Australian attitudes to early and late abortion

A study of public opinion published in the Medical Journal of Australia has found a high level of support for access to early abortion, and little support for professional sanctions against doctors for providing terminations after 24 weeks’ gestation.

Abstract

The study set out to investigate community attitudes to abortion, including views on whether doctors should face sanctions for performing late abortion in a range of clinical and social situations.

This was an anonymous online survey of 1050 Australians aged 18 years or older (stratified by sex, age and location) using contextualised questions, conducted between 28 and 31 July 2008. The main outcome measures were attitudes to abortion, particularly after 24 weeks’ gestation.

The results found a high level of support for access to early abortion; 87% of respondents indicated that abortion should be lawful in the first trimester (61% unconditionally and 26% depending on the circumstances). In most of the clinical and social circumstances described in our survey, a majority of respondents indicated that doctors should not face professional sanctions for performing abortion after 24 weeks’ gestation.

The authors concluded that a majority of Australians support laws which enable women to access abortion services after 24 weeks’ gestation, and that support varies depending on circumstances. Simple yes/no polls may give a misleading picture of public opinion.

The study

The authors note that abortion laws in Victoria were reformed in October 2008 following a review by the Victorian Law Reform Commission, and that abortion laws elswhere in Australia are currently under debate. Previous surveys of community attitudes to abortion have several limitations: it is unclear what proportion of those who support the right to access abortion believe that it should be restricted on the basis of factors such as gestational age and women’s reasons for seeking abortion.

The authors also note that Europeans tend to support women’s access to abortion; Americans are more likely to oppose it. ‘Late’ abortion is especially controversial, although less than 2% of abortions occur at 20 weeks or later. Few data support the belief that Australians strongly oppose women’s access to late abortion.

This study found that 87% per cent of respondents indicated that abortion should be lawful in at least some circumstances in the first trimester; 69% indicated this for the second trimester and 48% for the third. In a wide range of clinical and social circumstances, a majority of respondents indicated that doctors should not face professional sanctions for terminating a pregnancy after 24 weeks’ gestation. In no circumstance did a majority indicate that a doctor should be sanctioned for terminating a pregnancy after 24 weeks’ gestation. Of the subgroup of respondents who indicated that termination of pregnancy in the third trimester should be unlawful, a majority indicated that doctors should not be sanctioned for terminating a pregnancy after 24 weeks’ gestation in six of 16 circumstances. In the same subgroup, there was majority support for professional sanctions in five of these 16 circumstances.

There were no statistically significant differences between the responses, regarding attitudes to both lawfulness of abortion in each trimester and to sanctions in the various circumstances, of respondents who resided in Victoria and those who resided in any part of Australia, nor between men and women. Seventeen per cent of women indicated they had personally had a pregnancy termination, and these women were more likely to oppose sanctions than the female population generally. Respondents aged 45 years and older were more likely to oppose sanctions than those aged 18–44 years. Respondents who nominated a religious affiliation were slightly more likely to support sanctions than those who reported no religion.

Discussion of findings

The authors noted that their survey shows a high level of support for access to early abortion. There was little support for professional sanctions against doctors for providing terminations after 24 weeks’ gestation. When asked to consider specific, realistic situations in which late abortion might be considered, many respondents opposed sanctions against doctors, particularly when abortion is sought because of maternal or fetal complications rather than personal reasons.

The authors argue that public opinion research can have a major impact on government policy and, therefore, on access to quality medical care. To the authors’ knowledge, this is the first detailed survey of Australian attitudes to late abortion that includes attitudes in various clinical and social situations. Previous surveys in Australia have not usually specified the gestational age at which an abortion is performed.

Simple yes/no polls do not allow people to accurately express the subtlety of their views in the complex range of clinical and social situations in which access to abortion might be sought. For example, although 48% of respondents indicated that abortion in the third trimester of pregnancy should be unlawful, less than a quarter indicated that a doctor should face professional sanctions for performing termination after 24 weeks’ gestation when there is a risk to the physical or mental health of the woman or baby.

Respondents were more equivocal about sanctions in scenarios regarding late termination for reasons relating to the preferences or social circumstances of the woman. But less than 50% of respondents indicated that a doctor should face professional sanctions for performing a termination after 24 weeks’ gestation, even when there is no medical reason for the termination.

The authors argued that one possible explanation for the difference in responses to questions about lawfulness and sanctions is that respondents drew a distinction between legalising abortion and removing sanctions. Respondents with ambivalent attitudes to abortion may favour removal of sanctions but retention of a legal bar on abortion as an intermediate position between full legalisation and full prohibition. This could reflect the prevailing semi-legal status (which was in place until recently in Victoria, and is still in place in most other Australian jurisdictions), where abortion is illegal under at least some laws but professional sanctions are rarely, if ever, enforced.

Another possibility is that respondents may have an in-principle objection to abortion but are more prepared to accept it when they understand the reason, especially if there is a medical reason for abortion. Support for abortion was generally higher when respondents were given greater information about timing and reasons.

The authors speculate that this higher level of support could have been because respondents had a greater ability to identify with women seeking an abortion when contextual information was present, or because respondents thought that the contextual details were morally relevant factors — that is, that they provided moral reasons for allowing abortion. It is possible that, when no context is given, respondents tend to assume there are no significant moral reasons for abortion to proceed.

The authors argue that the sensitivity of Australians’ views on abortion to contextual details may have implications for other debates about ethics. The more permissive attitude elicited when context was provided in this study may, for example, carry over to debates about euthanasia, the use of medicine or technology for human enhancement, organ donation, and embryonic stem cell research. A simplistic division between ‘pro-choice’ and ‘anti-abortion’ does not accurately reflect the views of Australians: individuals have nuanced views that depend on the reasons for which women seek abortion. Nonetheless, opinion surveys — no matter how robust — should not dictate policy or law.

The authors conclude that policies and laws should be grounded on ethical arguments, and they have attempted to provide such arguments, adding to previous discussions of abortion and the law. This study has shown that Australians are supportive of both access to abortion, including late abortion in many circumstances, and liberal abortion law reform.

The full study is avalailable here:

Australian attitudes to early and late abortion. de Crespigny, L., Wilkinson, D., Douglas, T., Textor, M. and Savulescu, J. (2010), Medical Journal of Australia, Vol: 193(1) pp. 9-12

More detailed data from the survey are located here.