Australia: Abortion law to be modernised in Victoria

Legislation to remove abortion from the Crimes Act has been introduced into State Parliament by Women’s Affairs Minister Maxine Morand.

Ms Morand said the Abortion Law Reform Bill 2008 reflects broad community views and current clinical practice.

‘Legislation to come before the Parliament this week will provide Victorians with a modern legislative framework that reflects community attitudes and current clinical practice,’ she said, in a media release from the Premier of Victoria’s office.

Under the Bill, terminations of pregnancy will be regulated like any other medical procedure up to 24 weeks’ gestation. After 24 weeks’ gestation, a registered medical practitioner may perform an abortion on a women only if the medical practitioner -

a) reasonably believes that the termination of pregnancy is appropriate in all the circumstances and

b) has consulted at least one other medical practitioner who also reasonably believes that the termination is appropriate in all the circumstances.

In considering all the circumstances the registered medical practitioners must have regard to all relevant medical circumstances and the woman’s current and future physical, psychological, and social circumstances.

Ms Morand said the legislation represents a significant and fundamental change in the way abortion will be regulated in Victoria.

“The Government has committed to the development of legislation that provides clarity for women, health practitioners and the community about the circumstances in which the termination of pregnancy can be performed,’’ she said.

Health Minister Daniel Andrews said the Bill will provide women and health practitioners with a certainty that has been lacking for many years.

“By clarifying the law in this area, we are not intending to expand the extent to which terminations occur, or restrict access to services,’’ Mr Andrews said.

The Brumby Government sought advice from the Victorian Law Reform Commission in August 2007 about options to clarify the law relating to terminations of pregnancy, and to remove abortion from the Crimes Act.

In providing advice, the Commission was to have regard to the government’s commitment to modernise and clarify the law, and reflect current community standards, without altering current clinical practice.

The Victorian Law Reform Commission report was tabled in May after extensive consultation with individuals and organisations. The Bill will be subject to a conscience vote by Government MPs.

Abortion laws to be modernised in Victoria. Media release: The Premier of Victoria, 19 August 2008

Also read:

Why there will always be life in the abortion debate. The Age, 24 August 2008

Australia: Changes proposed to abortion law. Abortion Review, 20 August 2007

Mexico: Supreme Court to rule on legal abortion

Over a year after abortion was decriminalised in Mexico City, abortion opponents hope the highest court will reverse the legislation.

The Federal District is governed by the left-leaning Party of the Democratic Revolution. Through its control of the city assembly, the party in April 2007 legalised abortion in the city for women who are up to 12 weeks pregnant, the UK Guardian reports. The measure is unusual because it legalises abortion in the capital. Except in cases of rape or risks to the mother’s life, abortion remains illegal in most of rest of this devoutly Roman Catholic nation.

States in Mexico set their own policies on abortion rights, and only Yucatan in Mexico’s far south has allowed abortion in cases of extreme poverty. University studies estimate between 500,000 and 1 million abortions take place in Mexico annually, but most are of questionable legality.

The Catholic Church and anti-abortion activists want the high court to strike down the Mexico City measure. They argue that life begins at conception and carrying out an abortion amounts to a taking of life that violates Mexico’s constitution. But when the Mexican Supreme Court addresses issue in the week beginning 25 August, its 11 members may look beyond the constitutional question.

“It is not a philosophical debate. It is mostly about the criminality. Should you or should you not be penalising it,” said Miguel Sarre, a university law professor at the Autonomous Technological Institute of Mexico.

In prior rulings, Mexico’s high court declared abortion to be a crime but said it should not be penalised. That ruling mollified both sides, but such a broad decision is unlikely this time, Sarre said, partly because Mexico City is drawing women in from other parts of the nation for abortions.

Since May 2007, 12 participating public hospitals in Mexico City have performed more than 12,000 free abortions, and are averaging about 35 to 40 such procedures per day, according to the city’s director of emergency medical services, Dr. Arturo Gaytan. Most of the women are poor, he said.

Women who could afford it traditionally went to private clinics for abortions that technically were illegal. Today, these clinics continue to perform the procedures, but women who visit them have more recourse.

Of the now-decriminalised abortions at public hospitals, 39 percent involved women who already have children and cannot afford another. Students represented almost 27 percent of the women seeking abortions, while 20 percent were maids and domestic workers. In 58 percent of the cases, the women seeking an abortion had an intrauterine device implanted to prevent another unwanted pregnancy.

Legalised abortion in Mexico City faces supreme court fight. The Guardian, 21 August 2008

Also read:

Mexico’s supreme court to rule in abortion fight. International Herald Tribune, 23 August 2008

Mexico City Struggles With Law on Abortion. New York Times, 25 August 2008

USA: New conscientious objection rules may threaten contraception provision

The Bush administration has proposed stronger protections for health-care workers who refuse to participate in abortions. 

The new rules, which could take effect after a 30-day comment period, threaten state governments with a cutoff in federal funding if they force medical personnel to perform, assist in or refer patients to abortion services, according to Stephanie Simon, writing for the Wall Street Journal.

But supporters and opponents of abortion rights said the regulation is ambiguous enough to affect contraception services, including the so-called morning-after pill.

An earlier draft of the regulation had defined abortion to include contraceptive pills, as well as the intrauterine device, which can prevent a fertilised egg from implanting in the womb. The 42-page document issued on 21 August doesn’t include that definition.

“This regulation is not about contraception. It’s about abortion,” said Mike Leavitt, secretary of the Department of Health and Human Services. But Mr. Leavitt acknowledged that some medical providers may want to “press the definition” and make the case that some forms of contraception are tantamount to abortion.

Karen Brauer, president of Pharmacists for Life, said she expects members of her group will do exactly that. “It would be pretty excellent,” she said, if states lost federal funding over laws requiring pharmacists to fill birth-control prescriptions.

Activists on both sides of the debate said that hospitals, insurers and HMOs may be able to use the regulations to challenge other state laws, such as requirements that insurers include contraception as part of prescription-drug benefits. Or the federal government could force states to change those laws as a requirement for federal funding. “We fear that’s possible,” said Roger Evans, director of litigation for Planned Parenthood. If the regulation passes, his group would try to convince the federal government that it has “gone awry,” he said. If that fails, he added, the group will consider litigation to block the regulation.

The religious right - a key ally of Republicans in this election year - has long pressed for more restrictions on abortion and contraceptive access, writes Simon. John McCain, the likely Republican presidential nominee, has repeatedly said he would enact “pro-life” policies, including expanded protections of life in the womb, if elected. He has not signalled his stance on this regulation and declined to comment when asked about an earlier draft.

Barack Obama, expected to accept the Democratic presidential nomination next week, signed a letter opposing that draft. If he were to win the White House, he could reverse the regulation.

It is unclear how many women might be affected if the regulation takes effect as written. Catholic hospitals account for more than 10% of the nation’s emergency rooms, and many would like to be freed from state mandates requiring them to offer emergency contraception to victims of sexual assault.

Studies have shown that state laws requiring insurance companies to cover contraception have significantly expanded access for women. But it isn’t known whether those insurers would remove birth control from their coverage plans if those state mandates expired.

The Department of Health and Human Services wouldn’t comment on any state laws or how they might be affected.

Mr. Leavitt stressed that the regulation “does not affect the rights of patients” to obtain “any legal procedure.”

But it could make access to those procedures more difficult. Institutions and individuals opposed to abortion need not refer patients to other providers, Mr. Leavitt said. That could leave some patients stranded, especially women in isolated areas, or those who need quick access to the morning-after pill.

The number of abortions in the U.S. has dropped steadily over the past two decades and now stands at about 1.2 million a year. More than a third of American women live in counties with no abortion provider.

Opponents of the regulation said they were most concerned about the prospect that some federally funded clinics, which serve mostly low-income women, could assert a right to refuse to prescribe or even discuss birth-control pills with their patients.

