In future, will there be enough doctors who are willing and able to perform abortions to fulfil demand for termination services?
The two strands to this question – about doctors who are willing and doctors who are able, i.e. trained, to carry out abortions – look to be under threat, according to recent trends.
On the question of willingness to carry out abortions, the pro-choice movement should be concerned by the results of a survey carried out by Dr Sophie Strickland, and published in the Journal of Medical Ethics in January of this year.
The survey asked 733 medical students at four UK universities about their stance on conscientious objection and whether doctors have the right to refuse to perform certain medical procedures. In all, nearly half (45.2%) agreed with the statement: “Do you think doctors should be entitled to object to any procedure for which they have a moral, cultural or religious disagreement?”
On the topic of abortion, large minorities of respondents reported an objection to five different abortion scenarios presented in the survey’s questions (see table). In each scenario, the percentage of respondents who said they would not perform the procedure was lower – but still significant.
|Procedure||Students reporting objection to procedure (%)||Students who would not perform procedure (%)|
|Abortion for congenital deformities before 24 weeks||22.2||15.8|
|Abortion for congenital deformities after 24 weeks||43.7||29.5|
|Abortion for failed contraception before 24 weeks||31.9||23.5|
|Abortion for a raped minor before 24 weeks||13.1||10.5|
|Abortion for a raped minor after 24 weeks||31.2||19.8|
Source: Conscientious objection in medical students: a questionnaire survey, by Dr Sophie LM Strickland
Media reports on the issue of conscientious objection in medical students tend to highlight answers from respondents who identify as belonging to religious groups, particularly Muslim students. Of the Muslim students surveyed, levels of objecting to and refusing to perform the five abortion scenarios presented by the survey were higher than the group average in all cases.
Dr Strickland notes: “In light of increasing demand for abortions, these results may have implications for women’s access to abortion services in the future. The Department of Health has issued statistics showing that, although there are an increasing number of abortions taking place in the UK, fewer doctors are willing to perform them.”
She also points out that falling numbers of students opting to specialise in obstetrics and gynaecology “could further complicate the problem”.
Compounding the problem of the unwillingness of large numbers of medical students to carry out abortions is the fact that more and more of them are not even receiving the necessary training in this area.
Ann Furedi, chief executive of the British Pregnancy Advisory Service, comments: “Abortion is taught increasingly infrequently in medical school, and students may not be required to engage much with the reasons why a woman may find herself with an unwanted pregnancy and the distress this may cause.
“All of us involved in women’s reproductive healthcare need to ensure that young doctors understand why women need abortions, and that this is a profession to be proud of.”
Dr Patricia Lohr, BPAS Medical Director adds:
“It’s extremely important that abortion is included in the medical school curriculum. Medical students may not currently engage much with the reasons why a woman may find herself with an unwanted pregnancy and the decision making process women undertake when determining whether to continue or terminate a pregnancy. Abortion is the most commonly performed gynaecological procedure in the country. Regardless of whether a doctor specialises in this area or not, they will during their career come across many women facing an unintended pregnancy and considering abortion.”
In 2007, the Royal College of Obstetricians and Gynaecologists said it was “aware of the slow but growing problem of trainees opting out of training in the termination of pregnancy and is therefore concerned about the abortion service of the future.
It added: “The future of the sexual healthcare services requires careful workforce planning in order for abortion services to be available to the women who need it most.”
Pro-choice advocates need to watch this situation carefully, as the future of abortion provision in the UK could be under threat.