Select Committee on Science and Technology Minutes of Evidence

Examination of Witnesses (Questions 360-379)


24 OCTOBER 2007

  Q360  Dr Harris: Assuming that legal advice is correct, my understanding is that it is unlawful in this country to trial what happens in America, even to research the safety, effectiveness and susceptibility under the current law without class of place regulation being promulgated. Is that also your understanding?

  Dawn Primarolo: That is true.

  Q361  Dr Harris: In 1990, the class of place provision—which enables you, as the Department, the Minister, to classify a woman's home as a class of place for the specific purpose of taking Misoprostol, the second dose—was given with a view, at some point in the future, to allowing research or practice to take place in this country which takes place in lots of other countries in the world safely, effectively and acceptably. I am wondering why, 17 years later, no progress has been made in doing that. Given that women already complete the termination at home, why do they have to step in to take a pill or the pessary in the hospital? Why has there not been an approved place regulation?

  Dawn Primarolo: Because I think the Department over the years has progressed very cautiously in this area. It is the truth, you are quite right. In identifying what can be done, because of the very strongly held views with regard to abortion, the Department has been very cautious. It has the pilots. Others have criticised that they are overly cautious but, in trying to move to a position of having a clear protocol with regard to class of place, there is no other answer that I can give.

  Q362  Chairman: That is perfectly clear.

  Dawn Primarolo: It is cautious.

  Q363  Dr Harris: That is very clear, but to clarify it further—and I am not arguing with you, Minister, I am just saying that the reasons are reasons of sensitivity—there have been no clinical or scientific reasons for thinking that what happens in other countries would be a disaster in this country.

  Dawn Primarolo: That is absolutely true. We are being careful.

  Q364  Chairman: That is an absolutely fair and appropriate answer.

  Dawn Primarolo: Given the views held across the board on this subject.

  Dr Harris: But not for medical or scientific reasons.

  Chairman: We have made that point.

  Dr Harris: I have finished.

  Chairman: You certainly have! Moving on to Linda.

  Q365  Linda Gilroy: On another area where there is a fierce debate—although the Committee's submissions overwhelmingly note, as you have already referred, that the earlier an abortion is carried out the safer it is—does the Government consider that women who ask for an early abortion always fulfil the requirement that the continuance of pregnancy would involve risk, greater than if the pregnancy were terminated, of injury to the physical or mental health of the pregnant woman? If so, should this language be dropped for abortions that take place within the specified time limit? The risk of pregnancy is always greater.

  Dawn Primarolo: I have to say I am uncomfortable with the arrangements as they are, given the inconsistencies around this debate. My preference as a minister is to ensure that we assist those who have taken a decision to seek an early abortion and that we ensure that happens and that they have access.

  Q366  Linda Gilroy: Given those sensitivities and the debates about the potential health risks, which become quite significant the further on the pregnancy goes, they are controversial. The level of risk is left with national bodies at the moment but why does the Government's Chief Medical Officer not assess the evidence and make judgments based on the balance of evidence?

  Dawn Primarolo: Because we think that it is better left to the medical judgment as quite clearly the arrangements in the sections of the qualifications of the Act require.

  Q367  Linda Gilroy: So you do not think that the Department of Health has a duty in relation to public health to do more to investigate and assess that evidence?

  Dawn Primarolo: On balance, I think we are in the right place.

  Dr Adshead: Our policy is already, as the Minister has already said, to promote abortion at the earliest possible stage and in the last few years we have invested significantly, over £8 million, in order to achieve that. Our statistics show that there has been a significant shift to abortions under ten weeks and, as the Minister has already said, the vast majority are carried out under 13 weeks. We are aware obviously of the evidence and we feel that the current Act is actually promoting early abortion.

  Q368  Linda Gilroy: But there are gaps in the evidence, particularly in the one example that has been drawn to our attention of studies that compare health outcomes in women who have had an abortion and in women who have been refused an abortion. Will the Government consider commissioning research on the safety of abortions so that clinicians can offer better advice to patients on that and other areas where there are gaps?

  Dr Adshead: Currently, under medical practice, if a doctor has a conscientious objection in terms of carrying out an abortion themselves, they have to, under good medical practice, ensure referral to another service, and from our statistics that we have, as I have said, we feel that there has been a significant shift to early abortion.

  Q369  Linda Gilroy: But I think the case that we are quoting is one where there just is not any research currently available to demonstrate what the impact on a woman's mental health is if she continues with the pregnancy.

  Dr Adshead: Well, there have been studies to look at the long-term psychological consequences, as you will be aware, and some have done comparisons with continuing with unwanted pregnancies and there is no overwhelming evidence that there is long-term psychological damage from carrying out abortions, but clearly what we are trying to do is ensure that women who wish to proceed have access as soon as possible to services. That is our policy because we want to promote safety and safety would obviously include any possible psychological distress that a woman might suffer, so our guidance and the guidance that we have developed with colleges and others promotes early access for women.

  Q370  Graham Stringer: Is there any way that a woman would know if her GP was a conscientious objector before going in to see her doctor?

  Dr Adshead: No, not as things are, but the General Medical Council, in its Good Practice Guidance, is absolutely clear that if a doctor feels that their own personal views stand in the way of providing advice to the patient, they have to declare that and they have to recommend to the woman that there are alternatives.

  Q371  Graham Stringer: But, Minister, do you not think it would be helpful in moving abortions to an earlier phase if the information was publicly available about a doctor's personal view on these issues because it is a delay factor?