“This raises very serious questions about contraceptive access,” said Louise Melling, director of the American Civil Liberties Union’s Reproductive Freedom Project.

Mr. Leavitt has been intensely lobbied about this regulation for weeks, since a draft was leaked by opponents of the Bush administration. Earlier this week, the Planned Parenthood Action Fund and MoveOn.org Political Action delivered 325,000 signatures of protest to Mr. Leavitt.

Other strong criticism came from the American Medical Association and the American College of Obstetricians and Gynecologists. Dozens of members of Congress raised objections as well.

In the face of this criticism, Mr. Leavitt wrote a blog post distancing himself from the draft, suggesting that he might not issue any regulation at all.

On 21 August, however, he signalled his desire to go forward, citing the need to protect medical professionals. Their right to refuse to perform - or inform patients about - certain procedures is “a fundamental freedom,” he said, “something every American values.”

Rules Let Health Workers Deny Abortions: Regulation’s Effect On Contraception Remains Unclear. By Stephanie Simon. Wall Street Journal, 22 August 2008.

Comment: The reality of abortion

We can reject the flawed claims that abortions threaten the mental health of women who choose to have them. By Melissa McEwan in The Guardian.

In what comes as a surprise to approximately no one with basic critical thinking skills, the American Psychological Association task force on mental health and abortion has found that “there is no credible evidence that a single elective abortion of an unwanted pregnancy in and of itself causes mental health problems for adult women”.

Over the last two years, the task force reviewed and analysed “all of the empirical studies published in English in peer-reviewed journals since 1989 that compared the mental health of women who had an induced abortion to comparison groups of women, or that examined factors that predict mental health among women who have had an elective abortion in the United States”. They found that, while some women do indeed experience negative feelings or suffer clinical depression after an abortion, there’s nothing to suggest that such feelings are directly attributable to the abortion itself as opposed to other circumstances, like, say the 73% of abortion seekers who terminate because they can’t afford a baby, for reasons ranging from unemployment to lack of healthcare to supporting the maximum number of dependents possible already. The report also notes that “women terminating a wanted pregnancy, who perceived pressure from others to terminate their pregnancy, or who perceived a need to keep their abortion secret from their family and friends because of stigma associated with abortion, were more likely to experience negative psychological reactions following abortion” – which suggests that fundamentalist religion might be a better indicator of post-abortion distress than abortion, ahem.

One of the most significant recurrent problems the task force identified was “serious methodological problems”, like a failure to control for other obvious risk factors. In addition to the aforementioned poverty and social stigma, many of the previously completed studies that claimed causation between abortion and mental distress ignored relevant indicators such as domestic violence, preexistent emotional and/or psychological problems, former or current substance abuse, and prior unwanted births. The exclusion of such evident risk factors renders any conclusion so laughably absurd it’s difficult to believe an ideological agenda was not at work. Because science certainly wasn’t.

In 2005, I questioned on these same grounds a Norwegian study which purported to find that women who had abortions suffer “mental distress” longer than women who miscarry. It made the very mistakes which the APA task force found are endemic to studies examining abortion-related distress – and I daresay the problem is that, even within the scientific community (as everywhere else, including the US supreme court), the idea women inevitably suffer distress after an abortion is taken as self-evident; these studies are coming to a foregone conclusion.

Thing is, not all women do suffer distress after an abortion. Some women feel distress at a pregnancy, which is why they seek out abortions. Plenty of women surely feel a combination of sadness and relief after an abortion, given that, to my understanding, abortions don’t eliminate the ability to hold two thoughts in one’s head at the same time.

But it’s really the women who feel no regret that seems to bother and confound us. There’s not a strong cultural narrative for women who are equipped to carry a child but totally don’t want to, irrespective of their reasons. Most discussions of abortion axiomatically regard pregnancy as something every woman wants and to which every woman will have a special connection, which is why so much legislation is designed with the presumption that women seeking abortions have had to deny the reality of being pregnant – that if only she sees it’s a baby on an ultrasound … if only she hears the fetal heartbeat … if only she just thinks about what she’s doing for 24 more hours …

To the women who seek abortions, the reality of being pregnant is not something they get an abortion in spite of. It is precisely what’s driving them to seek the abortion in the first place.

Maybe if we could wrap our heads around that, we could finally wrap our heads around the idea that abortions do not cause mental distress to the women who get them.

Comment: The reality of abortion. The Guardian, 19 August 2008

American Psychological Association reports on abortion

A major study from an influential American body finds abortion does not cause women to have mental health problems.

The American Psychological Association (APA) has issued findings from a comprehensive two-year review of published research on abortion and mental health. The APA concluded that there is ‘no credible evidence that a single elective abortion of an unwanted pregnancy in and of itself causes mental health problems for adult women’.

The APA evaluated studies in peer-reviewed journals since 1989. They found that some studies indicate that some women experience sadness, grief and feelings of loss following an abortion, and some may experience ‘clinically significant disorders, including depression and anxiety.’ However, the task force found ‘no evidence sufficient to support the claim that an observed association between abortion history and mental health was caused by the abortion per se, as opposed to other factors.’

The report noted that other co-occurring risk factors, including poverty, prior exposure to violence, a history of emotional problems, a history of drug or alcohol use, and prior unwanted births predispose women to experience both unwanted pregnancies and mental health problems after a pregnancy, irrespective of how the pregnancy is resolved.

According to the report, women terminating a wanted pregnancy, who perceived pressure from others to terminate their pregnancy, or who perceived a need to keep their abortion secret from their family and friends because of stigma associated with abortion, were more likely to experience negative psychological reactions following abortion.

The task force’s conclusions are consistent with the conclusions of a similar APA review published prior to 1989. Results of that review were published in Science in 1990 and in the American Psychologist in 1992.

Ann Furedi, Chief Executive of BPAS, which provided 55,000 abortions in 2007, said of the APA’s 2008 review:

‘The long-term psychological effects of abortion have been studied repeatedly since the legalisation of abortion in Britain and the United States. Abortion research is highly politicised but large, high-quality studies consistently show that having an abortion does not result in psychological damage. 

‘Psychological research is often cited by groups who oppose the availability of legal abortion. Abortion disrupts their view of the “natural” role of women as childbearers and mothers, so these groups strongly believe that abortion can only impact detrimentally on women’s psychological wellbeing. But far from being a traumatic aberration, abortion is among the commonest medical interventions that women have.

‘One in three women in the UK has an abortion before the age of 45. There has not been a mass epidemic of abortion-induced mental illness resulting from this. No woman ever wants to need an abortion, but for many, it is the solution to the very serious problem of an unintended pregnancy which they feel completely unable to cope with.’

APA task force finds single abortion not a threat to women’s mental health: Calls for better-designed future research. APA press release, 12 August 2008

Report of the APA Task Force on Mental Health and Abortion. American Psychological Association, 13 August 2008 [.pdf]

Major study from influential American body finds abortion does not cause women to have mental health problems. BPAS press release, 18 August 2008

APA study will ‘hinder’ campaign to tighten UK law

This authoritative study will undermine certain amendments to the Human Fertilisation and Embryology Bill, reports Mark Henderson, Science Editor of the Times (London).

A comprehensive review of research by the American Psychological Association (APA), one of the world’s most influential mental health bodies, found no evidence that the majority of abortions cause psychiatric problems.

By challenging a key scientific argument for reform, the findings will hinder the latest effort to make it harder for British women to obtain terminations, which is to be debated by the House of Commons in October, Henderson reports.

Anti-abortion MPs have tabled an amendment to the Human Fertilisation and Embryology Bill that would require all women to be counselled about psychiatric risks before they can be cleared to have a termination. They cite research suggesting that mental health issues such as depression and anxiety are more common among women who have had abortions.

The APA report said that the findings of such studies were unreliable because they either failed to distinguish between abortions of wanted and unwanted pregnancies, or they did not consider factors such as poverty and drug use that raise the likelihood both of having an abortion and suffering mental illness.

