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A woman’s right to choose

Forty years since the Abortion Act

THE 1967 Abortion Act, which legalised abortion on social grounds as well as purely health grounds, was 40 years old on 27 October this year. The act, introduced by David Steel, then a Liberal MP, was a big step forward in women’s struggle for reproductive rights. Its introduction was a testament to the determination of the labour movement women’s sections and other campaigners for women’s rights to end the suffering caused by illegal, ‘back street’ abortions.

The Abortion Act was passed for England, Scotland and Wales at a time of economic boom when women were starting to work outside the home in greater numbers, and were growing in confidence and demanding recognition of their role and rights within society. This same process gave rise later to legislation on equal pay and sex discrimination. Although the wording of the act is pretty restrictive, in practice it allowed abortion on social grounds. In other words, factors such as inadequate housing, domestic violence, poverty and family stress could be taken into account in allowing a woman to terminate her pregnancy.

This anniversary is an excellent opportunity to restate the importance of reproductive rights, to acknowledge what a huge step forward the 1967 act was, but also to examine its shortcomings. Most battles on abortion over the past 40 years have been defensive ones – holding the line against attempts to whittle away hard-won rights however imperfect they are. This autumn, the new Human Tissue and Embryology Bill will be debated by parliament and, predictably, anti-abortion groups intend to use this to introduce amendments reducing abortion time limits from 24 weeks to 18, 20 or 22 weeks.

Currently, the Abortion Act 1967, as amended by the Human Fertilisation and Embryology Act 1990, says that an abortion can be carried out in England, Scotland and Wales (not Northern Ireland) if two doctors agree that the woman is less than 24 weeks pregnant, and if continuing with the pregnancy would involve risk to her physical or mental health greater than if the pregnancy was terminated. There is no limit if the woman’s life is in danger, if there is a risk of grave harm to health, or (since 1990) in cases of foetal abnormality.

For the first time, eleven pro-choice organisations, including Marie Stopes International and Abortion Rights, grouped under the heading Voices for Choice, are taking the initiative and lobbying for positive amendments. These are to extend the act to cover Northern Ireland (currently 7,000 Irish women are forced to travel to the UK for a termination), to remove the need for two doctors’ certificates to approve an abortion, at least in the first 13 weeks, and to allow nurses to carry out terminations in the first three months of a pregnancy.

The current need for two doctors’ signatures causes unnecessary delays. In Sweden, for example, where abortion is available on request on any grounds up to the 18th week of pregnancy, 95% of terminations are carried out before the twelfth week of pregnancy, compared to 89% here. Research and statistics show that earlier abortions are safer and less traumatic.

The current law also leaves women vulnerable to the personal beliefs and prejudices of the doctors. A recent National Abortion Campaign survey found that nearly a quarter of GPs think that abortion should not be available on the NHS. Interestingly, the British Medical Association (BMA) supported removing the need for two doctors’ signatures at their last conference. These changes, if passed by parliament, would bring about for the first time a woman’s genuine right to choose and would bring Britain into line with 50 other countries containing nearly half the world’s population that have this right.

The Voices for Choice initiative is very welcome and we should ensure that a campaign is taken into the trade unions, universities and colleges, and in the community generally, so that the issues can be discussed and explained fully.

But, as we know only too well, legal rights are only half the battle. One of the biggest problems of the 1967 act was that it did not make provision for extra NHS funding or facilities for abortions. Women seeking a termination face the problem not only of whether their GP is pro- or anti-choice, but whether their health authority will fund an abortion. NHS statistics show that 98% of abortions are funded by the NHS in Scotland, 86% in Wales, but only 74% in England. To put it another way, a quarter of women in England have to pay privately for their abortion.

Within England there are wide variations in availability from region to region. London is particularly bad, with only 64% of abortions on the NHS. There is a desperate need for proper funding and expansion of abortion facilities so that women do not face the current ‘abortion lottery’ depending on where they live, and to ensure that they do not face unnecessary and often traumatic delays due to staff and bed shortages.

One of the worries expressed by abortion rights campaigners is that many women in their 20s may now take abortion rights for granted, that there might be an element of complacency among the ‘post-feminist’ generation who have grown up after the major legal reforms of the late 1960s and early 1970s. However, a positive campaign to extend abortion rights could get a very good response from many young women. This should go alongside campaigns for better access to safe and reliable contraception and the ‘morning-after pill’, but also for flexible, affordable childcare for young women, including students, and replacing loans with living grants, so that continuing with a pregnancy is an option also.

It is worth looking at what life was like before the 1967 act, when abortion was illegal, as this is where anti-abortion organisations like SPUC, LIFE and the Pro-Life Alliance want us to return, and this is the reality for many millions of women worldwide who do not have access to safe, legal abortions.

