31 October 2007

Parliamentary committee publishes report on abortion

The Science and Technology Committee has set out its conclusions on scientific developments which should be considered in any new Parliamentary debate relating to the Abortion Act 1967. 

The Committee held its inquiry in order to inform parliamentary and public debate after it was ruled that abortion would fall within the remit of the Human Tissue and Embryos Bill, which is likely to be presented to the House in the 2007/8 session. The Committee makes clear that its conclusions and recommendations are restricted to those issues capable of scientific evaluation and recognises that other factors also come into play when abortion law reform is being considered by Parliament.

The recommendations are as follows:

  • The Committee concludes that while survival rates at 24 weeks (the current upper limit for abortion) and over have improved since 1990, survival rates (viability) have not done so below that gestational point. The Committee concludes that there is no scientific basis - on the grounds on viability - to reduce the upper time limit. 

  • The Committee supports the removal of the requirement for two doctors’ signatures before an abortion can be carried out. The Committee is concerned that the requirement for two signatures may be causing delays in access to abortion services and found no evidence of its value in terms of safety.

  • Nurses and midwives with suitable training and professional guidance, should not be prevented by law from carrying out all stages of early medical and early surgical abortion.  The Committee says that it found there is no evidence that this would compromise patient safety or quality of care.

  • On the issue of fetal pain, the Committee says the evidence suggests that while fetuses have physiological reactions to stimuli, this does not indicate that pain is consciously felt, especially not below 24 weeks. It further concludes that these factors may be relevant to clinical practice but do not appear to be relevant to the question of abortion law.

  • While new 4D imaging techniques are a useful tool in diagnosis of fetal abnormality, there is no evidence they provide any scientific insights on the question of fetal sentience or viability.

  • Any debate on the impact an alteration to the upper time limit would have on those women who present late for abortion would be better informed if there was improved collection of information relating to the reasons why women come forward at this late stage and about how many women travel overseas for late abortions.

  • On the question of the merits of clarification or a definition of ‘seriously handicapped’, the Committee does not consider that an exhaustive list of abnormalities is feasible, but believes that guidance on what ‘serious handicap’ means would be helpful; and further that data collection in this area be improved.
  • The Committee concludes there is no evidence relating to safety, effectiveness or patient acceptability that should deter Parliament from passing regulations which would enable women, who chose to do so, taking the second stage of early medical abortion at home. The Committee would like to see the necessary legislative change that would enable this to be pursued or at least piloted.

  • The Committee also recommends that the clinical guidelines on abortion provision, including health risks associated with abortion, should ultimately be taken over by the National Institute for Health and Clinical Excellence (NICE). 

    Phil Willis, chairman of the Science and Technology Committee, said:

    ‘Abortion is a complex issue. Legislative decisions are informed by ethical, moral, religious and political views, case law, scientific and medical evidence. As a Science and Technology Committee, we have focused on the science, and have done so rigorously.

    ‘In our inquiry we have attempted to sift the evidence on scientific and medical developments since the last amendment of the law in 1990 and since the 1967 Act.

    ‘We urge all MPs and the public to study the evidence we have taken and the conclusions we have reached.’

    Responding to the report, Ann Furedi, Chief Executive of BPAS, said:

    ‘This pragmatic and sensible report provides a valuable reference point for anyone who is thinking seriously about how modern abortion care should be provided.

    ‘An evidence-based report like this shows up the forty-year-old Abortion Act, which was framed in different era of medicine, as now looking a little threadbare. Surely laws should be able to respond over time to permit doctors and nurses to offer the best possible practice?

    ‘There is strong evidence which the Committee heard, consistently supported by medical and nursing bodies, that the current time limit for abortion does not require lowering on the basis of fetal viability. Our experience is that a small number of vulnerable women in especially complex, difficult situations request treatment at these later stages. We support the call for additional research about these women’s needs.

    ‘Other recommendations in the report seem entirely sensible. In other areas of healthcare, nurses are seen as capable practitioners in their own right. Early abortions are not more complex than other procedures that nurses perform routinely.

    ‘We all know that our doctors’ and GPs’ time is precious, so why retain a clinically useless administrative burden on them to double-sign abortion forms? This 1960’s requirement can delay women from getting the earliest and least invasive treatment possible- while sending a pretty poor message about how women’s decision-making is looked upon.

    ‘No woman ever wants to need an abortion. The decisions involved can be really tough. So we feel that in this serious situation, when they’ve made their decision, women shouldn’t have to jump through unnecessary legal hoops. A better law would allow their medical care to be the most up-to-date and and woman-centred that it can be.’

    PRESS NOTICE: SCIENCE AND TECHNOLOGY COMMITTEE, HOUSE OF COMMONS. ‘PUBLICATION OF REPORT: SCIENTIFIC DEVELOPMENTS RELATING TO THE ABORTION ACT 1967’. 31 October 2007

    Download the full report: Scientific Developments Relating to the Abortion Act 1967

    Also read:

    The written evidence for the STC inquiry into ‘Scientific Developments Relating to the Abortion Act 1967’.

    1967 Abortion Act section, Abortion Review