Memorandum 44
Submission from Abortion Rights
INTRODUCTORY COMMENTS
Access to safe, legal abortion is a crucial
issue for women—fundamental to women's equality, autonomy
and freedom. No means of contraception is 100% effective and women
will always need to be able to control if, when and how many children
they have.
Abortion Rights is concerned that current reviews,
including by the Science and Technology Committee, have been initiated
in a climate dominated by the misleading narrative of an increasingly
vocal anti-abortion lobby. This lobby has sought to win support
for incremental restrictions in abortion rights as a tactical
step on the road to their ultimate goal of criminalising all abortion.
We are particularly worried that women's needs and real experiences
have been largely eclipsed from the debate and are disappointed
that the terms of the Science and Technology Committee's review
specifically excludes such social evidence from its scope in considering
later abortion.
40 years ago parliament decided it was no longer
acceptable for women to suffer unsafe backstreet abortion in Britain.
Today we are concerned that women's current abortion rights should
not be chipped away as a result of pressure from the minority
anti-choice lobby. Instead, we believe it is time that some of
the remaining unfair, sometimes distressing, barriers to accessing
abortion are removed to allow women to make the abortion decision.
1. The scientific and medical evidence in
relation to the 24-week upper time limit on most legal abortions.
Research on later abortion published by Marie
Stopes International in 2005i corroborates substantial anecdotal
evidence collated by Abortion Rights (formerly Abortion Law Reform
Association and National Abortion Campaign) in the last 17 years.
We hope that the Committee will consider this
important evidence. We have spoken to a great number of women
who have had later abortions since 1990, revealing a continuing
need for legal and accessible abortion up to 24 weeks. Others
we have spoken to have needed abortion beyond 24 weeks and had
travelled abroad to access services.
KEY FINDINGS
Late diagnosis of pregnancy
Some women simply do not know they are pregnant
until later into their pregnancy. The signs of pregnancy can vary
widely between women and between pregnancies. Some women do not
experience a stop in their periods or weight gain. Others attribute
physical symptoms to other medical conditions. Others are misled
by failed pregnancy tests. This is a particular issue for women
who are very young or nearing the menopause and for those consistently
using contraception and even for some women who are breast-feeding.
For some women, the reduction in legal abortion time limit from
28 to 24 weeks in 1990 has forced them to travel abroad for a
later abortion or continue an intolerable pregnancy to term.
Denial of pregnancy signs
Some, often vulnerable, women enter into a profound
psychological state of denial that is maintained until the physical
manifestations of the pregnancy can no longer be ignored. This
is often associated with trauma at conception such as rape or
with very young women ill equipped to cope with their situation.
Late identification of problems in wanted pregnancies
The principle scans for fetal anomalies are
still only conducted at around 20 weeks. Identification of a problem
at this scan will almost always mean further tests are required.
This leaves little time for women to consider whether or not to
continue with an often much-wanted pregnancy and leads to a need
for some abortions up to 23 weeks and six days into the pregnancy.
Poor service provision and limited rights
Abortion Rights frequently hears from women
who contact us in desperation when they are told that the earliest
appointment for an abortion is six or eight weeks away. This adds
unnecessary delay to the process and pushes some women into having
a later abortion if they cannot afford hundreds of pounds in independent
sector service fees. We have been contacted by representatives
of international students and trafficked sex workers who have
no rights to NHS care. These are women who are in desperate situations
and whose access to an abortion is delayed until they can raise
money through money lenders, prostitution or other means. Other
women have difficulty accessing services because of a failure
to facilitate their language or cultural needs or because of a
lack of knowledge of NHS entitlements and legal rights in Britain.
Some women from Northern Ireland, where reproductive
rights are particularly restricted and ill defined (the 1967 Act
was never extended to Northern Ireland), are forced to have later
terminations in Britain because of the enormous legal, practical
and financial barriers that that system creates for women traveling
to Britain for the procedure.
Difficult social circumstances
For some women, catastrophic changes in their
personal circumstances mean that they no longer feel able to continue
with a pregnancy. This can include the death or loss of a partner,
domestic violence or the needs of an existing child or family
member. Other women experience enormous pressure from partners
or relatives not to have an abortion which delays their decision-making.
