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19 Jul 2005 : Column 385WH—continued
Abortion Time Limits
10.59 am
Dr. Evan Harris (Oxford, West and Abingdon) (LD): Before I start, I declare an interest: I have been a member of the British Medical Association medical ethics committee for the last few years. In this debate I speak not for the committee but for myself, although my views are informed by the discussions and debates that have taken place within it and among the wider medical community. I am a former hospital doctor. As a medical student, I trained in obstetrics and gynaecology and as a doctor I was aware of the practice of termination of pregnancy in the hospitals in which I worked.
I am conscious that it can be argued that one can fully understand pregnancy and abortion issues only if one is first a woman and secondly one who has been through pregnancy. That is a fair point. Clearly, I do not meet those criteria, and I recognise that there will be those with direct experience of some of the issues that I shall raise. Nevertheless, it is an issue for society, for Parliament and for men and women to debate.
The remarkable thing about this debate is that we are having it at all. The House of Commons Library confirms that it is 16 years since the House of Commons debated abortion in such a way. I hope that, whatever our views, we would all agree that that is far too long to ignore an issue that is so important and controversial that it divides society; people have strong views both ways. It is, therefore, necessary to retain public confidence in the law, and public confidence is best retained not by running away from debate but by revisiting the issues. We must show that, as the people's representatives, we have acquainted ourselves with the ethical arguments and the changes in medical practice and social attitudes that have undoubtedly taken place since the law was enacted in1967 and amended in 1990.
It might well be that, having debated the issue, the House does not change its position but supports the existing approach. That will still be of benefit to the public and the media. They think that for too long politicians have run away from debating the matter further because it is uncomfortable—of course it is—and because it is an issue on which neither the Government nor the Opposition parties, through their party Whips, can control what hon. Members do. We Back Benchers think that that is great, but perhaps Government business managers and party Whips do not. The fact that we have not debated the issue for 16 years shows that Parliament is too heavily dominated by the business managers and Whips and not responsive enough to the views of the public in terms of changing, or at least debating, the law.
Nevertheless, we now have a debate and I have sent an outline of my comments to those on the Front Benches to aid them, particularly the Minister, in preparing their responses. The Minister cannot claim to have had no chance to consider my points, and I am grateful that I had an opportunity to speak to her about the questions that I am going to ask.
One of the key issues is the abortion time limit under the existing law, which is 24 weeks of gestation in almost all circumstances save serious threats to the physical health of the woman or foetal abnormality that could lead to serious handicap. What is the basis of that? Is it
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because that covers almost all abortions other than the exceptional cases that I have described, so it is a matter of practicality—nobody is denied the opportunity to have an abortion if she meets the criteria for which the law sets out that abortion is legal—or is it based on foetal viability? That is an ethical argument that recognises that the woman's rights have to be respected. However, at the point at which the foetus is capable of living independently of the woman, it gains a moral status that requires us to give consideration to its interests.
That may be a practical choice, but I think that it is the basis of the current limit. As someone who generally supports the existing laws, I am happy to defend my support on the ground of foetal viability, but we need to decide what we mean by viability. Some people argue that viability will move ever downwards, because foetuses will be deemed to be capable of living independently of the woman earlier as a baby will be able to be resuscitated and kept alive earlier by medical advances. It is unlikely that the time will reduce in the near future because of some basic biological issues surrounding the development of lungs. However, if viability is chosen as the reason for the time limit, people will feel that it will become difficult to get an abortion beyond a certain stage of pregnancy.
Mark Pritchard (The Wrekin) (Con): I congratulate the hon. Gentleman on securing the debate. If he accepts that the law lags behind modern science, is there not a strong case—the opposite of what he says—for reducing the abortion time limit from its current status at least to 20 weeks?
Dr. Harris : That is the point that we are discussing. I should say at the outset that I am seeking a parliamentary inquiry so that we do not choose a time limit at random. I am not suggesting that the hon. Gentleman chose 20 at random, but why not 19 or 21? I shall go through some of the premises on which the law is based, and if we accept the limit, we need to be informed in making the decision.
In the general election campaign, the right hon. and learned Member for Folkestone and Hythe (Mr. Howard) stated that he thought that the time limit should be reduced. That comment was perfectly reasonable, and it was wrong for him to be criticised for expressing a view in direct answer to a question. The argument that the issue is not political is ridiculous, as we in Parliament are the only people with the power to change the limit. It is not a party-political issue, in the sense that views vary across the parties, and I trust that it is one of the few remaining decisions on which even the Government allow a free vote to their Back Benchers.
Nevertheless, it is right that people, particularly before an election, should find out the views of the person seeking to represent them on an issue that they feel strongly about. I have always made my views clear, and other people should as well. It is right for party leaders to say that they would give Parliament time, in a way that the Government have so far failed to do in two terms, to debate and vote on the issue.
Returning to my previous point, we must bear in mind that if viability is the basis for the limit, earlier viability will impinge on the ability of some women to have
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abortions. I shall come back to that later. Nevertheless, it is reasonable to say that there will not be a rapid reduction in the time limit, as we are reaching a minimum.
There is also a second question. If we use foetal viability as the ethical backstop, what do we mean by viability? Do we mean that the foetus is capable simply of being born alive, or surviving for a reasonable length of time or surviving through childhood with no serious disability? Can we make a general statement about the limit of foetal viability, or will we have to talk about specific cases? For example, there may be some foetuses for whom a higher limit will apply if they are small for their date because of some developmental delay or if they are part of a multiple pregnancy, which usually goes along with a reduction in size. Gender will also have an impact, and we will need to discuss all of those questions.
The law is not clear. Case law, from a case in 1991, has interpreted the term "viable " literally, arguing that Parliament meant the literal meaning of "viable"; that is, capable of being born alive. It is probably wise, when talking about the difference between abortion and potential manslaughter, that the judges take a literal approach to the law where there has been no further explanation.
However, we are now in an era when it is reasonable for Parliament to seek to define our terms more clearly. If we mean "capable of being alive", that would imply that a baby that was anencephalic—missing most of its brain, but whose lungs were capable of functioning for a short time—would be considered viable. We would not argue that that would prevent the termination of a pregnancy where anencephaly had been diagnosed, because that would fall within the rule that allows termination up to term where a serious handicap would be produced.
In contrast, the US courts have used the concept of viability to mean "capable of meaningful life". That presumably implies a reasonable period of survival but that could usefully do with definition, unless we are happy to leave it to the courts. We may decide that we are happy to do that, but those are issues that we need to decide. If one follows the argument that we define viability or decide to leave it to the courts and we feel that viability is the basis for our law, the question then is this; what should the limit of viability mean? The key question is whether medical advances have meant that it has been reduced.
I do not, for example, take the view that the three-dimensional ultrasound images—sometimes they are described as four-dimensional—demonstrated by Professor Stuart Campbell have any bearing on that. Professor Alan Templeton, the president of the Royal College of Obstetricians and Gynaecologists, said that they add little to the abortion debate. He said:
"Observing these developments and physiological movements is not changing anything about the time of viability. These images, however, have given rise again to the question as to whether or not there should be a reduction in the time limit of 24 weeks. It is distressing that so much of the comment has been so ill-informed."
