Emotive images from the womb have distorted the case for abortion
Anne Weyman, The Guardian, Wednesday October 27 2004
In recent months concerted efforts by anti-abortion organisations, and their supporters in the press, have created a frenzy of activity around the emotive and complex issue of late abortion. Massively magnified images of a 12-week foetus and the imputation to it of “smiling” and “walking” have had a huge impact on the climate of opinion, and are being used to shift emphasis away from the woman to the foetus. Yet the pictures add nothing to medical knowledge nor have there been any other significant technological changes to justify the pressure for change that has been created in response to them.
The time limit for abortion is currently 24 weeks, a compromise that balances the needs and rights of women with the understanding that as pregnancy progresses the foetus approaches personhood. In doing so, it reflects that our society neither accepts the absolutist position of the anti-abortion lobby who want to ban all abortions nor, at the other extreme, the views of those who believe in a woman’s right to choose at any stage of pregnancy. The pre-25 week foetus, as the Panorama programme Miracle Baby Grows Up demonstrated last month, has very little chance of surviving. In Holland, babies born before 25 weeks are not resuscitated, and it has been suggested that the same policy be introduced here.
In 2003, fewer than 1.6% of abortions took place after 22 weeks, which shows just how unusual it is for women to have a late abortion. These are women who have very particular needs: those who decide to terminate a wanted pregnancy because of a foetal abnormality or because their personal circumstances have changed significantly; those who have irregular periods, including the very young or menopausal, and have only just realised they are pregnant; those who go into denial – again these are often the very young; and refugees or asylum seekers, who are unfamiliar with services and contending with many other difficulties. A reduced time limit would force such vulnerable women to continue with their pregnancies against their will.
Women who have late abortions for foetal abnormality are treated differently from others who present late. The former are looked after within foetal medicine services, but not the latter. There is a shortage of doctors with the skill to perform late abortions, so it would be logical for all these abortions to be provided within foetal medicine services, especially as the latter group often find it hard to get an abortion at all.
The gestation at which an abortion is considered “late” varies: in some parts of the country, it is after 12 weeks, in others, 18 or 20. Our helpline regularly takes calls from distraught women who are within the time limit but who have been refused as being “too late”. These women meet the law’s criteria, and are entitled to an abortion. They desperately need a service that will respond to them promptly and with compassion, not one that compounds their difficulties.
The current focus on late abortion means that the real issues that women face are hardly being discussed. In 2003, 181,600 women in England and Wales had abortions, 87% of these before 13 weeks. One in five pregnancies ends in abortion and it is estimated that two out of five women will have an abortion. Abortion services are a basic health service, yet they are characterised by inequity, delay and lack of priority.
There is a considerable variation in funding of NHS abortion across the country, from a high of over 90% to a low of just 46%. Some areas with the worst NHS provision argue that local women are affluent and prefer to pay, yet this “choice” may really be motivated by long waiting times.
The greatest inequity in the UK is Northern Ireland, which is not covered by the 1967 Abortion Act. Abortion is legal there, but more restricted than the rest of the UK. As a result, about 2,000 women travel to Britain every year to pay for their abortion. In 2002, fpa mounted a legal challenge in the high court in Belfast ,and the appeal court has recently ruled that the Department of Health, Social Services and Public Safety has actively sought to avoid its responsibilities regarding abortion and ought to issue guidance. This ruling has had little coverage in the British media but is of great significance to a great many women in Northern Ireland.
It is clearly best for women to have their abortion as soon as possible. The Royal College of Obstetricians and Gynaecologists’ (RCOG) guidelines say there should be no more than a three-week wait from initial referral to the procedure, but fpa recommends a 72-hour target, with one week as a maximum. However, many areas are far from achieving the RCOG standard.
Some of the 13% of women who have their abortions after 12 weeks do so because of delays in getting a referral at all, or long waiting times for the abortion itself. Women should not be subject to the terrible distress of waiting for five, six or seven weeks at an already fraught time.
The number of abortions carried out before 10 weeks’ gestation varies from 10% to nearly 80% across the country. These figures are particularly important because at this stage less invasive methods such as medical abortion (using drugs) and early surgical abortion under local anaesthetic or conscious sedation are particularly appropriate. Not all women are offered these choices and medical abortion accounted for only about 17% of the total number of abortions in 2003. In addition, a very high number of abortions are performed under general anaesthetic compared with other countries.
These methods have enormous potential for providing modern, caring, locally-based nurse-led abortion services for women. Our current laws make this impossible because two doctors have to agree to the abortion, it has to be carried out in an NHS hospital or licensed premises and only a registered medical practitioner can perform an abortion. The law needs to be changed so that appropriately trained nurses can carry out early medical and surgical abortions, and do so in general practice or community clinics.
In the United States over 200,000 women have had early medical abortions, going to a doctor or clinic for the first drug, which interrupts the pregnancy, and two days later using the second drug, which completes the process, at home. This option is not currently available to women in this country although there does not appear to be any legal reason to deny women this choice.
No method of contraception is perfect and human beings are fallible, so abortion services will always remain an essential feature of sexual health services. The challenge is to ensure that services are high quality, woman-centred and fit for the 21st century.
Anne Weyman is chief executive of fpa, formerly the Family Planning Association.