Devolution of abortion in Scotland - Words to watch out for

Thanks to the marvellous Ellie Hutchinson for this brilliant guest post!

Calling all pro-choicers! In case you missed it, a potential shift of power happened in the UK this week. But as it only concerns women’s bodies, it didn’t quite get the coverage it should have done. Blink and you’ll miss it, but Scotland may take control of a women’s right to choose. Abortion law may be devolved to the Scottish Parliament. This is huge. HUGE. 

The process of this and the reasons for this have been covered elsewhere, so now we know what some of the pitfalls might be, and whilst we acknowledge that women’s bodies are yet again a political football, let’s put that aside for one moment and get cracking and get organised. We can't afford to wait for it to happen, and sit and watch our law makers debate whether or not they will make laws about our bodies and the bodies of people we love/work with/know in passing/share a sense of humanity with, we have to start lobbying now.

We know those anti-choicers are sneaky, what with their bad science, manipulation of language and their dodgy ethics (sure, why *not* force someone to continue an unwanted pregnancy as punishment. Seems legit).  As such, we need to keep a close eye on what they are saying and who they are saying it to. In other words, we need to be ON. IT.

So I present to you a handy cheat sheet of words to watch out for and my own personal responses.

Pro-life - I am pro-choice, and I am also pro life. Confusing?!!! Not at all. I really like life. I have a good, fulfilling one, with people I love and good food to eat, and music to dance to. I have a daughter who is the best person in the world and I have a rewarding job meeting interesting people. I have a partner who makes me laugh and brings me wine. Life sure is good. I love life. You know what’s the best about life? The ability to choose what I do with it. (see where I’m going with this?) It is not about life, it is about choice. We need to keep reframing the debate and repeating the pro-choice mantra “it is not pro-life, it is anti-choice” because it is- it has nothing to do with life, and it has everything to do with control. 

Anti- child - As I’ve said, I have a daughter who is amazing and the best and oh my days so cute and funny, and I have lots of children in my life. I was one once! I am not anti-child. But I am anti forcing someone to continue a pregnancy that they don’t want. To give birth when they don’t want to. To raise a child when they don’t want to. What is anti-child is forcing someone (sometimes children themselves) to live a life of punishment, of regret because of your personal interpretation of science. No. That is not ethical. It’s also not how science works.

Protecting children - I’m all for protecting children, in fact I’ve spent most of my working life working towards making the world safer for children. Whether it’s been domestic abuse, poor housing and child sexual abuse, I’ve been there banging my pro-child drum- children deserve a good life. But spoiler alert- Fetuses aren’t children. That’s why they’re called fetuses. Or embryos. But they are not children.  When an anti-choicers talks about protecting children , let’s talk about decent sex and relationships education and money towards support services. Because they are the things that protect children.

Anti-family - I may have mentioned this but I have a family. I have a toddler, a partner, parents, a sister, a large extended family, a load of sort of in-laws, nieces who are all lovely and lively, a community of friends and a cat. I am really into my family. I love family! I grew up in a family with young parents, lone parents, traditional 2.4 families- the whole shebang, and it was amazing. We all choose different paths and different ways to have and raise our families, but we are all bound by love. And the buffet table. I really enjoy a family party. Family is the heart of my life. I will always, always support my daughter and my families right to make decisions about their lives and their bodies, even if I don’t agree with it. I don’t judge them (out loud anyway) and I certainly wouldn’t expect them to make the choices I’ve made. Because that right to choose your own path, go on your own journey, with people cheering you on- now that is family, that is love. I am 100 % pro-family, 100% pro choice.

The debate in Scotland is just beginning, and we have a lot of work to do.  So even though we weren’t asked, and even though it’s come as a wee bit of a shock, let’s do this debate. If abortion is to be devolved, what do we want to see? let’s get rid of gatekeeping, let’s review women’s access to non-surgical procedures, let’s talk about women’s access to services across the country- where can people go, and how much does it cost them to get there.  Let’s get organised and let’s get focused. Abortion, as always , remains a “matter of conscience”*  so who are our friends in Parliament? What support do they need?  

There are lots of groups across Scotland working on this issue locally and nationally, so if you’d like to get involved and support the right to choose, find them on Facebook or by emailing Abortion Rights, write to your MSP and get active.

If we are to have control over our own laws, then women surely should have control over their own bodies too. 

*like any other health care issue. Oh wait

Bruce amendment on "sex selective" abortion - write to your MP!

Fiona Bruce MP has introduced an amendment to the Serious Crime Bill, which aims to outlaw so called “sex selective abortion”. Bruce’s amendment, which has been signed by a long list of MPs including many who describe themselves as pro choice, is a worrying attempt by a seasoned anti abortion campaigner (Bruce is chair of the All Party Parliamentary Pro Life Group) to undermine the right to choose.

The amendment will be debated at the Serious Crime Bill's report stage on Monday 23 February.

Anti abortion campaigners are lobbying MPs intensively, so it is vital that MPs hear the pro choice movement’s arguments about why the amendment is unnecessary – and potentially incredibly damaging. At the end of this post, you will find a draft letter which you can use to email your MP – please do contact your MP, as every letter is vital.

The wording of the amendment is:

"Termination of pregnancy on the grounds of the sex of the unborn child 

"Nothing in section 1 of the Abortion Act 1967 is to be interpreted as allowing a pregnancy to be terminated on the grounds of the sex of the unborn child.”

A review by the Department of Health in 2013 into sex ratios at birth in the UK found “no group is statistically different from the range that we would expect to see naturally occurring”.

The amendment, if passed, will not even be effective, but could be the thin end of a wedge to undermine the 1967 Abortion Act. Laws already rightly protect pregnant women from reproductive coercion, as a form of domestic violence. 