Peter Hepper, the director of foetal behaviour research at Queen's university in Belfast, said:
"The images offer fascinating evidence of foetal development but did not advance arguments against abortion. It is unlikely that there is any emotional feeling behind these responses. They are probably just straightforward reflexes or practice for important behaviour at birth."
Some have commented that some of the images imply more movement than there was by using a loop in the pictures in some of the demonstrations. I do not have the details of that. I would argue that we do not need to deal with the question of viability, although it is clearly an emotive one. We need to consider whether, whatever definition of viability we choose, babies are capable of surviving at an earlier stage.
Sandra Gidley (Romsey) (LD): It is almost impossible to separate this debate from the comments made by Baroness Warnock about decisions that we make when women give birth 24 weeks into the pregnancy. There is now an opportunity to keep such a child alive, although it may lead to problems in later life. Surely one cannot separate the debate about late abortions from the ethical debate about when babies should be kept alive. Should medics try to do that with all babies—that is my inclination—or do we need further guidance for people making those decisions?
Dr. Harris : I am grateful to my hon. Friend for raising that question. They are separate issues, although some of the ethical issues are connected. There are clear rules and guidelines from professional medical bodies about what to do with babies that are born alive at a very young age and with profound disability. We do not have time to explore that now, but it is worthy of debate, because questions have been asked about whether we are striving too much or too little on some of those issues.
The Epicure study from 1995—it is somewhat dated—suggested that a small number of babies, two out of 138, born at 22 weeks' gestation, survived. One of them was severely handicapped and one had no impairment. Those are such small numbers that it is not helpful to use the term "percentages", because simply one more would double the percentage. That study also showed that at 23 weeks' gestation, 22 out of 242 babies—9 per cent.—survived with varying degrees of disability. At 24 weeks, 73 out of 382—19 per cent.—survived, also with varying degrees of disability, ranging from no disability to profound disability.
If we take a strict definition of viability, that is prima facie evidence that, in theory, the foetus is capable of living independently of the woman and that the age of viability needs to be reduced. However, we need to know whether those figures are reliable, and whether the gestational age can be determined sufficiently accurately. That is why we need a parliamentary review of the scientific evidence, so that those of us who will base our decision on the science—that will not, of course, apply to everyone—can make that decision in an informed way.
A further question that needs to be raised is whether if the time limit of 24 weeks were reduced, that would have an adverse impact on some women seeking abortion and, if so, whether that impact could or should be ameliorated. There are various reasons why women
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have late abortions. It is important that those reasons are made clear, because it is often suggested that women who seek late abortions go into it lightly, and that it is dealt with in a trivial way. That is not my experience, and I do not believe that it is the experience of those who see and treat those women. The reasons for late abortion can be listed, and I am grateful to the FPA, Marie Stopes and other organisations for providing that information. Those seeking late abortions include teenagers who cannot face the issue or find it difficult to make a decision; young women whose periods are irregular and who therefore do not realise that they are pregnant until late in the pregnancy; women who are in a similar situation perimenopausally, in which they do not have regular cycles and do not or cannot believe that they are pregnant; and the failure of the type of contraception that stops periods completely, which may delay recognition of pregnancy.
There may also be a problem with doctors not referring women for abortions because of their own religious views. In relation to that, I support the view that it should be made clear to patients in advance of a consultation on abortion which doctor they should see. An informed patient requires that information, and it would also make it easier for the doctor. In respect of late abortion, there are also young women whose doctors might insist that they consult their parents when they are unwilling to do so. It is lawful for them to be referred without parents being involved, but young people may not be able to negotiate with a doctor in that situation.
There are also cases of women who suffer a domestic disaster—there is probably no better word for it—during pregnancy, such as abandonment or physical abuse by a partner, which makes it impossible for them to seek to continue with the pregnancy at a time near the limit. We must recognise that those women have needs and we ought therefore to think about what changes could be made if the age limit were reduced.
I believe that there is now a good case for making first trimester abortions easier to access, without the need for the consent of two doctors. We should treat them as we treat other medical procedures; it should be subject to informed consent and an assessment of its appropriateness and the best interests of the patient. There is a strong argument for permitting medical abortion—the use of the so-called abortion pill at home—where it is shown to be safe, and I regret that the authorities and the Government seem to be stalling on permitting that.
Mark Pritchard : I am grateful to the hon. Gentleman for giving way again. In relation to the review of the law that he speaks about, does he agree that there should also be a review of abortion up to birth for disabled babies? The hon. Gentleman will know, as a medical professional, that many people are not born able-bodied, but nevertheless live perfectly fulfilled lives and make vast contributions to British society. Indeed, we have, and have had, fellow Members in the House who have not been able-bodied but who have made great contributions to public life.
Dr. Harris : The hon. Gentleman raises an important point, which I shall come to in a moment. There is a strong argument for extending the legalisation of
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abortion to all parts of the country, meaning Northern Ireland. It is depressing that the Government have still not come up with the guidelines for medical professionals in Northern Ireland that were requested by judicial review, so that they know what they are permitted to do in that jurisdiction. I believe that there is an argument for performance monitoring of the delivery of NHS abortion services, to ensure that they are more accessible, on a fairer geographical basis.
The hon. Member for The Wrekin (Mark Pritchard) asked about the law that permits abortion up to term in the case of foetal abnormality and I think that there is an argument that Parliament should revisit the matter and seek to define "seriously" and "handicapped" more closely, or make it explicit that it should be up to the courts or the doctors to decide. The Jepson case, in which there was a referral for what appears to have been, on the face of it—we do not know the full details—bilateral cleft lip and palate, and in which an abortion was carried out at 26 weeks, suggests that Parliament should revisit the matter. The hon. Gentleman and I may not agree on whether the procedure should ever be allowed, but it is reasonable that Parliament should consider it again.
Mark Pritchard : The hon. Gentleman raises the Jepson case. I live in Shropshire and am a Shropshire Member, and the county falls within the area of West Mercia police which, as the hon. Gentleman knows, was involved. I wrote to the chief constable asking him to investigate the case, because I have grave concerns. The police should enforce and not interpret the law on abortion, and there have been claims that abortions have taken place outside the law. I am glad that the hon. Gentleman raised that case, which shows a worrying trend.
Dr. Harris : I am reluctant to be drawn into the case. We do not know the full facts, and cleft lip and palate are often signs of a more profoundly disabling syndrome. I understand that Rev. Joanna Jepson has not yet indicated whether she will seek judicial review. We should discuss the generalities. I agree that the issues need to be debated, although they are somewhat outside the issue that I am raising today.
My final point is to discuss how we should take the matters forward. A Government response is awaited to the Science and Technology Committee's report on assisted reproduction and assisted reproductive technologies. I served on the Committee, which argued for a Commons and Lords Joint Select Committee inquiry into those questions, and the impact of technological, medical and social changes since 1967. There are several options for the Government to consider, and I hope that even if the Government will not say how they will proceed, they will at least say which they consider reasonable.
