Select Committee on Science and Technology Written Evidence

Memorandum 44

Submission from Abortion Rights


  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.


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."

    Zoe, 17, 21 weeks

(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.


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),—process.cfm

v  MSI, June 1999

vi  General Medical Council, Guidance on good practice, Good Medical Practice (2006), A-Z ethical guidance.—medical—practice/content.asp—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.—0599.html

ix  British Medical Association, "Wednesday's Updates from the Annual Meeting', BMA News, 27 June 2007 [Accessed 5 July 2007].

x  "The Care of Women Requesting Induced Abortion, Evidence-based Clinical Guideline Number 7", RCOG September 2004. and

xi  ibid.

xii  ibid.

xiii  WHO,

September 2007

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