Memorandum 39
Submission from the Maranatha Community
"We must courageously face the fact—finally—that
human life of a special order is being taken.
The fierce militants of the Women's Liberation
evade this issue and assert that the woman's right to bear or
not to bear children is her absolute right.
On the other hand the ferocious Right-to life
legions proclaim no rights for the women and absolute rights for
the fetus.
Somewhere in the vast philosophic plateau between
the two implacably opposed camps—past the slogans, past
the pamphlets, past even the demonstrations and the legislative
threats—lies the infinitely agonizing truth.
We are taking life, and the deliberate taking
of life, even of a special order and under special circumstances,
is an inexpressibly serious matter".
Dr Bernard Nathanson. (Deeper into Abortion)
New England Journal of Medicine. 28 November 1974
1. INESCAPABLE
SCIENTIFIC AND
CLINICAL CONSIDERATIONS
1.1 While we respect the intention of the
Select Committee to look "only" at the scientific evidence
regarding abortion, there must be a recognition that abortion
is not simply a medical or scientific issue. It is above all a
moral or ethical issue. It is, therefore, inappropriate to "hide"
behind "science" when science cannot give an answer
as to whether one course of action is "right" or "wrong".
1.2 There are two basic ethical positions
regarding abortion. One is rooted in thousands of years of Judaeo-Christian
tradition, based on the principle that life itself is of inestimable
value and that one should not take life away. Associated with
this is the concept of absolute moral values, ie that there are
certain principles that are necessary for a society to function
such as to have respect for life, to respect the individual, to
seek truth etc. The other is rooted in a comparatively recent
development of pragmatic morality, which is based solely on utilitarian
principles. This position maintains that whatever solves a problem
on a practical level must be considered as moral, that no action
is inherently "right" or "wrong" in itself,
and that the ends justify the means. This leads to moral relativism,
which depends on the extremely doubtful theory that circumstances
alone dictate what is right and what is wrong.
1.3 We cannot settle this philosophical
argument. We would however wish to point out that in terms of
scientific enquiry, moral relativism, where the end justify the
means, becomes a very dangerous concept. Through following this
concept enormous cruelties have been justified in the very recent
past. The consequences of moral relativism are that a decision
is being made that a certain type of life, for example that one
of a healthy or young person, is worthy of protection, whereas
another types of life is not considered worthy of protection.
It raises the question of who decides whether the life of an old
or terminally ill person, of a disabled baby in the womb, the
life of which can be terminated. This is the philosophical basis
of eugenics, a philosophy, which has led to the extermination
of millions of people whose only "crime" it was to have
certain characteristics, such as disability, mental illness, or
belonging to a certain ethnic/religious group like the Jews. Scientific
developments cannot be considered in isolation from ethical standards.
1.4 Fundamentally, the eugenics argument
persists in the abortion debate. It is relevant to note that for
example Marie Stopes, who opened the first family planning clinic
and after whose name one of the largest abortion providers is
named, was a eugenicist. In her Radiant Motherhood (1920) she
called for the "sterilization of those totally unfit for
parenthood (to) be made an immediate possibility, indeed made
compulsory." Her The Control of Parenthood (1920) declared
that "utopia could be reached in my life time had I the power
to issue inviolable edicts ... I would legislate compulsory sterilization
of the insane, feebleminded ...".
1.5 Similarly, Margaret Sanger, who was
the driving force behind the establishment of the International
Planned Parenthood Federation (IPPF), the parent body to national
family planning organisations, wrote an article on "The Eugenic
Value of Birth Control Propaganda" where she praised Eugenics
as "the most adequate and thorough avenue to the solution
of racial, political and social problems"[250]
Today, the family planning movement is at the forefront of calling
for widespread access to abortion under the pretence of "sexual
and reproductive rights".