I do not think setting up an independent scientific review, reporting to the Department of Health, is ideal, because it should not be solely in the Government's purview to set terms of reference. The matter is non-party political and subject to a free vote. Another option is setting up an ad hoc Select Committee of both Houses to review the issues and report back to the House, which would be for the Government to do. The third option is a Lords and Commons Science and Technology Committee joint inquiry, to be reported to the House.
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A report made under any of those arrangements should contain options for Parliament to vote on, based on the ethical, social and medical or scientific evidence reported. There would not be a consensus in such a report on the ethical basis of abortion between what are called the pro-life and pro-choice camps. Parliament will have to decide that question. However, there is a good chance of considerable consensus on what the options should be as to viability and time limits, if Parliament is minded, as seems likely, to support the existing basis for the law.
We need the Government to agree that if a Select Committee embarks on the exercise they will provide the time for a debate and vote on the outcome. Otherwise it will be another fruitless exercise.
During the election campaign, the then Solicitor-General, the current Secretary of State for Constitutional Affairs, was quoted in The Sunday Telegraph:
"Harriet Harman, the Solicitor General, said: "This has always been a matter of individual conscience. If something is a free vote it cannot be in a general election campaign."
I think that that is questionable. She added:
Can we debate it later? What is not acceptable is for the matter not to be brought back to the House. Sixteen years is too long a time for Parliament not to vote on the issue, let alone debate it substantively. I agreed when the party leaders said during the election campaign that there was an issue to be discussed and settled. It is time for the Government to back a parliamentary inquiry, after which they should allow time for the issue to be debated and settled.
I am grateful to the British Medical Association for its paper on abortion time limits, and for helping me to prepare for the debate with its briefing.
11.25 am
Jim Dobbin (Heywood and Middleton) (Lab/Co-op): The debate was inevitable. It is true that 16 years is a long time for such an important issue to have been ignored. We are all aware that many Members of Parliament are afraid to put their heads above the parapet on this issue, even in their own constituencies. I have never been of that ilk. I have made my beliefs on the issue clear locally. I am the chairman of the all-party pro-life group, so, naturally, I am against abortion, except in rare cases in which the mother's life is in real danger.
I listened carefully to the hon. Member for Oxford, West and Abingdon (Dr. Harris), who has a medical background. Much of the data he provided is backed by the medical profession, but it must not be forgotten that there is also a moral aspect to the debate. I see this debate as a follow-up to the recent debate at the BMA conference. I am not sure whether the hon. Gentleman had a vote at that conference, but from what he said, I assume that he might have abstained.
Dr. Harris : The hon. Gentleman will be aware that the BMA voted against a specific proposal to reduce the limit from 24 weeks to 22 weeks. I believe that we should
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review the scientific evidence before making that decision, so I would have voted against an immediate decision to reduce the limit. It is not logical to argue for a review so that a decision can be made on the evidence, and then to pre-empt that by picking a date.
Jim Dobbin : The debate and the demands for a review of the Abortion Act 1967 were stimulated—we cannot get away from this—by the sensational ultrasound pictures presented by Professor Stuart Campbell. I saw Martin Kemp's film "Science in culture: Womb with a view?" to which the hon. Gentleman referred, and heard Professor Campbell, who is eminent in the field, rethink his position on the number of weeks in the abortion limit. Since those pictures were printed by the national press, I have spoken to many colleagues in the House of Commons, who seem to be reviewing their personal positions on the limit. I believe that they would support a proper evidence-based review. That is the aim of the debate. Indeed, the Prime Minister and the Leader of the Opposition have said as much, and Lord Steel has indicated that he believes that changes are required.
For me, the issue is not just about the length of the abortion limit, but about the number of abortions and access to abortion at earlier stages. The pro-life charity, Life, recognises that abortion in the UK is legislated for within the framework of time limits, and it supports a reduction in the upper time limit to save unborn lives. The philosophical flaw in the framework is that it implies that bigger is better—that an unborn child of 24 weeks and one day is worthy of the protection of the law, whereas an unborn child of 23 weeks and six days is not. Where is the logic in that approach? That issue must be considered.
Our primary focus should be to reduce the overall number of abortions. In 2003, there were almost 190,000 abortions. That is 600 every working day. Surely, there must some agreement in this place that too many abortions are being performed in the UK.
What is society's response? Marie Stopes International has been mentioned this morning, as has the British Pregnancy Advisory Service, both of which advocate the liberalisation of abortion law. This weekend it was reported that Marie Stopes International would like to name and shame doctors who have a conscientious objection to abortion. Such organisations fail to appreciate that the Abortion Act 1967 does not provide for abortion on demand. A doctor who is faced by a woman seeking abortion is perfectly entitled to determine that, in his or her professional opinion, the conditions set out in the Act have not been met. If Marie Stopes International and BPAS get their way, there is no doubt that the abortion rate will continue to increase.
I would like the Government to consider offering more financial support to organisations such as Life that offer crisis pregnancy counselling. Life has a team of professional counsellors and skilled listeners who provide non-directional pre and post-abortion counselling.
Sandra Gidley : The hon. Gentleman seems to be leaving out a step in the procedure. Although I come from a different philosophical viewpoint, I agree with him that we need fewer abortions—no woman undertakes one lightly, I would suggest. However,
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should we not go back one stage, to better contraceptive advice in schools and other such measures, which will prevent so many women from accidentally becoming pregnant in the first place?
Jim Dobbin : That is another issue, for another debate, but my personal view is against contraception.
A growing body of peer-reviewed medical evidence shows that induced abortion is associated with increased mortality, increased suicide rates and a large number of severe, immediately life-threatening medical complications, as well as long-term consequences for subsequent pregnancies, such as an increased risk of premature birth and ectopic pregnancies. Two Finnish studies in recent years have provided particularly disturbing evidence of increased mortality and suicide rates following abortion. More research needs to be conducted on the physical and psychological consequences of abortion. Also, abortion providers have a duty to ensure that the women who are considering abortion are given all the facts about abortion and what it entails. A right to choose must be accompanied by the right to know, but that information and counselling are often not given.
Abortion law reform should not focus exclusively on time limits. Rather, we should consider other legislative options. There should be informed consent legislation, placing a legal obligation on all abortion providers to provide women considering abortion with the relevant information about the physical and psychological consequences. Also, there could be a compulsory cooling-off period between the decision to have an abortion and the abortion. We could consider giving greater financial and practical support to women in crisis pregnancy situations and introducing parental notification laws for minors, which has been in the news recently. However, the most important issue, right at the top of the agenda, is the rights of the unborn child. We talk about foetuses and use other technical terms, but in the end there is a baby—a child—and that must not be forgotten. Anyone who has seen Professor Stuart Campbell's pictures will know that that is the situation. To me, a child is there.
Some people call for a 22-week limit, some for a 20-week limit, others for an 18-week limit and some have even argued for 12 weeks as a possibility. This debate is the first salvo from the pro-abortion lobby. No doubt we will return to this important subject in the next Session.
