to the House amendment No. 31, which has been tabled by myself and by my hon. Friends the Members for Torridge and Devon, West (Miss Nicholson), for Langbaurgh (Mr. Holt), and for Dorset, West (Sir J. Spicer). The purpose of our amendment is limited, modest and, I believe, useful. I insist that it does not reopen the wider issues that were discussed and settled--at least for the time being--during earlier stages of the Bill's consideration. Its purpose is simple. When an abortion takes place, it is better for the woman concerned that the termination of her pregnancy should take place earlier rather than later. The medical arguments in support of that proposition are so overwhelming that I need not detain the House by repeating them. They were well described by the hon. Member for Peckham.
Therefore, I hope that the House can agree the general proposition that the law should be so drawn that it is not a deterrent to early termination--or, put the other way round, that it is not a positive encouragement to later termination.
All the evidence available to me points to the inevitable conclusion that the need to have two rather than one medical practitioner leads to later termination of pregnancy, but it does not deter termination. Therefore, it is neutral on the broad issue that has been engaging our attention for so long.
The House knows that I am not an enthusiast for abortion--nor do I hold the view that abortion is only a belated form of contraception. Indeed, I am most certainly opposed to abortion on demand. However, I accept the realities of life. Whatever the moral and religious attitudes of any society, abortions take place. The practical issue is whether those abortions take place within or without the law. Earlier in our proceedings we endeavoured to redefine the legal rules for abortion. Later this evening we will be discussing further refinements of those legal rules. This amendment lies clearly within those legal rules--and, indeed, can accommodate any of the further amendments on the Amendment Paper. As I said earlier--and I now repeat--it is directed simply to make earlier rather than later termination of pregnancy easier.
If the House accepts our amendment, we will, as the hon. Member for Peckham said, be entirely in line with our European partners in the European Community. The vast majority of abortions in Europe take place within the 12-week span. We find from Jennifer Gunning's helpful paper that terminations of pregnancies take place as follows in other European countries. In Denmark, 97.5 per cent. of terminations take place within the 12-week span. In France, the figure is 97 per cent. ; and in the Federal Republic of Germany, it is 93 per cent. The figure for the Netherlands is slightly distorted because it apparently has a large intake of foreign women seeking abortions in later pregnancy, largely because until now Belgium has not had legal abortion. Therefore, the figure for the Netherlands is only 89 per cent., but the figure for this country is only 84 per cent.
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If, as a result of passing amendment No. 31, we increased that figure of 84 per cent. to above 90 per cent., I believe that we would be making a useful and helpful contribution to a number of the women who are at risk. In addition, other European countries now have a strong bias in their law in favour of a 12-week limit. They include Belgium, Spain and Italy, where the limit is 90 days.I trust that I have said enough to demonstrate that it is now the general practice in Europe to terminate pregnancies, where the law allows termination, within 12 weeks.
Those who would resist our modest, but helpful amendment, must demonstrate that their insistence upon the opinion of two, rather than one, medical practitioners would provide a degree of medical protection for the pregnant woman which would be substantially diminished if the decision to terminate was taken on the opinion of only one medical practitioner, not two. I await the demonstration of such a proposition. I am unaware of its medical strength. I trust that I have said enough to persuade the House that amendment No. 31 represents a modest but medically useful change in our abortion law, which does not alter the basic criteria for a legal termination of pregnancy, but will be beneficial to the woman concerned-- the woman at risk.
Sir David Steel (Tweeddale, Ettrick and Lauderdale) ; It is not often that one is pressed to make a speech in the House, but on this occasion several hon. Members have asked me, as the promoter of the original legislation-- the Abortion Act 1967--to give my views on the amendments and new clauses that we are considering. I notice wryly that some of those who were pressing me are not present to have the benefit of what I am about to say-- but that's life.
I shall address my remarks briefly to the three issues central to our debate until 7 o'clock. The first has already been discussed--the easing of the regulations for abortions in the early part of pregnancy. The second is the proposed extension of the law to Northern Ireland, and the third is the proposed certification of conscientious objection.
On the first issue, I very much follow the line of argument of the hon. Member for Eastleigh (Sir D. Price). I vividly remember in our debates on the passage of the original legislation the general agreement in the House and across the Committee--regardless of the views taken about the merits of my Bill--that if abortion was to be carried out, it was best carried out early. Unhappily, the experience of the working of the Act over the past 22 years shows that the desire of the House, as then expressed, has not been fully carried out.
