Abortion: 24 reasons to defend 24 weeks

On 6 May, Britain’s Tory MP turned anti-abortion campaigner Nadine Dorries launched her latest publicity stunt: a website detailing 20 reasons for reducing the upper time limit for abortion from 24 weeks’ gestation to 20 weeks (1). In fact, this amounts to one reason: that Dorries does not approve of abortion, and she wants to stop women from having them.

There are any number of reasons why the time limit for abortion should not be lowered, and these too come down to one overriding argument. In order to play a full and equal role in society, women need the ability to control their fertility, and without access to abortion they cannot do that. Politicians understood this 41 years ago when they passed the Abortion Act, and they understand it now.

As the UK parliament moves to discuss amendments to the abortion law through the Human Fertilisation and Embryology Bill, those of us committed to women’s rights and freedom should counter the spurious arguments and junk science put forward by Nadine Dorries and the anti-abortion lobby, by offering a steady stream of reason, compassion and sound evidence. Here are 24 ways to start.

1. Women need access to safe, legal abortion
   History tells us that women with unwanted pregnancies will try their best to end them, sometimes with severe risk to their health. The 1967 Abortion Act was a humane piece of legislation, borne out of the understanding that women need and deserve to control their fertility, not be penalised because of it (2).

2. There is no right number of abortions
   Nadine Dorries’ campaign cautions that there are 200,000 abortions per year in Britain, and that it is ‘time to slow down’. But what is the right number of abortions for anti-abortion activists: 100,000, 100, one? For the anti-abortion movement to haggle over what might be a more acceptable number of abortions is as nonsensical a stance as it is unprincipled.

3. There is no right time to have an abortion
   Women never set out to have abortions – they are always the least bad option at a difficult time. While earlier abortions are easier, safer and less unpleasant than those in later gestations, there are a multitude of reasons why women may not have accessed abortion earlier on. None of these make that woman’s abortion any less necessary, or her any less deserving of it. Women need abortions when they need them, not when somebody else thinks is the right time to have them.

4. Women should not be pushed or panicked into having abortions before they have made their decision
   Developments in early abortion techniques and provision are progressive because they expand choice for women, giving women seeking abortion the option of having it sooner rather than later. A reduction in the time limit would reduce choice, and risk pushing women who are agonising over whether to continue their pregnancy into making a decision to terminate it before they have definitely decided that that is what they want to do – as well as forcing other women to continue an unwanted pregnancy to term.

5. There is no right reason to have an abortion
   Among the many reasons cited by women as to why they had an abortion in the second trimester of pregnancy, a 2007 study found that ‘I was not sure about having the abortion, and it took me a while to make my mind up and ask for one’ was one of the most important (3). Women can be deeply ambivalent about their pregnancies, and think very carefully before seeking abortion. Research shows that women do not take their abortion decisions lightly, and that these are personal decisions based on complex circumstances that policy cannot even begin to prescribe.

6. Women often make their abortion decisions based on their desire to be good parents
   It is a common misconception that women seeking abortion do not want children. Yet almost half (47 per cent) of women who had abortions in England and Wales in 2006 had had one or more previous pregnancies that resulted in a live or stillbirth (4). Research shows that an important factor in women’s decision-making about abortion is how well able they feel to be a good parent to a baby, or another baby, in the context of their particular family circumstances (5). In a social context where there is a great deal of pressure to take parenting very seriously, why should women be penalised for understanding that they cannot do that at a particular moment in time?

7. Changes in women’s circumstances can mean that a wanted pregnancy becomes unwanted
   Women who have wanted to be pregnant, or reconciled themselves to pregnancy, may find themselves seeking abortion when something in their lives goes badly wrong: the death or desertion of a partner, the discovery of fetal abnormality, or a major change in financial or other personal circumstances, to name a few reasons. For these women, the option not to have to go through with a pregnancy conceived in very different circumstances is crucial to retaining their reproductive autonomy and some control over their lives. To be told that she is ‘too late’ on the basis of spurious arguments advanced by the anti-abortion movement is insensitive and inhumane.

8. Women can take several months to realise they are pregnant
   Contraceptive failure, irregular periods or continuing periods are just some of the reasons why a woman might take several weeks or months to suspect that she is pregnant (6). Women who believe that there is no way they could be pregnant are not going to be looking out for the signs, and at the point at which a woman realises she is pregnant the gestation may be quite advanced. In the absence of other reasons to reduce the upper limit, why should these women be penalised?

9. Women can be let down by contraception
   Access to abortion exists as an integral part of reproductive health policy because it is understood that contraception fails (7). People sometimes fail to use it properly, and at other times it fails. The argument that ‘there is no excuse’ for unintended pregnancy at a time when contraception is readily available fails to grasp the essential point that contraceptive access provides no guarantees without the availability of abortion as a back-up.

10. Women know that they are carrying a human fetus well before there are photos to prove it
    The last of Nadine Dorries’ ‘20 reasons for 20 weeks’ is a picture of a fetus looking like a baby. She might want to ask herself, what do pregnant women think they are carrying: an alien, a baby frog? Women seeking abortion are fully aware that if they continue the pregnancy, they will give birth to a human baby; and it is precisely because of the consequences of having and raising a child that they have reached the decision to have an abortion.