11.35 am
Philip Davies (Shipley) (Con): I congratulate the hon. Member for Oxford, West and Abingdon (Dr. Harris) on securing a debate on this important subject. I find myself agreeing with elements of all the speeches that have been made and I do not see the issue in the black and white terms that some people do—it is much more complicated than that. I probably agree with the hon. Gentleman about focusing on the time limits.
I agree that this is a medical and scientific question, as well as a moral question, and we cannot divorce the two when debating issues such as abortion. My views on the moral issue are perfectly clear, and most people will have a clear moral view on it. I come at the issue as somebody who would not support an outright ban on abortion. It is not right to tell women in particular
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situations that they cannot have an abortion. How, for example, can we tell someone who has been raped that they must not have an abortion? I am not, therefore, one of those people who try to use the debate on time limits as a Trojan horse to get rid of abortions altogether; the issue is much more complicated than that.
Although my moral view is clear, my view about the science is not quite so clear. The hon. Gentleman asked whether the current limit was based on the viability of a baby at that time or whether it was intended to give people the chance to have an abortion should they wish to have one. I very much hope and believe that it is based on a baby's viability. Although I support abortions for people in particular situations, it is outrageous and morally wrong to accept the principle that it should be permissible to abort a viable baby. We will therefore always come back to the science.
I tabled an early-day motion on this subject not too long ago, calling for a reduction from 24 weeks to 20, and my hon. Friend the Member for The Wrekin (Mark Pritchard) mentioned that. I was, however, persuaded by the hon. Gentleman that 20 weeks is just as arbitrary in many respects as 21 weeks or 19 weeks. There may be no particular basis for 20 weeks—why should the limit be 20 weeks and not any other period? I felt myself persuaded by that argument.
There is, however, some dispute over the figures. The hon. Gentleman quoted some figures for survival rates, but when I contacted the House of Commons Library, I was told that 39 per cent. of babies born at 24 weeks survived. There is clearly some dispute about the survival figures, so I find myself agreeing with the hon. Gentleman's proposed way forward. Select Committees should debate the issue, and the Government should get people to look into it, so that we can have a debate that is based on science and fact rather than raw emotion. I accept that my figure of 20 weeks was perhaps arbitrary; it was designed to move the debate on, which is why I welcome this debate.
Medical science moves on regularly, and I agree that it is an outrage that we have not debated this issue for 16 years. Medical science moves on very quickly, and those like me who feel that abortions need to be legal find it unacceptable that the time limit has not been debated for 16 years. Perhaps the law should enshrine the medical science rather than setting what may, given the progress of medical science, end up being an arbitrary time limit that is out of date within a year or so. Perhaps it should focus on the medical science and say, for example, that the ongoing abortion limit should be based on 10 per cent. of the number of babies born at that time—I simply pluck that figure out of the air. Rather than sticking to a particular time limit, which will inevitably become out of date very quickly, we should stick to something that is based on science and on a particular principle.
The hon. Member for Heywood and Middleton (Jim Dobbin) talked about how many abortions there are. I agree that there are far too many unwanted pregnancies and far too many abortions. There is a feeling around the country that abortions are sometimes too easy to obtain. I, for one, want something to be done to tackle that view, whether or not it is a misconception. I certainly do not accept that more sex education in schools is the way to avoid unwanted pregnancies and abortions, which I believe is what the hon. Member for
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Romsey (Sandra Gidley) was talking about. So far as I can tell, the more sex education we have in schools, the more unwanted pregnancies and abortions there are.
Mark Pritchard : That is an important point. A huge amount of public money has been spent on so-called health education in schools, yet there has been a huge increase in teenage pregnancies and sexually transmitted diseases. I question the whole logic of all this public money being spent, as the outputs are clearly not what they should be. I hope that my hon. Friend agrees.
Philip Davies : I have an awful amount of sympathy for what my hon. Friend says. The evidence is perfectly clear.
Sandra Gidley : The hon. Gentleman is obviously new to the House, so may I refer him to the Health Committee report on sexual health, which demonstrates quite adequately that current levels of education in schools are woefully inadequate? We took evidence from young people, so perhaps he will read the report before he comments further.
Philip Davies : I thank the hon. Lady for her advice, but simply because a Select Committee gives a particular recommendation does not necessarily mean that I must agree with it. I am sure that she does not necessarily agree with every recommendation made by every Committee. I try to use my own practical experience and consider these things from my own perspective as well.
Dr. Harris : I rise briefly to clarify the record. The figure that I gave was of 19 per cent. of people surviving up to six-year follow-up. Perhaps the figures that the hon. Gentleman obtained from the Library were different because they did not relate to people surviving up to six-year follow-up. Is he really saying that the so-called Widdecombe strategy of more ignorance for dealing with unwanted pregnancy is the way forward?
Philip Davies : I thank the hon. Gentleman for trying to clarify the discrepancy in the figures. I suspect that he might well be right about that. I merely make the observation that sex education, which has been piled on schools more and more year on year, does not appear to have had any great impact on the number of unwanted pregnancies and the number of abortions. In fact, the problem seems to have worsened.
It strikes me that the idea that more sex education will sort out all our problems is an easy and cheap solution. We have given sex education a particularly good go for several years and it does not appear to have worked, so a different strategy might need to be adopted. This never-ending sex education thing seems to encourage a fascination in the whole subject rather than preventing people from indulging in these pastimes and successfully preventing unwanted pregnancies and therefore abortions.
The facts are there for people to see; sex education has not worked. I do not feel particularly comfortable sending my children off to school to be told someone else's moral view on such issues. Children go to school
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to be taught things that their parents cannot teach them, not to be taught things that parents can perfectly adequately talk to their children about. This sex education business does not help to reduce unwanted pregnancies and abortions. That has become evident to an awful lot of people around the country. I am sorry that so many people have been fascinated by this sex education bandwagon and will not challenge some of the conventional wisdom around the country on these matters.
This is an important subject that we should be prepared to debate openly and rationally. I accept that some people have a particular moral view and abhor all abortions. That is a perfectly legitimate view. I do not share it, but the point about time limits is important. Sixteen years is far too long. The hon. Gentleman's recommendations for getting the matter resolved in this Parliament are good. I support them wholeheartedly. I hope that the Minister will agree that, should the Select Committees give some time to discussing this, it can be debated in the Chamber and the matter can be decided once and for all in this Parliament.
11.45 am
Lynda Waltho (Stourbridge) (Lab): I congratulate the hon. Member for Oxford, West and Abingdon (Dr. Harris) on securing the debate. I am glad that we have been able to discuss the topic more or less intelligently and sensitively without anti-choice campaigners trying to revisit the long-decided debate over whether legal abortions should be available. As those who have seen the film "Vera Drake" are vividly reminded, the choice is not whether we have abortion, but whether we have legal or illegal abortion.
Abortion has been legal in this country since 1967 and is very tightly regulated. Uniquely, for a medical procedure, two doctors must authorise an abortion. It is not easy to obtain an abortion and we do not have abortion on demand. Statistics from 2003 show that 182,000 women in England and Wales had terminations; only 13 per cent of those were later than 13 weeks' gestation. Late terminations are very rare; so rare that the figures are difficult to obtain for any categories later than 13 weeks because to do so starts to compromise confidentiality.