1.6 Those in favour of easy access to abortion
are often called "pro-choice". Those opposed to abortion
may be called "pro-life", however some may also call
them "anti-choice". Underlying this discussion is the
issue of choice—that a woman has, or has not—the choice
to continue or terminate the pregnancy. However, the word "pro-choice"
is a euphemism, as the embryo/foetus has no choice in this matter
whether his or her life is being taken away. The terminology "pro-choice"
therefore should be dropped.
1.7 No-one can disagree that abortion is
the deliberate taking away of a life. While there may—or
may not be—"good" reasons given for an abortion
(failed contraception, financial problems, unstable relationship,
overcrowded housing, emotional instability, foetal disability,
rape, serious threat to maternal health, etc) the fundamental
question remains: can it ever be right to take a life away? If
there is societal consensus that it can be "right" to
take a life away, under which circumstances do we agree that life
can be taken away? Is it acceptable to take a life away for financial
reasons, for overcrowded housing, or not? Is it acceptable to
take away a life in the case of rape but not "just"
for failed contraception? It would be helpful if the committee
could, at least, give consideration these questions, even though,
perhaps, there may not be a universally agreed answer.
In the following sections, we comment on some
of the specific questions raised by the Select Committee.
2. THE 24-WEEK
UPPER TIME
LIMIT
2.1 We maintain that the 24 week upper limit
is by far too high in view of medical developments over the past
decade. The upper limit needs to be lowered and brought into line
with the limit of most European countries, to around 12 weeks.
2.2 Since Parliament last revisited the
issue of upper limit to abortion in 1990, there has been a steady
improvement in the survival of extremely premature babies so that
the majority of 24-week-old premature babies survive. In some
centres, the majority of infants born at 23 weeks gestation survive.
There has been a recent report of an infant born after 21 weeks'
gestation surviving.[251]
2.3 A recently published study found a significant
improvement in rates of survival and major neurodevelopmental
impairment in extremely low gestational age.[252]
Infants were born at 23 to 27 weeks of gestation. Outcomes at
one year adjusted age were compared for two epochs of birth: "epoch
1", July 1990 to June 1995 and "epoch 2", July
1995 to June 2000. The average survival of extremely low gestational
infants as a percentage of live births, was 67% in epoch 1 (1990-1995)
and 71% in epoch 2 (1995-2000). Major neurodevelopmental impairment
was present in 20% of survivors in epoch 1 and 14% in epoch 2.
In Epoch 1 11% of 23 weeks gestation infants survived. In Epoch
2 this had more than doubled to 25%; similarly in Epoch 1 44%
of 24 weeks gestational infants survived, whereas in Epoch 2 60%
survived.
2.4 A 15-year study of infants born between
23 and 26 weeks' gestation at one US specialist neonatal centre
show a consistent improvement in outcome. Between 1986 and 1990,
40% of extreme premature infants of 23 weeks survived, this increased
to 66% in the period between 1996 and 2000. The improvements in
survival rates for infants born at 24 weeks were 49% for the earlier
and 81% for the later period. Survival rates for infants born
at 25 and 26 weeks are now 85 and 93% respectively.[253]
2.5 A particularly distressing situation
occurs if, after abortion, the baby is born alive. A recent survey
in the North West of England showed that there were 31 cases between
1996 and 2001. Some of the babies surviving the abortion were
at 18 weeks' gestation and more than half under 22 weeks gestation.
The babies lived for between 5 minutes and four hours after the
termination. Some of the babies started breathing and gave an
audible cry. The authors of the study recommended counselling
women prior to the terminations that their baby might be born
alive.[254]
2.6 The current abortion limit, allowing
abortions up to 24 weeks therefore needs to be brought down significantly,
as in some centres the majority of babies born after 23 weeks
gestation survive.
2.7 We suggest that the upper limit be brought
in line with the majority of European countries, which is 12 weeks.[255]
The following European countries, all of which have a lower abortion
rate than the UK, have 12 week limits: Austria, Belgium, Denmark,
France, Germany, Greece, Italy, Luxembourg and the Netherlands
(13 weeks). Portugal has a 16 weeks limit, Sweden 18 weeks, and
Spain 22 weeks. The only European country with the same high gestation
limits as the UK is Finland (24 weeks).