The APA found ‘no credible evidence’ that single abortions could directly cause mental health problems among adults with unwanted pregnancies. It called for more well-designed studies to investigate the issue.

Even the evidence for adverse psychiatric effects of multiple abortions was equivocal, it found. Higher rates of mental illness among such women could be explained by social factors, such as poverty or drug use that also put them at higher risk of unplanned and unwanted pregnancy.

Brenda Major, who chaired the task force, said:

‘The best scientific evidence published indicates that among adult women who have an unplanned pregnancy the relative risk of mental health problems is no greater if they have a single elective first-trimester abortion or deliver that pregnancy. The evidence regarding the relative mental health risks associated with multiple abortions is more uncertain.’

The report, which was published at the APA’s annual conference in Boston, found evidence that women who had late abortions because of foetal abnormalities often suffered adverse psychological reactions, similar to those experienced by women who had miscarried or had a stillbirth. These effects, however, were seen among women who had lost a wanted pregnancy, and should not be extrapolated to those who chose to terminate for other reasons. They were also less serious than those seen in women who gave birth to infants with life-threatening defects.

The majority of UK abortions meet the criteria for which the APA said there are no attested psychiatric risks. About 90 per cent are conducted in the first trimester to end unwanted pregnancies, and two thirds of the abortions carried out in England and Wales last year were for women who had not had one before.

The results are significant, because after the defeat in May of attempts to reduce the 24-week time limit for terminations anti-abortion campaigners are now demanding mandatory psychiatric counselling and a ‘cooling-off period’.

Supporters pointed to research such as a New Zealand study led by David Ferguson, of Christchurch School of Medicine, which found in 2006 that women who had had abortions had an elevated risk of mental health problems. The study prompted a group of doctors led by Patricia Casey, of University College, Dublin, to write to the Times:

‘Since women having abortions can no longer be said to have a low risk of suffering from psychiatric conditions such as depression, doctors have a duty to advise about long-term adverse psychological consequences of abortion.’

In March 2008, Nadine Dorries, the Conservative MP who led attempts to reduce the time limit to 20 weeks, said: ‘We now know that abortion leads to depression and mental health problems in later life, along with other complications in future pregnancies.’

The Ferguson study was among those whose design was criticised by the APA review, in this case because it did not distinguish between abortions of wanted and unwanted pregnancies.

The APA’s conclusions matched those of the House of Commons Science and Technology Select Committee, which last year found no evidence for psychiatric damage caused by abortion. The Royal College of Psychiatrists also considered research inconclusive.

Ann Furedi, chief executive of BPAS, which provided 55,000 abortions in 2007, said: ‘Abortion research is highly politicised, but large, high-quality studies consistently show that having an abortion does not result in psychological damage.’

Mrs Dorries said: ‘If this rehashed, inconclusive and dated research is being used to deny women in the UK who seek an abortion the right to counselling, then it’s a fairly desperate act on behalf of the abortion industry and those who wish to deny women the right to make a fully informed decision.’

Abortion does not harm mental health, says study. The Times (London), 18 August 2008

APA task force finds single abortion not a threat to women’s mental health: Calls for better-designed future research. APA press release, 12 August 2008

Report of the APA Task Force on Mental Health and Abortion. American Psychological Association, 13 August 2008 [.pdf]

Major study from influential American body finds abortion does not cause women to have mental health problems. BPAS press release, 18 August 2008

India: Law faces test case

A court in the Indian city of Mumbai (Bombay) has rejected a couple’s plea to abort their 25-week fetus. 

The case was as a key test of India’s abortion law, which does not permit termination of pregnancies after 20 weeks unless it is fatal to the mother, the BBC reports.

Niketa and Haresh Mehta approached the court after doctors told them that the baby had a congenital heart block. The Mehtas took judicial action last week after doctors refused to abort the fetus. It is the couple’s first child.

The Mumbai High Court constituted a committee of doctors last week to assess the risks if the baby was allowed to be born as well as the risks to the mother if an abortion was allowed.

The committee told the court on Monday that there were “least chances” of the baby being born with a handicap. Doctors also said it could be risky for the mother if she had an abortion at such an advanced stage of pregnancy.

The couple had urged the court to allow a delayed abortion because they learnt about the problem only in the 24th week of pregnancy. Their doctor told the court that certain ailments could be detected only between the 20th and 24th week of pregnancy.

In their submission before the court, the couple said the child would need a pacemaker from the birth and would not be able to lead a normal life. They also said that they may not be able to afford expensive medical treatment for changing the pacemaker every few years. A pacemaker operation costs nearly $2,500.

An NGO offered to look after the baby if it was born with defects but the Mehtas turned down the proposal.

India court in key abortion order. BBC News, 4 August 2008

Review Northern Ireland law, says UN Committee

The UN Committee on the Elimination for Discrimination Against Women has repeated its call for a review of NI’s abortion law through public consultation. 

The Committee noted in its latest report the 1967 Abortion Act does not extend to Northern Ireland. It also suggested this was having a detrimental impact on women’s health.

The call coincides with moves by some Westminster MPs to have the act extended to Northern Ireland. This is despite significant opposition from NI church and political leaders.

Labour’s Diane Abbott is among the MPs who effectively want to end the ban on abortion in Northern Ireland, by tabling a legislative amendment to the Human Fertilisation and Embryology Bill.

In its report, the Committee on the Elimination for Discrimination Against Women urges the UK to amend the existing law to remove what it calls the “punitive provision” imposed on women who undergo abortion.

A spokesman for the Northern Ireland Office said it had not yet received a copy of the report. But it has long been the NIO’s position that abortion law is a matter for the people of Northern Ireland, with the best place for debate being a devolved assembly once Stormont accepts responsibility for justice.

Call for NI abortion law review. BBC News, 31 July 2008

Also read:

1967 Abortion Act section, Abortion Review

Catholics ignore contraceptive ban, survey finds

The Vatican teaching that prohibits the use of contraceptives is ignored by nearly all practising Catholics, according to The Tablet.

The Tablet, a weekly Catholic magazine, surveyed 1,500 Catholics from parishes across England and Wales and found that nearly half had never heard of Humanae Vitae, the 1968 encyclical that set out the teaching.

Most did know, however, that the Church’s official stance on contraception was that it should never be used, The Times (London) reports. More than half believed that this teaching should be revised.

The survey found that half of otherwise faithful Catholics use artificial contraceptives, especially condoms and the Pill. Most would not dream of discussing issues of family planning with a priest. Marriage was considered by most as the ideal lifelong commitment but nearly three quarters of Catholics said that separation or divorce would be better than an unhappy marriage. The same proportion also said that the Church should revise its teaching that divorced people who remarry are excluded from receiving Communion.

In a comment article, Catherine Pepinster, Editor of The Tablet, says that the Church’s stance has damaged its message. ‘The Church has much to teach society about the needs of the developing world and the nature of justice. Yet dialogue between secular society and the Catholic Church over climate change has been painfully limited and stymied until very recently. With the impact of a rapidly escalating world population playing its part in climate change, birth control has been the elephant in the room in discussions.’

Catholics ignore veto on the Pill. The Times (London), 25 July 2008

Sex and the modern Catholic. The Tablet, 26 July 2008

Extend Abortion Act to Northern Ireland, say MPs

MPs have tabled an amendment to the Human Fertilisation and Embryology Bill to give women in Northern Ireland the same abortion rights as in Britain.

The amendment was tabled by Labour MP Diane Abbott on the last day of the parliamentary session and will not be debated until the Autumn.

The Human Fertilisation and Embryology Bill is expected to reach report stage in the House of Commons after the summer recess – probably some time from mid-October. MPs will have a free vote on this issue then.

Northern Ireland is not covered by the 1967 Abortion Act. Women living there do not have access to safe abortion and are denied the NHS treatment and funding for abortion permitted to other UK women.