In the west midlands where my constituency is situated, 18,000 women had terminations in 2003. Much recent debate has been about reductions in the abortion time limit but I would argue, contrary to the hon. Gentleman, that it is as important and useful to call for research into why these few women who have terminations after 22 weeks—the figure is less than 2 per cent.—are requesting so late. We need to remedy that and also look at the requirement for a second doctor to authorise the procedure.
The decision to have a termination is never easy and never taken lightly by any woman facing an unplanned pregnancy. That is especially true for late terminations, which are not pleasant for anybody involved. Late termination is difficult emotionally for all in those circumstances. As the hon. Gentleman pointed out, the patients referred are often distraught because their wanted pregnancy is affected by abnormality, shocked by a late diagnosis of pregnancy, struggling with awful personal circumstances or, as in the cases I have come across in my work with young women, desperate because it has taken so long to arrange.
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We all know that while a termination still carries less risk to a woman than giving birth, the earlier a termination takes place, the more straightforward it is. In the west midlands we have the worst record for early termination; only 46 per cent. of terminations take place under nine weeks compared with 58 per cent. nationally. Along with local practitioners and counsellors I am calling for continued expansion of sex and relationships education, improved access to confidential contraception services and speedier access to termination services when contraception fails.
A recent evaluation of the teenage pregnancy strategy showed how seriously it has been taken at a local level and highlights the work of the teenage pregnancy co-ordinators, but it also confirmed how much needs to be done. More than two thirds of young people still do not feel that the sex and relationships education they receive at school fully meets their needs and they are not confident that they can access confidential services for advice and contraception. It is time to look seriously at making SRE a compulsory part of the national curriculum.
Sandra Gidley : The hon. Lady mentioned an important word there—relationships. That is crucial. In countries where SRE has a heavy focus on relationships, the unwanted pregnancy rate has dropped. I am pleased to hear the line of thought she is developing.
Lynda Waltho : I was hoping to come on to that point. Of course, it is the relationship part of the whole process that is important. Parents contributing to sex education is excellent. I hope that that is what I provide for my children at home, but not all children have parents or the sort of parents who can guide and listen to them and be available for sex education. The hon. Member for Shipley (Philip Davies) overlooks a great problem: many parents, for one reason or another, cannot provide sex education.
Comprehensive SRE would teach young people how to protect themselves against unplanned pregnancies and sexually transmitted infections and about local confidential services. It would also, crucially, help them to understand and resist peer pressure to have sex too early—that is the biggest problem—and to develop the communication and negotiation skills that they need to build successful relationships. I would welcome my hon. Friend the Minister's comments on that.
I welcome the recent input from the Royal College of Obstetricians and Gynaecologists in the form of guidelines to its members calling for women meeting the legal requirements to be referred without delay. That is a vital element. As a former teacher and a youth worker, I know that it is one of the biggest single issues in young women presenting late.
11.51 am
Steve Webb (Northavon) (LD): I congratulate my hon. Friend the Member for Oxford, West and Abingdon (Dr. Harris)—one of my predecessors as Liberal Democrat health spokesman—on initiating the debate and on his measured and well-informed contribution. As he said, he is a member of the British Medical Association's medical ethics committee, so he is very well informed on these matters. Coming from
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somewhat different ethical standpoints, we do not always reach the same conclusions, but I certainly respect both his contribution and the fact that he has brought this very important issue to the House today.
Although short, the debate has been lively. I was pleased to hear some discussion of prevention, because the danger of a debate on time limits is that we focus on the question of 22, 23 or 24 weeks when, according to the BMA's excellent factual briefing on the issue, which I think is intended to be fairly neutral, 0.75 per cent. of abortions take place after 22 weeks. If we spend all our parliamentary time, effort and energies focusing on the period after 22 weeks, we miss the other 99 and a bit per cent. For those who, like me and, I think, many hon. Members, take the view that there are simply too many abortions, not least for the welfare of women themselves, there is a danger in focusing the debate too narrowly, so I welcome our discussion of prevention.
Clearly, prevention can come at different stages in the process. As the hon. Member for Heywood and Middleton (Jim Dobbin) said, there are excellent pregnancy crisis services run by a variety of organisations, not necessarily by those that are strongly associated with one camp. A new service in my constituency, the Willow Tree pregnancy crisis centre, of which I am a patron, has been warmly welcomed by the local community as somewhere for a woman to turn to if she becomes pregnant unintentionally and wants to talk through the options with someone. The hon. Gentleman used the term "non-directive". The centre with which I am familiar will support a woman through her decision and will not turn its back on her if she takes a decision that perhaps is not the one that the founders of the group would have wanted. It supports people come what may.
One thing that I have observed is how poorly funded pregnancy crisis centres are. The group set up in my constituency has had to scrabble around for charitable funding in fairly small doses and has had to write to local businesses for small grants. Could the Minister say something more about what the Government are doing to ensure that women who want such support—often from other women from the local community and not necessarily from health professionals—can access it easily, locally and conveniently?
Prevention is critical, and an earlier stage of prevention involves education, which we have talked about. Where I perhaps differ from the hon. Member for Shipley (Philip Davies) is that the characterisation that he gives is of our schools talking about sex all the time. I strongly suspect that there is the whole spectrum in our schools. Some sex education is predominantly biological, and I would like to see it set in a moral context—not necessarily moralising, but, as my hon. Friend the Member for Romsey (Sandra Gidley) mentioned, in the context of relationships. That would make it easier, particularly for young women who want to delay having sex for the first time.
Although some parents are good at communicating what children need to know about sex, we have a responsibility to the children whose parents will not do that, as the hon. Member for Stourbridge (Lynda Waltho) said. I am not sure how the hon. Gentleman would respond, but from where will the children whose parents are not providing sex
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education—it is clear that there are such children—get the information, if not systematically and reliably at schools?
Philip Davies : It would be fair to say that sex education in schools may have a small part to play. What I object to is the continuing call for more and more sex education in schools, which strikes me not as the solution to the problem but as the easy, cheap response. Does the hon. Gentleman not accept that with the more calls that we have for more sex education in schools, the problem seems to get worse and worse?
Steve Webb : As my hon. Friend said, we need to look at the evidence. There are different approaches to sex and relationship education across Europe and beyond, and there are very different patterns of unwanted pregnancies. It is far from clear that there is a simple link. In a sense, why would one be opposed to education? Perhaps the hon. Gentleman is saying that he does not think that it is education—
Philip Davies : More and more education.
Steve Webb : Why would anyone object to more education? What is wrong with education? I think that the hon. Gentleman does not agree with the philosophy behind the education and thinks that it is propaganda or something else. Clearly, we need to ensure that what is happening in our classrooms is education based on information and a moral and ethical framework, including the context of relationships. We need to ensure that that happens, and I do not see how anybody could be against proper education. If children do not get information from their parents or teachers, they will get it from their mates, who may not be the most reliable source.