3. DEFINITION
OF "SERIOUS
ABNORMALITY"
3.1 Abortion for "serious abnormality"
is a problematic issue. This is fundamentally an ethical issue,
whether or not life is worthy of preservation, even though there
is the chance of an abnormality. The philosophical term which
best describes this practice is eugenics, a rarely used term in
view of its association with the euthanasia programme initiated
in Nazi Germany in the 1930s and 1940s.
3.2 There has been the widely reported case
of Joanna Jepson, a curate in the Church of England, who brought
a legal challenge against the Police for failure to prosecute
as illegal the late termination of a baby with cleft lip. This
has highlighted the issue that there is no universally acceptable
definition of disability.
3.3 Conversely, as there is the possibility
of having an abortion for a baby with disability, there is the
possibility of medical error, ie that a healthy baby may be aborted.
It has been estimated recently, that if all pregnant women underwent
amniocentesis for Downs syndrome it could lead to the termination
of 3,200 healthy babies a year. As all antenatal tests have a
false positive rate (ie the test suggests that the baby has Downs
syndrome, while the baby is in fact healthy) there would be 160
healthy babies aborted for every 50 cases of Down's or Edwards
Syndrome detected.[256]
3.4 There is anecdotal evidence which ties
in with our experience that if through antenatal tests the possibility
of a disability is raised, parents are being pressurised into
having a termination, which some parents find difficult to resist.[257]
It appears that the "default" procedure after the diagnosis
of a foetal disability, however minor, is termination. We are
aware of a recent case, where parents have been told that their
unborn child—at that time 30 weeks gestation—could
have slightly shorter legs and may have dwarfism. A termination
was offered, which the parents refused. They had a healthy baby
some weeks later.
3.5 In this context we would like to draw
attention to a statement made by the Disability Rights Commission
(DRC), a disability rights watchdog set up by the government.
The DRC has labelled the Abortion Act as discriminatory, as it
allows for abortions to be carried out at any time during pregnancy
if there is a significant risk of the baby being born seriously
disabled. The DRC stated:
The Abortion Act "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. 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".[258]
This statement is particularly relevant, as
the Government are currently embarking on a major review of anti-discrimination
legislation.[259]
3.6 We therefore believe that there ought
to be clear guidance on what constitutes "serious disability"
in the context of the Abortion Act.
4. DEMOGRAPHIC
IMPACT OF
ABORTION
4.1 One area of the abortion debate is frequently
not considered: After more than 6 million legal abortions since
1967, what has been the demographic impact of abortion on the
total population and what are the projections for the next decade?
4.2 It is beyond doubt that the increase
in the abortion rate has contributed to the decline in the birth
rate since 1968. For several years after 1968, the shortfall of
fertility below replacement level was approximately equal to the
abortion rate. However in recent years the abortion rate has exceeded
this.
4.3 Using a mathematical model in order
to assess the demographic impact of abortion, "Lost Generations"
have been computed to illustrate what the population might have
been had there not been legalised abortion. The First Lost Generation
is based on abortion numbers, assuming that 90% of abortions could
have been live births six months later. The Second Lost Generation
is then the children of the First Lost Generation whose fertility
follows a birth rate augmented by 90% of the abortion rate. The
Third Lost Generation is the children of the Second and grandchildren
of the First. The 10% of abortions assumed not to have been possible
live births are assumed to have been miscarriages or stillbirths,
legal abortions on limited grounds or illegal abortions under
the old law had it been enforced after 1968.
