An imaginary abortion crisis?

Have English abortion clinics succumbed to FUD?

In April, 2007, the Independent carried a story, Abortion crisis as doctors refuse to perform surgery, based on a press release by the Royal College of Obstetricians and Gynaecologists (RCOG) and a statement by Ann Furedi, chief executive of the British Pregnancy Advisory Service (BPAS), which performs a quarter of all abortions in England, that “There is a real crisis looming. Unless we can address the problem and motivate doctors to train in abortion, we may well face a situation in five years’ time in which women’s access to abortion is severely restricted. It is our biggest headache.” The RCOG has no central figures for physicians refusing to perform abortions but cited “anecdotal reports” in support of the notion that an increasing number of its members were refusing to perform abortions on conscientious grounds, and an increasing number of abortions were being carried out in private clinics because of this.

In UK law a doctor has always had the right to refuse on religious grounds to terminate a pregnancy.  In the 1990s the RCOG introduced a “conscientious objection” clause into its guidelines.

In May this year, the warning of a crisis for the National Health Service (NHS) was taken up in the tabloid Daily Mail, which said: “NHS doctors are refusing to carry out late abortions, forcing hospitals to contract them out to private clinics and charities. Growing moral objections mean three quarters of the 7,000 terminations carried out after 17 weeks of pregnancy are outside the Health Service.”

But is this crisis real?  Not so, says Wendy Savage, gynecologist and coordinator of “Doctors for a Woman’s Choice on Abortion“, a group set up in 1976 to campaign for a change in the law to allow women to have an abortion on demand.  With figures from official government sources and others gathered by Savage and Colin Francome in 1989 and 2008, she argues that it is not true that an increasing proportion of late abortions are being carried out outside the NHS.  She points instead to an increase of 25 per cent of late abortions funded by the NHS.  There has been a shift to such abortions being carried out in the charitable sector, which she says “is recognised to be good for women”.  In 1988 77.8 per cent of women had to pay for their late abortion (20 weeks or later) whilst in 2006 the figure was down to 10 per cent, “which”, she suggests, “is probably about twice the proportion that would choose this option.”  There has been no significant change in the proportion of women having late abortions being cared for directly by the NHS.

Furthermore, she argues, the talk of an increase in doctors avoiding abortions because of conscientious objections is not born out by her figures.  Her analysis here is quite complex and finds a wide difference in attitudes of NHS gynaecologists from region to region–she argues is the reason why the move from NHS abortion provision in-house to provision by charities was a good one because it smooths out the “post code lottery” effect.  In the North East 93 per cent of all abortions are carried out in NHS hospitals.  In the West Midlands, the figure is 11 per cent.

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