There have been no significant changes since
1990 in women's experience of any of these key issues that delay
abortion procedures. Reducing the abortion time limit as proposed
by some would lead to women being forced to endure a pregnancy
to term against their will and interests; travel aboard at great
cost and distress; or resort to a self induced or back street
abortion, risking their health and perhaps life.
"I had always been very conscientious
about contraception and had been taking the pill throughout my
relationship. When I had a missed period, I went straight to my
doctor to have a pregnancy test. It came back negative. I was
still missing periods. I returned to my doctor who said I had
nothing to worry about explaining that hormonal changes due to
my contraceptive pill were responsible. A short while later I
met someone who had had a child after finding out too late that
she was pregnant to have an abortion. I did another pregnancy
test, which came back positive. It took a further two and a half
weeks before I could have an abortion by which time I was 21 weeks
along. I have always known it was the right thing for me to have
done and have never regretted it."
(a) developments, both in the UK and internationally
since 1990, in medical interventions and examination techniques
that may inform definitions of fetal viability
As far as we are aware, the viability of fetuses
before 24 weeks has not significantly changed since the last legal
review in 1990, when legislation was passed to reduce the upper
time limit for abortion from 28 to 24 weeks. Survival rates are
currently 0% at 21 weeks, 1% at 22 weeks and 11% at 23 weeks.
ii Very severe disabilities are often associated with those babies
that survive at the threshold of viability and may be as high
as 67% at 23 weeks. Recent scientific enquiries, such as that
conducted by the Nuffield Council of Bioethics, have not found
any significant change in outcomes at the borderline of viability.
iii
(b) whether a scientific or medical definition
of serious abnormality is required or desirable in respect of
abortion allowed beyond 24 weeks
Abortion Rights believes that a scientific or
medical definition of "serious abnormality" is not necessary
or desirable to ensure good decision-making on abortion.
Contrary to the impression cultivated by the
anti-abortion lobby and sensationalist media headlines, there
is no evidence to suggest that women are commonly seeking abortions
after 24 weeks for frivolous or cosmetic reasons. High-profile
stories about fetuses aborted in the third trimester because of
a "cleft lip", for example, have often distorted reality
and failed to reflect the seriousness of the cases concerned.
They are often promoted by those with a political interest in
restricting abortion access.
Our extensive contact with women who have had
an abortion demonstrates to us that women make decisions about
abortion very carefully, particularly when considering a later
abortion. Women who need later abortion because of serious fetal
impairment often have much-wanted pregnancies and go to great
lengths to find medical information and research the possibility
of continuing with the pregnancy. Abortion Rights believes that
a woman herself, in consultation with her doctors, is in the best
position to make a judgement about whether or not to continue
with a pregnancy. To impose proscriptive definitions of "serious
abnormality" would only restrict the options of such women
in very difficult circumstances and impose motherhood on a small
number of women against their will.
Abortion Rights fully supports the rights of
disabled people, and supports the work of the disability rights
movement to bring about recognition of their dignity and human
rights and to change society so that the social barriers to equality
are removed and to thereby ensure the fullest participation of
disabled people. We recognise that we live in a society that discriminates
against and devalues disabled people.
We believe that defining particular fetal impairments
would not be helpful to advancing the status of people with impairments.
It would be a blunt instrument, insensitive to the differing impact
of impairments on different people and society's contribution
to disabling or enabling people to live full and dignified lives.
We believe women, with advice and support from medical professionals
and social and welfare organisations, are best placed to make
their own judgements about whether or not to continue their pregnancy.
2. Medical, scientific and social research
relevant to the impact of suggested law reforms to first trimester
abortions, such as:
(a) the relative risks of early abortion
versus pregnancy and delivery;
Early abortion is the most common gynaecological
procedure and is extremely safe, especially in the first 12 weeks.
Pregnancy is not without risk, carrying a pregnancy to term and
giving birth can cause complications and subsequent health problems
or even death. Even if a woman is in good physical health continuing
with a pregnancy is more risky than an abortion.