  Dawn Primarolo: Well, there is not evidence in terms of we are using the figures of access to early abortion. There is not sufficient evidence to indicate that there is a delay tactic there and, to be frank, I think it is difficult to see how that could be achieved given the requirements on the doctor and how the consultation may proceed, so the doctor concerned does have to say to the patient, "I can't proceed. I have an objection", and make arrangements for referral to another doctor and, if they are ethically opposed, they have to follow the relevant professional guidance. Now, I am sure you saw this evidence as well, the Marie Stopes International research, that looked at over 7,000 GPs and something like 82% of them describe themselves as pro-choice. It seems, therefore, firstly, is there an issue here that needs to be addressed with regard to doctors using a conscientious objection? We are not seeing that as an issue in the evidence that we have. Secondly, if it was an issue, how would we deal with it? It is very difficult given the interaction with the requirements for the doctor to behave in accordance with their own medical guidance, so I hear what you say, but I am not sure how we could proceed on this. Are you suggesting a register?

  Q372  Graham Stringer: Well, yes, which would be publicly available because there is, I suppose, an a priori case because, if you are going to have to see your GP to find out that they are a conscientious objector, that is a natural, inbuilt delay before the woman goes to another doctor, and there is anecdotal evidence that some conscientious objectors use the time of seeing the woman to delay the abortion, so I think there are two routes of evidence there.

  Dawn Primarolo: We would have to raise that with the GMC, frankly, if that is what is being suggested to us because it is about the guidance issued by the GMC which is quite clear on how a doctor should behave under those circumstances and, if it is being suggested that they are not, that would be a matter for the GMC in terms of its guidelines and the correct route would be to raise it with them. Presumably, the GMC will be listening very carefully to the debates in Parliament.

  Chairman: Listening to every word!

  Q373  Linda Gilroy: There is a small, extra question which I thought of earlier which Mr Stringer's question has prompted me to think of again. Earlier, Minister, you said, I think, that 89% of abortions were carried out within what might be defined as an "early stage" and certainly 68% within 10 weeks. What does the Government then consider are further steps that could be taken for the one in 10, the 10% of abortions which are carried out beyond that point to try and ensure that they are done sooner rather than later?

  Dawn Primarolo: There has been research in connection with why there is sometimes a delay, so failure to recognise pregnancy, knowing where to go to get the correct advice and I think under some circumstances, and we would all understand this, the considerations that the woman herself is undertaking before seeking advice, going through the issues about what steps she wants to take. Now, the one where the Government can have the most influence is to ensure that the information is there to properly inform where to go once the woman has taken the decision to seek an abortion and to make sure and work, as Fiona has pointed out, in getting women quickly to that. That would be the main way because both for the considerations of the woman or failure to recognise pregnancy early enough, they are about advice and making sure that is clear.

  Chairman: There is one issue that I know Robert wants to raise on the plus-24 weeks.

  Q374  Mr Flello: One of the concerns I have around the implications of a reduction of the time limit from, say, 24 weeks to 20 weeks is that, rather than women deciding to continue with the pregnancy or to present themselves for an earlier termination, what might happen is that women will seek other ways of having an abortion, so, in order to shed some light on that, what is currently happening with women who seek an abortion after 24 weeks? For example, are they going abroad and, if so, is there any evidence on that? What is the situation?

  Dr Adshead: As we know, under the Act, if two doctors feel that there is, for example, a reason why continuing with the pregnancy would put the woman or the child at risk in terms of congenital abnormalities, then they are able to advise that an abortion needs to be carried out beyond 24 weeks.

  Q375  Mr Flello: Sure, but, if that is not the case, what is happening at the moment with women who discover late or it takes them some time to decide that they want to have an abortion and they are at the point of 24 weeks? Is there any evidence?

  Dr Adshead: We do not have any evidence of that, of what is happening that I am aware of.

  Q376  Mrs Dorries: Actually the Chief Medical Officer instigated an investigation into BPAS who are actually referring women who are post-24 weeks to Spain for terminations, and that is freely available on the web to be seen.

  Dr Adshead: Yes, I mentioned that earlier, when doctors had been asked if there had ever been any circumstances in which we had carried out an independent review, and you are absolutely right, the Chief Medical Officer did do that. What he found was that in fact BPAS was acting within the law.

  Q377  Mrs Dorries: But they were not carrying out the terminations themselves, they were giving women the contact details of other hospitals where they had the terminations carried out later in other countries, which is within the law, but BPAS are advising women to go to other hospitals.

  Dr Adshead: And we are absolutely now trying, as I have already said, to promote early abortions.

  Q378  Mrs Dorries: But do you not think that there should be a strengthening of the law to stop BPAS from referring women at 24 weeks plus to other hospitals which will carry out the terminations?

  Dr Adshead: That is a matter for the law and they are acting within the law.

  Dawn Primarolo: I think that one of the issues as well to look at is the question, and I do not know whether the Committee have looked at this and I certainly asked for the figures on it, was looking at the question of abortions as a percentage of conceptions and what the trends were and looking at age as well because obviously one of the issues and continually the case that is put is for—

  Q379  Chairman: Sorry, but what is this to do with plus-24?

  Dawn Primarolo: Well, I think that what we are trying to do, within the law in this country, is ensure that we get women where they have taken the decision on the grounds of right to early abortion and that is the provisions that are made in this country within the law, that advice can be given.

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