New clauses on abortion: a once-in-a generation opportunity for MPs

Ann Furedi, Cheif Executive of the BPAS, writes on the upcoming Human Fertilisation and Embryology Bill and argues this is a once-in-a generation opportunity for MPs.

Speaking at the Human Fertilisation and Embryology Authority conference on 13th October, Public Health Minister Dawn Primarolo MP spoke of her enthusiasm for the Human Fertilisation and Embryology Bill, which reaches third reading and report stage in the Commons on 22nd October. The Minister stressed to the IVF and embryo research regulatory body that the law must keep pace with scientific and medical developments, and that services need ‘proportionate’ regulation. She rightly called for a law that is both ‘right for science and right for society’.

As a former Director of Policy and Communications at the HFEA, I remember the frustration of scientists and clinicians who were unable to persue rational and ethical lines of work because of the prohibitions of an overly prescriptive and out-of-date law. This HFE Bill is necessary, if not overdue, to set the legislative framework necessary for fertility research and treatment in the twenty-first century.

The same frustrations are shared by the doctors and nurses striving to provide a modern, evidence-based abortion service as part of family planning care in the UK. The 1990 HFE Act amended the 1967 Abortion Act, shaping the manner in which abortion services are currently provided. Ungainly as it may seem to yoke these two areas of legislation together, new clauses to the HFE Bill on abortion are appropriate and necessary to make sure that abortion services, too, can keep pace with scientific and medical developments and are regulated proportionately. The proposed new clauses to the HFE Bill affecting abortion care are primarily:

 ▪ Removal of the need for two doctors’ signatures to give permission before an abortion can be carried out- instead abortion would be provided on the basis of informed patient consent and in their best interests, as with all other medical procedures. (Evan Harris MP et al, New Clauses 1 & 13)

▪ Allowing nurses and midwives to carry out abortions where appropriate (Frank Dobson MP et al, New Clause 2 & 14)

▪ Allowing abortions to be carried out in GPs surgeries and Family Planning Clinics where appropriate (Jacqui Lait MP et al, New Clauses 7 & 10)

▪ Home administration of misoprostol (the second dose of medication when undergoing early medical abortion (Christine McCafferty MP et al, New Clause 9)

▪ Preventing misleading advertising by pregnancy counselling services to require clarity in advertising where they won’t refer for abortion and don’t provide treatment (John Bercow MP et al, New Clause 11)

▪ Clarifying that the legal right of conscientious objection does not also extend to the non-provision of contraception on this ground (Evan Harris MP et al, New Clause 12)

▪ Extending the Abortion Act 1967 to Northern Ireland (Diane Abbott MP et al, New Clause 30)

Abortion, as a solution to the serious public health problem of unintended pregnancy, is very much a part of modern society. No woman ever wants, or sets out to have an abortion, but women want, and need abortion to be there as an option for them when our contraception fails, or we fail to use it effectively.

Today’s abortion services have tried to develop as best they can in spite of our out-dated law, by working to limit best practice to within its strictures. But this approach requires constant clinical compromise and it negates the needs of women in Northern Ireland entirely. Why should women and their doctors be expected to continue trying to ‘work around’ a law that is no longer fit for purpose? 

Two doctors are still required to give permission for an abortion, by certifying that an abortion would be in the interests of the woman’s mental or physical health. Everyone can agree that forcing a woman or girl to have a child that she doesn’t want, or can’t cope with will damage her state of mind. As an abortion is never more dangerous than continuing the pregnancy and birth, the physical health grounds of the Act are always met- so why the need for women to receive two doctors’ permission, which can delay them from medical treatment in their best interests?

Nurses are still prohibited from taking legal responsibility for abortions, while with appropriate training their role has expanded in all other areas of the health service. Yet in many services that provide the non-invasive early abortion ‘pill’ method at under 9 weeks, nurses already treat women, doing everything except sign the prescription and legal permissions, which must be done by a doctor in accordance with the 1967 Act. Why should women have to wait to access the nurse-led services they need, while a doctor is sought to sign off their paperwork?

Because the Act was written in the days before the abortion ‘pill’ method was developed, women having early medical abortions must also return to clinics unnecessarily to have the second part of their abortion medication administered on ‘licensed premises’ to accord with the law. They then discharge themselves to hurry home to expel the non-viable pregnancy in the comfort and privacy of their home with their partner or friend at their side. If that same woman spontaneously began to miscarry at the same gestation, good practice in the NHS is to offer her these same drugs to self-administer at home, in recognition that the medical treatment involved is extremely safe. Both scenarios can be emotionally demanding and women understandably may prefer to be in their home surroundings to experience the early end of a pregnancy. Why should the law not make this possible?

Women are still denied abortion in Northern Ireland because the 1967 Act did not extend there. Those who can afford it can travel abroad for services, but they must pay privately for them. Poor, young and vulnerable women bear the burden of not being able to access a safe, legal abortion and are known to be turning to unlicensed, often fake drugs available over the internet with no medical supervision. How can any UK citizen’s healthcare be legally forbidden, simply because of where they live?

In all these aspects, the requirements of the out-dated abortion law, framed for a different era of medicine, force women to jump through extra hoops to get treatment, or prevent them being treated according to best practice and accepted concepts of patient choice and autonomy. This Government should wear a commitment to abortion law reform as a badge of honour. It already has policies recognising- in line with the medical and nursing professions- that the earlier it is possible for an abortion to be provided, the safer and better for the woman it is and the more cost-effective for the NHS to provide. All sides of the debate can see that the current 1960’s law is no longer fit for purpose. The 22nd October offers MPs an opportunity to bring the law into line with the needs of a modern society that values women and acknowledges our need to plan our families. If this opportunity is lost, Ministers will need to explain to us how they had a once-in-a-generation chance to provide us with a modern, evidence-based abortion law and threw it away.

Ann Furedi is the chief executive of BPAS (British Pregnancy Advisory Service) and is writing in a personal capacity. BPAS, (the British Pregnancy Advisory Service) has been a registered charity since 1968, and is the UK’s leading not-for-profit sexual healthcare provider. BPAS carried out 55,000 terminations of pregnancy last year. 92% per cent of all treatments carried out by BPAS were on behalf of the NHS. Please see www.bpas.org for further information.

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 RCOG:  ‘How safe is abortion?’ http://www.rcog.org.uk/index.asp?PageID=649#safe ‘For most women an abortion is safer than carrying a pregnancy and having a baby. All medical and surgical procedures have risks, but the earlier in pregnancy you have an abortion, the safer it is.’