The amendment will however introduce a duty upon doctors to consider something other than the health and wellbeing of the person who is pregnant: doctors will be tasked with policing the intentions of people seeking access to abortion. As intentions are impossible to prove, this will in practice lead to racial profiling, and differing levels of availability of the full range of reproductive options, based on perceived ethnicity.

Supporters of the amendment claim it will ‘send a message’, which it will – it will send the message that in certain circumstances, a foetus’s rights trump those of the person carrying it. Abortion laws don't need to change – what needs to change are ways of thinking that value a foetus of one sex over another.

Numerous pieces have been published in response to the Bruce amendment pointing out its deeply flawed nature, in the New Statesman, on the Conversation, in the Letters page of the Daily Telegraph, and in the Scotsman among others. Abortion Rights has written a letter to MPs which you can read here. For more background on how bans on “sex selective” abortion are an ineffective response, the Guttmacher Policy Review published an excellent piece in 2012. This very blog has two posts on the issue (from September 2013 and January 2014) which call into question the claims and evidence used by anti choice campaigners who are calling for a ban.

The Bruce amendment presents a real danger to the right to safe, legal abortion in the UK. Please act now to put forward the pro choice case, which will in the end strengthen women’s rights more than an amendment that pays lip service to feminism while undermining the right to bodily autonomy. 

Proposed letter to your MP

You can find your MP’s email address and contact details via this link: 
www.parliament.uk/mps-lords-and-offices/mps/

Feel free to use the below letter as a template, or to adapt it, or to write your own – we just need to make sure we contact as many MPs as possible.

Dear [MP name],

I am writing to you to express my strong opposition to the amendment to the Serious Crime Bill tabled by Fiona Bruce MP, “Termination of pregnancy on the grounds of the sex of the unborn child”.

Reproductive coercion, including forced abortion, is already illegal, as it is a severe and abhorrent form of domestic violence. Abortion clinic staff are trained to recognise the signs of someone being forced into having a termination they do not want, and follow procedures to ensure that women’s right to choose is respected. No new law criminalising women seeking abortion is required.

A review by the Department of Health in 2013 into sex ratios at birth in the UK found “no group is statistically different from the range that we would expect to see naturally occurring”. While there have been several highly upsetting first person accounts of women forced to abort due to the foetus’s sex, there is no evidence that this is a widespread practice in the UK, and no compelling argument that the Bruce amendment would have protected the women in question.

The amendment will do nothing to address the causes of boy-preference in some communities, and will lead to racial profiling of people from communities assumed to be 'at risk' of sex selection. It will give doctors the impossible task of policing the intentions of pregnant women, and remove the Abortion Act's requirement that the physical or mental health of the pregnant woman be the overriding concern of doctors authorising terminations.

I ask you to vote against this amendment and to make the case that your colleagues do the same.

Yours sincerely

[Name, address]

Crisis pregnancy centres in the spotlight again

We were really pleased to be asked to write an article on crisis pregnancy centres for Comment is Free. Here's our original version...
-------------------------------------------------------------
Last year, Education For Choice (EFC), a project within young people’s sexual health and wellbeing charity Brook, produced a report into the UK’s crisis pregnancy centres (CPCs), which are, as the introduction says, “organisations independent of the NHS that offer some form of counselling or discussion around pregnancy”. Sounds quite neutral, right? After all, when faced with an unplanned pregnancy, surely as a baseline everyone can agree that people of all ages deserve impartial, non-judgemental and medically accurate information about all the options open to them, including but not limited to abortion. But instead, after extensive mystery shopping trips carried out by dedicated volunteers across the country, we found that far too many CPCs are using their counselling room as an anti abortion space, giving people facing often complicated circumstances a dose of anti abortion propaganda and misinformation, rather than a truly impartial space to talk through their feelings and come to an informed decision.

We were really glad to see the media pick up the issue of the uneven quality of counselling provided by CPCs, shining a light on what goes on in these secretive places which, unless you’re either someone who’s faced an unplanned pregnancy and has Googled “I’m pregnant and I’m not sure whether I want to be” or a dedicated pro choice activist, you’re not all that likely to have heard of. Sunshine is the best disinfectant, and if a CPC advertises itself as providing non directive counselling, the public has a right to know whether this is indeed the case.

Now CPCs are back in the spotlight, thanks to a sizeable donation to an English CPC, Choices Stortford, by the charitable foundation set up by evangelical Christian multimillionaire Brian Souter. Now, he has a perfect right to spend his fortune as he desires, even if it means trying to keep homophobic laws on the books, or – as in this case – supporting CPCs. But it’s hard not to look at the donation, and think that, if he really wanted to reduce the number of abortions in the UK, Souter could have thrown his weight and his cash behind any number of different causes, from campaigning for better parental leave, to schemes to support single parents, to ensuring that all young people are given comprehensive, age appropriate sex and relationships education, to improving access to contraception and sexual health services.

How will Souter’s donation be used? We can get an idea from Choices Stortford’s Facebook page, which links to a piece in a local paper proclaiming that six of its counsellors have received training on how to deliver a 10-step so called “post abortion recovery programme” called ‘The Journey’. It’s very hard to find more than the most basic details about this programme online, but we found a blog post by a CPC about it (which was taken down, coincidentally after the report’s publication), saying: “Accountability: After the grieving process, a woman may become more open to the part she played in the abortion, and willing to face its consequences” (see p16 of our report). This doesn’t sound like the most neutral language in the world to us, casting doubt on whether use of ‘The Journey’ is compatible with the tenets of non directive counselling – which Choices Stortford says it offers to people with “Post Abortion Syndrome”, a pseudo-medical condition made up by the anti abortion movement.