The hon. Member for Peckham (Ms. Harman) mentioned the report of the Royal College of Obstetricians and Gynaecologists, which strikingly reminds us that one fifth of all abortions performed over 20 weeks are on women who had been referred within the first 12 weeks of pregnancy. It is significant that that was not an early report--it was published in 1984. But in the 16 or 17 years of the working of the legislation until then, there was clearly still a bottleneck somewhere in the system, resulting in undesirable late abortions which could have been carried out earlier.
There are three reasons why the House should give favourable consideration to the suggestions before us. The first is administrative--too many abortions are needlessly
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carried out late. If we could simplify the procedure for earlier abortion, we could transfer later abortions into those carried out earlier in pregnancy--Mr. D. N. Campbell-Savours (Workington) : Does the right hon. Gentleman recall the arguments that he deployed when promoting his Bill in 1967 to justify the use of two doctors, as opposed to one, and will he outline those arguments to the House?
Sir David Steel : Yes, of course I recall them and I stand by that basic provision. But the House should now look carefully at the experience of the working of the legislation, compared with the intentions at the time --
Mr. Campbell-Savours : What were the arguments?
Sir David Steel : I do not deny that there are good arguments for having two doctors-- [Interruption.]
Madam Deputy Speaker (Miss Betty Boothroyd) : Order.
Sir David Steel : I shall not be deflected from my speech. I shall stick to the narrow issue before us which is whether we should contemplate a change in the law relating to the early period of pregnancy--
Mr. Campbell-Savours : What were the arguments?
Sir David Steel : The hon. Gentleman can make his own speech later.
What the hon. Member for Eastleigh said about the European experience is instructive. Most of our European neighbours introduced legislation on abortion after we legislated in 1967. The hon. Gentleman mentioned the case of Belgium which made abortion legal only this year. Austria, Belgium, Czechoslovakia, Denmark, France, Greece, Hungary, Italy, the Netherlands, Norway, Sweden and Turkey all adopted a system which makes abortion difficult after the early period of pregnancy but makes it easy in the first stage. In a sense our legislation has been overtaken by the light of experience and views in other countries. There are good administrative grounds for making this minor change to the 1967 Act.
Mr. Edward Leigh (Gainsborough and Horncastle) : Will the right hon. Gentleman give way?
Sir David Steel : I am reluctant to give way too often, but I shall give way to the hon. Gentleman.
Mr. Leigh : Surely the point that the right hon. Gentleman does not address is that, as he said, in those countries late abortions are more difficult than here. If the amendment is accepted we shall have abortion on demand up to 12 weeks and relatively easy abortion after 12 weeks. That is quite different from the position on the continent.
Sir David Steel : If I catch your eye, Mr. Deputy Speaker, I shall deal with the law on later abortions in the debate on a later amendment. I should like to confine my remarks to the provisions of this amendment.
I do not pretend for a moment that the law in each of the countries that I listed is identical to that of all the others. It is not. In some cases there is almost a total prohibition on late abortion. The hon. Member for Eastleigh gave the figures for Denmark, where there is almost total prohibition after 12 weeks of pregnancy. It is
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most difficult to obtain an abortion after 12 weeks. In other countries it is relatively easy, but there is still a distinction between the two periods of pregnancy. We should be wise to adopt that distinction.The second reason why I favour the change is the simple reason of publicity. If it becomes known that, in short, the law of the land states clearly that abortion before the 12th week is administratively easier and that the law encourages abortion before the 12th week of pregnancy, if it must take place at all, people will be more likely to present themselves earlier. In support of that I cite a letter from the Brook advisory clinic. It tells us :
"While recognising that Parliament has now voted for a 24 week upper limit for the termination of pregnancy we still have many concerns for those vulnerable young people who turn to us late in pregnancy. Many fail to recognise the signs and symptoms of pregnancy through a lack of sex education and appropriate services to which they may turn."
If it enters people's minds that there is a new 12-week cut-off before which abortion is relatively simple to obtain and after which the administrative complications and medical referrals are much more difficult, we shall take a major step towards pushing abortions into the earlier part of pregnancy.
The third argument that I adduce is that abortion techniques have changed since we legislated in 1967. In those days almost all abortions were carried out by one form of surgery or another. Nowadays they can be carried out by injection or what is euphemistically called the morning-after pill, which is an early abortifacient. There have always been legal doubts about whether the morning-after pill can be prescribed within the present abortion law. The amendment would remove that doubt because a single doctor could prescribe the drug, which works in the early period of pregnancy. For all the reasons that I have given, I favour the proposal of the hon. Members for Peckham and for Eastleigh and I shall support them in the Lobby.
