Submission from CARE
CARE is a well-established mainstream Christian
charity which provides resources and helps to bring Christian
insight and experience to matters of public policy and practical
caring initiatives. CARE is represented in the UK Parliaments
and Assemblies, at the EU in Brussels and the UN in Geneva and
CAREconfidential is part of CARE and undertakes
caring work in the fields of pregnancy counselling and advice
on dealing with abortions. Through its extensive contact over
20 years with those affected by abortion, CAREconfidential is
one of the major national organisations providing counselling
support in this sensitive area with over 150 affiliated pregnancy
The aim of the centres is to provide a safe, impartial environment
in which women and men can talk through their circumstances of
unexpected pregnancy and discover all of the options open to them.
The combined impact of developments in neonatal
medicine that result in babies surviving below the 24 week limit,
the significant evidence highlighting medical complications resulting
from abortion: psychological trauma, physical sequelea and pre-term
birth, and the problems associated with assessing disability in
utero highlight the need for major revision of Britain's abortion
1. THE SCIENTIFIC
(a) Developments since 1990 informing foetal
Over the past 15-20 years the quality and success
of neonatal care has increased dramatically.
In many hospitals it is almost routine for babies that are born
preterm, at 24 weeks' gestation, to survive as long as they have
good clinical input. This is backed up with evidence from recent
studies: for example, Hoekstra et al published outcome data for
a cohort of infants born between 23 and 26 weeks of gestation
over a 15 year period.
This data shows a consistent year-on-year improvement in survival
and for the period 1996-2000 there was a survival rate of 66%
at 23 weeks of gestation and 81% at 24 weeks of gestation.
Clearly therefore, medical developments are resulting in ever
higher survival rates of ever younger babies and this trend will
undoubtedly continue as medical research and practice advances
and improves. Many of the infants born will live healthy, independent
"It appears that against all odds, a significant
majority of extremely low birthweight adults have overcome their
earlier difficulties to become functional in terms of educational
attainment, employment and independent living."
In the light of such developments, the 24 week
upper limit is outdated.
We further note that only 27% of people questioned
in a poll believed that the current 24 week legal limit for abortion
should be retained. 58% of those questioned by YouGov said abortions
should not be carried out after the 20th week of pregnancy.
(b) Whether a scientific or medical definition
of serious abnormality is required or desirable in respect of
abortion allowed beyond 24 weeks
The current wording of the UK law, permitting
abortion because of a perceived risk of "serious handicap"
at any stage of pregnancy until term is unclear, unhelpful and
open to very broad interpretation, leading to late feticides being
carried out in the UK for relatively minor congenital malformations
(such as cleft palate) which can in no way be conceived as serious
It is also at odds with the Disability Discrimination
Act, which aims to end discrimination. The Disability Rights Commission
states that section 1(1)d which permits abortions at any time
to birth for disability alone "... is offensive to many people;
it reinforces negative stereotypes of disability; and there is
substantial support for the view that to permit terminations at
any point during a pregnancy on the ground of risk of disability,
while time limits apply to other grounds set out in the Abortion
Act, is incompatible with valuing disability and non-disability
CARE agrees, and strongly believes that there
is NO good reason for treating a healthy fetus at 23 weeks gestation,
a disabled fetus at 28 weeks or a newborn infant at the same gestational
age, in a different manner. Late feticide should not be legal,
for any reason.
The above problem is compounded by the fact
that attempts to assess disability in the womb are in any event
the subject of great uncertainty. As CMF warn: "We recognise
that there are a small number of lethal abnormalitiessuch
as anencephaly or Tay Sachs diseasewhere outcome can be
predicted with a high degree of certainty, but in clinical experience
the majority of neonatal cases involve high levels of uncertainty
about detailed neurological, cognitive and behavioural outcome"
(our emphasis). There is still limited scientific understanding
of the developing central nervous system and the relationship
between fetal abnormalities and long-term function. In fact, there
is evidence now of the ability of the fetus" central nervous
system to adapt, repair, regrow and "rewire" its neural
tissue in response to injury.
