Do people really want to ban late abortions?

The Observer claims, on the basis of a new poll, that ‘a majority of women in Britain want abortion laws to be tightened to make it harder, or impossible, for them to terminate a pregnancy’. Ann Furedi, bpas Chief Executive, is not convinced.

The Observer, widely regarded at the thinking liberals’ Sunday paper, on 29 January ran a front page report claiming: ‘a majority of women in Britain want abortion laws to be tightened to make it harder, or impossible, for them to terminate a pregnancy’. The report, based on a MORI opinion poll, claimed that 47% of women (and 42% of respondents overall) believe the legal time limit for abortion should be cut from its present 24 weeks. Thirty-one per cent of women and 35% of men believed that the ‘the current time limit is about right’ and just 2 per cent of women and 5 per cent of men thought the time limit should be extended. The report suggested that increased awareness of the ‘realities of abortion’ and the publicity given to new ultrasound imaging techniques have increased public queasiness about abortion.

It is difficult to assess whether this is, in truth, the case, as it is notoriously difficult to poll opinion on abortion time limits in a way that gives meaningful results. People may have a fairly clear idea of why they think abortion should be allowed, but views on gestational limits occupy much more tricky territory. Most people have views on the circumstances in which abortion should be provided. These may be highly subjective and prejudiced by stereotypes: for example, in cases of rape, but not just when a woman changes her mind; for teenagers but not for women who are able to afford a family; in the case of a ‘genuine mistake’ but not when it’s her third unwanted pregnancy.

The matter of time limits, it could be argued, is a rather more subtle judgement call.

The Observer/MORI poll told people that ‘women are allowed to have an abortion at any time within the first 24 weeks of her pregnancy’, and then asked whether this time limit should be reduced, increased, or whether it was ‘about right’? When a question is framed in this way, it is difficult to know how people’s answer is framed by their own understanding of the issues.

The current legal period for an abortion to take place is when a woman is up to 24 weeks pregnant. That is, women are allowed to have an abortion at any time within the first 24 weeks of her pregnancy.  Do you believe that this time limit should be reduced (i.e. should be less than 24 weeks), increased (i.e. should be more that 24 weeks), or is it about right?

Questions that address just the time limit, as this one did, providing no information about the circumstances in which late abortions are provided, can implicitly (even if unintentionally) suggest that abortions are as easy to arrange at 23 weeks, and are just as common, as at 8 weeks. They can also suggest that abortions are available ‘on demand’ rather than subject to the certification of two doctors that the woman meets the legal requirements. As Dr Ellie Lee, a sociologist at Kent University, remarked, given the way this question was phrased it is surprising that a third of people think the current 24-week time limit is about right.

A major problem with the time limit question is that it reduces the complexities of the rights and wrongs of abortion to how long a woman has been pregnant (code for how developed the fetus is), and then it separates this from the circumstances of why an individual woman requests the termination of her pregnancy. By focusing on the single fact of the gestation of the pregnancy, it turns attention away from the reasons for the abortion, and the reasons why it is late. This is why abortion providers and anti-choice speakers debating time limits can sometimes appear to have no point of connection. The anti-choice speaker is thinking about the well-formed, recognisable ‘unborn baby’ just months away from birth. The abortion provider is thinking about how she would face a distraught 15-year-old with the news that she has to accept motherhood. For abortion opponents the moral priority is the life of the fetus; for the rest of us the moral priority is the future of the woman.

If respondents to such polls knew that only 3,000 women a year access abortion after 20 weeks, would they think differently to the way they would think if they believed tens of thousands of abortions take place at this gestation? Would it affect their answer if they knew that it was much, much more difficult for a woman to obtain an abortion at 23 weeks than at 9 weeks? What about if they knew that even when the abortion is of an unwanted pregnancy, doctors have confirmed that it would damage a woman’s health if she had the baby? How would the answers fall if respondents were presented with the kind of case histories that have informed articles in previous issues of Abortion Review?

If people knew that the number of late abortions could be reduced to the absolute minimum by better sign-posting and easier access to publicly-funded early abortion services and better investment in contraception and crisis-pregnancy counselling, and if they understood the circumstances in which women might still need the choice of late abortion, would they still want to use the blunt instrument of legislative change?

All this type of poll question can really tell us is that people don’t like the idea of late abortion – and that really is not news. After all, there is a broad consensus that late abortion is ‘not a good thing’ and it would be better if abortions were carried out earlier rather than later. Even those who see no ethical distinction between early and late abortions acknowledge that the earlier the procedure, the easier and safer it is for the woman. The risks of abortion, which are extremely low, increase with the gestation of the pregnancy.

It is important to consider how public opinion sits because today, the way that such opinion influences policy is a distinguishing feature of modern British politics. Currently, public policy is built on an assumption that people believe abortion is the lesser of two evils: a moral ‘wrong’ that is ‘right’ in some circumstances. The Department of Health’s sexual health strategy assumes that the number of late abortions should be lowered, but that it is appropriate to do this by making it easier for women to access abortion earlier in pregnancy. The Minister for Public Health has made clear her concerns about the number of women who have ‘repeat abortions’, but it is planned that this will be addressed by promoting the more effective methods of contraception. At the moment there seems no inclination to control abortion further by prohibiting access, by lowering the time limit, or any other measure. Rational analysis would suggest there is no need to consider this.

The Government’s sexual health strategy, which has included increased funding of abortion services and quality performance assessments of Primary Care Trusts’ (PCTs’ performance in delivering abortion services to women before 10 weeks’ gestation, is achieving some excellent results. The official statistics for England and Wales (Scotland’s are recorded separately) show that in 2004, 18% of women paid for their own abortions compared with a 33% in 1994. In numerical terms, this amounted to NHS funding for an additional 47,500 women.

The additional funding, along with the focus on PCTs’ performance and the more widespread availability of early medical abortion (which is another good news story), meant that in 2004 60% of abortion patients were treated at gestations of less than 9 weeks, compared with 54% a decade earlier. Were these advances made against other Government health targets, they would be trumpeted - but the Government seems reluctant to brag about making abortion easier for fear of legitimising it.

Providing easier early abortion will not eliminate the need for late procedures – but it could reduce them. The Catholic Church may feel that informing people about the reality of abortion encourages them to be more conservative, but it could be that information about the reality of late abortion leads to a greater understanding what an ordeal it is for women, and how much worse it would be if that small number of procedures were denied. Ultimately there needs to be a comprehensive public debate about whether this is right or wrong, acceptable or unacceptable. This debate needs to be considered, informed and temperate.