4.4 The absence of the Lost Generations
results in the working age population that is 6.07 million (or
6.7%) smaller than it would have been had 90% of the aborted foetuses
become live births. As a result of abortion, the working age population
in 2017 is forecast to be 10.9% smaller (7.56 million in absolute
numbers) than it might have been. The projection for 2027 is a
reduction of the working age population of 11.3% (or 9.54 million)
than it might have been without abortion.[260]
5. THE RISK
OF EARLY
ABORTION VERSUS
PREGNANCY AND
DELIVERY: MORTALITY
5.1 The Guidance issued by the Royal College
of Obstetricians and Gynaecologists makes an astonishing statement:.
"( ... ) abortion is safer than continuing
a pregnancy to term".[261]
Taking into account the wording of Section C
of the Abortion Act (by far the most common cause for terminations
is under Section C) which allows an abortion if:
"the continuance of the pregnancy would
involve risk, greater than if the pregnancy were terminated, of
injury to the physical or mental health of the pregnant woman".
5.2 If indeed, abortion is safer than continuing
a pregnancy to term, then, according to the wording of the Abortion
Act, essentially every pregnancy could—or perhaps even should—be
terminated as it would be in the interest of the mother.
5.3 However, the statement that abortion
is safer than continuing a pregnancy is based on abortion-related
mortality. based on the Confidential Enquiry into Maternal Deaths.
However, we are not convinced that official data regarding the
abortion-related mortality are accurate. Death certificates rarely
mention abortion and there is evidence that—if one relies
on death certificates alone—abortion-related deaths are
not recognised.[262]
5.4 Better data can be achieve through record-linkage
studies. A Finnish record-linkage study found that the maternal
death rate after abortion was nearly three times greater than
the maternal death rate after child birth.[263]
The all (natural) cause mortality rates for women who were pregnant
or within 1 year of pregnancy termination was compared among Finnish
women for a 14-year period, 1987 to 2000. The age-adjusted mortality
rate for women during pregnancy and within 1 year of pregnancy
termination was 36.7 deaths per 100,000 pregnancies. Maternal
deaths within 12 months of end of pregnancy (per 100,000 women)
in Finnish population:
Miscarriage 51.9/100,000.
Induced abortions 83.1/100,000.
5.5 This study shows a nearly three-fold
increase in total mortality after termination compared to carrying
a pregnancy to term. The increased number of deaths after abortion
are due to an increased number of violent deaths such as accidents,
suicides and homicides but also an increase in overall mortality
due to medical causes.
5.6 Using record-linkage among low-income
Californian women also found a significant increase in mortality
after abortion compared to pregnancy. This study noted that compared
to women who delivered, women who had an abortion had a 60% increased
mortality due to all causes, a 150% increased risk of suicide
(after controlling for pre-existing psychiatric conditions) and
an 80% increased risk of deaths from accidents over an eight-year
period.[264]
5.7 The Finnish and Californian studies
show very clearly that abortion is not safer than continuing a
pregnancy to term. We therefore urge the Royal College of Obstetricians
and Gynaecologists to revise their guidance in the very near future.
6. THE RISKS
OF EARLY
ABORTION VERSUS
PREGNANCY AND
DELIVERY: PSYCHOLOGICAL
AND PSYCHIATRIC
CONSEQUENCES AFTER
ABORTION
Abortion is not such a harmless procedure. It
has significant emotional consequences. In light of recent evidence,
the psychological harm done through abortions can no longer be
ignored.
6.1 Increase in suicide after abortion
6.1.1 Suicide rate. Studies from three different
countries find a significant increase in suicide rate after abortion
which is up to six times higher than after childbirth.
6.1.2 Finnish data find a six-fold increase
in suicide rate after abortion1:[265]
Maternal suicide rate within 12 months of end
of pregnancy (per 100,000 women):
Miscarriage 18.1/100,000.
Induced abortions 34.7/100,000.