Ms Abbott says she believes there is ‘a very good chance’ of the amendment being passed by MPs - but it would face stiff opposition from Northern Ireland MPs who are against such a change.

All the main Northern Ireland parties at Westminster oppose moves to extend abortion rights. There was speculation last month, at the time of the vote on detaining terror suspects for up to 42 days, that assurances were given to the Democratic Unionist Party that the abortion legislation would not be extended to Northern Ireland. The nine DUP MPs were crucial to the government winning that vote - although Gordon Brown insisted there had been no deals.

Despite this, supporters are hopeful that the amendment may be successful as the abortion time limit that applies to the rest of the UK was discussed as part of the HFE legislation, so it would be difficult to rule it out of order.

The Northern Ireland amendment was backed by Labour MPs John McDonnell and Katy Clark, plus Tories Jacqui Lait and John Bercow and Liberal Democrat Evan Harris.

Diane Abbot MP said:

‘This fundamental inequity must be remedied. Forty years after the 1967 Act women in Northern Ireland are still facing conditions more reminiscent of the 19th century. All women in the UK must be given fair and rapid access to safe, legal abortion when they need it. The Abortion Act must be extended to include women in Northern Ireland.’

Dr Audrey Simpson, Director of fpa Northern Ireland, said:

‘A Northern Irish woman in the twenty first century who is the victim of rape or incest is expected to give birth, or find up to £2,000 to travel for treatment in England where women have the right to access safe abortion. These are a vulnerable group of women who need support – not to be forced to find money and travel long distances on their own.’

Marge Berer, Chair of Voice for Choice, the coalition of pro-choice groups in the UK, said:

‘This is an opportunity for the voices of the women of Northern Ireland to be heard. The UK Parliament must stop ignoring the needs of its own citizens.’

MPs pushing abortion rights in NI. BBC News, 23 July 2008

‘Move to give Northern Irish women full family planning rights: MPs seek equal access to abortion for all women in the UK by extending 1967 Abortion Act to Northern Ireland’. Press release, Voice for Choice, 23 July 2008

Voice for Choice provides the following summary of the current position in Northern Ireland:

The Future of Abortion: Controversies and Care

Summary of the BPAS conference held in central London, 25-26 June 2008.

This two-day conference marked the fortieth anniversary of BPAS, Britain’s leading abortion provider and a significant voice in policy developments and media debates. The event took place in the midst of a major Parliamentary debate about amending the British abortion law, and brought together doctors, nurses, commissioners, politicians, philosophers, journalists, campaigners and abortion providers from across Europe and the USA.

Presentations were from leading international and UK experts in abortion and sexual health services with the intention of stimulating debate and presenting best practice in service delivery. The conference was opened by the Rt Hon Dawn Primarolo MP, Minister of State for Public Health. Many issues were discussed. Four main themes emerged:

Abortion is a fact of life

Opening the conference, the Rt Hon Dawn Primarolo MP, Minister of State for Public Health:

Ann Furedi, chief executive of BPAS:

Discussing the issue of ‘repeat abortion’, Dr Sam Rowlands of Warwick Medical School:

The presentation by Professor James Trussell of Princeton University, USA:

Addressing the question ‘what use is emergency contraception?’, Kate Guthrie, clinical director of Hull and East Riding Sexual and Reproductive Healthcare Partnership:

A good abortion service puts the woman to be treated at the centre and is part of a “joined up” sexual health service.

Chris Plummer of bpas:

Simon Henning, sexual health network coordinator for Cheshire and Merseyside PCT, discussed the challenges involved in commissioning sexual health and abortion services, including:

Donagh Stenson of bpas drew upon the organisation’s 40 years of experience to suggest ‘what makes a good contract’, including:

Stenson drew attention to innovations such as offering Chlamydia testing online, which show how willingness to challenge the status quo can result in a better service.

Reviewing the National Sexual Health Strategy, Baroness Gould of Potternewton, chair of the Independent Advisory Group on Sexual Health & HIV, situated abortion care firmly within a broad approach to contraception provision and the treatment of STIs, emphasising the need to provide a seamless service.

The emphasis on providing a woman-centred service was endorsed from a clinical perspective. Dr Christian Fiala, a specialist in obstetrics and gynaecology in Vienna, Austria, described the historic shift in abortion care from ‘women’s domination’ to ‘respecting women’, and from ‘decision-based evidence-making’ to ‘evidence-based decision-making’. 

Discussing possible improvements in the provision of EMA, Mitchell D. Creinin, MD, professor of obstetrics, gynaecology and reproductive sciences at the University of Pittsburgh:

Presenting new research areas in medical and surgical abortion, Daniel Grossman, MD, of Ibis Reproductive Health:

Referring to the high proportion of second-trimester abortions carried out by D&E in the USA compared with the UK, Elena Drey, MD, EdM, of the University of California raised concerns that, despite the retention of the 24-week time limit in the British abortion law, second-trimester abortion may become ‘endangered’ through lack of public, political and medical empathy with the woman.

Abortion law should reflect developments in science and international clinical practice

Dr Ellie Lee of the University of Kent:

The future of abortion should be determined by an honest, ongoing and rigorous debate

Engaging with the question of how abortion providers set their personal limits on ‘how late is too late?’, Lisa H. Harris of the University of Michigan argued for ‘a new kind of abortion discourse’ that is honest about the procedures used in second-trimester, and recognises the extent to which some providers can feel ‘conflicted’ by their desire to help women in need of later abortions, balanced against their possible discomfort with the procedures they are carrying out. 

Speaking at a lively evening debate asking ‘What’s so bad about abortion?’:

The importance of self-awareness in determining the value of life was central to the presentations given by Dr Stuart Derbyshire of Birmingham University, and Professor John Harris of the University of Manchester. Harris argued that to have a view on the ethics of abortion is to have an answer as to what makes life valuable. Derbyshire argued that ‘anatomical answers’ to the question of fetal pain are insufficient to address the complexity of the pain experience, which can be understood only through a broader understanding of what makes human beings develop.

Commenting on the conference, Ann Furedi, Chief Executive of bpas, said:

‘We are proud to be able to host an event of this significance at an important time for abortion legislation. For us this was an opportunity to demonstrate that through providing abortion, we understand it. It was a chance to show that we do not ignore ethical concerns about the value of life and importance of conscience, but consider and address them. It was a space to discuss new developments in clinical practice and a platform to argue for the legal and regulatory frameworks that we believe would best serve women and those who provide the services they need.’

Further information about ‘The Future of Abortion’ conference, including key presentations and speakers’ biographies, is available on the conference website.

See here to read some of the substantial media coverage attracted by the conference.

Nurse cautioned for misoprostol error

A nurse who gave a medical abortion to a patient who had come for a consultation has been cautioned.

Ann Downer, based at the Calthorpe Clinic in Edgbaston, Birmingham, failed to check the woman’s personal details before giving her the drug, the BBC reports.

The woman was recalled when Ms Downer realised her mistake but the drug had already taken effect.

The Nursing and Midwifery Council said she could keep her job but would have a caution on her record for three years.

A spokesman said the council’s conduct and competence committee heard the clinic’s practice was to only call out patient’s first names in a bid to protect confidentiality while in the waiting room. Once the patient was inside a private room, other details, such as full name, birthdate and address were checked to make sure it was the person they were expecting.

Ms Downer failed to carry out an identity check and gave misoprostol to a woman who was due to have an initial consultation. When she was recalled, she was suffering from pain and bleeding and was given a procedure to finish the abortion. The woman made an official complaint about the mix-up.

Nurse gave wrong woman abortion. BBC News, 18 July 2008

Parliamentary debate on abortion law put back until Autumn

The third reading of the controversial Human Fertilisation and Embryology Bill has been delayed for three months.

Downing Street was embroiled in a row with the Department of Health after a ‘flagship’ government bill to push back the boundaries of science - by allowing research using animal-human hybrid embryos - was suddenly withdrawn from the Commons, the Guardian reports.