There is also a need for a new approach given
that there is not an automatic causal relationship between physical
abnormalities and the long-term "life-satisfaction"
of the individual. Disabled individuals frequently report that
the attitudes of others within society, and the provision of appropriate
aids and resources, make a greater impact on their overall "quality
of life" than the medical or biological disability itself.
Finally, one must have regard for the fact that
abortion for disability can negatively impact the parents. Indeed,
abortion for fetal abnormalities can have long lasting traumatic
effects and can be a source of trauma detectable many years after
the event. It is associated with persistent psychological distress.
Davies et al 2
found high levels of distress for first and second trimester abortions,
but, of the two, distress levels were higher in those having 2nd
trimester abortions. One study that compared the effects of abortion
for fetal anomalies on women immediately after the abortion and
women 2-7 years on found no difference in distress bewtween the
2. (a) The Risk of Early Abortion Versus
David et al found that there was a lower risk
of psychotic reactions post partum than post-abortion: 18.4/10,000
for women who had an abortion compared to 12/10,000 for those
who gave birth. 
A 2003 comparison of psychiatric problems of
over 55,000 low-income women following abortion and childbirth
(up to four years after) found significant differences in admission
rates for women who had abortion compared to those giving birth.
For example, post-abortion the odds ratio of a depressive episode
was 1.9, of a recurrent depressive disorder 2.1 and of a bipolar
disorder 3. The post-delivery admission rate was 635/100,000 whereas
the post-abortion admission rate 1117/100,000 (Odds ratio 1.7).
A 2002 study of out-patient mental health claims
over a four year period, comparing abortions versus deliveries,
found that after 90 days there were 63% more claims post abortion,
after 180 days there were 42% more claims, after 1 year there
were 30% more claims and after 2 years there were 16% more claims
post abortion than delivery.
A register linkage study of suicides after pregnancy
in Finland, 1987-1994 found that the suicide rate associated with
birth was "only" 5.9/100,000. In comparison, the mean
suicide rate among women in Finland was higher, at 11.3/100,000.
And even higher was the suicide rate associated with abortion,
Such evidence clearly shows that outcomes are
comparatively worse post abortion than post birth. (see also 3
(b) The Requirement for Two doctors' Signatures
The Royal College of Obstetricians and Gynaecologists
does not support the removing the two doctors requirement. An
RCOG spokeswoman said:
"Some of the late abortions that are done
are not straightforward so having the built-in safety net of two
doctors is important, and you can't have one rule for them and
another for women who have early abortions".
Abortion is already effectively available on
demand today and is rarely hindered, in practice, by the two doctors
requirement. The role played by doctors in certifying abortions
is important for at least two reasons. First, Doctors are in the
best position to talk through the request, to assess the medical
indications, to discuss the procedure itself, to inform on the
potential consequences of abortion and to cover other available
options. It is essential for the long-term impact on the women
that she does not feel that termination is the only option open
to her and instead has the opportunity, knowledge and time to
make a fully informed decision. Second, given the high risk of
negative health consequences following abortion, it is useful
for continuity if the same person who assesses for the abortion
also has to engage with the resulting health problems and is consequently
the patient's doctor.
The fact that the person seeking the abortion
has to see two doctors is important for at least three reasons.
First, the complexities involved and long term potential consequences
mean that it is only prudent to provide the patient the safety
of two opinions. Second, the fact that there must be two doctors"
signatures is also important because women need time and the opportunity
to explore all their feelings without pressure or judgment and
it is not helpful for them to feel rushed into making major decisions
that may have a long-term impact. The need to gain two signatures
makes it more likely that the patient would be given time to reflect.
Finally, the two doctor's provision is important because it is
also a means of recognizing that having an abortion is not like
having a gall stone removed or your appendix out. It is a procedure
that has far reaching potentially negative consequences and one
that involves terminating the life of a human fetus.
(c) The practicalities and safety of allowing
nurses or midwives to carry out abortions
Given the seriousness of the procedure we don't
think this is a burden that should be put on nurses and we note
that the BMA recently voted against this proposal.
