Too many abortions?

David Steel is rightly credited with introducing a breakthrough Bill to legalise abortion in 1967 which took away the horror of women dying in backstreet procedures and helped to liberalise attitudes towards sexual freedom and a woman's control over her body. Today he gave a worrying interview to the Guardian in which he suggested that everybody could agree "there were too many abortions" and that women were using abortion as a form of "contraception" - an argument which is made more often by writers in the Daily Mail.

While it could be argued that there are too many "unnecessary" abortions, it's difficult to know what number might constitute an acceptable or expected level of abortion. In the year following the Abortion Act, 55,000 abortions were undertaken. That figure has now risen to 193,700 in 2006, a 4% rise since 2005. A number of sexual health charities have suggested some of the increase could be due to Eastern European migrants. Others have blamed cuts in provision of contraception and sexual health advice for the increase.

What is clear is that there are still too many barriers to early abortion and we should be trying to break them down rather than turning up the moral indignation or putting the blame on women's "irresponsibility". The first barrier, which Lord Steel raised in his speech today to the Global Safe Abortion Conference, is the need for two doctor's signatures to allow an abortion to proceed. There is no reason why one doctor cannot give consent as is the case in all other operations. The only other situation that I know of where the consent of two doctors is required is the compulsory admission of a mentally ill patient to hospital.

The second barrier which should be overcome is the need to prove that not terminating the pregnancy would "involve risk of injury...to the physical or mental health of the pregnant woman". It is demeaning for women to have to pretend their physical or mental health might be harmed by the continuation of pregnancy, when in fact there may be any number of reasons why giving birth and taking on the responsibility of another human being may not be a good idea. Women should be able to ask for an abortion within the time limit on the basis of their own decision about their best interests.

The third barrier is the number of GPs who feel as though they can appeal to their own moral compass, rather than stick to the guidelines of their profession which requires them to refer women wishing to have an abortion on to those who can give impartial advice and counselling. Stronger guidelines should be issued to GPs about the seriousness of making judgments on the basis of their personal rather than professional opinions, and checks should be made on the provision of advice by GPs by mystery shoppers to see how widespread the problem is.

Another barrier is the lack of access to the morning after pill. An article written by Ellie Levenson described how women have to lie in order to access the pill, and yet arguments to allow women to keep a stock of the pill are batted away on the grounds that it would make women take even more risks with their contraception. The anti-abortion lobby can't have it both ways - if they think there are too many abortions taking place, there has to be greater access to ways of preventing unnecessary abortions in the first place.

And finally we need to stop arguments which suggest that women are using abortion as simply another form of contraception. First, this trivialises what is an incredibly difficult decision, and a medical procedure which can hold risks particularly at the later stages. Second, this assertion could actually lead to women thinking that abortion really is available at the drop of a hat. As many providers will tell you, there aren't any waiting list targets for women waiting for abortions and it can often take a number of weeks to be provided with one. Some women miss the abortion time limit altogether and are faced with an unwanted baby, or a journey to another country with more relaxed rules. Current debates risk forgetting the important steps made forward in the interests of women's health and sexual freedom - we can rage about the viability of unborn babies at 24 weeks, but these questions only affect a small proportion of women every year. Many more face barriers at the start of their pregnancy and that is where the debate really ought to be focused.

Comments

[Graeme Kemp]

A "acceptable" level of abortion would be a low one!

Far from breaking down barriers to accessing abortion we should be putting a few more up, at least in the UK. Too many abortions are not really carried out because of a threat to the physical or mental health of the woman. And that's wrong. I hope many more G.P.s get in touch with their moral "compass".

We need to focus a bit more on the rights of the unborn child.