Health ministers were said to be stunned when No 10 decided that the final Commons stage of the HFE Bill, which was to have its third reading on 14 July, would be delayed until the autumn.

Downing Street had been bracing itself for a bruising day of votes on 14 July because pro-choice backbench MPs from across the Commons were planning to table amendments to the bill to liberalise Britain’s abortion laws.

While the abortion votes would have been free, the government would have faced embarrassment because at least one Catholic cabinet minister would have missed the vote to avoid supporting the bill as a whole. Ruth Kelly, the transport secretary, had been given clearance to be out of London as she cannot support the bill on conscience grounds because it will pave the way for, among other things, human-animal embryos.

Labour MPs were given free votes on controversial aspects of the bill during earlier Commons stages. But they were all due to face a three-line whip to support the measure - apart from any backbench amendments on abortion - at its final Commons stage on Monday.

The Tories said the bill had been delayed because the government feared a confrontation with Catholic Labour MPs less than two weeks before the byelection in Glasgow East, which has a high Catholic population. David Mundell, the shadow Scottish secretary, said: ‘This legislation will be contentious with key voter groups in Glasgow and it is clear they are worried about the effect of a vote next week.’

The Department of Health was angry, the Guardian reports. One senior MP said: ‘The delay came as a complete surprise to most people in the department. Supporters of this bill say we have taken a lot of pain on this and we should get on with it rather than allowing it to linger over the summer months.’

But there was concern among some ministers about the proposed amendments on abortion. These would allow nurses to perform abortions; to end the ‘two doctor rule’, allowing an abortion to be carried out with the approval of just one doctor; and to allow women less than nine weeks pregnant to take a pill to terminate their pregnancy.

Ministers are privately uneasy about changing the abortion laws after the emotional scenes in the Commons last month when anti-abortion campaigners failed in their attempt to cut the 24-week upper time limit. But because all abortion votes are free prominent pro-choice politicians such as the Commons leader, Harriet Harman, would be free to support the amendments.

One possible change - to end the abortion ban in Northern Ireland - could have proved difficult for Gordon Brown. The prime minister reached a tacit understanding with the Democratic Unionists - which helped him to win the Commons vote on the 42-day detention plan - that Britain’s liberal abortion laws would not be extended to Northern Ireland. Senior Labour MPs believe that Harman would have supported any changes to this, contravening the agreement with the DUP. ‘It could all have become very messy on Monday,’ a senior Labour figure said.

Harman told MPs yesterday that the bill had been delayed to allow for more time to debate it. ‘Of course the bill remains a flagship government bill ... as much time as possible needs to be found for it and the other issues that the government are committed to. It would therefore be good to look for a date in the autumn.’

Dr Evan Harris, the Liberal Democrat MP who was planning to table the abortion amendments, welcomed the delay.

‘Unless you were running a gynaecologist versus a priest, no byelection would be affected by a vote on abortion,” he said. “We needed more time to debate our amendment than just the three hours we were going to get and so asked for and got more time.’

Health ministers stunned by embryo bill delay. Guardian, 11 July 2008

Also read:

1967 Abortion Act section, Abortion Review

Embryology bill delay criticised, BBC News, 10 July 2008

Abortion restrictions turn women to the Web

Some women in countries where abortion is restricted are using the internet to buy medication enabling them to abort a pregnancy at home, the BBC reports. 

Women in Northern Ireland and over 70 countries with restrictions have used one of the main websites, Women on Web, according to a British Journal of Obstetrics and Gynaecology review of 400 customers.

The research into those who had used Women on Web found that about 8% did not end up using the medication they had ordered. Almost 11% went on to need a surgical procedure - either because the drugs had not completed the abortion or because of excessive bleeding. 

Almost 200 women answered questions about their experiences - 58% said they were just grateful to have been able to have had an abortion in this way, while 31% had felt stressed but found the experience acceptable.

Women on Web posts the drugs only to countries where abortion is heavily restricted, and to women who declare they are less than nine weeks’ pregnant.

A US woman, who has a rare medical complication meaning pregnancy is life-threatening to her, described her experience when she used the website while in Thailand.

‘Women on Web kept in contact with me via e-mail. The medication arrived through Customs, properly blister-packed, with complete paperwork and a doctor’s signature. Medication from other websites came in unmarked bottles with no instructions or paperwork - it was quite frightening.

‘I was not very far along - only three or four weeks. It went smoothly for me. I think it’s very important women have this resource to turn to in that situation - and they can need it for a number of reasons.’

The fpa in Northern Ireland has had several calls from women considering buying abortion pills online. The FPA said that on two occasions, women bought drugs without appropriate medical information. They experienced complications and needed aftercare.

Northern Ireland FPA director Audrey Simpson said:

‘The Women On Web site is very helpful and reputable. But for Northern Ireland women, it is encouraging them to break the law - and as an organisation, we have to work within the law.

‘We’re really concerned about women accessing the rogue sites - we’re hearing about it and we know it’s happening. There are potentially serious medical complications for women from sites which aren’t well managed and this could be the new era of backstreet abortions.’

Anti-abortion campaigners said they were appalled by such websites.

Josephine Quintavalle, from the group Comment on Reproductive Ethics, said:

‘This is very worrying indeed. It represents further trivialisation of the value of the unborn child. It’s like taking abortion into the shadows. These drugs have side-effects and tragedies will increase.’

Women ‘using web for abortions’. BBC News, 11 July 2008

Parliamentary debate on modernising the 1967 Abortion Act

As the Human Fertilisation and Embryology Bill reaches Report Stage, a cross-party group of MPs proposes ending the two-doctor rule, expanding the role of nurses, and permitting home use of misoprostol in EMA. 

But there will also be a fresh attempt to cut the 24 week upper limit, the BBC reports.

The Bill reaches Report Stage in the House of the Commons on Monday 14 July. A series of amendments have been put forward to the bill - although it will be up to Commons Speaker Michael Martin whether or not they are debated and voted on. Labour’s former health secretary Frank Dobson, Tory frontbencher Jacqui Lait and Liberal Democrat frontbencher Evan Harris are backing proposals that would ease aspects of abortion law.

These include reducing the number of doctors required for approval from two to one and scrapping the need for some abortion drugs to be taken on approved premises. They would also allow nurses with relevant qualifications to carry out early stage abortions and increasing the number of places where they could be carried out.

If supported by MPs, these would be the first changes to the 1967 Abortion Act since 1990, when the upper limit for terminations was reduced from 28 to 24 weeks.

The amendments reflect the findings of the Commons science and technology committee’s report last October, which suggested that requiring women seeking abortion to get approval from two doctors might be causing delays, and called for more nurses’ involvement in early abortions.

But not all members of the committee agreed with the report - Conservative MP Nadine Dorries and Bob Spink, a former Tory who has since joined the UK Independence Party published their own report, saying MPs had been ‘misled’ on some issues.

Debating the Bill in May, MPs rejected a series of options to reduce the upper time limit for abortions - the closest vote was an attempt to bring it down to 22 weeks, which was rejected by 304 votes to 233.

Prime Minister Gordon Brown and most of the cabinet voted to keep the existing 24 limit, as did Liberal Democrat leader Nick Clegg.

Conservative leader David Cameron voted for a 20 week limit and then for a cut to a 22 week limit - which was backed by most of the shadow cabinet.

Ms Dorries, who led the campaign to reduce the limit, has tabled her own amendment to the bill, which returns to the Commons next Monday - again asking for the limit to be reduced from 24 to 20 weeks.

MPs’ bid to change abortion laws. BBC News, 8 July 2008

View the Parliamentary progress of the HFE Bill, and amendments, here.

Also read:

1967 Abortion Act section, Abortion Review

Comment: Beyond the dogma - the real abortion debate

Dolan Cummings, editor of Culture Wars, reports on the debate ‘What’s so bad about abortion?’ at the BPAS conference in June. 

