APPENDIX 58
Memorandum by the All-party Parliamentary
Pro-Choice Group (SH 94)
1.The APPG Pro-Choice with its Chair, Baroness Joyce
Gould, wishes to respond specifically to the strategy's provision
for improvements in termination services in the UK.
This APPG has an expert body of advisers who include
the fpa, BPAS, Marie Stopes International, Voice for Choice, the
Abortion Law Reform Association and the National Abortion Campaign.
Because of this, we are particularly interested in the choices
that women make or cannot make at present as regards termination
services in the UK. We regard, as does the national Strategy,
these services and access to them, as an essential part of sexual
and reproductive health. Improvements in these services bring
with them benefits that reach far beyond areas of physical health,
not least by addressing issues of social exclusion.
2.As a request for concise evidence has been made
by the Health Committee, we will consider briefly just three topics,
keeping in mind the Strategy's key areas of Prevention, Services
and Sexual health. They are:
(i)The significance of the RCOG's Guidelines
of 2000.
(ii)Current gaps between theory and practice.
(iii)The role of the strategy in connecting professional
guidelines to national and local practice, and to individual needs.
3.(i)The guideline development group of the RCOG
Guidelines "The Care of Women Requesting Induced
Abortion" addressed the discrete topic of abortion
care, but emphasised their support for the concept that abortion
services, a healthcare need, should be provided as an integral
part of broader sexual health services.
They looked ahead to placing abortion, contraception
and genito-urinary medicine services together within a national
service framework for sexual and reproductive health.
Amongst their recommendations, the guideline group
include:
—The earlier in pregnancy an abortion is
performed, the lower the risk of complications.
—Direct access should be offered from referral
sources other than general practitioners which minimise delay.
—As a minimum standard, no individual woman
need wait longer than three weeks from her initial referral to
the time of her abortion.
The context of these recommendations can be seen
in the Guidelines' Introduction. This underlines abortion as one
of the most commonly performed gynaecological procedures in Great
Britain that involves at least a third of British women before
they reach the age of 45. Ninety eight per cent of these abortions
are undertaken because the pregnancy threatens the mental or physical
health of the women or her children.
(ii)The APPG Pro-Choice and its advisers strongly
support the recommendations of a national Strategy
that includes a target of 2005 for all women to
access an abortion within three weeks of referral.
However, such are the wide discrepancies in the access
to and quality of TOP services, both national and local, this
APPG must address the wider context in which the gaps between
theory and practice occur.
If we consider the working of the 1967 Abortion Act
alone, it is evident that as a piece of legislation, it has not
kept pace with the medical, technological and cultural changes
in attitude that have taken place over the last 35 years.
This has contributed to a situation where, in 2002,
women still have to negotiate consent with two doctors. In addition,
if a woman finds herself in one health authority, she may find
her access to the NHS unproblematic, supportive and effective.
In another, this situation may be the opposite. Throughout the
West Midlands, for example, she may discover that only 5.4% of
pre-week abortions are medical. In the Northern and Yorkshire
regions, this choice rises to 58%.
If she wishes to access a termination in the Thames
region, she will find that only 63% of abortions in this region
are funded through the NHS. Yet, her sister, cousin or friend
who may be resident in Wales, Trent and Northern and Yorkshire
will find this figure rises to about 85%. And, if they live in
Northern Ireland, none of the above is relevant.
(iii)As a national strategy, the consultation
document before us opens up a number of opportunities for lasting
improvements to womens' sexual health in the UK. It has usefully
identified the types of difficulties that may be encountered on
a geographical basis by women accessing TOP services. It has set
out potential areas for concern and established some broad principles
on which to build.
Looking at the health "map" of the UK,
a national strategy will always be of use where discrepancies
in healthcare quality and access are found to exist between geographical
areas.
—The APPG Pro-Choice has to, however, consider
the bigger picture—and in the past year has addressed concerns
that compromise not only womens' access but also the excellent
proposals of the Strategy. These are not so easily "mapped"
out. For the sake of brevity, we offer two main concerns.
—The ROCG's Audit of Termination Services
in England and Wales in 1999 considered 71% of abortion providers.
Of these, 34% failed to meet the target for women to see a gynaecologist
within five days of a first appointment. Thirty three per cent
of units failed to offer both surgical and early medical abortions
to women in the first nine weeks of their pregnancy.
—A 1999 report on the recruitment and training
of obstetrician-gynaecologists for abortion provision, only 13%
of consultants (in a survey of 226 consultants) stated that all
their junior doctors had received in TOP in the year prior to
the survey. Thirty two per cent said that none of their trainees
had received training.
(Source: Reproductive Health Matters, Vol.7.,No.14.)
—Unintended pregnancies may have a long
lasting impact on the quality of life for both mother and child.
The All-Party Parliamentary Pro-Choice Group welcomes this opportunity
to address unacceptable geographical inequities in the levels
of sexual ill health and service provision. We also strongly support
a Strategy that considers increased primary care involvement and
the widening role of nurses.
July 2002
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