Memorandum 32
Submission from Brook
1. INTRODUCTION
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. EXECUTIVE
SUMMARY
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. ROLE PLAYED
BY REQUIREMENT
FOR TWO
DOCTORS' SIGNATURES
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. ALLOWING THE
SECOND STAGE
OF EARLY
MEDICAL ABORTION
TO BE
CARRIED OUT
AT THE
PATIENT'S
HOME
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. EVIDENCE OF
LONG TERM
OR ACUTE
ADVERSE HEALTH
OUTCOMES FROM
ABORTION OR
FROM THE
RESTRICTION OF
ACCESS TO
ABORTION
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. LIMITATIONS
OF THE
EVIDENCE BASE
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.
REFERENCES
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 (http://news.bbc.co.uk/1/hi/health/4717786.stm).
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 www.plannedparenthood.org/files/PPFA/fact-induced-abortion.pdf,
January 2007.
September 2007
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