Select Committee on Science and Technology Written Evidence

Memorandum 32

Submission from Brook


  1.1  Brook, a registered charity, is the country's leading sexual health organisation for young people, offering young women and men under the age of 25 free and confidential sexual health advice and services. Brook is in contact with around 200,000 young people a year through its network of Centres and the AskBrook service which provides a telephone helpline, online enquiry service through Brook's website and a text messaging service.

  1.2  Brook Centres see around 7,500 pregnant young women a year. Of these around 60% are recorded as requesting an abortion at their first contact with Brook. Others whose intentions are recorded as undecided at their first contact will decide to terminate the pregnancy following counselling to explore their options and feelings. Around 3,000 young people contact AskBrook with an enquiry related to pregnancy; only around 5% of these are generally recorded as being about a wanted pregnancy.

  1.3  We have focussed our submission on the evidence around first trimester abortions and adverse health outcomes of abortion or from restriction of access to abortion. Others are better placed than we are to provide scientific or medical evidence relating to the upper time limit on abortions. However, from what we know of that evidence we see no compelling scientific reasons to reduce the upper time limit from 24 weeks.


  2.1  There is evidence that the need for two doctors' signatures causes some women delays in obtaining an abortion. There is evidence that some women would welcome early medical abortions carried out at home. Anecdotal evidence from Brook Centres does not suggest abortion has an acute adverse psychological effect on women. Younger women are likely to be disproportionately affected by restrictions on access to abortion. There is a limited evidence base relating to young women and abortion and the potential impact that law reforms could have on them.


  3.1  Statistics from the AskBrook service suggest that the requirement for 2 doctors' signatures can introduce unnecessary delays into the referral process for an abortion where the first doctor contacted has a conscientious abortion and does not declare it. 34% of enquiries logged as policy issues (ie ones where women encountered significant problems with a service) in the 2 years April 2005-March 2007 were from callers who had encountered judgemental attitudes, delaying tactics, or outright refusal to help without being referred to another doctor.

  3.2  There is similar anecdotal evidence from Brook Centres of GP's delaying young people requesting abortion, some by asking them to return a week or two later for a pregnancy test then introducing a further delay for the results or others just saying they don't agree with abortion and not referring on to another service. This can lead to trauma for the young person who when they eventually present to Brook are often past the time limit for early medical abortion or may be much later in the pregnancy than they realised making the decision much more difficult for them, and are sometimes past the limit for an abortion altogether.


  4.1  A studyi of the views of women undergoing hospital based early medical abortion in England and Scotland found that over a third would have opted to have a home abortion if that was available and 71% of them said nothing happened that they could not have coped with at home. Media coverageii of one of the two pilot studies set up by the Department of Health to assess the use of early medical abortion outside hospital reported that none of the women who took part suffered serious complications supporting the use of early medical abortion in community settings and patient's homes. The Royal College of Obstetricians and Gynaecologists guidelinesiii cites several international studies which indicate that a home early medical abortion regimen is both acceptable and safe.

  4.2  There is a lack of research around the acceptability of early medical abortion at home to younger women. Younger women are more likely to have concerns about privacy and confidentiality if they have not confided in their families and could experience practical difficulties miscarrying at home. Evidence from a small scale survey by Marie Stopes Internationaliv suggests that around 30% of under 16s had not informed their parents about their abortion. It is crucial therefore that both choice of abortion method and choice of setting are maintained to meet the needs of individual women. .


  5.1  The Royal College of Obstetricians & Gynaecologists Guideline On The Care Of Women Requesting Induced Abortionv concludes that while some studies have shown higher rates of psychiatric illness among women who have had an abortion compared to women who have given birth there is no evidence of a direct causal association and they may reflect a continuation of pre-existing conditions.

  5.2  Similarly the Planned Parenthood Federation of America's fact sheet on The Emotional Effects Of Induced Abortion, vi which we commend to the committee's attention for its thorough analysis of the evidence on this subject, finds that emotional responses to induced abortion are generally positive except where pre-abortion emotional problems exist or when a wanted pregnancy is terminated, for example because of a physical abnormality.

  5.3  These conclusions are supported by anecdotal evidence from Brook's counsellors. Brook provides pregnancy options counselling to all clients with a positive pregnancy test and offers post abortion counselling. However, there is a low rate of return for post-abortion counselling bearing out the evidence that most women do not suffer acute adverse affects from induced abortion. Of women who do seek post abortion counselling at Brook most have been referred for abortion by other services and often talk about feeling rushed into a decision, sometimes by a partner/parent or by a health professional, which can lead to feeling that perhaps it wasn't the right decision at the time. Our experience also suggests that encountering judgemental attitudes from referring professional or clinic staff can have adverse effects.

  5.4  Brook's experience suggests that the provision of counselling as part of the abortion referral process makes the experience easier for women, that it empowers young women and leaves them feeling they have a better idea of what will happen. There is also anecdotal evidence from some Centres that women who have received counselling at a Brook Centre have an almost zero DNA rate at abortion services. However, we believe counselling should be offered rather than required since counselling per se is a voluntary relationship between client and professional and adding another step in the referral process for a woman who is certain of her decision could add to distress and the feeling of being judged.

  5.5  Research cited by the Planned Parenthood Federation of America (in the fact sheet referred to above) has shown that women who are denied abortion are more likely to deliberately self harm than women who have abortions or maternities. They are also more likely to show ongoing resentment lasting for years and their children have been found to be more likely to have increased emotional, psychological, and social problems.

  5.6  Younger women are more likely to present later in pregnancy for abortions for a variety of reasons. In 2006 12% of abortions amongst women under 20 were carried out between 13 and 19 weeks gestation and 2% were carried out at 20 weeks and over compared to 9% and 1% respectively amongst women aged 20-34. Restrictions on access through reductions of time limits or mandatory "cooling off" periods are therefore more likely to affect younger women with the negative consequences identified above.


  6.6  There is a limited evidence base relating to young women and abortion and the potential impact that law reforms could have on them.


  i Hamoda et al, The acceptability of home medical abortion to women in UK settings, BJOG, Volume 112, No 6, June 2005.

  ii Study finds home abortion "safe', BBC News website, 15 February 2006 (

  iii The Royal College of Obstetricians & Gynaecologists, The Care Of Women Requesting Induced Abortion, Evidence Based Guideline Number 7, September 2004.

  iv Marie Stopes International, Abortion & young women issues of confidentiality, 2006.

  v RCOG, op cit.

  vi, January 2007.

September 2007

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