The issues of unplanned pregnancy and pregnancy options, including abortion, are ones we in Britain, in common with – let’s face it – most of the rest of the world, have a problem talking about with honesty. It’s really important to note that there is a strong pro choice majority in the UK. But we can’t ever take our abortion rights for granted: abortion is illegal in Northern Ireland in most circumstances, Health Secretary Jeremy Hunt said in 2012 he backs cutting the time limit for abortions from 24 weeks to 12 weeks, and anti abortion protests outside clinics are becoming more visible and are using tactics borrowed from the US. An EFC report from 2013 (PDF) into how abortion is taught in schools found widespread failings, meaning that young people were often left “ill-equipped to make decisions about pregnancy”. Our CPC report, meanwhile, found that many of the CPCs which told our mystery shoppers manipulative misinformation about abortion also go into local schools to deliver sex and relationships education. Improving education about pregnancy options must be a priority for all schools, to fight myths about abortion, and to reduce stigma.

Money talks. When it comes to CPCs, we have reason to be worried about what anti abortion pounds are saying to people in sometimes difficult circumstances.

Young people and 'repeat abortion'

Thanks to a small grant from the European Society of Contraception and Reproductive Health we have been able to undertake a project looking into repeat unplanned conceptions amongst young people in London. This blog gives an overview of what we found out from our workshops with young people in Croydon.

Readers of this blog will probably already know that a third of women in Britain experience abortion. What you might not know is that over a third (37%) of those accessing abortion have already had one or more terminations. Recent statistics for England and Wales show that in 2013 27% of abortions to women aged 25 and under were ‘repeat abortions’. In Croydon, 50% of abortions (for all ages) were ‘repeat’ procedures.

The Telegraph claims the statistics show that women are having ‘lifestyle abortions’ and ‘using abortion as a contraceptive’. But what’s the real story? Why do some people have more than one abortion? Is it a problem? If so, when and why? We produced this document, Frequently Asked Questions about Repeat Abortion, to try to answer some of these questions and to offer recommendations for professionals supporting young people to prevent unwanted pregnancies. It’s free to download so please do have a read, and pass on to your colleagues. 

There are of course a number of factors which might contribute to someone experiencing one or more unplanned pregnancies – including failure rates of contraceptive methods. For example, the pill and the condom, the two most popular methods of contraception, come with actual-use failure rates of 8% and 15% respectively. In order to get young people’s input with the project we carried out workshops and focus groups in Croydon.  We talked about the fact that pills and condoms are the most common forms of contraception for young people and discussed some of the problems they might have in using these methods effectively:

“Pills - sometimes you don’t remember to take them. You have to take it at a certain time...so if you don’t actually remember to take it, you’re kind of unprotected.”

“As a female, you might not know how to put on a condom for instance, yeah I know it sounds really silly but let’s say you get to do the deed, you might not actually know how to put on a condom and stuff, and you kind of feel a bit stupid asking.”

“A lot of my friends didn’t (carry condoms) when we were younger, because no one wanted to be called a slag...you’ve been out with your boyfriend and you pull out a condom, he’s gonna think ‘Oi, you’re ready!’ Nah, he might not be thinking that, but in your mind you could possibly think it. 

He’s probably thinking, ‘Ah, I’m well up for this!’ But like it would be a bit embarrassing.”

Many of the young people formed opinions about contraceptive methods based on the experiences of their friends, often expressing an objection to LARC methods, seeing them as ‘invasive’:

“My friend’s got it (the implant) yeah, and I went with her and it’s horrible. It’s like this massive thing yeah, and to get it out she has to have an operation, she cuts it open, urgh, it’s horrible. Like, you can feel it.”

“I know it sounds silly, and you’re probably gonna laugh but it reminds me of something out of a movie, like an alien movie, you know like when they put things under your skin! The fact that you can feel it, in your day to day life, just, I don’t like that thought.”

“I went to the clinic with my friend, she got that (IUD) and the curtain was there - she was on that side and I was on this side, and I could hear her like ‘owwwww’!”

“And you have to be on your period to have it done don’t you, that’s what they said to my friend.  And I was like, dignity?! Come on!”

The young people (who were 16+) said that their school education had lacked details on the full range of contraceptive methods:

“Whenever you had any lessons at school it was always about condoms or the pill, it was never anything else about any other contraceptions.”

“When you’re at school, there’s not enough. All you hear about is the pill, not the implant or the injection, I never heard of that until a couple of years ago and I was like ‘what’s that?’. But then you are put off as well, by other people’s stories – of when they’ve put it in and you’re like, ‘Oh god, that doesn’t sound very nice’.”

These young people made various suggestions for improving knowledge about reproductive health and the range of contraceptive methods available:

“Make it less scary... if you see a picture like that (diagram of IUD), like they need to draw it to scale maybe! You know when you look at that, even though it’s small, in your mind, you’re gonna think, oh my god it’s massive...instead of drawings (you need) an actual picture of what it actually looks like. Cos you wouldn’t know what it looked like until you actually went there would you?”

“Maybe nurses do talks or something about how they put it in, ‘cause someone like me, could never do that ‘cause I’d just cry my eyes out. I’m really squeamish.” 

“I feel like there should be more talks within schools, about different types, like it is only condoms and the pill that are discussed.”

“Tell teenagers about contraception through videos, so they can just watch it – when people give me leaflets on the street I just throw them away, or just put it in my bag and it will stay in there for like a year! Whereas if, I don’t know, there was like pop up ads or something .”

“A video to show in schools, ok, these are the different types of contraception. These are the facts.”

So young people are telling us that they would like more practical demonstrations of contraceptive methods – we’ve certainly had positive reactions when using the FPA’s contraceptive display kit, which allows young people to see and touch different methods. There is also the suggestion that educators use more videos – and since we know young people respond to other people’s experiences, how’s about a UK version of these Bedsider videos? Someone fund us and we’ll do it!

