Let us decriminalise abortion altogether
It's high time we had a frank inquiry into England's Abortion Act, which remains, on paper, one of the most restrictive in the Western world.
Ann Furedi, chief executive of the British Pregnancy Advisory Service, the leading provider of abortion services in the UK, welcomes the new inquiry into the Abortion Act 1967.
It’s about time there was an inquiry into the English Abortion Act of 1967, and at last one is to be carried out: an influential group of British MPs will look into the scientific developments relating to the Act in the first dedicated inquiry into the 40-year-old law to be held in Parliament.
Since 1990, when the abortion law was last amended, governments and their civil servants have done their best to keep abortion out of parliamentary politics. It’s easy to understand why. Abortion is a complex and polarising topic, which confers political advantage on no party. Abortion is something that policymakers, like most people, accept but don’t want to talk about. There have been other pressing political priorities, and the way in which the Abortion Act was drafted has allowed services to develop as society has needed them.
The way that abortion is provided has changed dramatically over the years, while the law has remained the same. In 1990, the last time that the law was subject to substantial parliamentary scrutiny, the National Health Service (NHS) paid for less than half (48 per cent) of abortions to women entitled to NHS care. Today the NHS funds 87 per cent of a much greater number of abortions. Last year, almost 194,000 resident women obtained an abortion in England and Wales, 20,000 more than in 1990.
Today’s social expectations create a climate where liberal access to abortion is a necessary part of healthcare. We expect to be able to plan our families. We regard sex as a celebration of love, comfort and intimacy – and even fun – and not necessarily a means of procreation. We know that contraception methods and their users are not infallible and so if we are to achieve planned parenthood, abortion is a necessary back-up to birth control.
Society regards parenthood as a significant responsibility to be undertaken with forethought and consideration. This view of parenthood does not easily sit alongside the idea that women with unwanted pregnancies should have no choice other than to broach unwanted motherhood. One woman in three will seek a termination of pregnancy before the age of 45. Although abortion is still stigmatised, it is now widely accepted as ‘part of life’.
The ProLife Alliance recently told the UK Guardian that the increased number of abortions was evidence that Britain now had abortion on demand, ‘which was never the intention of parliament’ (1). And this is a fair point. Britain does now have a situation where the law is interpreted to allow abortion when a pregnancy is unwanted. This may not have been the intention of parliament in 1967, but it is regarded as acceptable today. The public seems comfortable with it. A poll carried out by Ipsos/MORI in 2006 found that almost two thirds of respondents (63 per cent) agreed that, ‘If a woman wants an abortion, she should not have to continue with her pregnancy’.
And government ministers feel comfortable with this. Public health minister Caroline Flint was notably un-defensive in her comments on the release of official statistics showing that in 2006 abortion numbers had increased by four per cent on the previous year. She used the opportunity to stress how government was improving the quality of services by facilitating earlier, easier access for women. While stressing that the NHS needed to work harder to reduce the need for abortion, she highlighted that ‘we have invested £8million to improve early access to [abortion] services and set a maximum waiting time of three weeks’. She also flagged up that the performance of Primary Care Trusts on abortion would continue to be measured as part of their performance ratings. In short: improving abortion services is officially a priority.
However, despite liberal interpretation and permissive practice, the Abortion Act 1967 (as amended by the Human Fertilisation & Embryology Act 1990) remains, on paper, one of the most restrictive in the developed world. Formally, the decision about whether a woman can end her pregnancy is placed in the hands of her doctors, with two doctors required to certify that certain medical conditions are met. In practice, most doctors accede to a woman’s request for abortion, understanding that forcing a woman into unwilling motherhood is going to be damaging to her mental health; also abortion is less risky than childbirth. But other restrictions imposed by the Act are practical blocks on progress and cannot be circumvented.
The requirement that abortions may only be performed by doctors is ludicrous given the extended role of nurses. It may have seemed a sensible safeguard in the 1960s, when the procedure was regarded as complicated and potentially dangerous, but the modern vacuum aspiration used in early suction abortions could easily be carried out by nurses, as is the case in some US states and in South Africa. And the abortion pill can just as easily be issued by a nurse as by a doctor. Restrictions on where abortions can be performed limit the number of premises able to deliver services and leads to the ludicrous pantomime where a doctor assessing a woman’s suitability for abortion in a family-planning clinic has to make a separate appointment to see her at an approved clinic to give her the drugs (which she has to take on site).
And, of course, women and doctors in Northern Ireland are still excluded from the provisions of the Act.
Now, with the fortieth anniversary of the Abortion Act approaching, it’s about time we looked ahead and framed what a modern abortion law should look like; it’s time we created a law that reflects contemporary knowledge and social values, ending the hypocrisy that pretends abortion is rare and the attempts to ‘ghettoise’ it. We should not have to work around an Act that stigmatises abortion, setting it aside from other procedures and privileging doctors’ opinions about unwanted pregnancy above those of the women who experience them. Women deserve better: a flexible, fit-for-purpose law accepting that restrictions on abortion should be solely to protect health.
The new inquiry – which will be conducted by the parliamentary Science and Technology Committee – is an opportunity to review the evidence around abortion and allow policymakers to separate the facts from the fantasy.
Paradoxically, the issue that has propelled the demand to carry out a review of the Act has been concern about fetal viability and the upper gestational limit. The great advantage of the current abortion legislation is that it draws no distinction between the grounds for abortion in the first or second trimester. Doctors are as free to refer women to end an unwanted pregnancy at 23 weeks’ gestation as they are at six weeks. The inquiry will be a welcome opportunity to show there is no compelling scientific research to suggest we should reduce the upper time limit on abortion, while there is compelling social research that demonstrates why a 24-week limit is necessary.
It is excellent that the scope of the inquiry extends beyond consideration of fetal viability and the upper gestational limit to such issues as: the relative risks of early abortion versus pregnancy and delivery; the need for two doctors to confirm a woman meets the legal requirements; the practicalities and safety of allowing nurses or midwives to carry out abortions; regulations regarding where the ‘abortion pill’ can be used; and evidence of long-term or acute adverse health outcomes from abortion or from the restriction of access to abortion. It’s interesting that the ProLife Alliance has objected already that ‘the thrust of the inquiry appears to be geared towards gathering evidence in relation to measures that would further liberalise our current abortion law’ (2). Another way of looking at it might be that the scope of the inquiry is comprehensive.
Women rely on termination of pregnancy as a back-up to their usual method of birth control. A third of women use an abortion service at some point in their life. They, and their elected representatives, should know that services are delivered to the highest clinical and ethical standards. An evidence-based inquiry is an opportunity to take the discussion forward towards a law that would explicitly allow abortion at the request of a woman because her pregnancy is unwanted; permit suitably qualified healthcare providers other than doctors to carry out abortions; remove ‘class of place’ restrictions; require the NHS to fund services to meet local demand; and remove the geographical anomaly that excludes Northern Ireland from the reach of the Abortion Act.
More simply, Britain could look simply at decriminalising abortion altogether.
Ann Furedi is chief executive of the British Pregnancy Advisory Service.
Ann Furedi explained why she and her colleagues were not scared by the UK LifeLeague’s ‘name and shame’ antics and said that, when it comes to abortion, some messages can’t be massaged. Ellie Lee argued that it’s better to be able to have abortions ‘late’ than never. Jennie Bristow said that, today, the abortion debate is far from a discussion about equal rights and women’s independence. Stuart Derbyshire explained that the USA’s ban on ‘partial-birth abortion’ rests on flawed arguments about fetal development. Or read more at spiked issue Abortion.
(1) Guardian, 21 June 2007
(2) Guardian, 21 June 2008
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