This October sees the 40th anniversary of the passing of the UK Abortion Act, which came into force the following year. The anniversary gives all parties involved in the debate an opportunity to pause and reflect. In 2005, 194,353 termination procedures were carried out in England and Wales;[1] abortion is now seen by many as 'an essential part of women's healthcare',[2] and it is thought that one in three UK women has an abortion at some point in her life.[3]

Seeking change

Marie Stopes International, the UK's largest provider of family planning and abortion services outside of the NHS, is holding a conference in October that will focus on abortion. A spokesperson described the Act as 'a paternalistic piece of legislation that denies women the right to decide for themselves', and announced that the conference will be used as 'a platform to advocate for much needed law reform'.[4]

At the same time, Alive and Kicking,[5] an alliance of nine organisations, including CMF, is seeking to challenge the status quo on several counts. These include eliminating discriminatory abortion of disabled babies up to birth, as well as a prohibition of abortions for social convenience. In addition the organisation is calling for an immediate, substantial reduction in the upper age limit for abortion. Currently the law prohibits abortion after the 24th week of pregnancy, except on grounds of fetal handicap, but in 2005, 2,500 procedures took place between the 20th and 23rd weeks.

In addition, Nadine Dorries, a Conservative MP and former nurse, is currently seeking to get a bill through Parliament that would reduce the upper limit on abortion to 20 weeks. It would also introduce a seven day period of 'informed consent' after the first relevant point of contact with a registered medical practitioner, during which the pregnant woman would receive counselling.

Late abortions

The recent weeks have seen a flurry of media activity surrounding abortion, and in April the BBC reported a study from Southampton and Kent Universities that explored why women had abortions in the second trimester, between 13 and 24 weeks of pregnancy.[6] Around 11% of terminations take place after the twelfth week of pregnancy.

Dr Ellie Lee, who was part of the study group, and is also a member of the Pro-Choice Forum, remarked that the project had been undertaken to gain 'an understanding of why women have abortions at this stage… and properly address how women can be helped to terminate pregnancies earlier.'[7] However, 41% of the 883 women interviewed reported that they had delayed the procedure as they had not come to a decision about whether or not to have an abortion. Others had simply not realised they were pregnant.

A further study, published in the British Journal of Obstetrics and Gynaecology followed a ten year analysis of abortions for fetal abnormality in the West Midlands. 3,189 were carried out during the study and 102 babies (3.2%) were born alive.[8] In a statement for Alive and Kicking, spokesperson Julia Millington noted that the increasingly widespread practice of abortion for fetal handicap reflects very poorly on a society that otherwise prides itself on equal rights for those with disabilities.

An abortion 'crisis'?

However, from a primary care perspective, a survey carried out by Pulse magazine suggests that 24% of UK GPs will not sign abortion referral forms, and 19% do not believe the procedure should be legal. Currently, two doctors are required to sign a form referring a patient for an abortion, in order to demonstrate that the woman meets the grounds laid out in the Abortion Act. Of the 309 GPs surveyed, 55% also said they wanted the current 24-week limit for abortions to be reduced.[9]

The Daily Mail interviewed Dr Tammie Downes, a Christian GP in Cornwall, who also refuses to sign abortion referral forms: she reports that she has witnessed the birth of at least eight babies who could have been aborted were it not for the advice she gives her patients. Dr Downes is happy to see women seeking terminations, and provide them with the information and advice they need. She estimates that one in three eventually decide to keep their babies. She said, 'Some of my colleagues are happy to sign an abortion form without helping a woman to think the decision through, which is such a tragedy. Women can be traumatised by having an abortion, not just for a few weeks but for many years afterwards.'[10]

In 1969, the first full year after the Abortion Act came into force, there were 54,819 abortion procedures carried out, so demand has risen almost four-fold in the intervening time. However, recent media reports suggest that Britain is facing an 'abortion crisis' as doctors are refusing to be involved in carrying out the procedure. The Pulse survey further supports this. It is thought that the reluctance of NHS staff to be involved has led to a doubling of abortions carried out in the private or charitable sector but paid for by the NHS: these rose from 20% in 1997, to almost 40% of the total today.[11]

The reasons for this are complex. The Royal College of Obstetricians and Gynaecologists (RCOG) recognises a doctor's right to refuse to carry out abortions if they have ethical objections. However, changes to junior doctors' training, and a reduction in working hours, have also meant that specialist trainees increasingly have to 'pick and choose' which areas they focus on, with fewer opting to carry out terminations.

The dinner party test

Kate Guthrie, a consultant in sexual and reproductive health in the North of England, said, 'You get no thanks for performing abortions; you get spat on. Who admits to friends at a dinner party that they are an abortionist? It is not a sexy area; it is a bog standard area of women's care.'[12] Another commentator writes that 'admitting being an abortionist is a conversation stopper, reflecting what is perhaps a growing social distaste for the less glamorous side of medicine.'[13] This seems paradoxical for a service that is so commonplace and, apparently, so crucial.

Writing in the Independent, journalist Michael McCarthy describes abortion as 'an unexceptionable part of the fabric of society' and notes that we have become 'blasé' about it. He contrasts this with the United States, where the issue splits the nation and abortion has 'infinitely greater social, religious, and…political resonance'. This represents the large part religion plays in US social policy, in contrast to the UK where faith groups, particularly of the Christian variety, are increasingly marginalised. McCarthy paints a picture of a society that has 'lost [its] religion and acquiesce[s] entirely placidly in all the liberations of the Sixties and Seventies.'[14]

Abortion is one of the oldest debates in Christian medical ethics, and although much has been written elsewhere about the issues surrounding the beginning of life, it is well worth revisiting these:[15] the theological principles remain unchanged, even if the specific challenges are perhaps becoming more complex.

The media is giving almost unprecedented coverage to the abortion debate, with several stories breaking that help to endorse the pro-life cause, such as a the Pulse survey and BJOG study cited above. At the same time, it appears that the tide of public opinion is beginning to change against abortion, as many pro-choice campaigners apparently seem to fear.

The forthcoming anniversary of the Abortion Act gives us chance to re-focus, re-group and re-assess how we can strategically impact this area. There may well not have been a better opportunity in the last 40 years!