In 2002, four women died from abortion related
complications versus 36 from pregnancy related complications.
iv
(b) the role played by the requirement for
two doctors' signatures.
The requirement for doctors to sign agreement
for a woman to have an abortion is in reality allowing some doctors,
who oppose abortion to unfairly delay, make difficult or even
veto women's decisions.
The Marie Stopes' study "General Practitioners
attitudes to abortion"v found 10 percent of doctors oppose
all abortion. Doctors who conscientiously object to abortion are
required by the General Medical Council (GMC) to refer women to
another doctor. All doctors are required to ensure personal beliefs
do not prejudice patient care and to respect patients' right to
reach decisions about their treatment and care within the law.
vi Unfortunately this guidance is not policed and Abortion Rights
has encountered countless examples of women who have been humiliated,
delayed or refused treatment by doctors opposed to abortion.
Quotes from women
My GP was against it. I had to apply to Marie
Stopes. Joy, 1975, London, nine weeks.
Everything he did was obstructive until eventually
he just told me to go away and think about it. Kat, 23, Warwick
My doctor was very rude and gave me no information.
I had to look in the phone book for a clinic. Kerry, 2004,
Manchester, eight weeks.
The family planning doctor who told me I was
pregnant didn't inform me of my options, simply told me to "keep
baby" or "adoption". Allison, 1994, North East,
11 weeks.
My doctor was very anti-abortion, which he
made clear by the way he treated me. I first went to him when
I was two weeks pregnant, but because of his delaying tactics
I had to wait another 10 weeks before I got the abortion. And
then it turned out that my local hospital didn't perform abortions,
so I had to travel miles to a BPAS clinic. Cath, 1997, Norwich,
12 weeks.
The appointment she offered me for an NHS
consultation was three weeks away, never mind the procedure. I
approached the doctor at eight weeks—if I'd have waited
for the NHS it could have been over 15 weeks before I was offered
an abortion. Lynne, 2004, London, 10 weeks.
Abortion is the only healthcare procedure in
Britain excluded from the principle of patient autonomy and informed
consent. With the exception of some mental health care, it is
the only procedure where the patient's decisions are subject to
the approval or disapproval of two doctors. This is unnecessary
and is discriminatory against women.
Opinion polls consistently show an overwhelming
two-thirds majority support for women being able to make their
own abortion decision. vii Many countries including most European
countries, the United States of America and Canada allow women
abortion on request at least in the first three months of pregnancy.
viii An overwhelming majority (67%) of doctors at the British
Medical Association Conference in 2007 voted in favour of removing
the need for two doctors" signatures in the first 13 weeks
and upholding the 24-week time limit (73%).ix In this respect,
the 1967 Act is outdated and should be brought into line with
women's needs, public and medical opinion.
Abortion is a straightforward, common, low risk
procedure which is often now not even surgical but medical. One
third of British women will have had an abortion by the time they
are 45.x Across the world, an estimated one third of all pregnancies
end in abortion. Ending the requirement of doctor's permission
would help reduce the current unacceptable delays in service provision
and the abuse of women's current legal rights by some doctors
with a conscientious objection. It would not end doctor's role
of providing information, access to counselling and medical advice
to women to help them make an informed decision—one that
no woman takes lightly. Given the complexity of this decision,
the only person equipped to make it is the pregnant woman herself.
At the beginning of the 21st century, it is essential that women
in Britain have this legal right.
3. Evidence of long-term or acute adverse
health outcomes from abortion or from the restriction of access
to abortion.
The consensus of all authoritative psychiatric
and medical opinion is that, for the vast majority of women, the
effects on psychological health of having an abortion are neither
major nor long lasting.
Most women report feeling a sense of relief.
They suggest that the most stressful thing is deliberating and
coming to a decision, particularly when the circumstances are
difficult. Some women may experience feeling of sadness and loss:
this is not mental illness; it is just a normal reaction to what
can be an undesirable set of circumstances.
Anti-choice organisations claim that abortion
causes women to suffer severe psychological effects which they
call "Post-abortion Syndrome" (PAS). They liken PAS
to post traumatic stress disorder, a real syndrome sometimes experienced
by people who have suffered a terrible trauma. However, research
in the UK and the USA shows that there is no evidence of such
a mental illness. To describe the possible emotional problems
that women may experience after an abortion in this way is a distortion
of the facts.
