Tuesday, May 20, 2008

Abortion Limit in Balance as Divide Deepens

This article appeared in the Observer on Sunday May 18 2008
By Robin McKie and Denis Campbell

A group of MPs is seeking to cut the current abortion time limit of 24 weeks.

Kate Guthrie lacks no experience in dealing with abortion. For two days a week, the consultant gynaecologist talks to pregnant women. Many are frightened by their condition and each highly-charged appointment takes a considerable amount of her time.

On two other days, Guthrie performs abortions on those women who elect to end their pregnancies. Those who are less than nine weeks' pregnant are given the abortion pill, while those between nine and 14 weeks attend Hull Royal Infirmary - where Guthrie is based - as day patients for a termination. Those beyond 14 weeks are referred to the British Pregnancy Advisory Service, which performs later terminations on women up to 24 weeks pregnant. In 2006, a total of 911 women in Hull had abortions in one of these three ways.

'Women of all ages and social classes end up needing an abortion,' Guthrie says. 'In Hull, girls of 14 and women of 47 have had them. An abortion is the net result of something that's gone wrong. That could be a woman's contraception failing or because they've had unprotected sex, sometimes as a result of risky behaviour after alcohol or drugs have reduced their inhibitions, or because they've been coerced into sex by a man. Men have a part to play in this as well. Women say "Will you wear a condom?", and some men say no and cajole the woman into having unprotected sex.'

Such stories are repeated across Britain every year. In England and Wales in 2006 a total of 193,700 abortions were carried out, against 186,400 in 2005. Some politicians and religious groups believe this is unacceptable and say it is time to put a stop to such increases.

As a result, parliament will this week debate a series of amendments to the Human Fertilisation and Embryology Bill which are aimed at reducing the number of abortions carried out in Britain. This would be done by cutting the current abortion time limit from 24 weeks to 22, 20, 18, 16 or 12, according to each amendment. Most analysts expect the 22-week option has the best chance of success. By making it more difficult to have late abortions, figures will drop, they argue.

'We have reached the point where we need to pull back on abortion,' says Conservative MP Nadine Dorries. 'If we don't, we will overtake America in a couple of years, making us the abortion capital of the world.'

The argument is also based on the viability of foetuses around the 24-week period. Science has made great strides in improving the age at which premature babies can be kept alive, from 28 to 24 weeks over the past 20 years. These advances are used by campaigners to argue that abortion times should be cut. Society should not terminate foetuses at ages when they can be kept alive outside the womb. And as medicine progresses, and foetuses are kept alive at lower ages, abortion limits should be dropped even further, it is argued.

It is not a view shared by the scientific community, however. Research shows that 24-week viability limit has not changed in recent years. While 67 per cent of babies born at 25 weeks survive to go home from neo-natal unites, only 26 per cent survive if born at 23 weeks. Scientists have reached a limit below which they cannot keep a baby alive and ensure it has an unimpaired life. Nor is this limit likely to improve.

In addition, doctors are horrified by the prospect that the HFE bill is to be used as the means to reduce abortion time limits in Britain. 'People think abortions are what little girls or feckless women have, and that's just not true,' says Guthrie. 'For some women their circumstances are such that the only solution for them, after heart-searching, is to turn to abortion. To patronise women this way is treating them as if they are not capable of self-determination and decision-making, which is not credible in Western society today.'

Doctors point out that many women only discover their unborn baby suffers from a serious congenital condition when they go for their second ultrasound scan at 20 weeks. At present they still have four weeks before reaching the abortion time limit and have time to talk to experts and their partners before making a decision about termination. Cut the limit, as some MPs wish, and that option will disappear.

It is a point demonstrated by freelance journalist Karen Dugdale, who discovered in 1999 - when she was 20 weeks pregnant - that her baby had spina bifida. 'I was told that, at best, our child would have a range of handicaps that would restrict mobility and cause ongoing bladder and bowel problems, and at worst the outcome would be paralysis and permanent brain damage. In this instance, the chances of survival beyond early childhood would be slim and quality of life seriously impaired.'

Karen elected to have an abortion, a decision that caused her heartache but which she still feels was correct. 'No woman would ever want a late abortion,' she says. 'But it is our choice and it would be fundamentally wrong of parliament to take away that right for a few, often very desperate, cases each year. It would show society was regressing.'