Where I part company with my hon. Friend the Member for Oxford, West and Abingdon is on the close link between the debate on the time limit of 24 or 22 weeks and the rules for first trimester abortions. I am happy to debate access to abortion in the first 12 weeks, but the link between the two is tenuous. It is interesting that some people see this debate as a stalking horse for a total ban on all abortions while others see it as a stalking horse for a great liberalisation. I was surprised to see briefing material from the Society for the Protection of the Unborn Child, which was against the debate because it was worried that it would lead to greater liberalisation. The issues might be usefully debated, but I do not see much of a causal link between the two. We should not just assume that if we are going to reduce the upper limit, we have to make abortion easier in the earlier days. I do not accept that logic.
Dr. Harris : I see my hon. Friend's point, but I was trying to make a wider point that women find it very difficult to get even second trimester abortions without significant delay. If the limit were reduced to 22 weeks, that would mean that women who would otherwise qualify would be outwith the limit, simply because of the delays in the system for referral or provision of service.
Steve Webb : That is a helpful clarification, and clearly what we want to avoid is arbitrariness. It would be unfair if one woman fell the wrong side of the line because of local delays in provision.
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On my hon. Friend's important point about a joint science and technology Committee, there is a strong case for a Committee of both Houses advising us. Where I part company with him again—this comes back to the point made by the hon. Member for Shipley—is that it is clearly not an issue just for the scientists. One of my worries about having the two Science and Technology Committees reporting to the House is that we are being dominated by the science. The science is important—we need to be well informed—but it is far from the whole issue. If we are considering a strategy for reducing abortions, we should think about the causes, education and social issues. Scientific committees do not have a unique insight into such things. A wider group of parliamentarians, informed by the science, might be able to help the House in its deliberations.
While the hon. Gentleman was talking about education, I looked up the figures on the ages of mothers having abortions. Nearly three quarters are over 20. There is, again, a danger of thinking that we are debating teenage mums. Many of the women having abortions are relatively mature adults—their ages range across a wide spectrum. Therefore, our policy must be broadly drawn. The issues affecting women further into their childbearing years will be different from those affecting 15-year-olds. Policy needs to be tailored to the needs of individuals, rather than being broad brush and dealing with generalisations.
I very much welcome the fact that my hon. Friend raised the matter, on which he is very well informed, in such a measured way. I am concerned that if we focus just on abortions post-20 weeks and post-22 weeks, we will miss the bigger picture. The Government are not doing enough to tackle the fact that the number of abortions is gradually but remorselessly rising. It does not matter where one stands, whether one is pro-life or pro-choice, none of us can regard that as satisfactory. What is the Government's strategy for turning the tide, regardless of any specific decision on the small number of abortions that take place in the later weeks of pregnancy?
12.2 pm
Mr. John Baron (Billericay) (Con): I, too, add my congratulations to the hon. Member for Oxford, West and Abingdon (Dr. Harris) on having secured the debate. I also thank him for having sent me an indication as to what he intended to say. I found that very helpful.
No law can deal perfectly with such complex issues, and our present abortion laws are not perfect. However, it is important that, however complex the issue, the law reflects society's view. If it does not, it risks being seen as over-restrictive or morally at fault, and thereby undermining the rule of law in general. Aspects of the current legislation need to be addressed. On serious handicap, the law states that non-emergency abortions should not take place after 24 weeks. We are, however, aware of a recent newsworthy example of a foetus that was aborted after 24 weeks because it had been diagnosed with a cleft lip and palate. Although that condition might be a symptom of a failure of the skull to fuse—and, therefore, a serious handicap under statutory ground (e)—it might also be something as trivial as a harelip. It is vital that the wishes of Parliament are clear. This might, therefore, be the time
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to issue guidance under the 1967 Act as to what constitutes a serious handicap. To my knowledge, there has never been a definition of that term. I would welcome the Minister's views on that.
As we know, more than 90 per cent. of abortions each year take place on ground (c), a risk to the physical or mental health of the woman. There is a fear that that is a vehicle through which abortion on demand is being secured. If that is the case, we may need to examine whether changes are required to our legislation. Perhaps, like France, Germany, Holland and Russia, we should place abortion on demand in the first trimester on a firm legislative footing, or perhaps statutory ground (c) should be tightened further. Either way, Parliament, in full command of the evidence, should be free to take the decision. It is important that the wishes of Parliament, once decided, be respected. I am not sure that that is the case at the moment.
Sir John Butterfill (in the Chair): Order. I should point out that I am not a Deputy Speaker. The correct address while I am in the Chair is Sir John.
Mr. Baron : Thank you, Sir John. I apologise.
We should respect other countries' views on abortion. Last October, it was reported that the British Pregnancy Advisory Service was facilitating terminations after 24 weeks by referring women to a clinic in Spain that was willing to perform such terminations. However, Spain does not permit abortions after 22 weeks unless the health of the mother is in grave danger. A report into the activities of the BPAS by the chief medical officer has been concluded but has yet to be published. Will the Minister say when that report will be published? It is important that the laws of this and other countries are respected, especially as the BPAS receives NHS funds of about £12 million a year to carry out abortions.
The time limit has raised several issues. Last summer, the debate about the upper limit on abortion was sparked by the vivid images of a foetus at 18 weeks' gestation. The images displayed a foetus seemingly exhibiting uniquely human, child-like characteristics, the effect of which was to sharpen our minds on the debate surrounding the moral status of that foetus.
Our abortion laws have to date steered clear of moral issues, as the hon. Gentleman said. Instead, the upper time limit for non-emergency abortions has been based on the simple and probably most objective test: the point at which the foetus becomes viable. The precedent for that was the Infant Life Preservation Act 1929, which made it an offence to destroy the life of a child capable of being born alive. When the 1967 Act was passed, the limit for non-emergency abortions was assumed to be 28 weeks, because that was the point at which a foetus became viable. In 1990, for the first time, legislation set a time limit at 24 weeks, reflecting medical advances since 1967. There have been developments in the use of mechanical ventilation which should be studied very carefully. It is likely that a foetus can be viable at 22 weeks or even earlier.
I refer the Chamber to data published on the website of the British Medical Journal as part of the Trent health region study, which shows that between 1998 and 2001, 7 per cent. of all European births at 22 weeks in the
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Trent health region survived through to discharge from hospital. A few years later, that proportion may be even higher. If the time at which a foetus becomes viable has indeed fallen, we must consider reducing the limit in the 1990 Act, which amended the 1967 Act. However, the medical and scientific evidence must be properly examined and hon. Members are not in a position to take such decisions because we are not in full possession of the facts. That is why I support the hon. Gentleman's call on the Government to respond to the Science and Technology Committee's report on human reproductive technologies and the law, published in March. The report called on both Houses to set up a Joint Committee to consider the scientific, medical and social changes in relation to abortion that have taken place since 1967, with a view to presenting options for new legislation.
I hope the debate that follows will be much fuller and broader than we have had in the past on this issue, for two reasons: first, because it is obvious that there is a broad range of views. We, as hon. Members, have a free vote on the issue; I make it clear that the views I express are my own and do not necessarily reflect the views of the official Opposition. Secondly, there should be a broader debate because so far it has been too restricted, concentrating on time limits as guided by the concept of viability.