3. EVIDENCE OF
Since the 1967 Abortion Act was passed, there
have been 5.5 million abortions in England and Wales (if one caters
for the whole UK the figure is more like 6.7 million),
with over 95% of these on the grounds of safeguarding the physical
or mental health of the mother or existing children. However,
there is strong, and increasing, evidence that many women who
have abortions, for any reason, subsequently suffer unwanted side-effects:
(i) Long-term psychological effects
Despite the unpopularity of views expressing
concern over the psychological consequences of abortion on women,
the scientific evidence (that recent longitudinal studies point
to a causative association between abortion and mental problems)
cannot be ignored or dismissed. The following editorial comment
in the Canadian Medical Association Journal highlights this concern
"... if it is true that more explicit research
into women's health issues will point the way to better care,
better outcomes and more equity in access, we cannot toss out
data any time we don't like their implications"
In the last ten years
significant new evidence has emerged demonstrating that psychological
ill effects follow abortion, even in women with no previous psychological
problems. The findings mean that a woman having an abortion can
no longer be said to have a low risk of suffering from psychiatric
conditions like depression.
A large longitudinal, methodologically robust
study from New Zealand
has set a new landmark and led to the American Psychological Association
withdrawing an official statement which denied a link between
abortion and psychological harm.
The New Zealand research followed up 500 New
Zealand girls and young women from the time of their birth to
25 years of age. Each woman's mental health was measured at 16,
18, 21 and 25. Ninety reported having had an abortion, and these
women experienced nearly twice the level of mental health problems
as those who had either given birth or never been pregnant. They
also had three times the risk of major depressive illness compared
to the other groups. These results were statistically significant
even after controlling for previous mental health: psychological
ill effects occurred even in women with no previous psychological
The epidemiologist author Fergusson stated that:
"... the findings did surprise me, but the results appear
to be very robust because they persist across a series of (mental)
disorders and a series of ages".
Specifically, the research found a significantly
higher risk of:
Major depression 78.7-41.9% (depending
on age group).
Anxiety disorder 64.3-39.2%.
Suicidal ideation 50-27%.
Illicit drug dependence 0-12.2%.
Overall number of mental health problems
1.93-1.27 depending on age.
Among those who had abortions compared with
those who had not been pregnant or who had delivered.
The author stated: "The present research
raises the possibility that for some young women, exposure to
abortion is a traumatic life event which increases longer-term
susceptibility to common mental disorders. ..[I]t is difficult
to disregard the real possibility that abortion amongst young
women is associated with increased risks of mental health problems".
A separate academic review of evidence on the
long term consequences of abortion states that "Although
earlier studies focusing on secondary outcome were reassuring,
more recent large cohort studies linking abortion to the `hard'
outcomes of either suicide, psychiatric admission or deliberate
self-harm are concerning ... the uncertainty limits a clinician's
ability to reassure such a woman that her decision will not have
long-term mental health effects. The observation of the association,
regardless of the lack of causal linkage, suggests careful screening
and follow-up for depression ..."
In a letter to The Times on 27 October
2006, 15 specialists in Psychiatry and Obstetrics and Gynaecology,
called for the Royal College of Psychiatrists and the Royal College
of Obstetricians and Gynaecologists to revise their guidance on
the link between abortion and mental health. They quoted the strong
evidence that women who choose abortion subsequently suffer from
higher rates of depression, self-harm and psychiatric hospitalisation
than those who carry their babies to term.
The RCOG guidance which plays down the link
between abortion and psychological harm is now three years old
and predates much of the recent research. As such it is out of
step with the latest evidence and now requires revision.
It is essential that all women considering an
abortion are warned of the significant possibility that there
may be long-term adverse psychological effects which is NOT just
a "reflection of a pre-existing condition'. Women considering
an abortion have a right to know that that there may be long-term
adverse psychological effects.
We further note that there is of course no evidence
in any of the literature that abortion is good for women's health.
