Abortion is about public health not morality

I haven’t blogged about abortion for, oh, 3 or 4 posts so thought I’d revisit. Prompted by a great blog about the horrendous Nadine Dorries MP on Liberal Conspiracy from the Lay Scientist.

I written quite a lot about this in the past particularly at the time of the Human Fertilisation and Embryology Bill (now Act) and the activism I was involved in then (I’ll get around to posting some of that information here at some point).

This blog is going to focus on abortion as a public health issue, but I’m also working on a post about data on abortion in the UK and the oft repeated claim that ‘there are too many abortions’ which I believe is based on flawed logic. But that post requires some graph compiling so will take me a little longer. In the meantime…

I personally do not see abortion as a moral issue but primarily as a public health issue. As a medical procedure we treat it differently to any other, such as the continuing need for two doctors’ signatures which seriously undermines the concept of women’s consent to medical procedure. No other procedure puts the authority squarely with the medical profession rather than the female patient, and this is not an authority that health professionals are comfortable with and have repeatedly called for this to be changed.

Globally approximately 67,000 women every year due to unsafe illegal abortions. The deaths of women due to unsafe abortions are counted among the staggering statistics on maternal mortality where it is believed that a woman dies every minute due to reproductive related issues. The vast majority of these deaths are preventable easily and cheaply and primarily through empowering women through access to information, education and even the most basic healthcare that their predominantly developing world country can offer (99% of maternal deaths happen in the developing world).

Plus, all of these statistics are at best an educated guess because statistics on maternal mortality are notoriously terrible. The fact is that we don’t count dead women and we particularly don’t count those who have died after a botched abortion.

The best way to prevent deaths through unsafe abortion, is unsurprisingly, to offer access to safe and legal abortion. This has had a dramatic affect on the maternal mortality and morbidity stats for Bangladesh.

Not only does a restriction on access to abortion put women seeking an abortion at risk, it also regularly creates a chilling effect that prevents doctors performing therapeutic abortions for ectopic pregnancies and even from performing routine gynaecological examinations. This is most starkly apparent in Nicaragua where the complete ban on abortion has even lead the State being taken to the UN Committee against Torture on the basis of their abortion laws amounting to torture, cruel, inhuman and degrading treatment.

The chilling effect can extent to women being criminalised when they suffer a miscarriage and are accused of abortion as has been documented in West Africa (currently unpublished).

All of these examples put the UK situation into context but we also need to be vigilant against unscientific attacks on women access to health services in the UK. The attempts to reduce time limits in this country during the passage of the Human Fertilisation and Embryology Bill were based on bad science and instigated by those morally and religiously entirely opposed to abortion.

What is worse is that it would have put particularly vulnerable women at risk of being excluded from vital health services in this country. So what was the evidence?

UK Human Fertilisation and Embryology Act 2008
Forty years on from the passing of the Abortion Act, the Westminster Science and Technology Committee examined whether advances in science require a change in the law. Many advocating reducing time limits did so on the basis of “advances in medical science”. This was not however, supported by the evidence or medical establishment. (This is where in fact the Nadine Dorries story started, see Ben Goldacre’s blog on this at the time)

The British Medical Association and the Royal College of Obstetricians and Gynaecologists, neither known for their radical feminism, both submitted evidence in support of the 24 week time limit and a liberalisation of access to abortion in the first trimester (e.g. removing need for doctors signatures among other things).

So where are the medics and scientists marching in the streets asking for the law to be changed? Well, there were submissions to the Science and Technology Committee advocating time limit restrictions from medical professionals who have not declared their religious affiliations. Luckily the press can do this for us. The majority of them are activists from the Christian Medical Fellowship, an organisation which is opposed to abortion (unlike most Christians) and had made its own submission as an organisation

The scientific case hinges on the principle of the "viability" of the foetus outside the womb. It is claimed that foetuses that have been born prematurely at 24 or 22 weeks have be kept alive by ‘science’. As stated by the BMA, it is only a fraction of births at this gestation that survive, and most of those are severely disabled. A study in the British Medical Journal reiterated the point - the latest stats indicate that survival pre-24 weeks has not improved since 1995. It is also important to draw attention to the conflation between the theoretical viability of a foetus at 22 weeks and the viability of a foetus that a woman chooses to abort at this time – these are two distinct situations.

Women get a scan at 20 weeks which can show up problems with the pregnancy. Obviously we can't be certain, but it is very very likely that those being terminated at this late stage have serious problems. Let’s remember that 20 weeks is half way through a pregnancy, women would have a very good reason for going through what is a particularly invasive surgical procedure. Either the foetus is in fact not viable or these are particularly vulnerable women. Restricting their rights further is hardly the answer.

So if the evidence didn’t back up the claim that there had been ‘scientific and medical advancements”, why were we talking about time limits? Suspicions rise further when we start looking at how many abortions we are actually talking about – in England and Wales 1.5% of all abortions in 2008 were over 20 weeks (that percentage is even lower in Scotland and abortion is illegal in Northern Ireland). So we are talking about a fraction of the abortions that take place in the UK which became a lightening rod for the abortion debate.

Why? Because this is a tactic, part of a wider strategy to chip away at the right to abortion. Banning by increment. This isn't my wild paranoia; this is exactly the course of action taken by the Anti-Choice movement in the USA. Lowering time limits, reducing services, enforcing health professionals read out 'warnings' to women before a termination, 'cooling off' periods, parental consent, arguing against the licensing of drugs for chemical terminations with the regulators - all of these mount until it is effectively banned in some States and restricted to 13 weeks in others.

Abortion laws in the global North affect not only women in those countries, as Bush’s global gag rule demonstrates. Not only is this about public health and women’s access to safe and legal health services, it is also fundamental to the principle of female reproductive autonomy and about women’s rights over their own physical integrity. Women and girls are brought up in a global society where their bodies are open spaces for public debate. Where individuals believe their morality justifies a violent imposition on another female human being. I do not believe that I have the right to tell a woman what to do with her body and that is why I am a pro-choice campaigner.