Opponents of abortion rights talk as if abortion did not happen in this country before 1967. Nothing could be further from the truth. An estimated 100,000 abortions a year took place in the years leading up to 1967, the same as in 1971, four years after legalisation. These illegal abortions were usually carried out by (sometimes well-meaning) unskilled people under unhygienic conditions, and thousands of women each year died or were left with permanent health problems after suffering haemorrhaging or infection from a ‘bodged’ abortion. Many were too scared to seek medical attention as they risked prison by doing so.

Millions of women worldwide still face these risks in countries where abortion is banned or severely restricted. The World Health Organisation (WHO) estimated in 2005 that there are 46 million abortions carried out worldwide in a year. Twenty-six million of these take place in countries that have liberal abortion laws and 20 million where abortion is restricted or illegal. It is in the countries where abortion is illegal that the majority of the 80,000 deaths a year occur from unsafe abortions.

Attitudes towards abortion over the last 40 years have become more tolerant, in line with social attitudes generally, such as views on lone parents, divorce, gay rights, etc. Most recent opinion polls show a majority support for the right to choose. Given that, according to the Royal College of Obstetricians and Gynaecologists, an estimated one in three women will have an abortion by the age of 45, this is perhaps not surprising. However, anti-abortion lobbyists have been on the offensive in the last year or two, using their seemingly limitless financial resources to fund high-profile legal cases and send their media machines into overdrive. SPUC, LIFE and the Pro-Life Alliance (PLA) oppose abortion under any circumstances, including if a woman is pregnant from being raped. Realising that only a tiny minority of people agree with them that abortion should be outlawed completely they have targeted what they consider are ‘weak points’, such as late abortions, abortions for foetal abnormality and so-called ‘lifestyle choice’ abortions.

Late abortions (20 weeks or later) make up less than 1% of the total number of abortions and this rate has stayed the same for the last 20 years. In many cases, these are the most vulnerable women, those with mental health problems or learning disabilities, teenagers who are scared and ignorant about their bodies, victims of incest or domestic violence. However, some women ‘leave it late’ to seek a termination because they simply do not know that they are pregnant. They may be menopausal, have an IUD fitted or be on the pill, having regular ‘bleeds’ with no obvious signs of pregnancy until they are quite well advanced. Sometimes, even when a woman goes to her GP early on, because of the need for two signatures, staff or bed shortages and admin delays inherent in an internal-market NHS, she can end up having a late abortion. The government target is that no-one should wait longer than three weeks for a referral but many wait five weeks or even longer.

The argument for reducing the time limit has centred on viability of the foetus, because survival rates of premature babies at 24 weeks have increased (although they are still unfortunately low at 26%). This was the argument for reducing the limit from 28 weeks in 1990. However, the ‘cut-off’ point for abortions is actually more like 22 weeks because doctors usually allow a two-week ‘margin of error’ to ensure that they do not fall foul of the legal time limits. Any attempt to reduce the time limit will not significantly reduce overall numbers of abortions, 99% of which take place before 20 weeks, but will have a devastating effect on the individual women who are forced to go through with unwanted pregnancies.

Abortions for foetal abnormality only account for 1.6% of total terminations, but they are often later because testing for many of the most serious, disabling or life threatening conditions is not generally available on the NHS until 16-18 weeks and confirmation via amniocentesis is generally at 20 weeks.

The issue of ‘foetal abnormality’ hit the media last year, when Pro-Life Alliance member Rev Joanne Jepps applied for a judicial review of a decision by doctors to agree to terminate a pregnancy on the grounds of a cleft palette, post-24 weeks. She argued that this was not disabling enough to fit the criteria under the Abortion Act. In fact, no-one but the doctors and the woman concerned knows the extent of any potential disability. The legal action did not succeed and the doctors were vindicated (having faced police questioning after the matter was referred to the Crown Prosecution Service). However, following this case, doctors and support staff may be more reluctant to perform late abortions, fearing legal action or press hounding.

Women who find out that their baby will be born with a disabling condition should have access to all relevant information and support and, of course, should not feel pressured into having an abortion. Every woman should have the right to choose when and whether to have children. No matter what a woman’s circumstances are, she should have the right to decide whether to continue with her pregnancy. But too many women do not face a genuine choice under the present system.

We campaign for a minimum income for carers and disabled people that reflects the real cost of living, for decent affordable housing and childcare, for accessible public transport, for properly funded social services and respite care. After more than ten years of New Labour government, however, having a child still often leads to poverty and social exclusion, and this is even more likely if you have a disabled child.

We need to fight any attempts to restrict our already limited choices, and to raise our sights - not just on legal rights to abortion, but to campaign for public funding for all abortions, and for a massive increase in resources to the NHS. More than that, we need to change society so that we can use the resources we have to build an economic, social and political system that allows us a genuine choice about when and if to have children, one that enables us to bring up children free of poverty.

Eleanor Donne