Tuesday 29 March 2011

Why Field and Dorries are wrong

Nadine Dorries and Frank Field will propose an amendment to the Health and Social Care Bill to ensure that women receive pre-abortion counselling from someone who does not ‘have a financial interest’ in providing the abortion.

In an interview on LBC radio on Friday evening (no link possible as it's subscription only) Dorries laid bare the assumptions behind this amendment. An interview with Michaela Aston of LIFE showed how eager anti-abortion organisations would be, in the event it became law, to exploit it for their own ends.

Assumption 1: Women seeking abortion all need Counselling (big C)

In fact women considering abortion all need different levels of support to ensure they are making the right decision.

At one end of the spectrum you will encounter women who have always been clear that they do not want to be pregnant and that they would have an abortion in the event of pregnancy. When they experience pregnancy this certainty remains and they are able to make a quick and unambivalent decision to end the unwanted pregnancy.

At the other end of the spectrum are women who are carrying wanted pregnancies, but whose health, circumstances or other factors mean that the continuing the pregnancy now carries serious risks for them. This may present an excruciating decision for the woman and she may require a great deal of professional and family/partner support during this time.(Antenatal Results and Choices – ARC – provides excellent support for women who have been given a diagnosis of fetal anomaly)

In between these two ends of the spectrum women experience the dilemma of unintended pregnancy in a range of ways. Some have sufficient support around them to have the conversations they need to have and to do the thinking they need to do about the pregnancy before they even reach a healthcare professional. Others may present to a healthcare professional needing either more clarification of health issues or additional support with decision-making.

‘Counselling’ with a BIG C may be useful for a woman who presents with a range of complex emotional problems, when pregnancy has brought pre-existing and unresolved problems to a head, when she is particularly conflicted by the decision, or when a health care professional is anxious that they sense deep-seated ambivalence about the choice she is making. Counselling may be experienced as overkill by women in more settled situations.

Women’s circumstances are all unique, and their knowledge levels, support systems, age, confidence and other personal characteristics will all impact on the difficulty or otherwise of making the decision. Women seek help, support and advice from a range of people other than health care professionals and may well have done absolutely all their thinking before they go to their GP to ask for an abortion referral. Ideally flexibility and responsiveness from healthcare professionals and organisations should provide women with the level of support they choose and need. (see EFC Best Practice Tookit: Pregnancy Decision-Making Support for how best to support teenagers)

Assumption 2: Women who get an abortion from an independent abortion provider such as bpas and MSI do not get sufficient counselling or accurate information about risks because those organisations have a vested interest in pressurising women to have an abortion

No healthcare provider wants a woman to undergo an abortion she feels ambivalent about. Abortion services traditionally have a relatively high ‘did not attend’ (DNA) rate because women are reassured that they can change their mind at any time and some do. Moreover, BPAS calculates that 20% of women referred to them for abortion - having used their consultation appointment to reflect again on their decision - choose to continue their pregnancy.

The idea that they have a vested interest in women having abortions is linked solely to the fact that they are paid for the abortions they carry out. It is an undeniable fact that, like brain surgeons, GPs, dentists, opticians and all other health professionals, abortion providers are paid to do the work they do. They are professionals not volunteers...

Like all health providers, abortion providers are obliged to ensure informed consent by outlining risks and side effects of procedures. This is the same for people providing abortions in NHS hospitals, in independent non-profit providers such as bpas and MSI, and in Harley Street. In fact, abortion is highly regulated in non-NHS settings.

Assumption 3: The Royal College of Obstetricians and Gynaecologists which produces the guidelines for professionals providing abortions are not the appropriate body to do so because they too have a vested interest in promoting abortion.

The idea that the RCOG wants to promote abortion is, quite frankly ridiculous. The RCOG is engaged in developing and disseminating best practice across a wide range of areas relating to women's health, including: pregnancy and childbirth, maternal health, treatment for obstetric and gynaecological conditions and more. Abortion occupies a fraction of its attention.

The RCOG guidelines are evidence-based. They draw upon methodologically sound studies from around the world and UK experience to inform their conclusions and recommendations.