Government amendment No. 54 deals with whether the law should extend to Northern Ireland. I cannot remember exactly why the 1967 Act was not extended to Northern Ireland, but I suspect that one reason was that in those days Stormont still existed. We had only a small coterie of Northern Ireland Members in the House. Again, we are entitled to examine the practice of the law since 1967. Ireland--both the north and the south--is now the only country in Europe where abortion has not been legalised. It is no good people saying that abortion does not take place in Northern Ireland. We have the figures for women who come from Northern Ireland to obtain abortions in England and Wales. In 1988 the figure was 1,815. That does not include those who made the journey to Scotland, for which I do not have the figure to hand. We are talking about almost 2,000 women a year who come to Britain from Northern Ireland for abortions. Again, that has the effect of causing late abortions. By the time a referral has been made and a place found for a woman, precious weeks have passed. The extension of the Abortion Act 1967 to Northern Ireland would reduce the number of late abortions.
We must also consider the cost. If the national health service cannot provide the facility in Northern Ireland, it is unlikely that much of the NHS will provide it on the mainland. The result is that in the main such women go to private clinics. On top of that, they have the cost of travel, so the cost of abortion becomes prohibitive and may be a cause of further delay.
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A survey has been carried out among members of the British Medical Association in Northern Ireland. The proposal in the amendment is supported by the majority of doctors in the Province.A further argument for extending the Act relates to the section which deals with foetal abnormality. Ante-natal screening for foetal abnormality is not widely offered in Northern Ireland because if an abnormality is detected termination cannot be offered under the present law. That should be changed.
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Rev. Ian Paisley (Antrim, North) rose --
Mr. Alton : Will the right hon. Gentleman give way?
Sir David Steel : I shall give way to my hon. Friend in a moment. For all the reasons that I have given, I believe that it is right to extend the legislation to the Province of Northern Ireland.
Mr. Alton : Will the right hon. Gentleman cite the reference in the BMA report that he quoted to the House? The latest poll that was conducted among doctors in Northern Ireland showed that over 80 per cent. were entirely opposed to extending the legislation to the Province. The latest opinion poll in Northern Ireland showed that 90 per cent. of people were opposed to it. Only last week 60,000 signatures were presented from people in Northern Ireland against the extension. Does he agree that on any other occasion he would recognise that, where Catholic and Protestant opinion in Northern Ireland is united and there is a shared platform, public opinion should be listened to?
Sir David Steel : I am prepared to concede to my hon. Friend, who, like me, has some knowledge of the Province, that the majority of public opinion in Northern Ireland is probably against the extension. That is a valid point for the House to ponder. However, we must decide whether that prevailing opinion in the Province should lead us to deny a facility and a right which is extended to all other female citizens of the United Kingdom. That is the issue before us. I do not pretend that extending the Act will be met with enthusiasm, but I do not see how my hon. Friend can defend the fact that Northern Irish women must travel to Britain to obtain something which they cannot obtain in their own Province. He cannot say that there is no requirement for abortion when the figures show that that is what happens and that it results in delay and later abortions. That is the argument with which I counter my hon. Friend's argument. I do not deny that the figures that he produced are right.
Mr. Alton : What is the reference for the right hon. Gentleman's figure?
Sir David Steel : I shall find the reference in my papers ; I do not have it to hand.
New clause 5, which deals with a register of conscientious objection, has not yet been spoken to. I am afraid that at this point I part company with the hon. Member for Peckham. Together with the now Lord St. John of Fawsley I introduced the conscience clause in 1967 although we had opposite views on the substance of the
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Bill. I have taken an absolutely consistent view on the matter of conscience. I fought within my own party conference on the issue. Abortion divides hon. Member from hon. Member, church from church and doctor from doctor, so group dynamics should never be made to operate. The individual conscience is important. I have tried to stop my party passing resolutions on the subject which would bind its members. I regret that the Labour party has proposed such resolutions. I regret even that there is a two-line Whip on the Third Reading of the Bill. I am wholly consistent. I object to the idea that a conscience should somehow be held in a public register. That seems to me a repugnant concept. It would bring undue pressure to bear on those who hold that view.I do not deny that, as a result of the exercise of that conscientious objection by some doctors, in some cases women would be denied the facility and the right to which they are entitled. However, in the general practices of which I am aware the doctor who holds that conscientious objection tells the patient so and refers her to doctor X who will consider her case. That is proper, good practice. The idea of a public register of conscience is objectionable and I shall not support new clause 5.