For more information on young people and repeat unintended conceptions have a look at EFC's own research from 2007 and Hoggart and Phillips' 2010 research report.

Abortion rate continues to drop in England and Wales

The latest statistics for abortion in England and Wales (2013) have been released today and can be viewed here on the Gov.UK website. Here's a summary.

For women resident in England and Wales, in 2013:

• The total number of abortions was 185,331 
• The abortion rate (for ages 15-44) was 15.9 per 1000 women, 0.8% lower than last year's abortion rate, and 4.7% lower than in 2003
• The abortion rate was highest for women aged 22
• The under-16 and under-18 abortion rates are both lower than last year, and than in 2003
• 37% of women having an abortion had had one or more previous abortions
• 53% of women having abortions had one or more previous pregnancies that resulted in a live birth or a still birth
• 91% of abortions were carried out at under 13 weeks gestation

• In 2013, there were 5,469 abortions for non-residents carried out in England and Wales. The 2013 total is the lowest in any year since 1969

So those are the numbers but what do they tell us?

Well, first of all, the abortion rate is the lowest it's been for 16 years, the 2013 stats show a continued decrease. The same is true for the rate of abortion for under 18s - this has gone down from 18.2 per 1000 women to 11.7 per 1000 women in the last ten years. This drop reflects the reduced rate of teenage conceptions in general and is likely a result of young people's increased access to contraception. The rate of women accessing abortion early on in pregnancy is a positive sign that most are able to have their pregnancy confirmed early and access abortion when it is safest.

When asked, people often assume abortion rates will be highest for teenagers, when in fact, the most common age to have an abortion was 22, and there was a slight increase in the abortion rate for women aged 25-29. Bpas suggests that that this may well reflect the increasing desire to have children later (the average age for first time motherhood in the UK is now over 28). Over half of women accessing abortion are already mothers.

In 2013, approximately 5500 abortions were performed in England and Wales for non-resident women. The majority of these women (67% and 15%) were from Ireland and Northern Ireland respectively. This shows a continuing decline in the numbers of non-resident women accessing abortion in England and Wales. The FPA suggests that this could be due to under-reporting, or women travelling to other countries for the procedure. We also suggested last year that these women may well be (illegally) finding abortion medication online, rather than travelling for the procedure, which can be very expensive.

We join the FPA in calling for Northern Irish women's right to free, safe, legal abortion in line with women in other parts of the UK, and with bpas that, "we should stop politicising abortion and accept that it is a standard part of women's healthcare."

Teaching about periods - Guest post from Chella Quint

Chella Quint is a performer, writer, and education researcher who uses her unique brand of comedy to engage the public in positive and enlightening conversations about menstruation. You can watch her TEDx Talk here. For Menstrual Hygiene Day we've asked her to write a guest post and share top tips from her newly launched #PeriodPositive project which is all about challenging stigma connected to menstruation.

There are many sensitive topics within reproductive health and sex and relationships education.  Sometimes teachers and other educators are afraid to tackle these topics in case they ‘get it wrong’, and that’s understandable: making a mistake can be scary or embarrassing, or could even feel shameful. Challenging shame is one of the goals of Menstrual Hygiene Day, and it’s an issue I tackle frequently when challenging the messages in feminine hygiene product advertising.

There’s nothing to be ashamed of when talking about menstruation. It is a reproductive right for young people to understand their own fertility, and anyone can become a confident menstrual educator. 

Menstruation education should be:

• Free, unbranded, objective, and inclusive of re-usables like menstrual cups and cloth pads
• Consistent, accurate, up-to-date and peer-reviewed 
• Supported more comprehensively by the National Curriculum, particularly in Science and PSHE
• Aimed at different age groups, starting before puberty, and revisited regularly
• Inclusive of different genders, cultures, abilities and sexualities

I've really enjoyed researching and developing this work both formally and informally, with schools, universities and through science engagement, and I'm continuing to create resources and test out lesson ideas. 

I always start by asking participants to plot their menstruation comfort zone on a spectrum line and on a bulls-eye chart: 

Here are some of the top tips from my research so far:

The full set of tips can be viewed here.

 Follow @Periodpositive for updates, and check back at www.periodpositive.com for more free resources soon.

High Court ruling against free access to abortion for Northern Irish women

Today, a High Court judgement ruled that women from Northern Ireland are not entitled to access abortion free of charge through the NHS in England. 

Abortion is severely restricted in Northern Ireland and is only available where the pregnant woman’s life is in danger or where there is a risk of permanent and serious damage to her physical or mental health. This means that the vast majority of those seeking abortion in Northern Ireland will need to travel to access a safe, legal procedure. Currently, these women are required to pay for the procedure, which can range from approximately £400 to over £1000 for those at a later stage of pregnancy. The test case brought to the High Court by two women was rejected, meaning that the need for Northern Irish women to pay for abortion procedures carried out in England remains.

Northern Ireland is not covered by the current 1967 Abortion Act which applies in England, Scotland and Wales. The key legislation governing abortion in Northern Ireland comes from the Offences against the Person Act 1861. This means that women’s access to reproductive health care is managed according to a law which is over 150 years old and precedes the invention of the telephone and the light bulb.

The restrictive law in Northern Ireland does not prevent Northern Irish women having abortions, but it does make it more difficult. Those who can afford the private clinic fee and travel costs to England will be able to access a safe, legal abortion, but might have to significantly rearrange work and childcare to do so. Others may face delays in their attempts to raise a large sum of money in a short period of time. Overall, abortion is safe, but is safest the earlier in pregnancy it is performed, so delayed access means higher prices and also an increased chance of complications.

