Conscientious objection and the ‘looming crisis’ in abortion care

A recent survey of medical students in the UK has shown that a number of those questioned would object to providing abortion care in certain circumstances. The survey’s author Sophie Strickland believes these findings have worrying implications for the future of abortion care, with fewer future doctors willing to perform terminations. Indeed the dwindling numbers of doctors opting to train in abortion services has been labelled a ‘crisis’ in terms of women’s access as this article attests.

Dr Patricia Lohr, medical director of BPAS, takes a less pessimistic view of the survey findings:

“Importantly, this study suggests that many students surveyed would perform an abortion in a variety of scenarios. For example, just under 16% stated they would not perform a termination for fetal anomaly under 24 weeks gestation, implying that the majority would perform the procedure if necessary. Similarly, less than one quarter stated they would not perform an abortion before 24 weeks for a contraceptive failure suggesting that three-quarters of those questioned would. More research on the medical student attitudes and knowledge about abortion are clearly needed.”

She notes the importance of education and training in this area:

“It’s extremely important that abortion is included in the medical school curriculum. Medical students may not currently engage much with the reasons why a woman may find herself with an unwanted pregnancy and the decision making process women undertake when determining whether to continue or terminate a pregnancy. Abortion is the most commonly performed gynaecological procedure in the country. Regardless of whether a doctor specialises in this area or not, they will during their career come across many women facing an unintended pregnancy and considering abortion.”

The issue is not just with having fewer doctors willing to perform the procedure but also a lack of wider professional support for women’s right to choose abortion. Similar surveys of GPs have shown that almost a quarter refuse to refer women for abortions. (This form of conscientious objection is protected by the General Medical Council guidelines which state that a doctor has a right to refuse referral but is obliged to pass the patient on to a supportive colleague.)

Some doctors have religious or moral objections to abortion, others simply wish to specialise in areas of medicine with more prestige or social support but clearly there is an issue with the numbers willing to refer for or provide abortion versus the number of women requiring terminations. If we look to the States, where abortion doctors have been harassed and even killed for providing medical services we can see a resistant pro-choice medical movement which refuses to take the stigma and abuse lying down. Groups like Medical Students For Choice have been set up to encourage medical students to engage with the importance of reproductive health care and the potential erosion of vital services. Activist groups like Abortion Gang and I Am Dr Tiller write passionate blogs affirming the essential work abortion providers do. At a time of rising anti-choice sentiment in the UK perhaps it’s time we too started to see this work as not only essential but also laudable.