Abortion – the real issues
Abortion – the real issues |
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The workshop on Abortion was one of the parallel sessions held during the 4th Annual Teesside Sexual Health Conference. The conference took place on the 15th of March 2003. More than 50 delegates that included general practitioners, sexual health practitioners, GU physicians, public health directors, gynaecologists, counsellors, nurses, social workers and sixth form students attended the session. The background to the enactment of the Abortion Act in 1967 was explained. The alleged number of illegal abortions was used as a reason for legalising abortion in Britain. Before legalisation, pro-abortionists claimed that there were 200,000 illegal abortions each year and between 30 and 50 women died annually following abortion [the figure of 100,000 –200,000 abortions annually turned out to be exaggerated]. The Church and pro-life lobbyists mounted a great opposition to the bill. The church accepted that the Christian moral and legal tradition recognises implicitly that there are circumstances in which the killing of the unborn child does not come under the general condemnation attached to murder. There was mounted opposition to the bill but nonetheless, the bill was passed by 167 to 83 votes. Royal Assent was given on 27th October 1967. The current legislation allows a woman to exercise the right to have an abortion up to 24 weeks gestation provided two medical practitioners agree with the request.
Statistics
More than 5 million abortions have been procured since the enactment of the 1967 abortion act. There has been a rise in abortions from 108,565 in 1972, 173,900 in 1990 to 186,200 abortions in England and Wales in year 2002. In Scotland, 11,995 abortions were carried out in 2002. Induced abortion is the second most common procedure in the Scottish NHS gynaecological workload, accounting for 12% of inpatient plus day case
discharges.1
Reasons for abortion
Thirty-six years on, over 70% of abortions carried out are for social reasons, a reflection of society’s acceptance of abortion. Although more than 90% of abortions are certified as being done to safeguard the mother's physical or mental health, it is widely recognised that the majority of these abortions are actually performed in response to social reasons rather than medical problems. This is in contrast to the original reasons behind the enactment of the abortion act. Abortion in Britain is effectively practised on demand with the right to choose safeguarded.
Ethics of abortion
There is an on-going controversy as to the morality of abortion. Pro-life lobbyist and the Church argue that abortion denies the most basic of human rights, the right to life.
Abortion has not solved social problems, such as unstable relationships, poor housing and financial insecurity that lead women to seek to have
abortions.2
The participants explored the ethics of abortion and came to the conclusion that within the current legislation the pregnant woman has the ultimate decision
Provision of service
The delay in accessing the service was highlighted during the workshop and this makes decision-making harder. Areas of delay in both primary and secondary care are being improved. Utilisation of non-NHS providers has helped reduce the waiting time. Out of the 175,952 abortions performed in England and Wales in 2001, fewer than 50% were provided directly by the NHS, about 33% through agency agreements under contract with the NHS and less than 25% privately
funded.2
Methods of Abortion
Early Medical Abortion 1 to 9 Weeks
This is a relatively new method of abortion and is an alternative to the surgical termination. The process is carried out through the intake of Mifegyne (RU486) an antiprogesterone. A second visit is made to the clinic or hospital two days later during which a prostaglandin pessary is placed in the vagina. This results in uterine contractions, bleeding and eventual abortion of the fetus within six hours.
Surgical Termination of Pregnancy
(a) Vacuum Aspiration
This surgical suction procedure is often carried out between 6 and 15 weeks. It is carried out under general anaesthetic and usually as a day-case. The cervix is dilated and the products of conception evacuated through a cannula.
(b) Dilatation & Evacuation 15 to 20 Weeks
This operation requires a general anaesthetic. The cervix is gently opened using metal dilators. The pregnancy is then removed using surgical instruments.
(c) Medical Induction 15 to 24 Weeks
This is carried out using a prostaglandin pessary that is inserted into the vagina. This ripens and softens the cervix. Uterine contractions ensue and the pregnancy is aborted within 6 to 12 hours. If the uterus is not completely emptied it may become necessary to evacuate the retained products of conception surgically.
Consequences of abortion
Abortion no doubt leaves mental and physical scars on the woman. The role of counsellors and psychologists in supporting women faced with an unplanned pregnancy was discussed. Consensus was reached on the importance of non-judgemental counselling and the exploration of all issues to assist women in making an informed choice.
Alternatives to abortion
There is no doubt that an unplanned pregnancy creates emotional turmoil. Emphasis should be placed on the prevention of events necessitating abortion. The role of the male partner in sexual health matters was discussed and the session advocated that men take more responsibilities in the prevention of unwanted pregnancies.
The workshop was of the opinion that more efforts should be directed to the prevention of unwanted pregnancy. This should include sex health and sexual relationship education in schools and easy access to contraceptive services. National recommendations advocate that abortion care should include the provision of contraceptives and the prevention of subsequent
abortions.3 Adoption as an alternative to abortion was discussed.
Abortion is an emotional issue. Sexual health strategies should be directed at reducing the incidence of abortion. Sexual education and easy access to contraception are important factors in reducing the need for abortion. The liberal abortion legislation will continue to generate passionate debate and this should be welcome.
The proceedings of the workshop were fed back to the plenary session
Helpful resources
Pregnancy Crisis and Post Abortion (PCPA) CARELINE, a national free phone help line for those facing the need to make a decision on abortion or experiencing problems following an abortion. (Telephone 0800 028 2228)
References
(This was part of the workshop on Child sexual abuse which R. Jaiyesimi acted as the facilitator during the 4th Teesside Sexual Health Conference on 15 March 2003)
©2001 Sexual Health Matters. Published Quarterly by Express Print Works, Middlesbrough,
UK
ISSN 1469-7556
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