I, for one, have trouble with the idea that the state has a right to interfere in such difficult decisions, especially during the early weeks and months of a pregnancy when, for example, the woman has been raped. We must question the right of the state in such circumstances. However, the state should do more to help women to go their full term. We must not underestimate how difficult such a decision is for many women, who suffer the heartache of making the decision, and who often feel alone when they are making it. There are many groups that support women in those circumstances, and we, as a Chamber, want to acknowledge that and congratulate them on the excellent work that they do. However, the state could, for example, put more resources into the adoption services, so that if a woman were toying with the idea of abortion because she felt that she did not want the child after birth, at least there would be a further option, that of adoption, which could avoid abortion itself. We must, as a Parliament, question whether the state is doing enough to support women who are making those difficult decisions, often at times when they feel alone.
I look forward to a broad and full debate when the time comes—perhaps broader than we have had in the past. However, before that debate takes place—I am conscious that time is pushing on, and I want to give the Minister time to answer the various questions that have been asked—I should like to end by reiterating some of the questions that I have raised regarding the existing law. I shall focus on existing law, because I believe that it needs to be examined carefully.
The Minister needs to answer the questions about serious handicap that I have asked. For example, has she given any thought to publishing guidance under the 1967 Act to provide health practitioners with an exact definition of what "serious handicap" means? In that vein, I should like briefly to flag up one issue that is of interest to me. First, the Minister will be aware that something like 9,000 women travel to the UK to have
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abortions, many from Northern Ireland. Will the Government now consider extending the scope of the 1967 Act to Northern Ireland?
Secondly, there is a suspicion that the will of Parliament is not being abided by, and that category (c) is perhaps a loophole through which abortions on demand are progressed. That must be addressed. We must recognise that fact, and decide whether we should allow abortion on demand, perhaps in the first trimester, or whether category (c) needs to be tightened up. That is an issue where the will of Parliament is not being abided by.
Thirdly, the Government must face up to their responsibility and address the issues raised by the cases surrounding the BPAS at a time when we are all calling for a greater examination of the medical advances and the evidence that should be made available. It is wrong when the Government delay the publication of relevant evidence in the case of the BPAS. When will the Government set a date on which to publish the BPAS study?
Finally, the Government must recognise—I hope to hear encouraging noises from the Minister—that medical advances have been made. I supported the hon. Gentleman in his call for a full debate on this difficult and sensitive issue, and I believe that the Government should set up a Joint Committee to consider it. I look forward to hearing the Minister's response.
12.13 pm
The Parliamentary Under-Secretary of State for Health (Caroline Flint) : Sir John, I am pleased to be able to respond to the debate introduced by the hon. Member for Oxford, West and Abingdon (Dr. Harris). I am going to try to get through as many questions that were asked as possible, so I shall try to avoid taking interventions. If there is something that I have not covered, I suggest to hon. Members that they seek me out and I will write to them further if they are not happy with my reply.
First, in 1967 and 1990, Parliament decided that abortions may be lawfully carried out in the circumstances specified in the Abortion Acts. We have heard a considerable number of contributions about that legislation this morning. Women are legally entitled to seek an abortion at the gestation periods that Parliament sets. It should be recognised that the proportion of abortions carried out at over 20 weeks gestation is small; just 1.6 per cent. of abortions carried out on residents of England and Wales in 2003. In fact, 87 per cent. of abortions are carried out at under 13 weeks gestation and of those, 58 per cent. were at under 10 weeks.
I am pleased to say that since 2002–03, there has been an indicator on access to abortion services in the primary care trust star ratings that have been set. That is important, because a number of hon. Members have raised during the debate the issue of access to abortion during the first trimester. The Government have put a lever on PCTs to do what they can to improve services. I am afraid to say that services are patchy in different parts of the country. We are trying to improve that with the star rating. Early indications are that it is having some effect. I hope that those who are not against abortion in principle will welcome that.
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Access to abortion before nine weeks' gestation is important because it allows women a choice of surgical or medical abortion. I will address the point on medical abortion made by the hon. Member for Oxford, West and Abingdon later.
The time limit in section 1(1)(a) of the Abortion Act 1967 was reduced from 28 weeks to 24 weeks by a free vote in Parliament in 1990. There is no time limit for certain categories. Amendments were submitted by Back Benchers and were attached to the Human Fertilisation and Embryology Act 1990. The Government made parliamentary time available for the issue then because there was a consensus in the medical and scientific community that the time limit should be reduced. The debate that informed that decision considered a wide range of ethical and practical issues. Today, neither the Royal College of Obstetricians and Gynaecologists nor the BMA thinks that abortion time limits need to be reviewed, which is why the Government have no plans to do so. The circumstances were very different in 1990, when there was more of a consensus across the medical world that the situation needed to be addressed.
The Births and Deaths Registration Act 1953, as amended, provides for the registration of babies born dead after 24 weeks' gestation. That is described as the legal age of viability. Guidance from the British Association of Perinatal Medicine introduces the concept of a threshold of viability of 22 to 26 weeks' gestation. Although the possibility of survival for extremely pre-term babies has improved—of course, we are aware of that—data suggests that even with modern intensive care, the chances of survival at 22 weeks' gestation are only about 1 per cent, whereas at 24 weeks they are about 26 per cent. A recent BMA briefing paper entitled, "Abortion time limits", highlighted the fact that gestational age is not the only factor that affects whether a foetus is considered to be viable. Several Members have acknowledged that today.
One question asked today was whether the reduction of the 24-week limit would impact adversely on some women seeking abortion. If the time limit were changed, there would need to be a full assessment of the impact and outcomes of the change. Recent research gave some reasons why women seek abortions at later gestations, including their failure to recognise the pregnancy earlier, a delay in seeking abortion due to personal circumstances, and, of course, the diagnosis of foetal abnormality. In some cases, screening is available only at 18 weeks and onwards.
It is important to allow the woman, her partner and other family members who may be involved sufficient time to make that decision based on the information resulting from such a screening. The woman must be allowed enough time to assess the reality of caring for the child should it be born with a disability. It is important that there is time in the process not only for women to decide to have an abortion, but for them to decide not to have one.
We are bound by the science. I am sure that if there were an earlier opportunity to test for foetal abnormalities, most people would welcome that, but, as far as I am aware, science has not advanced to the point at which that is possible. There are clear issues about what information is given to the pregnant woman and the time that she is allowed to make a choice in difficult
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circumstances. Therefore, there are a number of reasons why abortions take place beyond 20 weeks, and such abortions are few compared to the overall number.
The hon. Member for Billericay (Mr. Baron) and other Members asked about abortions beyond 24 weeks on the ground of foetal abnormality.
Dr. Harris : The Minister said that because the RCOG and BMA have not called for a reduction in the time limit, the Government have no plans to review it. They are two different considerations. Neither the RCOG nor the BMA has said that there is no need to review the issue. The comment I have from the RCOG is to the effect that it is not convinced of the need to change the upper gestational limit of abortion at present and that that would require a debate that went much wider than just the context of abortion. My question is whether the Minister envisages a review so that all of us, including those organisations, can decide whether there should be a change.
