Abortion is the poor relation of public health services. Together with contraception and sexual health, it remains a hidden and stigmatised area, vulnerable to ideological assault and all too often an easy target when cutbacks are looming – as they are now.
As the reality of the government’s plans for the NHS becomes apparent, it is increasingly clear that the service is facing not only the most radical reorganisation in its 62 year history, but that the £20 billion of ‘efficiency savings’ it is being asked to make will be achieved by swingeing and ill-considered cutbacks across the board. Already 27,000 jobs are earmarked to go, waiting times are rising and ‘non-essential’ procedures are being delayed.
In the field of reproductive and sexual health there is great concern and uncertainty around the future of contraception and abortion services – both in terms of funding and service delivery – once responsibility for public health is transferred to Local Authorities, who are themselves facing 28% cuts over the next four years.
As Primary Care Trusts and Strategic Health Authorities prepare for their own abolition, while at the same time having to identify possible areas to cut back, colleagues in the field report a dangerous paralysis in the commissioning of vital sexual health services.
Both the Independent Advisory Group on Sexual Health and on Teenage Pregnancy were abolished in the government’s quango cull. These groups were not just talking shops – they guided strategies which have made genuine improvements to reproductive healthcare in this country. The teen pregnancy rate is at its lowest for 20 years, with some areas seeing a 45% fall in the number of teenagers becoming pregnant. Access to abortion has been significantly improved, with the NHS now paying for 94% of abortions in England and Wales (up from 75% in 1997), and 75% of abortions now take place at under 10 weeks gestation, when the procedure is safest, compared to just 51% in 2002 – a real sign that waiting times have fallen.
But if commitment and investment in these areas is not sustained, the improvements seen in the past decade will be reversed. Sadly, the outlook is not positive: in its final report before closure last month the Teenage Pregnancy Group states “It is truly shocking to hear about the current level of disinvestment, the loss of posts and projects and closure of CASH [contraceptive and sexual health] services”.
We already know that cuts to public services and benefits will hit women – particularly low income and working class women – disproportionately hard. Economic hardship and reduced support and welfare services – maternity grants, Sure Start centres, childcare, to name but a few – make it harder for families to thrive. This has a knock-on effect on whether women feel able to start or expand their families, limiting genuine reproductive choice. And economic disadvantage is strongly associated with increased levels of abortion and teenage pregnancy. The ultimate effect of the government’s spending programme could mean that abortion rates among teens and women of all ages, start to rise again – something none of us, whether pro-choice or pro-life, want to see.
As many commentators have pointed out, the current round of cuts is being driven by ideological zeal rather than economic necessity. All public services are suffering as a result, but abortion services are in a uniquely vulnerable position on this score. Cuts in this area not only save money (in the short term, at least) but can be used to advance conservative social goals.
If public health is placed in the hands of elected local authority members, then there is a real threat of the politicisation of commissioning and funding decisions, so for example, a failure to fund second trimester abortion services, would result in a de facto time limit cut just as real as one enacted by Parliament. Questions also need to be answered about the accountability of the new Directors of Public Health. Further down the line we will need guarantees that abortion provision will be protected when services are outsourced to private – possibly American – healthcare companies, whose ideological position on abortion is a major issue in the United States.
When each day brings warnings from those within the NHS that another vital service is under threat, advocating for an area that is seen by many as peripheral to core health provision may seem like special pleading. But remember: one in three women will need to have an abortion at some point in her life; and to plan their families women need access to reliable contraception for at least 30 years. This makes abortion and contraception a major issue for the nation’s public health – failure to properly address it will prove costly on many levels, both personal and economic.
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