Organisations that provide terminations have never produced serious
research that would support the view that abortion promotes women's
(ii) Risk of physical sequelae
CARE is similarly concerned about the underplaying
of the risk of physical complications after abortion. For example,
an in-depth Finnish study of deaths within a year of delivery,
miscarriage or abortion from 1987-94 showed a nearly three-fold
increase in total mortality after termination compared to carrying
a pregnancy to term. Compared to women who gave birth, women who
aborted were 3.5 times more likely to die within the year. The
risk of death from suicide was seven times higher than the risk
of suicide within a year of childbirth. Women who aborted were
also four times as likely to experience a fatal accident, 13 times
more likely to be murdered and 1.6 times more likely to die of
natural causes than women who gave birth.
The risk of Pelvic Inflammatory Disease (PID)
is greatly increased when Chlamydia or Neisseria are present with
up to 23% developing PID within four weeks.
This will be an increasingly common complication of abortion.
Chlamydia has been increasing markedly in the UK in recent years,
especially among young women in the age group in which they are
also most likely to have abortions. Chlamydia infects the neck
of the womb but is often symptomless, meaning that infected women
may be unaware of their condition for years. An abortion may carry
the infection, via the abortionist's instruments, into the womb
and cause PID.
These important consequences should not be minimised
to women seeking to make informed decisions that could impact
their future health and reproductive outcomes.
(iii) Preterm Delivery
There is a known risk of abortion adversely
impacting any future reproductive outcome, specifically, preterm
delivery: "Previous abortion was a risk factor for placenta
A major EUROPOP 2004 study of 60 maternity units in 17 countries,
with controls, reported an increase in preterm birth rate due
to induced abortion.
An EPIPAGE 2005 study in France likewise reported increased preterm
birth rate due to induced abortion.
Byron Calhoun, Prof of Obstetrics and Gynecology,
West Virginia University, using a database of nearly 240,000 UK
births, estimates that in the UK 31% of premature deliveries are
due to abortion. When looking at various studies together, he
found that induced abortion increases ptb rates by 130-1200%.
PTB increases risk of cerebral palsy by 38 times. NO studies show
a decreased risk of PTB from abortion.
Patients should be informed of the increased PTB risk from induced
abortion in order to be able to make fully informed decisions.
Such findings also have financial implications because of the
significantly increased costs in the first five years of life
for preterm delivery.
All women requesting abortions should be warned
of these sequelae. Without such warning, we can expect women to
bring legal action against practitioners and abortion clinics
for the damaging physical, reproductive and/or psychological consequences
192 This support is provided by using a specialist
10 week programme called The Journey. The centres offer a range
of facilities including free pregnancy testing, counselling relating
to unplanned pregnancy, post abortion counselling, miscarriage
counselling, befriending services, adoption schemes, accommodation,
provision of free clothes and equipment for those on low income,
advice on benefits and accommodation and parenting classes. There
are 800 trained volunteer counsellors working across the network
of 150 centres. The network has approximately 800 trained volunteer
counsellors in the UK, as well as a help line and website.1 The
network provides services to over 38,000 clients per year and
there have been over 10,000 calls to the help line.1 The website
has self help information and access to online advisors plus links
to the network of centres throughout the UK and recently won a
BT Helpline Association Award for innovative use of web based
Riley KJ et al. Changes in survival and neurodevelopmental outcome
in 22 to 25 weeks gestation infants over a 20 year period. Pediatr
Res 2004. Back
Hoekstra Re et al. Survival and long-term neurodevelopmental outcome
of extremely premature infants born at 23-26 weeks gestational
age at a tertiary centre. Pediatrics 2004;113:e1-e6. Back
This is backed up by other data, see Vollmer B et al. Predictors
of long-term outcome in very preterm infants: gestational age
versus neonatal cranial ultrasound. Pediatrics 2003;112:1108-14. Back
Saigal S et al. Against all odds: transition of extremely low
birthweight infants from adolescence to young adulthood. Pediatr
Res 2005. Back
Johnston P. Abortion limit must be cut to 20 weeks, says public.