Abortion providers are included in the committee that creates the guidelines for professionals because it is normal practice to include medical experts on panels providing guidelines on a specialist area of medicine.

Assumption 4: Anyone who is not an abortion provider will give better support and information for women because they do not have a vested interest in ‘making’ a woman have an abortion

Some GPs will be able to provide good quality information and support with decision-making. In fact many women already go via their GP for an abortion referral and some will be getting information about abortion at that point. However, a significant number of GPs (at least one in 20% of GP practices) actively opposes abortion and may use their right to conscientiously object as licence to refuse to give accurate information and impartial support to a woman seeking abortion. This fact cannot have passed by the supporters of the amendment.

This amendment is part of a wider bill which is about giving GPs the power to decide on how much of the NHS budget will be used, it seems unlikely they will consider spending proper time counselling women about abortion the best use of their resources.

The anti-abortion charity LIFE's response to this amendment (via Aston on LBC) was little less than a licking of lips. Anti-abortion charities may well see this as an opportunity to 'help' GPs out by offering with their own particular brand of counselling via Crisis Pregnancy Centres.

Most independent pregnancy advice organisations or Crisis Pregnancy Centres (CPCs) originate from organisations that are very anti-abortion. While many different organisations run these centres and their practice varies enormously, the bottom line is that most people working for these organisations believe that abortion is at worst a moral abomination and at best harmful. Some are guilty of deliberately misinforming women about the risks of abortion, others of convincing women to continue unwanted pregnancies. There may be examples of CPCs that provide impartial, evidence-based advice and guidance, but as they are totally unregulated it is hard to know which of them do and which of them don’t.

No comprehensive study of Crisis Pregnancy Centres has been carried out in the UK, but this Channel Five news feature shows examples of particularly poor practice:

This report on CPCs from Ireland suggests they are not a reliable source of information

This report from United States outlines the many ways in which CPCs deceive women

This is an extremely ideologically driven amendment. Dorries admits its purpose is to reduce the number of abortions. It is probably just the first of a planned programme of legislative attacks on women's right to choose and access safe, legal abortion.
This is why we oppose these amendments.

Hoping that GPs will step up to provide good quality counselling around abortion is either extremely naive or extremely cynical. Encouraging women to attend (or even insisting they attend) counselling at a separate provider, and bypassing central booking systems, will increase the time it takes to access an abortion. Creating unnecessary delays for women is unethical as abortions are safer the earlier in pregnancy they are carried out.

GPs are likely to mitigate the additional costs of providing this counselling by relying on voluntary organisations like CPCs (see above) who may have the funding to provide this free of charge.

It is unlikely that full funding for professional counselling will be mandated in the bill or that Field and Dorries will call for proper regulation of those providing abortion counselling in Crisis Pregnancy Centres.

It is unlikely any provision will be made to protect women from 'conscientiously objecting doctors'

This amendment is not about improving health outcomes for women, but is an attempt to dissuade women from accessing abortion, and obstructing those who do want to have one.

By casting doubt on the integrity of the Royal College of Obstetricians and Gynaecologists this amendment aims deliberately to undermine a really important source of evidence-based information - information they would rather the public didn't access, as it does not support the anti-abortion case.

There are more effective and more ethical ways to try to reduce the abortion rate than making access more diffcult and time-consuming, or giving women misinformation about the consequences.

If Nadine Dorries and Frank Field’s main aim is to stop women having abortions wouldn’t they be better off putting in an amendment to the health and social care bill that guarantees funding for all women to have easy access to the full range of contraceptive methods, including the three methods of emergency contraception, free of charge, seven days a week and at a range of outlets?

Wouldn’t they be better supporting calls for statutory, comprehensive Sex and Relationships - teaching young people about fertility, contraception, emergency contraception, pregnancy decision-making and encouraging them to think about the risks, benefits and consequences of sexual relationships?

Only today news came out that in the UK there are many preventable deaths of pregnant women each year from pre-eclampsia as a result of lack of investment in maternity services. If you really cared about women wouldn't this be the issue you might choose to campaign on?

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