The debate about abortion today often takes the form of competing scientific claims: about exactly when the fetus becomes viable, whether it feels pain, the psychological effects on the woman, and so on. These are the issues regarded on both sides as the crucial ones on which to convince the public and more particularly policy-makers. But fundamentally the question of whether women should be free to have abortions is not a scientific one but a moral and political one. And this was the focus of a public debate taking place as part of the ‘Future of Abortion’ conference organised by BPAS on 25 June, with heavyweight speakers on either side.

BPAS chief Ann Furedi was joined by Jon O’Brien of the intriguing US lobby group Catholics for Choice, up against Josephine Quintavalle of the anti-abortion Comment on Reproductive Ethics and conservative journalist Dominic Lawson. The discussion ranged widely, but was most interesting when it touched on the core moral question that is at the heart of the political controversy. While acknowledging that nobody ever sets out to have an abortion for fun, Ann Furedi made the case boldly that abortion can be a morally good thing, as opposed to a ‘necessary evil’. This position is rarely heard, but it is crucial to any serious debate about abortion.

Dominic Lawson’s anti-abortion argument hinged on the idea that a woman’s decision to abort is the crucial moral factor. This seems reasonable enough, but it is one-sided. Too often the discussion proceeds from the assumption that once pregnant all a woman has to do to have a baby is not have an abortion. Debates about ‘when life begins’ focus on the sperm, the egg and the embryo as if those factors alone are sufficient to create a human life. The forgotten ‘factor of production’ is nine months of a woman’s life. The availability of abortion means this factor cannot be taken for granted. The principles of autonomy and equality mean that it should not.

Of course, it is quite true that if a woman does not abort her embryo or fetus, and if she continues to look after herself and eat properly, ‘nature will take its course’, and the chances are she will have a child. But human beings have always tried to exert control over this process, and modern medicine allows women to have relatively simple and easy abortions at almost any point during pregnancy. In this context, it is disingenuous to pretend that women, like wild animals or plants, are mere vessels for natural processes. Not only is it untrue, but it obscures the resulting moral significance of a woman’s decision not to abort. A woman’s decision to go ahead with a pregnancy, to have a child, is not morally neutral – depending on the circumstances, it can be a morally good or morally bad decision. Crucially, since it concerns her own life, it need not – and probably should not – be a selfless decision.

In fact, many mainstream anti-abortion arguments implicitly acknowledge that what is really at issue is not the life of the fetus, but the motivation of the woman, and especially whether it is selfless or selfish. The greatest moral condemnation is reserved for those women who have abortions because they want to pursue their careers, or simply for the sake of convenience (as with the notorious news story about a woman choosing to have an abortion because pregnancy would have interfered with a skiing holiday). Dominic Lawson suggested at the debate that, with so many infertile couples desperate for children, it was obvious that women with unwanted pregnancies ought to opt for adoption rather than abortion. In this view, abortion is immoral because it is selfish.

Ultimately, who is to decide whether any particular woman’s reason is good enough? The real question here is how much value we place on individual autonomy. Anti-abortionists typically see virtue in resignation (especially when it comes to women), and ‘accepting the consequences of our actions’, however avoidable. Those of us who support the right to abortion do so because we believe men and women should take responsibility for our own lives, and assert as much control over them as possible.

Even those who condemn abortion in general are usually sympathetic to women who want abortions because they’ve been raped. Living with the consequences of a careless night of passion is one thing, but the idea that a brutal physical violation should lead to such a serious disruption to a woman’s life as having to carry the child of her attacker is abhorrent to most people. Given the possibility of a swift abortion, it is impossible to justify in ordinary moral terms. Here, anti-abortionists must fall back on ‘the absolute sanctity of life’. Josephine Quintavalle deliberately brought the example of rape up at the debate, because it is the one most often used against her. She gave the example of a woman she’d counselled and who had gone ahead with a pregnancy in such circumstances and now had no regrets. This anecdote is hardly a convincing argument for denying abortion to anyone else, but Quintavalle had already confessed that her position is grounded in Roman Catholic doctrine rather than moral reasoning.

Too often, religious doctrine is presented as the beginning and the end of the anti-abortion argument. This is partly because Catholics and other religious activists are the most vocal opponents of abortion. But Jon O’Brien reminded us that millions of morally thoughtful Catholics do not accept the teaching of the Vatican on the issue (as is even more the case with contraception), and some actually question its theological foundations. Perhaps more importantly, millions of non-believers (like Lawson) have strong moral intuitions against abortion, which they bring to bear on the political debate without recourse to irrational absolutes. It is not enough, then, to dismiss anti-abortionists as zealots.

Most people, certainly in Britain, do accept that abortion is morally acceptable at least some of the time, and further, that the best person to decide whether it is or isn’t is the particular woman in question. If these women are to continue to have access to safe abortion, we must not be afraid to have out the argument, and should not be afraid to make a strong moral case grounded not in science, but in respect for individual autonomy and equality between the sexes.

This article is reprinted from the Culture Wars website.

There will be a debate on ‘Abortion: the hard arguments’ as part of the Battle of Ideas festival in London on 1-2 November 2008.

USA: A psychosocial profile of adolescent abortion patients

This study examined the psychosocial problems of a sample of adolescent women who presented for a pregnancy termination appointment at a family planning clinic located in the southeastern region of the United States. 

The sample consisted of 120 adolescent women, age 14-21 who were administered the Multidimensional Adolescent Assessment Scale (MAAS) while waiting for their pregnancy termination procedure. The MAAS is a self-administered instrument with multiple subscales that measure a variety of psychosocial problems.

Results indicated that most subjects did not score in the clinical range on the various subscales, thus indicating respondents as overall being stable and healthy. This paper reviews the specific findings from the study and discusses implications for practice and future research directions on this understudied population.

University of Kentucky, College of Social Work, 639 Patterson Office Tower, Lexington, KY 40506-0027, USA.

A psychosocial profile of adolescent pregnancy termination patients. Ely GE, Dulmus CN. Social Work in Health Care. 2008;46(3):69-83.

UK: Literature on medical abortion

This literature review aims to supplement guidelines by providing an overview of recent evidence relevant to medical termination of pregnancy.

The author notes that termination of pregnancy is available to women in the UK within legal parameters. Although guidelines form a strong body of evidence on which nurses and midwives can base their practice, there is a need to supplement them with up-to-date robust research findings.

A systematic search of the literature with high sensitivity and low specificity was undertaken on five databases using medical subject headings (MeSH) terms including (medical) induced abortion, therapeutic abortion and termination of pregnancy. The literature search revealed articles under the following headings: The importance of choice for the women involved the need for the optimal medication type, dose, route and interval between stages one and two, and the optimum place for medical termination to take place.

The author found that women attach a great deal of importance to the opportunity to choose their method of termination. The first stage of mifepristone is now a standard practice and an optimum dose has been determined. Several studies examined misoprostol used in the second stage of medical termination. There was some evidence for repeated doses of misoprostol, particularly in later gestation, with conflicting evidence on the optimal route. There were some grounds for reducing the interval between stages. Consideration should be given to home medical termination based on individual circumstances and choice. Gestation and previous obstetric history is an important factor to take into account when determining optimal regimen. Relevance to clinical practice. The number of medical termination of pregnancies performed has risen in recent years together with the nurses’ involvement. As new research is published, it is imperative that nurses adapt to base their involvement on the best available evidence.

Faculty of Health, Sport and Science, University of Glamorgan, Pontypridd, UK. Email

A review of developments in medical termination of pregnancy. Lipp A. Journal of Clinical Nursing. 2008 Jun;17(11):1411-8.

USA: Abortion care for adolescents

This article notes that over 800,000 pregnancies occur among adolescents annually in the United States. The majority of teen pregnancies are unintended and one-third of these pregnancies end in abortion.