Daily Telegraph 2005; 29 August. Back
DRC Statement on Section 1(1)(d) of the Abortion Act 1967, http://www.drc.org.uk/library/policy/health_and_independent_living/drc_statement_on_section_11.aspx
"In common with a wide range of disability and other organisations,
the DRC believes the context in which parents choose whether to
have a child should be one in which disability and non-disability
are valued equally. In a positive manner the medical professions
and others should ensure that parents receive comprehensive balanced
information and guidance on disability, the rights of disabled
people and on the support available." Back
"Submission from Christian Medical Fellowship to the Nuffield
Council on Bioethics "Working Party on The Ethics of Prolonging
Life in Fetuses and the Newborn", CMF, 2005. Back
Psychological outcome for women undergoing termination of pregnancy
for ultra-sound detected fetal abnormality: a pilot study, Davies
et al. 2005. 25,4. 389-392 Ultrasound Obstetric Gynaecology. Back
Trauma and Grief 2-7 years after termination of pregnancy because
of fetal anomalies-a pilot study Kersting et al. J Psychosom.
Obstet and Gynaecol 2005. Back
David et al 1981. Family Planning Perspectives. 13 (1):. 32-34. Back
Reardon, Cougle, Rue et al . Canadian Medical Association Journal.
2003. 168 (10). 1253-6. Data excluded those with prior psychiatric
admissions or pregnancy events in year before the target pregnancy.
Numbers with pregnancy ending in abortion-15, 299, or in delivery-41,442. Back
Coleman et al. 2002. American Journal Orthopsychiatry. 72,1. 141-152.
Study of first time psychiatric out-patient contact in 4 years
post-abortion. Data set: 14,297 in abortion group, 40,122 in birth
group. Resarch controllled for pre-existing psychological problems,
age, number of pregnancies and months of eligibility. Back
Gissler et al BMJ. 1996. 313. 1431-1434. Back
Most "favour right to abortion', BBC News Online, 28 November
Written Answer to a Parliamentary question, Hansard, 10
July 2007. Back
Editorial. Canadian Medical Association Journal. 2003. 169 (2) Back
Ten years ago CARE ran the Secretariat to a Commission of Inquiry
into the "Physical and Psycho-Social Effects of Abortion
on Women". At one evidence session, two representatives from
the Royal College of Psychiatrists stated that there was in fact
NO psychiatric justification for abortion. Physical and Psycho-Social
Effects of Abortion on Women .... Back
Abortion in Young Women and Subsequent Mental Health, Fergusson,
Horwood and Ridder. Journal of Child Psychology and Psychiatry.
2006. 47 (1), 16-24. 25 year longitudinal birth cohort study of
New Zealand children. Back
Fergusson, Horwood and Ridder Abortion in Young Women and Subsequent
Mental Health, Journal of Child Psychology and Psychiatry, 2006.
47 (1), 16-24. A 25 year longitudinal birth cohort study of New
Zealand children. Back
Thorp, Hartmann and Shadigian, Long Term Physical and Psychological
Health Consequences of Induced Abortion: Review of the evidence..
Obstetrical and Gynecological Survey 2003. Back
Maternal deaths within 12 months of end of pregnancy (per 100,000
women) in Finnish population: Births 28.2/100,000; Miscarriage
51.9/100,000; Induced abortions 83.1/100,000. Gissler M, Berg
C, Bouvier-Colle MH, Buekens P. Pregnancy-associated mortality
after birth, spontaneous abortion, or induced abortion in Finland,
1987-2000. Am J Obstet Gynecol. 2004 Feb;190(2):422-7. Back
Westergaard L et al. Obstet Gynecol 1982;60:322-5. Back
Long-term physical and psychological health consequences of induced
abortion: review of the evidence. Thorp J M, Hartmann, KE, Shadigian,
E, Obst Gynecol Survey, 2003, 58. Back
Ancel et al, History of induced abortion as a risk factor for
preterm birth in European countries: Results of EUROPOP survey,
Human Repro 2004; 19£):734-740. Back
Moreau et al, EPIPAGE, BJOG 2005; 112:430-437. Back
Presentation by Prof Calhoun, Palace of Westminster, 15 May 2007. Back