The authors state: "rather than being a
relief, an abortion for them may be additional proof of their
worthlessness and might contribute to suicidality and to the decision
to commit suicide." The researchers also noted that only
11% of the suicides following pregnancy had this connection reported
in their death certificate. Therefore there is a significant problem
with underreporting of suicides following pregnancy outcome, especially
abortion.[266]
6.1.3 Data from Wales. A study examining the
effect of abortion on suicides was carried out in Wales among
a population of 408,000 women.[267]
Morgan and colleagues studied hospital admissions for attempted
suicide among women post abortion, post miscarriage and postnatal.
Following induced abortion, there was a doubling of suicide attempts
compared to women who delivered normally.
6.1.4 A recent US study examining the medical
records of over 173,000 low-income women who underwent a state-funded
delivery or induced abortion in 1989. 8 years later, the suicide
rate among aborting women was over 2.5 times the rate among women
who had delivered:[268]
Deaths due to suicide in women who delivered
a baby 23.9/100,000.
Deaths due to suicide in women who had an induced
abortion 62.0/100,000.
Violent deaths in women who delivered a baby
233/100,000.
Violent deaths in women who had an abortion 428/100,000.
The mortality due to violent deaths (accidents,
suicides and homicides) was 80% higher among women who had an
abortion compared to women who had given birth.
6.2 Increase in violent deaths after abortion
The increase in violent deaths and deaths due
to accidents after abortion was also observed in Finland, where
after abortion, there was a five-fold increase in mortality due
to accidents and a ten-fold increase in mortality due to homicide
after induced abortion.[269]
PREGNANCY-ASSOCIATED MORTALITY PER 100,000
PREGNANCIES
| Pregnancy or birth
| Spontaneous abortion or ectopic pregnancy
| Induced abortion |
| All external causes | 9.6 |
34.6 | 60.0 |
| Unintentional injuries | 3.9
| 14.3 (NS) | 20.4 |
| Suicide | 5.0 | 16.0 (NS)
| 31.9 |
| Homicide | 0.7 | 4.2 (NS)
| 7.7 |
All data are statistically significant apart from (NS).
6.3 Increase in psychiatric hospitalisation after abortion
Other "hard" data showing an increase in psychiatric
morbidity after terminations are shown due to increased psychiatric
hospitalisation after abortion. This study only included women
with no previous psychiatric history. After abortion, twice as
many women had to be admitted to a psychiatric unit for conditions
such as adjustment disorder or single/recurrent depressive psychosis.
The risk of admission for bipolar disorder was increased threefold
after abortion.[270]
6.4 Increase in substance misuse after abortion
There is an increased risk of substance misuse after termination
compared to women who continued with their pregnancies. A recent
review of a large number of studies investigating this area found
women who had an abortion were two to six times as likely to develop
substance and/or alcohol abuse following abortion compared to
women who continued with the pregnancy.[271]
6.5 Increase in psychiatric morbidity after abortion
Perhaps one of the most significant recent studies examining
adverse psychological effects after abortion is a 25 year longitudinal
study from New Zealand. This study followed 500 young women from
birth up to age 25 with regular measurements of mental health.
After adjusting for confounding factors, those women who had an
abortion experienced twice the risk of anxiety disorder, three
time the risk of major depression, four times the risk of suicidal
ideation and over six times the risk of illicit drug addition
compared to those who had given birth. The data analysis controlled
for variables such as social background, education, ethnicity,
previous mental health and exposure to sexual abuse.[272]
In view of the above evidence, the RCOG statement that "(
... ) abortion is safer than continuing a pregnancy to term".[273]
cannot be maintained and needs to be revised urgently.
7. MEDICAL ABORTIONS,
HOME ABORTIONS
AND NURSE-LED
ABORTIONS
7.1 Fundamental to the safety issues surrounding both
home abortions and nurse-led abortions is the safety of the medical
abortion regime, based on the use of two drugs, mifepristone (RU-486)
and a prostaglandin, usually misoprostol. As mentioned in the
previous section, abortions, whether carried out at home or performed
in a hospital setting, have serious adverse physical, emotional
and spiritual consequences.