11. Unwanted children carry a significant physical, emotional and financial cost
    Women know that having a child is a life-changing event, and that pregnancy is a major physical undertaking. While women pregnant with wanted children often welcome this, those for whom a child is unwanted face far more than a minor inconvenience through being forced to carry a pregnancy to term.

12. Women’s mental health does not suffer as a result of abortion
    Despite persistent claims from the anti-abortion movement that abortion causes mental illness, evidence does not show a causal link between abortion and negative mental health (8). While some women have serious psychological problems following abortion, these cases are relatively rare, and they are often a continuation of problems a woman experienced before the abortion. Research does indicate that the most stressful and emotionally difficult time for women is immediately before the abortion, when they are making the decision to terminate. Post-abortion, the most common response exhibited by women is relief (9).

13. Women’s physical health does not suffer as a result of abortion
    Legal abortion carried out by trained practitioners is now a very safe, effective procedure (10). A woman is more likely to die as a result of pregnancy and childbirth than from terminating a pregnancy (11). Despite claims to the contrary by the anti-abortion lobby, there is no proven association between abortion and ectopic pregnancy, infertility or breast cancer. As with all clinical procedures, there is a small risk of complications following abortion – but women who undergo the procedure do so having weighed potential problems against the definite and known disadvantages of having an unwanted child.

14. Women’s access to abortion services is often not as rapid as it could be
    Access to abortion in the UK has improved greatly in recent years, but it continues to take time to arrange an abortion – particularly at later gestations, when fewer services are available and the procedure demands greater resources. It is already the case that a woman seeking abortion at 21 weeks may find herself pushed over the 24-week limit by service constraints. Reducing the time limit further would exacerbate this problem.

15. There is no evidence of improved fetal viability prior to 24 weeks
    In its recent inquiry into ‘Scientific Developments Relating to the Abortion Act 1967’ (12), the UK Parliamentary Science and Technology Committee (STC) found that that while survival rates (viability) at 24 weeks and over have improved since 1990, viability has not improved below that gestational point. This point has been reinforced by recent British studies (13). The STC concluded that there is no scientific basis, on the grounds of viability, to reduce the upper time limit on abortion – a point accepted by the government (14).

16. There is no evidence that fetuses feel pain before 24 weeks
    The STC’s review of the evidence also found that while fetuses have physiological reactions to stimuli, this does not indicate that pain is consciously felt, especially below 24 weeks. It further concluded that these factors may be relevant to clinical practice but do not appear to be relevant to the question of abortion law (15).

17. 4-D images tell us nothing of relevance to abortion
    The anti-abortion lobby has made much of the advances in 4D ultrasound technology, in which fetuses appear to be ‘walking’ in the womb. But while these make for emotive images, scientific opinion has stressed that they contain no insights into fetal sentience or viability (16).

18. A 20-week limit would make very little difference to the abortion statistics, and a massive difference to the minority of individual women whom it would affect
    A tiny proportion of abortions in England and Wales are performed at 20-23 weeks’ gestation: fewer than 3,000 abortions, comprising 1.5 per cent of the total number (17). This figure has remained stable over the past decade despite policy attempts to encourage abortion at earlier gestations, indicating that women’s reasons for later abortions are more complex than simply struggling to access services earlier on. Reducing Dorries’ headline figure of ‘200,000 abortions per year’ by 3,000 would do nothing to ‘slow down’ the national abortion statistics, but would force hundreds of individual woman to bear an unwanted child.

19. ‘20 weeks’ is an arbitrary figure
    If there is no evidence of improved fetal viability at any gestation under 24 weeks, why pick 20 weeks as a cut-off point? Why not 22, or 18, or 10, or none? The focus on ‘20 weeks’ shows how little scientific basis there is to this campaign, despite its pretensions.

20. ‘20 reasons for 20 weeks’ is a dishonest campaign
    The anti-abortion lobby is opposed to all abortions, but it knows that the public is not. By focusing on emotive, later abortions, anti-abortion campaigners pretend that there are legitimate reasons to ban these abortions while allowing abortion at earlier gestations to continue. There are no such legitimate reasons; and for campaigners to claim that there are is cowardly and dishonest.

21. Public opinion accepts that women need access to abortion
    An Ipsos MORI poll carried out in 2006 found that 63 per cent of adults in the UK agreed that ‘if a woman wants an abortion, she should not have to continue with her pregnancy’, while only 18 per cent disagreed (18). There is no public movement to ban abortion, or even to restrict it further. While nobody likes abortion, the public accepts that it is a necessary fact of life in a country committed to women’s equality and reproductive freedom.

22. Political opinion accepts that women need access to abortion
    The UK 1967 Abortion Act was conceived as a necessary public health initiative, and as a progressive piece of legislation that would enable women to play a full role in public life. Since that time, parliament has shown no desire to repeal this legislation, and the government today remains committed to providing women with access to safe, legal abortion. The government has accepted that there is no scientific case for a reduction in the upper time limit, and it is to be hoped that it will retain a principled commitment to allowing women access to abortions when they need them, not when the odd pro-life MP claims they ought to have them.

