House of Commons - Science and Technology

Select Committee on Science and Technology Written Evidence

Memorandum 33

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 New York.

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 crisis centres.[192] 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.

EXECUTIVE SUMMARY

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 laws.

1. THE SCIENTIFIC AND MEDICAL EVIDENCE RELATING TO THE 24-WEEK UPPER TIME LIMIT ON MOST LEGAL ABORTIONS INCLUDING:

(a) Developments since 1990 informing foetal viability

Over the past 15-20 years the quality and success of neonatal care has increased dramatically.[193] 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.[194] 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.[195] 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 lives:

196

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.[197]

(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 disabilities.

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 equally".[198]

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 abnormalities—such as anencephaly or Tay Sachs disease—where 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.[199]

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[200] 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 two groups.[201]

2. (a) The Risk of Early Abortion Versus Pregnancy

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. [202]

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).[203]

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.[204]

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, at 34.7/100,000.[205]

Such evidence clearly shows that outcomes are comparatively worse post abortion than post birth. (see also 3 below)

(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:

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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.

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 LONG-TERM OR ADVERSE HEALTH OUTCOMES FROM ABORTION OR FROM RESTRICTING ACCESS TO ABORTION

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),[207] 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 well:.

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In the last ten years[209] 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[210] 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 problems.

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".[211] (Our emphasis).

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 ..."[212] (Our emphasis)

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 health.

(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.[213]

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.[214] 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 previa".[215] 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.[216] An EPIPAGE 2005 study in France likewise reported increased preterm birth rate due to induced abortion.[217]

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.[218] 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 they experience.

September 2007

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 applications. Back

193 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

194 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

195 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

196 Saigal S et al. Against all odds: transition of extremely low birthweight infants from adolescence to young adulthood. Pediatr Res 2005. Back

197 Johnston P. Abortion limit must be cut to 20 weeks, says public. Daily Telegraph 2005; 29 August. Back

198 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

199 "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

200 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

201 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

202 David et al 1981. Family Planning Perspectives. 13 (1):. 32-34. Back