Those without access to such funds will be forced to continue an unwanted pregnancy (which again, is likely to have severe financial implications for someone who cannot afford an abortion), or they will resort to an illegal and potentially unsafe method of ending the pregnancy. Abortion Support Network is an organisation which helps women in Ireland and Northern Ireland to afford the cost of an abortion abroad. Mara Clarke, who runs the organisation, details some of the desperate measures people have taken to try to end their pregnancies:

“We have mothers calling us, telling us that their 18-year-old daughter drank a bottle of floor cleaner after she was raped at her own birthday party. We hear about women taking whole packets of birth control and washing it down with vodka.”

Others unable to travel will buy abortion medication online through sites such as Women on Web – however, if they do, they risk life imprisonment for ‘procuring (their) own miscarriage’.

The latest statistics from England and Wales show that in 2012 905 women travelled from Northern Ireland to access abortion. Many more will have travelled elsewhere or bought illegal abortion medication to end their pregnancies. Clearly, strict abortion laws do not stop abortions from happening, but can make them less safe by causing delay and restricting access. Abortion for Northern Irish women is largely a matter of economic resource. As Mara Clarke puts it, “women with money have options, women without money have babies”.

As a young people’s project we're particularly concerned about young women’s access to reproductive healthcare. In 2012, 43% of abortions in England and Wales for Northern Irish residents were for those under 25. Young women are less likely to have the resources necessary to travel and pay for a private abortion. A pregnant teenager seeking an abortion in Northern Ireland may suffer from stigma and lack of support, as well as financial limitations. 

The young woman who presented a test case to the High Court was just 15 when she became pregnant and travelled to Manchester for an abortion. Her mother paid £600 for the procedure, some of which was covered by the Abortion Support Network, and described the process of raising the funds as ‘harrowing’. Not all young women will have the support of their families. We believe that the abortion law in Northern Ireland should be brought into line with the rest of the UK, so that all women, especially young women, are able to access the full range of reproductive healthcare they need, which includes abortion.

Conscientious objection obstructs women’s health … it’s not brain surgery

Blogpost by Lisa Hallgarten

It doesn't take a brain surgeon to work out that you can’t be a brain surgeon if you don’t believe in brain surgery. Nor does it take a rocket scientist or even a person of average intelligence to work out that a doctor who is not willing to prescribe the full range of contraceptive methods should not have a qualification that implies that they are able and willing to do so. The Faculty of Sexual and Reproductive Healthcare (FSRH) which provides a diploma in sexual and reproductive health, has recently updated its guidelines to confirm that doctors and nurses who have a ‘conscientious objection’ to prescribing hormonal contraception - including emergency contraception – and fitting women with IUDs and IUSs will not be able to complete the whole syllabus that is required in order to receive its diploma.

This seems uncontroversial. No woman should go to a certified doctor with a specialist qualification to discuss contraception, only to discover that her doctor will not prescribe or fit some of the available methods for reasons of personal conscience. It would be worse still for a woman seeking emergency contraception, because those who seek the right to conscientiously object do not support any method of emergency contraception. In this situation time is of the essence: if a woman wants to take Levonelle it is most effective in the first 24 hours following unprotected sex, EllaOne must be taken within five days and an IUD fitted within the same time-frame. No woman should have to scrabble about trying to find an alternative doctor who will provide her with this last ditch chance to prevent an unwanted pregnancy. Nor should any woman be preached at about why the only moral thing to do in this situation is to cross her fingers and hope for the best. You would think that even those who support a doctor’s right to conscientiously object must agree with this, but apparently not. The Christian Medical Fellowship (CMF) objects to the updated guidance because, ‘it bars pro-life doctors from specialising in sexual and reproductive health and also makes it much more difficult for non specialists to get jobs in family planning or reproductive health’.

The CMF seems to be asking for something over and above the right to conscientiously object. It seems to be asking for the right for anti-choice doctors to be certified so that they can advertise their specialism in family planning and attract women seeking contraception, with the full intention of refusing access to the full range of family planning methods.  This is not about passively opting out, this is obstruction. Likewise, the case of the two Scottish midwives who insist that they can use conscientious objection to opt out of even supervisory and management duties in relation to staff carrying out abortions.  Their appeal against an original judgement which refused them this right, on the basis that it would jeopardise abortion provision in their hospital, was funded by anti-choice organisation SPUC. This kind of extension by stealth of the right to conscientiously object is addressed in a new paper, ‘Dishonourable disobedience – Why refusal to treat in reproductive healthcare is not conscientious objection’. The authors, Canadian abortion rights advocate, Joyce Arthur, and Austrian obstetrician Christian Fiala question the moral basis for conscientious objection and challenge its interpretation and implementation by anti-choice doctors and anti-choice institutions. It is the latest salvo in a pro-choice fightback against the once uncontested concept of conscientious objection, and crucial reading for anyone who still believes that it is a benign practice which is simply about the quiet expression of personal belief.

Other useful articles on conscientious objection personal, and institutional:

• Conscientious commitment, Bernard Dickens in The Lancet
• Termination of pregnancy as emergency obstetric care: the interpretation of Catholic health policy and the consequences for pregnant women. An analysis of the death of Savita Halappanavar in Ireland and similar cases, Marge Berer for RHM Journal

Intimate Partner Violence, Pregnancy and Abortion

The World Health Organisation defines Intimate Partner Violence (IPV) as “one of the most common forms of violence against women and includes physical, sexual, and emotional abuse and controlling behaviours by an intimate partner”. IPV has been shown to increase during pregnancy. Women’s Aid states that 30% of IPV starts during pregnancy and that between four and nine women out of every 100 are abused during their pregnancies and/or after having given birth. Women’s Aid identifies IPV as a prime cause of miscarriage, still-birth and of maternal deaths following childbirth.