Caroline Flint : I was trying to explain the context in which a decision was taken to accept amendments to the Bill that was discussed in 1990. That decision was taken because there was consensus across the medical community that the 28-week time limit was too high, but as I have tried to explain, there is not the same consensus now. We keep all these issues under review and we are, of course, open to contributions from not only Committees and Members of the House, but organisations outside the House, which keep us in touch with the latest science and medical developments.
When the issue of abortion beyond 24 weeks was discussed in 1990, it was decided that abortion should be available without time limit in some circumstances. The decision is a difficult one. About 100 abortions take place each year at gestations beyond 24 weeks, most of which are done on the grounds
"that there is a substantial risk that if the child were born it would suffer from such physical or mental abnormalities as to be seriously handicapped."
Parliament did not define serious handicap in the Act; indeed, it chose to leave that to the expert judgment of the two doctors involved, who are required to form their own opinion about the seriousness of the handicap that the child would suffer if born, taking into account the facts and circumstances of each individual case. That approach was based on an understanding of the difficulties that arise in such circumstances and of the fact that each woman's pregnancy presents a unique situation to the doctors who have to give her the choice of a termination and set out the grounds.
The guidelines issued by the Royal College of Obstetricians and Gynaecologists include guidance to be taken into account when addressing that issue where the grounds in the Act are met. The document "Termination of Pregnancy for Foetal Abnormality" states that if an abnormality has been detected and two medical practitioners are of the opinion that that there are grounds for a termination, the woman should be advised that she has that option. The royal college guidelines are a helpful aid to professionals who have to make a decision in accordance with the law.
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I turn now to judicial review and Rev. Joanna Jepson's case. Further to the Crown Prosecution Service decision earlier this year not to prosecute the doctors involved in the case, Rev. Joanna Jepson has decided not to pursue her application for judicial review.
Several hon. Members raised the issue of improving access to abortion. The requirement for two doctors to agree an abortion was a safety mechanism to ensure that the law was taken seriously. If proposals are introduced to amend current abortion legislation, that will be a matter for Parliament. It is accepted that the current measures are a safeguard. I understand the hon. Member for Billericay when he asks whether that creates unnecessary delays, but I am unsure whether he is suggesting that we should have a policy of abortion on demand or whether he is raising the issue as a debating point.
Mr. Baron : Will the Minister give way?
Caroline Flint : I really would like to make progress because I have got to deal with a lot of contributions from other hon. Members.
The hon. Gentleman asked about permitting medical abortions and asked where they should be allowed to be carried out. We agree that women who have grounds for an abortion should be offered the choice of an earlier medical abortion and that primary care trusts and abortion service providers should ensure that such provision exists. Use of medical abortion increased from 5 per cent. of abortions in 1995 to 17 per cent. in 2003.
Section l(3A) of the Abortion Act 1967, as amended, gives the Secretary of State for Health the power to approve a "class of places" to perform medical abortion. That could enable such abortions to be available in a wider range of health care settings. Two early medical abortion pilots are in progress, the purpose of which is to enable us to help define a "class of places". What is uppermost in my mind, however, is that no "class of places" will be approved unless the Government are content that a woman's safety is not at risk.
I was also asked about ensuring that patients are aware which doctors are willing to refer patients directly for abortion services and which are not. Doctors with a conscientious objection to abortion should make their views known to the patient and enable them to see another doctor without delay if that is the patient's wish. That is reinforced through the General Medical Council's guidance and the Department's recommended standards for sexual health services.
A few hon. Members mentioned the legislation in Northern Ireland. In Northern Ireland, abortion can be performed to save the life of the mother or to prevent serious damage to her physical or mental health. The law on abortion is governed by a combination of the Offences Against the Person Act 1861, the Criminal Justice (Northern Ireland) Act 1945 and certain case law.
We are aware of a body of opinion in Northern Ireland that considers the law on abortion there to be either unsatisfactory or unclear but we also recognise the strength of feeling for not changing the existing legislative provision. I will follow up with Northern Ireland Ministers the point about guidance and will ask them to reply to those concerned in due course.
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We are considering how we can look at the performance of NHS services in respect of the time from presentation to termination in abortion services in order to reduce delay.
My hon. Friend the Member for Heywood and Middleton (Jim Dobbin) was frank about his point of view. The debate has been a microcosm of the different points of view in society. Representing those different points of view is hopefully one of the things that Parliament can do best.
Mark Pritchard : Will the Minister give way?
Caroline Flint : I will not give way; I have only four minutes left.
Quite rightly, concerns were raised about the safety of people who have a termination and whether they are given full information about the possible consequences. It should certainly be discussed with a woman by those from whom she is seeking advice about services.
Abortion, both medical and surgical, is a very safe procedure and complications are uncommon. Deaths following abortion are extremely rare, with about one death a year out of about 180,000 abortions. It is a Government requirement that all maternal deaths should be subject to confidential inquiry and all health professionals have a duty to provide the information required. Maternal deaths in the UK for all women are at a rate of 53 per million maternities, compared with about five per million abortions. Pregnancies are not risk free, and it is important to see the risk involved in abortion in the context of other complications that arise out of pregnancy. I hope that provides those listening to or reading the debate with the context for issues of health and abortion.
Any woman considering an abortion must have all the facts, including accurate information about possible complications, so that she can make an informed choice. Some studies suggest that rates of psychiatric illness or self-harm are higher among women who have had an abortion compared to women who give birth or non-pregnant women of similar age. It must be borne in mind that these findings do not imply a causal association and may reflect some continuation of pre-existing conditions, which may or may not have contributed to the pregnancy in the first place.
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My hon. Friend the Member for Heywood and Middleton is absolutely right. The woman concerned should be given support and counselling.
Dr. Harris : Will the Minister give way?
Caroline Flint : I am afraid that I will not, as I have only two minutes.
I come to the question of Professor Stuart Campbell's 4D images of the 12-week-old foetus, which was described as showing
Those images stir huge emotions, of course. However, it is important not to prejudge that those images somehow change our knowledge about foetal viability. It is a complex area and the pictures—
Mark Pritchard : Will the Minister give way?
Sir John Butterfill (in the Chair): Order. The Minister has made it quite clear that she will not give way.
Caroline Flint : I have had 15 minutes out of the full time, so I will carry on.
When it comes to conscientious objection, the Abortion Act provides that, except where treatment is necessary to save the life of or prevent grave permanent injury to the pregnant woman,
"no person shall be under any duty, whether by contract or by any statutory or other legal requirement, to participate in any treatment authorised by this Act to which he has a conscientious objection".
Finally, I turn to the points made by the hon. Member for Shipley (Philip Davies) and my hon. Friend the Member for Stourbridge (Lynda Waltho). We have seen progress on the teenage pregnancy strategy. If we consider the dates between 1998 and 2003, under-18 conceptions have fallen by 9.8 per cent. and under-16 rates by 9.9 per cent. In some areas, those figures are higher. We must consider why some services are achieving better outcomes than services in other parts of London or the country. It is not about more sex education; it is about making sure that we have the right sex and relationship education.
Sir John Butterfill (in the Chair): Order. Time is up.
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