Sir Bernard Braine (Castle Point) : Whatever my disagreement has been with the right hon. Member for Tweeddale, Ettrick and Lauderdale (Sir D. Steel) since he introduced his Bill, I pay honour to him for sticking to his guns regarding the necessity for preserving the right of conscience in this matter.
I also agree with the right hon. Gentleman that if an abortion--always a tragic happening--is to be carried out, the earlier the better, given that there are satisfactory grounds for it and proper medical approval and attention. That proviso is absolutely key.
I am profoundly disturbed by the group of amendments now under discussion, the like of which I have not heard discussed in this place in the 40 years I have sat here. I venture to suggest that public opinion will be outraged when it learns what has been advocated today.
On 2 May I wrote a letter to a colleague in the House who was canvassing support for an amendment that would allow abortions up to 12 weeks on the agreement of a single doctor. We have been repeatedly told that new clauses 1 and 6 and amendment No. 31 will not allow abortion on demand, but, whatever is said, everyone knows that under the present system, when two doctors' signatures are required, collusion sometimes occurs. Abortions for the most trifling reason are granted on one ground or another. Over the years there have been enough scandals for me not to go into detail. If only one doctor's signature is now to be required it is inevitable that the situation will get worse.
My thoughts on this matter have not been dreamed up in response to what has been said this afternoon. I shall quote from the letter that I sent to my colleague on 2 May as it sets out the history of the matter and its inherent dangers. I wrote :
"The idea of allowing abortion on the agreement of only one doctor was first floated by Government advisers as far back as 1977. At that time it was suggested that the development of abortifacient drugs would enable women to abort at home, thus diminishing the need for late abortion."
Incidentally, at that time no one ever mentioned legalising abortion up to birth, but the Bill, as it is presently drafted, would permit that in certain circumstances.
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Ms. Dawn Primarolo (Bristol, South) : Not true.Dr. Lewis Moonie (Kirkcaldy) : How many abortions have taken place as late as that in Scotland, where the Infant Life (Preservation) Act 1929 has never applied?
Sir Bernard Braine : Over the years, I have participated in debates relating to England and Wales and I have learnt never to engage in a discussion of the different approaches and nuances involved in Scottish practice. After all the disappointments in the world cup I must say that my admiration for Scottish things has gone up greatly. I shall not tangle with the hon. Gentleman about this, except to say that there are differences.
My letter continued that the idea of allowing abortions on the agreement of a single doctor had then been floated again by Government advisers at the time of the Corrie Bill, when the development of abortifacient drugs was stressed once again. My letter stated :
"Today, of course, we have RU 486 and the Government could no doubt save millions of pound through a law enabling women to be aborted at home by their own GPs"--
if the proposals that we are debating are accepted, we shall be talking about not two doctors, but one. I also wrote that at that particular stage- -the letter was written on 2 May--there was no attempt to amend section 1(3) of the Abortion Act with regard to the operation being carried out in an "approved place".
This week, however, the final piece in the jigsaw is found. Later today we shall debate amendment No. 29, which would allow the Secretary of State to extend the meaning of approved places for abortion treatment consisting primarily in the use of medicines or, more bluntly, abortifacient drugs.
New clauses 1 and 6 and amendment No. 31, together with amendment No. 29, would therefore change the law to allow abortions through abortifacient drugs such as RU 486 to be carried out by one doctor in the patient's home. The Secretary of State must give us a clear explanation as to why we should change the meaning of "an approved place" in order to allow abortion in the home. That is a grave matter.
Over the years and throughout our debates on abortion the spectre of the back-street abortionist has been raised. Pro-abortionists have always failed to mention, however, that before 1967, many back-street abortionists were doctors or midwives aborting women in their own homes or in a private clinic.
I am one of the few hon. Members still in the House who--after the right hon. Member for Tweeddale, Ettrick and Lauderdale had had his Bill enacted- -served on the Select Committee on Abortion, which met on 15 March 1976 to hear evidence from Sir John Peel. Sir John was a former president of the Royal College of Obstetricians and Gynaecologists, he was then president of the British Medical Association and he was one of the most distinguished gynaecologists of that time. It is important to record what he told that Committee, on page 78 of the minutes of evidence. Sir John was asked by my hon. Friend the Member for Brighton, Kemptown (Mr. Bowden) what effect the 1967 Act had had on illegal back-street abortions :
"if the present Act were tightened, would this be likely to lead to a substantial increase in the number of illegal back-street abortions?"
Sir John replied :
"I always did think that the back-street abortion prior to the 1967 Act was nothing like as common an event as it was
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