One form of IPV is termed ‘reproductive coercion’ – where abuse relating to contraception or pregnancy decision-making is exercised by a woman’s partner. For example, the abuser may sabotage contraception, refuse to use it, or pressurise a partner into continuing or ending a pregnancy against their wishes. Perhaps unsurprisingly, a recent study found an association between IPV (naming rape and sexual assault, contraceptive sabotage and pregnancy coercion as examples) and termination of pregnancy. The study found that women in violent relationships were three times more likely to conceal an abortion from their partner as women in non-violent relationships and that “women undergoing terminations of pregnancy welcomed the opportunity to disclose their experiences of intimate partner violence and to be offered help”. What this tells us is that pregnancy support services need to be attuned to the risk factors for IPV and to be able to provide signposting and support where required. Domestic violence support services in turn, need to be equipped to provide accurate information on pregnancy choices and impartial support with pregnancy decision-making.

We were concerned to see that information about IPV and pregnancy is being misrepresented by anti-abortion organisation LIFE, in its recent ‘Finding Hope’ campaign. In a glossy animation LIFE claims that “the association between abortion and violence towards women is strong”. LIFE claims that one in four women seeking abortion are “victims of domestic violence” and “at least one in every four women seeking abortion, therefore, (is) not doing so freely but from a position of fear.” LIFE makes a causal relationship between IPV and abortion which is simply not in the data, implies that abortion itself is a form of violence, and states that “women who have abortions can become more self-destructive, and remain in or seek out abusive relationships as a form of self-punishment.” It is highly offensive to suggest that women have abortions, or remain in violent relationships as a form of ‘self-punishment’. It is also inaccurate to extrapolate this data to claim that a quarter of women seeking abortion do so out of ‘fear’.

It is not surprising that a large proportion of women who have abortions have also, at some point, experienced IPV. Both are very common within a lifetime. A third of women have an abortion. A quarter of women experience IPV. It is therefore inevitable that a significant number of those accessing abortion services will have also experienced IPV. What we know about IPV increasing during pregnancy, and about reproductive coercion as a form of IPV, means that there is of course a link between IPV, unplanned or unwanted pregnancy and therefore abortion, but this link is not one of simple causation as the LIFE Finding Hope campaign implies.

LIFE’s suggestion that “no one even asks them (pregnant women) if they are ok...let alone, why do you want an abortion...not even the health professionals tasked with caring for them” is particularly misleading. The Finding Hope campaign claims to, “draw attention to abortion providers' conveyor-belt service and their failure to adequately support women vulnerable to abuse”, the implication being that women seeking abortion are not assessed, supported or fully consenting to the procedure. In fact, bpas, a leading abortion provider and charity, takes a ‘routine enquiry’ approach to domestic abuse, which means staff routinely ask women about safety in their relationship. All staff are trained on domestic abuse issues and bpas provides information in formats which are accessible to a range of people and signposts to relevant agencies. The Royal College of Obstetricians and Gynaecologists advises medical professionals to work to identify those at risk of IPV and provide appropriate support.

LIFE’s campaign culminates in a fundraising appeal for its helpline service. LIFE, which campaigns against legal (and therefore safe) abortion does not appear to be promoting genuine advocacy on domestic violence issues, but rather conflates abortion with abuse in order to argue against abortion. We are particularly concerned that LIFE’s ‘counselling’ services have been shown to be misleading and biased, for example, one LIFE counsellor falsely claimed that abortion leads to an increased risk of breast cancer. Giving women false information in an attempt to influence their decision about a pregnancy is unethical. The narrative provided by LIFE, that women seek abortion only out of ‘fear’ or coercion, is simply not accurate, and negates women’s agency when it comes to making sometimes difficult choices about pregnancy. The connections between IPV and abortion are perhaps best looked at through the reproductive justice framework, which recognises that sometimes our 'choices' are restricted by factors such as economic status, race, class, location and so on. This useful factsheet from the National Women's Law Center, 'If You Really Care About Preventing Domestic and Sexual Violence, You Should Care About Reproductive Justice' makes clear the need to improve material conditions surrounding pregnancy and IPV and points out that restrictions on access to contraception and abortion services will only further constrain a person's ability to exercise bodily autonomy.

*****There is a confidential 24-hour National Domestic Violence Helpline on 0808 2000 247. This helpline is free and run in partnership by Refuge and Women's Aid who can provide information and support to those experiencing domestic violence. ******

Slide from LIFE's 'Finding Hope' animation which places abortion within a 'cycle of abuse'.

NICE guidance on young people and access to contraceptive services

Today, NICE released evidence-based guidance entitled ‘Contraceptive services with a focus on young people up to the age of 25’, which calls for improved access to contraception for young people. 

The guidance sets out various actions which it suggests will improve young people’s access to contraception, and thus decrease unplanned pregnancies amongst under 25s. As you may know, the teenage pregnancy rate in England and Wales is currently the lowest it’s been since 1969, but still remains one of the highest in Western Europe.

The guidance provides practical suggestions for improving young people’s access to sexual health services such as ensuring that services are:

• Accessible (have flexible opening hours and accessible materials for those with learning difficulties, or for whom English is a second language)

• Comprehensive (give information on the full range of contraceptive options, including the insertion of an IUD as a method of emergency contraception)

• Practical (youth-focused services based in schools and colleges, where young people can access them easily)

• Non-judgemental (staff should be trained and supported to offer impartial information)

We were glad to see that NICE specifically mentions the importance of access to contraception following pregnancy, encouraging professionals to "dispel the myth that there is no need for contraception after an abortion and explain that women are fertile immediately following an abortion." We have long been concerned that the myth that abortion causes infertility, often touted by anti-abortion groups which visit schools, may have an impact on a young woman’s access to contraception following an abortion.