The authors argue that as in older reproductive age women, medical and surgical abortions are safe and well tolerated by adolescents. Short-term morbidity is uncommon and no long-term adverse health or psychologic sequelae are associated with uncomplicated abortion. Adolescents encounter unique barriers in accessing abortion services that delay care and increase the cost and complexity of abortion. Clinicians function as a key resource for accurate information and support for adolescents with undesired pregnancies.

Department of Obstetrics/Gynecology, Columbia University Medical Center, New York City, New York, USA.

Abortion care for adolescents. Dragoman M, Davis A. Clinical Obstetrics and Gynecology. 2008 Jun;51(2):281-9. 

Italy: Unusual histologic finding in tissue obtained from voluntary abortion

An unusual histologic finding in tissue obtained from voluntary pregnancy termination (VPT) is discussed in this case report, to demonstrate the utility of pathologic examination of this specimen.

A 30-year-old woman with a history of depression was referred to the gynaecology clinic for VPT in the eighth week of gestation. Material obtained from uterine cavity curettage was macroscopically and histologically examined. Based on the histological findings, a molecular study by polymerase chain reaction amplification (PCR) was performed to evaluate the presence of human papilloma virus (HPV) DNA. For DNA extraction, 4-microm-thick histological sections were stained with hematoxylin and examined under a stereomicroscope. The PCR amplification was performed with the L1 consensus primers Gp5+/Gp6+, giving an expected PCR product size of 150 bp: these primers have been developed to allow the detection of a broad spectrum of mucosotropic HPV genotypes.

Histological examination of tissue obtained from the VPT showed immature villi with post-abortive hydropic degeneration and the presence of a small fragment of cervical mucosa with a squamous intraepithelial lesion characterized by mild to moderate nuclear atypia (SIL). PCR revealed that this lesion was related to HPV. Subsequently, the pap smear and cervical biopsy revealed a high-risk squamous intraepithelial lesion due to high-risk HPV.

The authors conclude that this report demonstrates that tissue obtained from VPT cannot be considered normal ‘a priori’ and that a histological study can be useful to provide new information regarding a woman’s gynecological health.

Department of Pathology and Laboratory Medicine, Pathology Section, Parma University, Italy. Email

Unusual histologic finding in tissue obtained from voluntary pregnancy termination: a case report. Giordano G, D’Adda T, Grassani C. European Journal of Gynaecological Oncology. 2008;29(2):177-8.

Iceland: Congenital diaphragmatic hernia and abortion decision making

This study aimed to compare surgical results for congenital diaphragmatic hernia (CDH) in two Scandinavian university hospitals and to evaluate the effects of abortions on the clinical profile of CDH in Iceland.

It was a retrospective study including all CDH-cases in Iceland 1983-2002 and children referred to Lund University Hospital 1993-2002. Aborted fetuses with CDH from a nation-wide Icelandic abort-registry were also included.

The results found that in Iceland, 19 out of 23 children with CDH were diagnosed < 24 hours from delivery, one with associated anomalies. Eight fetuses were diagnosed prenatally and seven of them aborted, three having isolated CDH at autopsy. In Iceland, 15 of 18 children operated on survived surgery (83% operative survival). In Lund 28 children were treated with surgery, 23 of them diagnosed early after birth or prenatally. Four children did not survive surgery (86% operative survival) and 9 (31%) had associated anomalies. All the discharged children treated in Iceland and Lund are alive, 3-22 years postoperatively.

The authors conclude that CDH is a serious anomaly where morbidity and mortality is directly related to other associated anomalies and pulmonary hypoplasia. However, majority of CDH patients do not have other associated anomalies. In spite of improved surgical results (operative mortality < 20%), a large proportion of pregnancies complicated with CDH are terminated. The authors conclude that the improved survival rate after corrective surgery must be emphasized when giving information to parents regarding abortion of fetuses with a prenatally diagnosed CDH.

Department of Cardiothoracic surgery, Landspitali University Hospital, Reykjavik, Iceland. Email

Congenital diaphragmatic hernia: improved surgical results should influence abortion decision making. Gudbjartsson T, Gunnarsdottir A, Topan CZ, Larssons LT, Rosmundsson T, Dagbjartsson A. Scandinavian Journal of Surgery. 2008;97(1):71-6.

Iran: Attitudes towards prenatal screening

This study was conducted to find out the attitudes of Iranian scholars towards prenatal screening and counselling with respect to ethical issues. 

Two hundred and one physicians, genetic and religious scholars were interviewed with regard to demographics and attitudes towards the ethical dilemmas in prenatal screening and counseling. Interviews were analysed using the four-principle approach.

Findings showed scholars’ attitudes towards: (1) the right of couples to choose prenatal screening, (2) the role of prenatal screening and counselling concerning termination of an affected fetus, (3) screening results and emotional distress in couples, and (4) the impact of prenatal screening and counseling on disability rate.

The authors concluded that Iranian scholars were willing to consider prenatal screening to help prevent transmission of diseases to the next generation. This goal is attained through the autonomous choice of the couple to participate in prenatal screening and counselling.

Research Center for Gastroenterology and Liver Diseases, Shaheed Beheshti University, Tehran, Iran. Email

Prenatal screening and counseling in Iran and ethical dilemmas. Saniei M, Mehr EJ, Shahraz S, Zahedi LN, Rad AM, Sayar S, Sherafat Kazemzade R, Shekarchi A, Zali MR. Community Genetics. 2008;11(5):267-72. Epub 2008 May 20.

The Future of Abortion

Opening the BPAS conference in London on 25 June, Public Health Minister Dawn Primarolo announced a new allocation of £6 million towards sexual health provision in further education sites over three years.

In her speech, Ms Primarolo also:

The full transcript of the Minister’s speech can be read here.

Also at the BPAS conference, the presentation by James Trussell, Professor of Professor of Economics and Public Affairs and Director of the Office of Population Research at the University of Princeton in the USA, on unintended pregnancy and contraceptive failure generated considerable press coverage. James Trussell said:

‘Reducing unintended pregnancy is an important public health goal. In the UK any significant reduction would require significantly increased use of highly-effective long-acting reversible contraceptives (intrauterine contraception and implants) that do not require the user’s ongoing attention to adherence. These modern “fit and forget” methods are popular with people who use them, and have been promoted across the health service, which is a good first step.’

His research was reported in the Daily Telegraph under the headline ‘“Contraceptive Pill is outdated and does not work well”, expert warns’.  Further coverage appeared in The Times (London), the Daily Mail, LifeNews, and Fresh News (India).

On the issue of early medical abortion, an international panel of doctors confirmed that the drugs used in EMA could be safely prescribed to women to take at home, in line with the practice of several other countries.

Dr Mitchell Creinin, professor of obstetrics, gynecology and reproductive sciences at the University of Pittsburgh, said:

‘It’s interesting that the UK leads the world in a lot of areas but it’s mind-boggling that the UK still has this paternalistic law. The current system involved incredible cost resources, but there are at least 10 studies that show that EMA can be done safely and effectively by women at home. The whole idea that British women need to be studied to see if it can be done is insulting. It implies that women and their doctors in this country are stupid and I’m sure that’s not the case.’

Ann Furedi, chief executive of BPAS, said an amendment to the Human Fertilisation and Embryology Act, allowing GPs to prescribe women both drugs at the same time, would be discussed Parliament early next month. She commented:

‘The organisation of early medical abortion services should be shaped by good clinical practice and not by political caution. The current abortion law, which requires the necessary medication to be prescribed and administered in specially licensed premises, is unjustifiable and senseless. In many cases it causes women additional unnecessary expense and inconvenience and can delay some women at what is already an emotional time.

‘Women are quite capable of taking medication according to directions. Service providers are quite capable of giving appropriate out-of-hours support. International experience shows that these barriers can be safely removed to make earlier abortions as accessible as possible to women.’