Her views are backed by statistics. In 2006, 89 per cent of abortions were carried out on women who were less than 13 weeks pregnant. By contrast, only 1.45 per cent were carried out on women more than 20 weeks pregnant. Yet it is the latter group who will be affected by the proposed time limit changes, not the former. So the prospects of cutting abortion numbers will be very limited.

More to the point, women in the late stages of pregnancy are the most vulnerable of all those who might want an abortion. Apart from the women whose scans reveal abnormalities missed by previous investigations, they include many other heartbreaking examples, as revealed by the British Pregnancy Advisory Service: the teenager who reacted to pregnancy by going into denial; the woman who discovered, late in pregnancy, that her partner was abusing her other daughters; the drug addict on methadone, which stops periods so prevented her from realising that she was pregnant; and the woman who continued to have period-like bleeds throughout her pregnancy.

In each case, termination was available. But will they be allowed it after this week's vote? Will MPs change the limit? Most observers expect it to hold, though some say there is a real risk that it could be reduced to 22 weeks. That alteration might seem relatively unimportant, but it would still cause havoc and misery, says the BPAS. 'Changes in current legislation would cause anguish for a lot of vulnerable women,' said a spokesman.

This view is supported by Jennie, who runs her own business and became pregnant not long after the break-up of her first marriage. 'I thought I couldn't have children,' she recalls. 'I had also been on the pill for a long time and my periods were disrupted. I had no way of knowing that my period was late.'

Jennie (not her real name) then had a brief relationship. 'It broke up in October, but I only realised I was pregnant in late January. It was the worst possible nightmare.' By the time she could have an abortion, she was more than 20 weeks pregnant. She was selling her house and would not have been able to hold down a job if she had had the child. She chose an abortion. 'It was not an easy decision, but I don't regret it. A lot of very remarkable people, including David Steel [now Lord Steel, architect of the 1967 Abortion Act], made it possible for me to have that abortion. Now these MPs want to take that right away from other women in my position. That would be utterly appalling.'

For their part, anti-abortion campaigners insist there must be a slowing down of abortion rates. 'I think the staggering number of abortions in Britain is something that must be looked at,' says Tory MP Iain Duncan Smith. There is a deep malaise in society, he argues, a casual disregard for the sanctity of life and the importance of family life. 'I think the real debate now is whether you curtail time limits on abortion.'

In a speech last year the Archbishop of Canterbury, Rowan Williams, said: 'The pregnant woman who smokes or drinks heavily is widely regarded as guilty of infringing the rights of her unborn child. Yet at the same time, with no apparent sense of incongruity, there is discussion of the possibility of the liberty of the pregnant woman herself to perform the actions that will terminate a pregnancy.'

But the idea that women choose abortion as an easy option is dismissed by pregnancy advisers. 'Some women say they are looking forward to a sense of relief and to being able to move on after an abortion, but others worry that they'll feel guilt, resentment, anger or regret,' says Julia Tuckey, a counsellor with the 24/7 free telephone advice line run by Marie Stopes International. 'For some women it can feel like grief or a bereavement. It's a very difficult decision that's fraught with emotion.'

In a typical five-hour shift Tuckey talks to up to eight women. At least one is usually under 16, while her caseload often includes a woman whose pregnancy has revealed her partner to be unsupportive or, worse, violent. She also counsels women who either already have children and were not planning any more, or have to consider a wider range of factors and people than a single or childless woman. Abortion dilemmas are rarely straightforward.

Sometimes a partner is supportive; sometimes not. Some parents give their daughter their backing, others throw them out. 'Last week I had two girls, both under 16, both of whose parents decided to support them whatever they chose to do. One had an abortion and one's having the baby,' said Tuckey.

The danger of changing the law, says legal expert Professor Emily Jackson, of the London School of Economics, is that women denied abortions in their own country would simply go overseas to get them. 'That would only be an option for the well-off, of course,' she added. 'For women who couldn't afford that, those who are on drugs, for example, that would not be possible. Then we would have to face the prospect that these women would try to do something themselves to halt their pregnancies.'

It is a point backed by Jennie: 'There would be a real danger we would return to the days of back-street abortionists and women bleeding terribly, alone and frightened, in a flat somewhere. I'd hate us to return to those days.'

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