APPENDIX 4
Memorandum from the Family Planning Association
fpa (Family Planning Association) is the UK's
leading sexual health charity working to improve the sexual health
and reproductive rights of all people throughout the UK. fpa wants
to see a society with positive and open attitudes to sex, in which
everybody enjoys sexual health and where sexual and reproductive
rights are respected. fpa's purpose is to enable people in the
UK to make informed choices about sex and to enjoy sexual health
free from exploitation, oppression and harm.
We run a comprehensive information service,
including a national telephone helpline, which responds to over
100,000 queries each year on a wide range of contraceptive and
sexual health issues. We also produce a variety of publications
to support professionals and the public, and provide resources
including training courses for those involved in delivering sexual
health services. fpa provides a national voice on sexual health
issues and works with the public and professionals to ensure high
quality information and services are available to all who need
them.
We recognise that this is a broad consultation
which addresses the full range of issues relating to human reproductive
technologies and the law. We are providing a short submission
which looks specifically and only at the issue of abortion.
Given that the Human Fertilisation and Embryology Act 1990 amended
the Abortion Act 1967, we submit this evidence for consideration
under point 2 of the inquiry: "To consider the provisions
of the Human Fertilisation and Embryology Act 1990 in the context
of other national and international legislation and regulation
of medical practice and research; to include related legislation
such as the EU human tissue directive, and law covering human
rights, surrogacy, adoption and abortion."
fpa believes that the law on abortion should
be changed in certain areas to allow improvements which more clearly
reflect both scientific evidence of what works well and the opinions
of the general public. We believe that it is inappropriate for
law in this area to be primarily governed by legislation laid
down over thirty-five years ago—in the Abortion Act 1967—particularly
given the developments both in public opinion and in medical practice
since that time.
Public opinion is clear on the issue of whether
abortion is primarily a woman's decision. A 2002 survey found
that 88% of British women believe that the decision to have an
abortion should ultimately rest with the woman herself.[4]
In practice, GPs are the gatekeepers to services and it is they
who decide on a woman's right to abortion. The requirements of
the Abortion Act, based on a view of society from over 35 years
ago, conspire to make access to abortion services an obstacle
course for women.
Moreover, recent advances in technology or initiatives
to improve the quality of the service provided have not been reflected
in clinical practice, as seen in the limited choice of abortion
method or procedure often offered to women. In England and Wales
use of medical (ie non-surgical) abortion is low, with only 14%
of abortions being by this method in 2002. In Scotland uptake
has been increasing and is much higher at nearly 50%. Medical
abortion costs less, is less invasive, and is preferred by many
women. If used more widely it would offer a greater level of choice
to women, and could significantly speed up access to the process,
thereby reducing waiting times.
Similarly, abortion by local anaesthetic for
surgical abortions offers benefits to some women but usage is
patchy and largely dependent on the personal preferences of the
clinicians involved. Enabling nurses to undertake uncomplicated
early medical and surgical abortions would also help to improve
access and reduce waiting times, and there is plenty of evidence
that health professionals such as midwives and nurses can safely
and effectively provide medical and early surgical abortion:
— Midwives already manage labour and
delivery, referring on to doctors when complications occur.
— Trained nurses or midwives perform
IUD insertions equally as well as doctors, according to a recent
study.[5]
— Physician assistants and certified
midwives have been receiving medical abortion training in the
United States.
Given these circumstances, we propose the following
amendments to abortion law:
— Doctors should not be gatekeepers
for women's access to abortion. The need for two doctors' signatures
should be abolished and the procedure treated like any other—where
the woman makes a choice and then consents to the procedure.
— The law should be changed so that
abortion services do not have to be licensed for a particular
location. Instead, they should have the same clinical governance
requirements and quality control systems as other clinical services.
— Recognising that abortion is an integral
part of sexual health services, abortion should be available in
a range of settings, including in the community. The range of
settings would include hospitals, general practices, family planning
and sexual health clinics, and other appropriate community settings.
— The law should be changed to allow
suitably trained nurses to perform early medical and early surgical
abortions.
May 2004
4 Marie Stopes International: Women's perceptions
of abortion law and practice in Britain. MSI, 2002. Back
5
Andrews GD. Appropriately trained nurses are competent at inserting
intrauterine devices: an audit of clinical practice. European
Journal of Contraception and Reproductive Health Care, vol
4, no 1, 1999, pp41-44. Back
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