Media attention at the BPAS conference was also given to the issue of repeat abortion, and the expansion of nurses’ role in providing early abortion.

The BPAS conference ‘The Future of Abortion: Controversies and Care’ took place in Westminster on 25-26 June 2008. The programme and speaker biographies can be viewed on the conference website.

Follow the links below to see some more press coverage:

Anti-abortion campaigns ‘encourage terminations’. Sunday Telegraph, 22 June 2008

Row As Abortions Increase. Staff Nurse, 23 June 2008

Women offered ‘home’ abortions. Sunday Express, 22 June 2008

Push for women to carry out early medical abortions at home. Practice Nurse, 26 June 2008

Nurses ‘may carry out abortions’ following Parliamentary debate. GP Newspaper, 26 June 2008

Why is Britain teetering on the verge of becoming the abortion capital of the world? Healthcare Republic, 25 June 2008

‘Contraceptive Pill is outdated and does not work well’, expert warns. Daily Telegraph, 26 June 2008

The Pill ‘has had its day as an effective contraceptive’. The Times (London), 26 June 2008

It’s time to ditch the ‘outdated’ Pill, women told. Daily Mail, 26 June 2008

Call to encourage LARC use ahead of the Pill. GP magazine, 26 June 2008

Pill is ‘leading to more pregnancies’. Irish Independent - front page

The Pill is an outdated method of contraception, says expert. Thaindian News (Thailand), 26 June 2008

The Pill is an outdated method of contraception, says expert. The Cheers magazine, Estonia

Abortion laws slammed by experts. Pulse magazine, 27 June 2008

Romania: Child rape victim to be permitted abortion

An 11-year-old Romanian girl who is 21 weeks pregnant after being raped by an uncle will be able to have an abortion, even though it is forbidden by law, the BBC reports.

A government committee said the procedure should go ahead due to the exceptional circumstances of her case.

Romania’s abortion limit is 14 weeks. It had been suggested the girl might travel to the UK for the abortion. Some 20 Christian Orthodox groups had threatened to press charges if the girl was allowed to abort the fetus.

In a letter to the government committee, the girl said she wanted to be able ‘to go to school and to play’. ‘If I can’t do this my life will be a nightmare,’ she said, according to a text read out by government committee member Vlad Iliescu.

‘The committee has decided that a voluntary termination of the pregnancy can be carried out,’ said Mr Iliescu. He said the abortion could take place because the girl was a victim of sexual abuse and faced ‘major risks to her mental health’ if the pregnancy continued.

Another committee member, Theodora Bertzi said the decision was made focusing on ‘the rights of this child who was subjected to rape and incest’. The committee said the case highlighted the need for ‘clarifications with regard to the exceptional circumstances’ that would allow late-term abortions to go ahead.

The girl was raped by a 19-year-old uncle who has since disappeared. Her family only discovered she was pregnant when they took her to the doctor because she seemed sick.

While some pro-life Christian Orthodox groups had urged the family to keep the child, and offered to raise it in a church institution, the Romanian Orthodox Church said any decision on abortion should be left to the family. The girl’s parents had said they wanted to travel to a country where such a late-term abortion was legal.

In Romania abortion is only normally allowed beyond 14 weeks if the mother’s life is deemed to be at risk. In Britain, they can be carried out up to 24 weeks in some circumstances. A Romanian living in the UK had offered to cover the costs of a termination there.

Romanian girl permitted abortion. BBC News, 27 June 2008

Abortion statistics: behind the headlines

Abortion has risen, but in line with demographic trends. And there’s even been a drop in the number of teenage pregnancies. By Ann Furedi, Chief Executive of BPAS.

The release of England and Wales’s abortion statistics from 2007 confirms the underlying trends we have seen as abortion and contraception providers over the past few years.

There is much to welcome, such as the rise in the proportion of abortions happening under 10 weeks. Women want access to abortion as early as possible and we have been working with the NHS to achieve this within the creaking confines of our 40-year-old abortion law. The current law can obstruct the provision of modern abortion care at the earliest stages.

As we’d anticipated, the rise in the total number of abortions from 2006 numbers was 2.5%. This modest increase makes sense, in a society where women expect to plan their families and abortion is recognised as a safe way to manage unwanted pregnancy. According to the latest Office for National Statistics figures, the UK’s fertility and birth rate is at a 28-year high, with the number of conceptions in total increasing year on year. The UK’s rising birth rate is to be celebrated, but going hand-in-hand with that happy statistic will inevitably be rises in the other outcomes of pregnancy – miscarriage and abortion.

The fact that the proportion of conceptions ending in abortion has not changed over the last 5 years or so (sticking at around 22%) is interesting – and to some surprisingly low – given that more women now have their first baby at an older age and then go on to have smaller families than in the past. This means there are more years in more women’s lives when they are sexually active but not intending to become mothers. At population level, there is more time when women are likely to experience an unintended pregnancy and so could be more likely to seek an abortion.

But what’s fascinating about the media coverage of this year’s statistics is the intense concentration on the increased likelihood to choose an abortion, in the small numbers of younger teenagers who become pregnant. Fewer media outlets also reported that, bucking the national trend, there has also been a fall in the number of teenagers becoming pregnant in the first place. This is a real cause for celebration. It appears that despite the complex reasons behind the public health problem of unintended conception affecting all age groups, teenagers are leading the way. Their use of abortion if things go wrong should not be used as a means to castigate them.

Like every other age group, teenagers recognise parenthood as a significant social responsibility and not something to drift into ambivalently because of inadequacy in negotiating or using contraception effectively. In typical use by couples of all ages, studies show the failure rate of condoms, a method which young people often rely on, to be as high as 15%. The small number of young girls and their parents who come to talk to the British Pregnancy Advisory Service about pregnancy options are always very distressed about their situation. But the problem for them is their unintended pregnancy, not the abortion. Nobody wants to see young people being faced with this difficult situation, but we should never compel a young woman to become a mother against her will.

This article was first published on the Guardian‘s Comment is Free blog on 20 June 2008.

Anti-abortion campaigns ‘encourage terminations’

Campaigns to bring down the abortion time limit may have encouraged more women to have terminations, the Sunday Telegraph reports. 

Ann Furedi, chief executive of BPAS, told the newspaper that lobbying against late abortions may have backfired by increasing women’s awareness of the services available.

Official figures last week showed that the number of abortions carried out in Britain rose last year to a record high. The most marked increase was in Scotland, which has seen some of the fiercest anti-abortion campaigning.

The political row over abortion was re-ignited last month as the Government’s Human Fertilisation and Embryology Bill went through Parliament, with anti-abortion MPs unsuccessfully submitting amendments to bring down the abortion time limit.

Mrs Furedi said that high profile media coverage of the debate, last month and in recent years, had made women more aware of their options, and of how common abortions had become.

She said: ‘The numbers show a 2.2 per cent increase in England and Wales, and a 4 per cent increase in Scotland, which is where some of the strongest attacks were made.

‘The intention may have been to dissuade women from abortions, but in fact, because these type of attacks attracted so much publicity, it fixes the idea in women’s minds that abortion is an option, and oddly enough, that may well reduce the stigma about it.’

She suggested the higher rate of increase in Scotland might be attributed to the attacks from several bishops, most notably the head of the Scottish Catholic church, Cardinal Keith O’ Brien, who last summer likened the country’s termination rate to ‘two Dunblane massacres a day’.

The BPAS chief said the messages the anti-abortion lobby intended to send out were not necessarily the same ones received by women with unwanted pregnancies.

‘Even if the message is railing about sin, and an amoral society, the other point getting through is that lots of women are doing this, and that it is more acceptable.’

She made her comments ahead of a BPAS conference this week, which will discuss the ethics and practice of abortion as the legislation goes through the Commons.

Further amendments likely to be debated next month would allow an abortion to be approved by one doctor, instead of two, and permit a nurse to carry out the surgical procedure.

The conference will also discuss the reasons why women have repeated termina