Memorandum 20
Submission from Medical Research Council
1. The Medical Research Council (MRC) welcomes
the opportunity to respond to the Science and Technology Committee's
inquiry into scientific developments relating to the Abortion
Act 1967.
2. The MRC is dedicated to improving human
health through excellent science. It invests on behalf of the
UK taxpayer. Its work ranges from molecular level science to public
health research, carried out in universities, hospitals and a
network of its own units and institutes. The MRC liaises with
the Health Departments, the National Health Service and industry
to take account of the public's needs. The results have led to
some of the most significant discoveries in medical science and
benefited the health and wealth of millions of people in the UK
and around the world.
3. The following response details research
of potential relevance to this inquiry, highlights some important
issues, and identifies areas that the MRC considers to be currently
under-researched.
The scientific and medical evidence relating
to the 24-week upper time limit on most legal abortions, including:
(a) developments, both in the UK and internationally
since 1990, in medical interventions and examination techniques
that may inform definitions of foetal viability; and
(b) whether a scientific or medical definition
of serious abnormality is required or desirable in respect of
abortion allowed beyond 24 weeks.
4. Whether fetuses feel pain is an important
consideration. The MRC Expert Group on Fetal Pain, set up in response
to a request from the Department of Health, published a report
in 2001 ("Report of the MRC Expert Group on Fetal Pain",
available on the MRC website at: http://www.mrc.ac.uk/Utilities/Documentrecord/index.htm?d=MRC002413).
The Group found that there was little direct evidence of the gestational
age at which fetuses might feel pain; this would be dependent,
inter alia, on the development of the central nervous system.
There was no definable stage of fetal life when one set of neurons
connected to another. The nervous system matured over many pre-
and post-natal months to produce complete pain awareness. The
Group concluded that there was still a great need for research
into many areas of fetal pain. For example the basic molecular
and cellular mechanisms of fetal pain were still poorly understood,
as were the effects of anaesthetics or analgesics. Since then,
the MRC has not received many applications in this area; one reason
for this may be that such research, particularly involving humans,
is very difficult to undertake.
5. The MRC has funded, and continues to
fund, studies on embryonic and fetal development which may help
inform discussions on abortion time limits. Research of this nature
should be reviewed during this inquiry.
Examples of MRC-funded research in this area
include:
— Mammalian neurogenesis—Dr V
Episkopou at the MRC Clinical Sciences Centre in London. Ongoing;
£1.9 million expenditure to date (to 2005-06). This research
aims to increase understanding of the molecular events that underlie
early embryonic patterning and central nervous system development.
— Molecular embryology—Dr D P
Norris at the MRC Mammalian Genetics Unit in Harwell. Ongoing;
£300,000 expenditure to date (to 2005-06). This work is focussed
on understanding how left-right (L-R) symmetry is broken in the
early embryo.
— Generation of neuronal diversity
in the developing telencephalon—Dr N Kessaris at University
College London. Ongoing; awarded £325,000. This research
aims to increase understanding of how the brain forms during normal
embryonic development.
6. The MRC has also funded research on the
effects of early delivery of fetuses, which may be relevant to
this inquiry. For example, we are currently funding a follow-up
study to the Growth Restriction Intervention Trial (GRIT) at the
University of Nottingham[121].
The initial study evaluated the short-term effect of the early
delivery of fetuses not thriving in the womb. The current study
is evaluating the long-term effect on the development of the baby's
brain, both the prevention of cerebral palsy and also for intellectual
development. The ongoing EPICure study, also at the University
of Nottingham[122],
is studying developing patterns of health problems in babies born
at borderline viability (25 weeks gestation or less).
7. A recently completed MRC study on the
clinical applications of advances in human genetics at the University
of Leeds[123]
has aimed to identify particular genes causing specific diseases,
in order to translate this knowledge into diagnostic tools which
could be used in clinical practice and for genetic counselling
purposes. Such early knowledge of potential genetic abnormalities
may have an impact on women's decisions on abortion.
8. Peripheral to the main aim of this enquiry,
but an important issue for medical research, is the availability
of fetal tissue for research. Birth defects are the biggest cause
of infant mortality in the Western world. Currently one in 30
babies is born with a significant malformation but the causes
of many of these malformations are poorly understood. Studying
tissues taken from embryos from the period when most malformations
arise is an important step towards understanding, and perhaps
eventually preventing, fetal abnormality. The MRC/Wellcome Trust
Human Developmental Biology Resource at the Institute of Child
Health in London helps to support research in this area through
the provision of donated embryonic and early fetal material. This
research not only promotes understanding of how birth defects
arise, it also may lead to the development of more sensitive and
specific diagnostic tests.
9. The MRC believes that any recommendation
to change the upper time limit on abortion would require specific
studies to be carried out to determine the effect on clinical
advice and on women's decisions. Abortion laws vary from country
to country, so findings from other countries could be informative.
Specific studies on the reasons for late termination of pregnancy
would need to be carried out, particularly given that some developmental
problems only show up late in development, and some pregnancies
are only discovered late. This would add to the difficulty of
defining "serious abnormality". A secondary consideration
would be the effects on the availability of fetal tissue for research.
Medical, scientific and social research relevant
to the impact of suggested law reforms to first trimester abortions,
such as:
(a) the relative risks of early abortion
versus pregnancy and delivery;
(b) the role played by the requirement for
two doctors' signatures; and
(c) the practicalities and safety of allowing
nurses or midwives to carry out abortions or of allowing the second
stage of early medical abortions to be carried out at the patient's
home.
10. This part of the inquiry is not directly
within the MRC's remit.
Evidence of long-term or acute adverse health
outcomes from abortion or from the restriction of access to abortion.
11. The MRC has not funded any work recently
in this area.
August 2007
121 Growth Restriction Intervention Trial (GRIT) and
long-term follow up study-Professor J Thornton at the University
of Nottingham. Ongoing; awarded £940,000. Back
122
EPICure: population-based studies of survival and later health
status of infants of 25 weeks gestation or less-Professor N Marlow
at the University of Nottingham. Ongoing; awarded £3.0 million. Back
123
Clinical Applications of Advances in Human Genetics-Professor
A Markham at the University of Leeds. Ended at the end of 2005;
awarded £37,500. Back
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