Memorandum 50
Submission from Wendy Savage, Press Officer
and Co-ordinator, Doctors for a Woman's Choice on Abortion
RE: LATE
ABORTIONS
My apologies for this late submission and thank
you for circulating to the committee.
I have been Press Officer and Co-ordinator of
DWCA since 1976, soon after I returned from New Zealand where
I had started an abortion service with the help of the Medical
Superintendent of Cook Hospital, the public hospital in Gisborne,
before the law was changed. I gave evidence about this work to
the Royal Commission on contraception, sterilisation and abortion
in 1974.
Before I went to New Zealand I had worked for
a year for Pregnancy Advisory Service both seeing women pre-operatively
and doing one list a week so that I saw over 1,000 women during
that time. I was closely involved with the late Professor Huntingford
when he set up the Tower Hamlets Day Care Abortion Service in
1977 and ran this after he resigned in 1981 until a Director of
Well Women's Services was appointed in 1985, a post I had created
linking the abortion service with the contraceptive and cervical
screening services. I did the vast majority of second trimester
abortions from 1985 until my retirement from practice in 2000.
I have attached a short personal account of
my experience over 35 years of women presenting for late abortions,
which leads me to the position that it is unecesary to change
the law. This view is endorsed by the members of DWCA who include
GPs, psychiatrists and public health doctors as well as gynaecologists.
If my evidence is thought to be relevant I would be prepared to
give oral evidence to supplement the paper which follows.
Should induced abortion be linked legally with
fetal viability?
Background
In 1989 Professor Colin Francome and I carried
out a postal survey of a random sample of practising gynaecologists
in the NHS in Great Britain. There was an 84% response rate after
three mailings and follow up telephone calls so the results seemed
valid. We found a marked discrepancy between their support for
a legal time limit and their own personal time limit.(Table 1,
ref 1). I would have fallen into the 8% who were prepared to do
an abortion at 25 weeks or later and therefore thought my experience
may be useful to the committee.
Table 1
| Gestation | Legal limit
| Personal limit |
| 0 | 2 (1%) | 14 (5%)
|
| <=12 | 7 (2%) | 71 (22%)
|
| 13-19 | 15 (4%) | 142 (43%)
|
| 20-23 | 42 (13%) | 74 (22%)
|
| 24 | 203 (64%) | 16 (5%)
|
| >=25 | 40 (13%) | 8 (2%)
|
| Not stated | 10 (4%) | 3 (1%)
|
Ref 1 (1989) Numbers may not add up to 100 because of rounding
n+318
Personal experience leading to my view on abortion
My own experience of abortion predates the passage of the
1967 Act. As a student I saw a woman in her mid-thirties die of
renal failure in the Forest Gate Hospital in 1959 after she had
syringed herself in an attempt to abort at about 20 weeks. She
was married and felt she could not cope with a fourth child. As
a pre-registration house officer in 1961 I only saw one woman
who had attempted an illegal abortion with potassium permanganate
whilst I worked in the Receiving Room at the London Hospital as
the ambulance drivers took these women to Mile End Hospital, she
was bleeding too heavily for them to make the extra mile—the
pregnancy was intact.
I then went abroad and saw several young women die from unsafe
abortions procured with native medicine or done by unskilled practitioners.
One of these in Nigeria in 1966, was my own housemaid, a beautiful
and lively 17 year old. In Kenya in 1968, an 11 year old nearly
died of sepsis and had probably lost her chance of having children
in the future. My housemaid had asked me to help and I had advised
her to go home and tell her parents and the mother of the 11 year
old had asked us in the hospital to do an abortion on her young
daughter and was told it was illegal. My experience in Africa
convinced me that abortion should be legalised and done by doctors
to prevent the loss of life and risk of ill-health from unsafe
abortion (Ref 2).
I returned to Britain in 1969 and got a post at the Royal
Free Hospital where I learnt how to perform abortions safely.
When I went to New Zealand in 1973 where the law was the same
as that in Britain before 1967, I found I could not refuse to
perform abortions and with the help of the Medical Superintendent
a system was set up.
I gave evidence to the Royal Commission that was held in
1976 to look at Contraception, Sterilisation and Abortion, which
led to a change in the law. I then returned to Britain and worked
with the late Professor Peter Huntingford in Tower Hamlets where
I assisted him with the Tower Hamlets Day Care Abortion Service.
I ran this after he resigned in 1981 until 1985 when I was
able to create a post of Director of Well Women's services which
combined contraceptive, cervical screening and abortion services.
I continued to do the second trimester abortions until my retirement
in 1990. I became the Press Officer for Doctors for a Woman's
Choice on Abortion in 1976 and co-ordinator in 2000.
Should induced abortion be linked to fetal viability?
