Select Committee on Health Appendices to the Minutes of Evidence


Memorandum from the Abortion Law Reform Association (SR 18)



  Difficulties in employing sufficient doctors to meet the need for terminations of pregnancy currently exist in the NHS and are likely to be exacerbated by lack of training and lack of awareness among junior doctors of the effects of unwanted pregnancy on women's health.

  (1) Because of the current advertising restrictions for posts in gynaecology and obstetric units, it is difficult to recruit an adequate number of doctors willing to carry out terminations of pregnancy in some areas.

  (2) As about one third of hospital doctors claim a conscientious objection and opt out of training for terminations, there are difficulties in finding adequately trained skilled staff in gynaecology and obstetrics units to cope with the local need in NHS Trust hospitals.

  A significant proportion of junior doctors are not being trained or gaining experience in this field although all consultant gynaecologists and obstetricians may be called upon at some time in their career to carry out abortions for obstetric reasons or in emergencies where a woman's life or that of the fetus is at serious risk.

  The Abortion Law Reform Association has recently carried out two surveys:

  (1) of all 310 consultants responsible for training in England, Wales and Scotland with an 81 per cent response rate, and

  (2) of a sample of 226 Senior Registrars, Specialist Registrars and Senior House Officers with a 65 per cent response.


Consultants and Career Grade Posts

  Health Service Guidelines (HSG (94) 39) state that no reference should be made to duties relating to termination of pregnancy in advertisements for doctors' posts. This applied to consultants from the late 1970s but was extended to all career grade posts in 1994.

  Mention may be made in the job description, after consultation with local consultants in the specialty and the Medical Executive Committee or a similar body, if it has been established that adequate services for termination of pregnancy would not otherwise be available.

  At interview, reference may be made to termination of pregnancy only if it has been explicitly included in the job description and then should be confined to matters of professional intention and not include the applicants' personal beliefs.

Training posts

  Guidelines state that the consultant is expected to assume ultimate responsibility for the care and treatment of women so it is not considered obligatory for staff in other grades to train in or undertake duties involving termination of pregnancy. Such duties must not be included in the job description, nor can applicants be questioned about their attitude to termination of pregnancy prior to their appointment.

  Once in post, trainees also do not have to state whether or not they hold a conscientious objection or give reasons if they claim one. A survey carried out by ALRA of all doctors responsible for training around the country has shown that some consultants are reluctant to ask those who do not volunteer for termination of pregnancy duties for fear of offending or appearing to persuade them. As a result the majority of termination work carried out in mainstream gynaecology units is undertaken by consultants, although that level of expertise is more than is necessary for the procedures used for abortions in the first 14 weeks of pregnancy.

  In some parts of the country termination of pregnancy operations are carried out by specially trained general practitioners or family planning doctors. The work is undertaken by community health services, separately from gynaecology and obstetric units, or under the supervision of a community gynaecologist. Staff are specifically recruited for this purpose and problems do not arise with conscientious objection.

Future Staffing

  There are a diminishing number of doctors who are strongly motivated to carry out abortions because of their experiences dealing with the alarming results of backstreet and self-induced abortions. Doctors who trained in the 1970s or later, since abortion has been legal, are also less aware of the damaging effect of unwanted pregnancy on women and their families.

  In the ALRA survey, 23 per cent of consultants stated they are currently unable to recruit sufficient Specialist Registrars and Senior House Officers to fulfill termination of pregnancy schedules. Significantly this rose to 30 per cent when asked whether they felt the current numbers being trained would not provide sufficient resources for the future.

  One third of all doctors in Senior Registrar, House Officer or Specialist Registrar posts in gynaecology and obstetrics units said they hold a conscientious objection to abortion.

  On training, the majority of consultants said that between 25 per cent and 50 per cent of trainees are currently opting out of abortion; a further minority said that as many as 75 per cent to 100 per cent of their trainees opted out. This may mean that there will be a serious shortage of suitably trained doctors in the future.

Recommendations for action

  ALRA would recommend that:

  (1)  Doctors who claim to hold a conscientious objection to abortion should be obliged to do so in writing, giving clear reasons for their refusal to be involved in abortion treatment. A general distaste of such work or a preference not to be involved with women stressed by unwanted pregnancy should not be regarded as sufficient grounds on which to withhold their services or opt out of training.

  (2)  While in no way wishing to force doctors to take part in abortion treatment if they genuinely hold a religious or moral objection to all abortions, there is a need to ensure that trainee doctors are aware of the effect of unwanted pregnancy on women's health and their families, the value of antenatal screening and abortion for fetal abnormality, the consequences of illegal abortion and the benefits of safe, sympathetic abortion services from the NHS.

  (3)  If termination of pregnancy is an integral part of a hospital gynaecology unit's duties, there is a need to include it in any job advertisement or interview for such a post to ensure that adequate staff are employed to fulfill the work of the unit on an equitable basis.

  (4)  Alternatively, termination of pregnancy could be carried out (a) by other specially trained staff such as GPs or family planning doctors, or (b) through an agreement with an outside agency many of which have become centres of excellence in this work. Contracts could incorporate an agreement to include training for local NHS doctors.

October 1998

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