The media reaction to the guidance has been interesting, with some outlets focusing on NICE’s suggestion that emergency hormonal contraception (EHC) be available in advance of sexual activity (rather than just obtained following unprotected intercourse).

The guidance states that "the evidence shows that advance provision of oral emergency contraception does not encourage risky sexual behaviour among young people. Evidence also shows that women who have emergency contraception in advance are more likely to use it, and to use it sooner after unprotected sex. Having emergency contraception on hand does not affect the use of other kinds of contraception."

Certainly, we have heard anecdotally of young women’s difficulty in obtaining the morning after pill. Some pharmacists refuse to give EHC to younger women, or attempt to charge them (at around £20 this can be too much for many teenagers). Some young people living in rural areas might struggle to get hold of EHC, especially in the first 24 hours after unprotected sex, when it is most effective. It makes sense to improve access to EHC for those who need it, to ensure it can be taken when needed, as quickly as possible.

However, some newspapers seem to think that there is a danger young women will ‘stockpile’ EHC. The Telegraph opens with:

“Teenage girls will be able to stock up on the morning-after pill under new NHS guidance which will allow young women to pre-order the drugs, despite Government fears the move will increase promiscuity.”

An interesting concept. These young women, who are seen as too feckless to access contraception before having sex, are organised enough to plan to ‘stockpile’ EHC in advance of having sex. Which is it to be, lazy and incompetent or cunning and prepared?! EHC is a form of contraception, which young people already have free access to. NICE is simply stating that it might be helpful for some young women (particularly those who live in rural areas, perhaps without their own transport) to be able to access EHC in advance, in case they ever need it.

We’re glad to see such sensible, evidence-based guidance being issued, we only wish the media could resist scare-mongering around young people and contraception, and that access to sexual and reproductive health could be rid of such stigma.

It's time to slay the 'killer abortion' story

Today’s guest blogpost is from Lucy V Hay, a novelist, script editor and blogger who has just written a novel exploring one young woman’s pregnancy decision making process. She shares her insight on fictional accounts of abortion.

I’m grateful to live somewhere that allows for a woman’s right to choose, but abortion is frequently depicted in a negative light by movies and television. This Slate article sheds some light on the offenders, but does not, in my opinion, give a viable reason as to why this is so often the case.
 
As well as being the author of a pro-choice novel, The Decision: Lizzie's Story, I'm a script editor for movies, so hopefully I can offer an explanation – and though it may surprise some progressives, it’s not that the people creating those movies or television shows necessarily disagree with abortion!

When learning how to create fiction, the first thing any wannabe writer is taught is that, “drama is conflict”. In other words, a writer needs to create the worst problems for his/her characters that s/he can; it is overcoming those problems that make an audience relate to that character and invest in the character’s journey. So, if a story about abortion is to have the “most” conflict it can, obviously it will include death.

Simple, eh? But this is also where it gets complicated …

… 1 in 3 women in the UK will have an abortion at some point in their lives. What’s more, the likelihood of dying from having a legal abortion is extremely low. In fact, the risk of death from childbirth is 14 times higher than for abortion. So for starters, a story has potentially up to a third of its female audience going, “Eh? That just wouldn't happen!” Not. Good.

Secondly, though an individual movie or TV show may feature a death from an unsafe abortion (for example, if it was set in a time or place where abortion was illegal or inaccessible, like in the film Vera Drake), the sheer lack of variety in the representation of abortion in the media becomes problematic. It’s worth remembering, lots of people get their information from fiction … That’s why soap operas carry the famous: “If you have been affected by any of the storylines …” bit at the end of the show, alongside helpline numbers.

So if writers and producers shrug their shoulders and say, “It’s just a story!”, they are right. In isolation, their “killer abortion” story is just a story.

But all those “killer abortion” stories put together? A statement.

Working with writers, I am always at pains to point out we must be varied in our depictions of characters and situations and the “killer abortion” is no different. We are extremely lucky that safe abortion is a reality in Great Britain and that our friends, daughters, sisters and mothers have the right to bodily autonomy. But it’s also a sad reality that very few stories reflect this: instead, whether the writers and producers believe in the pro-choice message or not, they go for the lazy and stereotypical notion that “abortion kills” or is ‘dangerous’ in other ways (such as leading to infertility). It’s time to slay the “killer abortion” story and seek out representations that empower female characters – and the audience watching them.

Report released today – ‘Crisis Pregnancy Centres’ in the UK

EFC is pleased to be able to release the first in-depth investigation of ‘Crisis Pregnancy Centres’ (CPCs) in the UK. Following on from today's reports of two pregnancy counselling centres in London providing biased and inaccurate information we are able to provide further information.

CPCs are organisations independent of the NHS which provide pregnancy counselling – over half also provide sex and relationships education in schools. They are often run by charities which are outwardly anti-abortion or which have ties to anti-abortion organisations. The tactics of CPCs in the U.S have been documented by groups like NARAL, but this is the first full-scale investigation of CPCs operating in the UK.

EFC has identified 135 CPCs in the UK. Just under a quarter of these centres (33) were visited by volunteer mystery shoppers and background research into the remaining CPCs and their affiliations was also carried out.