23. Medical opinion accepts that women need access to abortion
    The British Medical Association has called upon MPs to vote against any attempt to reduce the 24-week time limit, on the grounds that there is no ‘scientific justification’ for such a move (19). Because the law requires two doctors to permit any woman to have an abortion, the medical profession is an important player in both abortion policy and practice: that it sees no grounds for reducing the time limit for abortion is a serious consideration.

24. Women’s lives are too important to be played with by political poseurs
    Since the start of her one-woman anti-abortion campaign in parliament two years ago, Nadine Dorries MP has shown herself to be ignorant of the evidence about abortion, insensitive about women seeking abortion, and willing to play fast and loose with the facts according to whatever might suit her latest campaign slogan. Women seeking abortion are making decisions about a highly personal issue, which they are attempting to deal with in the best practical way they know. They should not be used as pawns in a game of political point-scoring, but provided with the progressive law and effective service that a civilised society should demand.

Jennie Bristow is editor of the bpas journal Abortion Review, and writes spiked’s monthly Guide to Subversive Parenting.

(1) Slow down – the 20 weeks campaign

(2) For an inspirational account by the campaigners, doctors and Parliamentarians who made the 1967 Act possible, read the pamphlet Abortion Law Reformers: Pioneers of Change, re-published by bpas in 2007

(3) Second-Trimester Abortions in England and Wales, by Roger Ingham, Ellie Lee, Steve Clements and Nicole Stone. University of Southampton and University of Kent, 2007

(4) Abortion Statistics, England and Wales: 2006. Department of Health, 2007

(5) “I Would Want to Give My Child, Like, Everything in the World”: How Issues of Motherhood Influence Women Who Have Abortions, Jones, RK; Frohwirth, LF; Moore, AM. Journal of Family Issues, Vol. 29, No. 1, 79-99 (2008). 1 January 2008; Finer, L.B., Frohwiths, L.F., Dauphinee, L.A., Singh, S. and Moore, A. M. (2005) ‘Reasons U.S. Women Have Abortions: Quantitative and Qualitative Perspectives.’ Perspectives on Sexual and Reproductive Health, 37(3):110–118

(6) Second-Trimester Abortions in England and Wales, by Roger Ingham, Ellie Lee, Steve Clements and Nicole Stone. University of Southampton and University of Kent, 2007

(7) Abortion: A solution to a problem, by Ann Furedi, Abortion Review, 11 March 2008; Trussell, J and Wynn, L. Reducing unintended pregnancy in the United States, Contraception, V77, N1, January 2008

(8) The Royal College of Obstetricians and Gynaecologists (2004) Evidence-based Clinical Guideline Number 7: The Care Of Women Requesting Induced Abortion Page 9: ‘Psychological sequelae: some studies suggest that rates of psychiatric illness or self-harm are higher among women who have had an abortion compared with women who give birth and to nonpregnant women of similar age. It must be borne in mind that these findings do not imply a causal association and may reflect continuation of pre-existing conditions.’

(9) Abortion Psychological Sequelae: the debate and the research, by Ellie Lee and Dr Anne Gilchrist. Pro-Choice Forum. Accessed 12 May 2008

(10) Memorandum of evidence to the Science and Technology Committee Inquiry into the scientific developments relating to the Abortion Act 1967 British Medical Association, August 2007. The BMA gives the maternal mortality rate due to direct and indirect causes (including following abortion) as 13.1 per 100,000 maternities for the UK, while the maternal mortality rate following abortion is lower than 1 per 100,000.

(11) The Royal College of Obstetricians and Gynaecologists (2004) Evidence-based Clinical Guideline Number 7: The Care Of Women Requesting Induced Abortion.

(12) Scientific Developments Relating to the Abortion Act 1967, House of Commons Science and Technology Select Committee, 2007

(13) Survival of extremely premature babies in a geographically defined population: prospective cohort study of 1994-9 compared with 2000-5, David J Field, Jon S Dorling, Bradley N Manktelow, Elizabeth S Draper. BMJ, doi:10.1136/bmj.39555.670718.BE, 9 May 2008; Prem baby survival rates revealed, BBC News, 11 April 2008

(14) Government response to the report from the House of Commons Science and Technology Committee on the Scientific Developments Relating to the Abortion Act 1967, Department of Health, 2007

(15) House of Commons Science and Technology Select Committee (2007). Scientific Developments Relating to the Abortion Act 1967

(16) House of Commons Science and Technology Select Committee (2007). Scientific Developments Relating to the Abortion Act 1967; Misconceptions over ‘walking’ fetuses, Abortion Review, 4 October 2006

(17) Abortion Statistics, England and Wales: 2006. Department of Health, 2007

(18) Poll shows majority support for legal abortion. Abortion Review, 28 November 2006

(19) Doctors call to retain legal time limit for abortion, Abortion Review, 9 May 2008