7.2 Medical Abortion. Royal College of Obstetricians
and Gynaecologist (RCOG) guidance (Royal College of Obstetricians
and Gynaecologists. The Care of Women Requesting Induced Abortion.
September 2004) recommends medical abortion using mifepristone
plus prostaglandin as the "most effective method of abortion
at gestations of less than 7 weeks" and describes medical
abortion as "appropriate method for women in the 7-9 week
gestation band." According to the RCOG guidance, this method,
however, can be used up to 24 weeks as it "has been shown
to be safe and effective."
7.3 Safety and side effects. In trials, almost all women
using mifepristone for medical abortions experienced abdominal
pain or uterine cramping; and a significant number experienced
nausea, vomiting, diarrhoea. Vaginal bleeding or spotting lasts
on average of nine to 16 days, while up to 8% of patients bleed
for 30 days or more. Pelvic inflammatory disease (PID), a serious
complication, occurred in about 1% . Between 4.5 and 7.9% of women
required surgical intervention following medical termination for
a variety of reasons, including treatment of bleeding, incomplete
expulsion of the pregnancy and ongoing pregnancy after medical
abortion. It is estimated that medical abortions are 5 to 10 times
as likely to "fail" as surgical ones, therefore requiring
surgical intervention in a then advanced pregnancy.[274]
7.4 Mortality. By early 2006, at least 5 women
had died in North America (5 in US and 1 in Canada) as a result
of taking Mifepristone followed by misoprostol. In the UK, there
have been two possible cases of death following medical termination.[275]
7.5 Four of the US fatalities and the Canadian fatality
resulted from infections with an virulent bacterium (Clostridium
sordellii) The cases have been described as deaths due to endometritis
and toxic shock syndrome associated with this bacterium that occurred
within one week after medically induced abortions.[276]
The disturbing features were that all the women who died were
young and healthy; they had apparently successful terminations
with no complications, the initial presentation of the toxic shock
syndrome were unspecific abdominal cramps, which commonly occur
after medical termination, and all women died within 5 days of
administration of medication. All died less than 24 hours after
hospital admission. Of note is that all five women who died of
infections had inserted misoprostol vaginally. It is estimated
that around half of medical abortions carried out in the UK use
vaginally administered misoprostol.
7.6 Medical abortion has ten times the mortality of surgical
abortion. A recent review concludes that the risk of death with
medical termination, while low (1 in 100,000), is still 10 times
greater than that with surgical abortion.[277]
As a result about these safety concerns, a number of US doctors
have been quoted as expressing serious concerns about the safety
of medical abortions and some have actually stopped providing
medical abortions altogether.[278]
7.7 There has been a case report of an adolescent girl
dying following self-administration of misoprostol in order to
induce abortion.[279]
8. CONCLUSIONS
8.1 For the past 40 years there has been a steadily growing
recognition of the immense social and clinical significance of
abortion and of its real dangers to society, which we believe
ought to be considered by the Select Committee on Science and
Technology.
8.2 There is growing recognition that the physical, emotional,
spiritual and social consequences of abortion have been widely
underestimated.
8.3 Many matters such as the reality of foetal memory
and evidence that the unborn child appears to feel pain and discomfort
cannot continue to be ignored and are radically changing public
attitudes to the value and sanctity of life in the womb. We believe
the Select Committee cannot ignore this.
8.4 We believe that it is crucial that the Committee
should not divorce issues of ethics and morality from their scientific
inquiries.
8.5 There is now sufficient scientific and clinical evidence
available to the members of the Committee to warrant them pressing
for a fundamental reconsideration of all policies, which have
led to the unprecedented level of abortion in our country today.
September 2007
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Hoekstra RE et al. Survival and long-term neurodevelopmental outcome
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Rebecca Smith. Down's syndrome test "risk to healthy babies'.
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257
Should only healthy babies be born? BBC News. 19.3.03. Back
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259
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260
Dr Patrick S Carroll, PAPRI, (Pensions And Population Research
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268
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