Very few women suffer prolonged emotional distress
following an abortion. However, distress may be triggered if the
circumstances surrounding the abortion were especially stressful,
eg if it had been illegal and was frightening or degrading; if
secrecy had been essential due to family, cultural, or religious
disapproval; if the woman had been unsure about her decision to
have an abortion; if she had wanted to continue the pregnancy,
but, for medical reasons, had had to have an abortion.
"Only a small minority of women experience
any long term, adverse psychological after-effects following an
abortion. ...[Risk factors are ambivalence before the abortion,
lack of a supportive partner, a psychiatric history or membership
of a cultural group that considers abortion wrong.]... Early distress,
although common, is usually a continuation of symptoms present
before abortion." xi
Safe, legal abortion rarely has negative psychological
effects. The denial of access to abortion can have serious consequences
for the woman and for the resultant child. xii
Several research studies have compared the effects
on women and their children of those granted abortion and those
forced to continue with their pregnancy. The evidence shows that
the psychological and social consequences of refused abortion
are frequently more serious than the consequences of abortion.
Overwhelming evidence from across the world
shows that when women's access to safe legal abortion is unfairly
restricted, women find other ways to terminate unwanted pregnancies—often
at great cost to their health, well being and sometimes life.
Every year, 68,000 die due to unsafe abortion procedures, countless
more are permanently injured. xiii
The mental health effects of forcing women to
become mothers are not well documented largely because of the
social pressure on women not to report that they are unwilling
mothers. Abortion Rights has however spoken to several such women
who have been in desperate mental distress.
"With my son, I wanted an abortion and
I was refused by my GP several times and I could not afford to
go private. This is an awful thing to say as he has now been born
and is two and a half years old but I was forced to do something
I did not want to and it ruined my life.
It is my body. My life. My choice. Why should
I have a baby I had not planned for? Why ruin my life? In fact,
why ruin the child's life by having it born to a mother and a
father that did not want it? Anyone who wants an abortion should
be able to have one. Time is of the essence with abortion and
it should be done ASAP". Charlotte, Nottingham.
References
i Marie Stopes International (MSI), Late abortion;
a research study of women undergoing abortion between 19 and 24
weeks gestation, 2005.
ii Costeloe K, Hennesy E, and Gibson AT, "The
EPIcure study: outcomes to discharge from hospital for infants
born at the threshold of viability', Pediatrics, vol 106, no 4
(2000), 659-671.
iii Nuffield Council on Bioethics, Critical care
decisions in fetal and neonatal medicine: ethical issues (London:
Nuffield Council on Bioethics, 2006).
iv World Health Organisation (WHO), http://www.who.int/whosis/database/mort/table1—process.cfm
v MSI, June 1999
vi General Medical Council, Guidance on good
practice, Good Medical Practice (2006), A-Z ethical guidance.
http://gmc-uk.org/guidance/good—medical—practice/content.asp
http://gmc-uk.org/guidance/current/library/confidentiality—faq.asp£q21
vii GFK/NOP poll commissioned by Abortion Rights
and the Joseph Rowntree Reform Trust in March 2007 showed 77%
of British citizens support a woman's right to choose an abortion
in the first three months of pregnancy and a further 72% said
it was not acceptable for a woman who had been referred for an
abortion to have to wait beyond three weeks for the procedure.
viii Guttmacher Institute. http://www.guttmacher.org/pubs/fb—0599.html
ix British Medical Association, "Wednesday's
Updates from the Annual Meeting', BMA News, 27 June 2007 http://www.bma.org.uk/ap.nsf/Content/BMAnewsarm2007weds
[Accessed 5 July 2007].
x "The Care of Women Requesting Induced
Abortion, Evidence-based Clinical Guideline Number 7", RCOG
September 2004. http://www.rcog.org.uk/index.asp?PageID=662 and
http://www.rcog.org.uk/index.asp?PageID=649
xi ibid.
xii ibid.
xiii WHO, www.who.int/en
September 2007
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