My view is that the time limit for abortion should not be
linked to fetal viability because if one is looking at the woman's
health her needs are paramount. She is a live sentient human being
with a nexus of relationships and expressed hopes for the future.
The fetus has the potential to become a live baby but whilst
in the womb is dependent on its mother and is not a sentient human
being. I believe that as pregnancy advances the rights of the
fetus become greater but never override the rights of the mother.
The law already allows for exceptions to be made after 24 weeks
if there is a lethal or serious fetal abnormality.
I saw no need to change the law in 1990 as very few abortions
were done after 24 weeks gestation and as most doctors are reluctant
to perform later abortions they were only done for compelling
fetal or maternal reasons. It laid the way open for the anti-abortion
organisations, (who really want to outlaw all legal abortion)
to seize on this emotive topic and campaign for a lowering of
the time limit by claiming that there have been significant improvements
in the survival of babies on the threshold of viability and yet
there is little, if any evidence to support this claim (Ref 3).
More importantly if an artificial womb were to become a reality
in the future and it became possible to keep a fetus alive at
12 weeks does that really mean that the rights of a 12 week fetus
should over-ride those of its' mother?
Secondly, in practice is rare for women to present after
24 weeks and even rarer for them to present after 26 weeks. This
was true when 28 weeks was taken as the time when a baby might
survive even without neo-natal intensive care.
I reviewed the case notes of all the women who had presented
after 20 weeks in Tower Hamlets in 1983, (one of the most deprived
areas in the country). 12 or 1.5% of the requests were made after
20 weeks. No abortions were done for fetal abnormality in that
year. There were seven women and five girls aged 12, 13 and 14
respectively and two aged 15. The 14 year old was recently arrived
from Bangladesh where she had been raped on the way to collect
water from the well. Her parents had sent her off to her aunt
and uncle but not revealed that she was pregnant. She was 30 weeks
pregnant and the only case that had presented over 28 weeks in
that decade (Ref 4).
I have seen over 3,500 women presenting with an unwanted
pregnancy in four different countries and the case above was one
of only two over 28 weeks. The other young woman was referred
to me by the Pregnancy Advisory Service after the doctor had said
they could not do an abortion so late and was concerned that she
might harm herself. After discussion I did not think she was suicidal
but desperate because of her social problems. She was not from
Tower Hamlets either. She remained in the antenatal ward for 18
weeks until she was re-housed and went home with her baby at six
weeks. This was in the late 1970s. Nine months later I met her
by chance in the market and enquired after the baby. She told
me he had died as a cot death at five months. Interestingly, the
Bengali baby had been placed for adoption and suffered a cot death
at five weeks whilst with experienced foster parents. Seven abortions
were performed and of the five pregnancies that continued only
two babies were alive after a year.
In the decade before I retired when the limit had been lowered
to 24 weeks I saw one English business woman in her twenties and
one Nigerian teenager in her late teens, both threatening suicide
and neither from Tower Hamlets and two Bengali girls, one aged
11 and one aged 12 whose mothers requested termination of pregnancy.
One had been abused by the Iman allegedly giving her lessons in
the Koran in her bedroom. I performed these abortions after 24
weeks under what is now ground B as I thought "it was necessary
to prevent grave permanent injury to the physical or mental health
of the woman".
For example when a woman threatens suicide because she cannot
face continuing with a pregnancy, one needs a psychiatric opinion
to assess her mental state and what mental health care she needs.
The Professor of Psychiatry at the London Hospital in 1989, after
a consultation with such a woman, estimated the risk of her actually
committing suicide was, in his opinion (based on experience which
started before 1967), as "only 1-2%". Compared with
the maternal mortality rate of 10 per 100,000 at that time I felt
this was sufficient to comply with the grounds in the Act and
carried out an abortion at 26 weeks. He also stated that in his
experience, once the acute crisis had passed most of these young
women's mental health improved miraculously and they rarely required
ongoing psychiatric care.
IN CONCLUSION
Firstly, if the woman's health is taken as the most important
factor when performing an induced abortion then it is wrong be
link it to viability.
Secondly, in practice, in my experience, women do not request
induced abortion after 26 weeks gestation.
REFERENCES
1. Savage W and Francome C. (1989) Gynaecologists' attitude
to abortion Lancet (ii):1323-4.
2. Khehar B and Savage W (1969) Septic abortion in Nairobi.
East African and Medical Journal 46: 634-642.
3. Tommiska, V, Heinonen, K, Lehtonen, L, Renlund, M, Saarela,
T, Tammela, O, Virtanen, Mi, Fellman, V, ( 2007) No improvement
in outcome of nationwide extremely low birth weight infant populations
between 1996-1997 and 1999-2000. Pediatrics. 119(1):29-36.
4. Savage W (1985) Requests for late termination of pregnancy:
Tower Hamlets, 1983. BMJ 1985, 290: 621-623.
October 2007
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