Why and When Women Have Abortions

A well written editorial by Wendy Savage in the Guardian should be required reading across the globe for anyone who needs or wishes to understand the reality in which women make reproductive choices.

Savage wrote the piece in response to comments by Jeremy Hunt, Britian’s newly appointed secretary of health, who wants to lower the abortion limit in that country from 24 to 12 weeks.

Jeremy Hunt, the newly appointed secretary of state for health, has unwisely shown his bias against the legal abortion limit laid down by the1967 Abortion Act and amended by the 1990 Human Fertilisation and Embryology Act. He told the Times in response to a question about when life begins: “Everyone looks at the evidence and comes to a view about when they think that moment is and my view is that 12 weeks is the right point for it.” It is hard to understand what evidence he has read that leads him to the bizarre conclusion that the limit should be reduced to 12 weeks.

Savage challenges Hunt’s assertion that the evidence supports his views by first showing us how the current limit of 24 weeks in the UK was decided –  based on medical science,  not personal opinion.

In 2007 the House of Commons science and technology committee published its 12th report on Scientific Developments Relating to the Abortion Act 1967. It concluded that although improvements in survival of babies born over 24 weeks had occurred since the upper limit was reduced in 1990, that was not the case for those under 24 weeks. This was based on the first Epicure study, a study of 4,000 premature babies (born from 22 to 26 weeks) treated in all the neonatal intensive care units in the UK and Eire, in 1995.

Since then the second national study of babies born in 2006 has been published and there is no significant change in the number of extremely premature babies surviving.

She explains how an arbitrary limit of 12 weeks makes no sense in the real world, where free access is not universal and where obstacles to abortion abound  – some of those obstacles within the very health system that Hunt now leads.

Some 91% of abortions now take place below 13 weeks and delays in the system have been reduced considerably, but some women still face difficulties from GPs who make them wait for unnecessary pregnancy tests or refer to a hospital consultant whom they know does not perform abortions. About a third of GPs are not prochoice and they should tell women this and refer to another partner who does not share their views but this does not always happen despite the GMCC guidance. Sometimes women are erroneously told that they are too far advanced in the pregnancy to qualify for an abortion, and younger women are more likely to accept the doctor’s view. These problems are less common today than 10 years ago.

She explains how it is that some women don’t come to their decision to have an abortion until the second trimester.

Research by Ellie Lee and colleagues published in 2007 into why women present late found that irregular periods was cited by a third, and a fifth continued having periods. A third were using contraception. In a quarter their relationship had broken down and a quarter were frightened of telling their parents. Women could give more than one reason and 41% were unsure about having an abortion and a third suspected they were pregnant but did nothing about it-possibly using denial as a defence mechanism. This shows that however good the service, there will always be women who present in the second trimester.

Finally, she tells us why the 1% of abortions that occur in later gestation will always be necessary – because some fetal anomalies, many incompatible with life, are not diagnosed until later in gestation.

Although the nuchal screening test for Down’s syndrome is available in most areas now, and allows a termination soon after 13 weeks compared with after 20 weeks when an amniocentesis was needed, other abnormalities are not picked up until the anomaly scan which is done at 18-20 weeks. Women are often devastated to learn that their planned and wanted pregnancy has not developed normally. They need time to come to terms with this and decide whether to continue with the pregnancy or have an abortion. Sometimes more sophisticated ultrasound to look at structural defects in the heart or genetic studies to see if there is a chromosomal abnormality are needed to make a diagnosis so the woman and her partner can make a fully informed decision. This all takes time and reducing the limit, as David Cameron would like, to 20 or 22 weeks would put more pressure on women and might even increase the rate of abortion at this later stage.

The one piece of evidence Savage leaves out is that limiting access will not prevent abortion, but will only serve to move it into settings where the procedure will be unsafe. The decline in maternal mortality that occurs when abortion becomes legal is undeniable. We cannot go back.

This is the real world that women and their families inhabit. 

It’s a world where not every pregnancy is planned, where not all women are in the position to determine when and how they become pregnant and where  not every pregnancy is diagnosed in time to allow for abortion before an arbitrary 12 week time limit. A world where the healthcare system actually works against early abortion, and where devastating fetal anomalies still occur and are not always diagnosable early in pregnancy.

The evidence shows that the best way to limit abortion is to increase access to contraception

And the best way to limit the gestational age at which abortion occurs is to stop trying to limit abortion in the first place.