Unfortunately the majority of CPCs visited were found to be giving misinformation about abortion and/or biased, unethical and unprofessional counselling methods. We are particularly concerned that many of these centres specifically market their services to young women. To give you an example, here are some quotes from the centres visited:

“The only other thing that has been reported with quite strong evidence is the increase in the possibility of breast cancer following termination of pregnancy” Oxford Care Centre (LIFE)

“There’s more risk of infertility from termination that there is from giving birth...some reports will say as low as 1% chance of infertility from termination and some will say as high as 25%” Central London Women’s Centre (Good Counsel Network)

“I do believe that God gives the gift of a baby” Reading Lifeline (Care Confidential)

“The other thing with abortion is the psychological effect of post abortion trauma.. of... the grieving that you lost, ‘cause you know at the moment for some girls it seems like a very quick option, you know and it’s a half day you go in, you’re out but you are left with the emotional turmoil of what you’ve done” Stillwaters Pregnancy Crisis Centre (Care Confidential)

Regular readers of our blog will know that abortion does not increase the risk of breast cancer, infertility or mental health problems. These ‘risks’ have all been discounted by medical professionals and to propose them as serious factors to consider in the decision making process inhibits someone’s ability to make an informed choice about their pregnancy. It is part of the anti-abortion agenda that seeks to limit choice under the guise of offering women support. 

Centres run by Care Confidential and Life do so under the name of the British Association for Counselling and Psychotherapy (BACP) which has a strict code of ethical guidelines for counsellors to follow. The directive, biased counselling offered in some CPCs cannot be considered good practice. Prominent psychotherapist Phillip Hodson states:

"Counselling is the opposite of conversion.  According to the ethical frameworks of our profession, no counsellor behaves properly by trying to sell to a client their personal religious or political outlook. Such an offence should trigger a formal complaint and - if this is proved - the offenders should be struck off by the regulating body. It goes without saying that supplying misleading medical information would be grounds for further sanction. It is my understanding that the regulator in such cases has always welcomed properly-founded complaints and their website explains how concerned individuals may proceed. I would hope for a swift response before it is suggested that counselling is not competent or motivated to regulate itself". 

EFC has sent an official complaint to the BACP and is awaiting a response.

More worrying still, Care Confidential is the primary service linked to on the front page of the NHS choices website about abortion. The organisation also claims to provide pregnancy counselling in five women's prisons. When the support Care Confidential offer is as sporadic and unreliable as our investigation has found it to be, it is far from acceptable for the NHS to offer their services to people looking for support.

Have a read of the report and watch this space for further developments.

Sex-selective abortion in the news. Again.

Back in September, we wrote a blog in response to the Telegraph’s ‘exposé’ of sex-selective abortion in the UK. Today, the Independent has launched its own campaign to raise awareness of "the illegal abortion of female foetuses" with a series of articles headed ‘The Lost Girls’.

Firstly, as before, we take issue with the claim that sex-selective abortion is ‘illegal’. Under the 1967 Abortion Act an abortion is legal if two doctors agree, in good faith, that the continuation of the pregnancy would involve more risk to the woman’s mental or physical health than having an abortion. Therefore, if a doctor considers a woman’s individual circumstances and believes that ending the pregnancy would be better for her health and well-being he or she can permit the abortion to take place. One of the Independent's articles recognises some of the potential risks for a woman in this predicament:

“Karma Nirvana, based in Leeds, said it had dealt with a woman brought from Pakistan after marrying her British husband, who then underwent fertility treatment to become pregnant with a boy after she gave birth to two daughters. She had been physically and emotionally abused by her spouse and inlaws over her failure to produce a son”.

The law permits a woman who has become pregnant as a result of rape to have an abortion if she feels it would negatively affect her to have the child, even though ‘rape’ is not a direct ground for abortion in the UK. Sex-selection falls under the same criteria – is the woman’s mental or physical health at risk if she is forced to continue with the pregnancy? (It's also worth noting that legal abortion is statistically safer than childbirth, some doctors would therefore always authorise a requested abortion on health grounds).

We haven’t seen the original data from which the Independent draws its evidence, so won’t comment on the claim that;

“The practice of sex-selective abortion is now so commonplace that it has affected the natural 50:50 balance of boys to girls within some immigrant groups and has led to the “disappearance” of between 1,400 and 4,700 females from the national census records of England and Wales”

The question is, if there is evidence of sex-selective abortion happening in the UK (albeit on an extremely small scale) what is to be done about this?

Anti-choice groups use the ‘evidence’ (from a newspaper, not a medical body) in an attempt to shore up their belief that ALL abortions should be banned. SPUC claims that sex-selective abortion "demonstrates how legalising abortion for ‘hard cases’ is so easily abused" and Life states:“We object to all direct abortion on principle, but to end a child's life because they are the 'wrong' sex seems particularly unjust.”

The ‘hook’ of sex-selective abortion is being used by these groups to argue that there should be no legal access to abortion. It feeds into anti-choice myths that women cannot be trusted to make decisions about their own bodies. 

We reject the co-option of feminist rhetoric by these groups, feigning concern about women’s rights when in fact they seek to curtail them. It’s crucial that all those dedicated to protecting human rights, and improving reproductive health and gender equality pay attention to the underlying thrust of these arguments about sex-selective abortion. In countries where sex-selective abortion is a reality, the answer is not to restrict abortion access. Unfortunately gender discrimination is ingrained in all societies and we have a lot of work to do to improve the status of women the world over. Refusing them ultrasounds or reproductive care is not the way to do this. Reproductive rights groups, alongside women's rights organisations, will continue to campaign for improved education and material conditions for women, to tackle male violence and discrimination in all forms.

Tim Montgomerie - 'moderate' on abortion? Really?

Yes, we're still officially on holiday, but we just couldn't resist commenting on the recent 'OpEd' from Tim Montgomerie in the Times. It's behind a paywall here, but we've included quotes from some of the parts which are particularly problematic.

Montgomerie positions himself as being a 'moderate' voice on abortion, arguing that the debate only allows for 'hot and cold'. For starters, this seems to be a dishonest presentation of where he actually stands. Montgomerie is a patron of SPUC Evangelicals. SPUC (Society for the Protection of Unborn Children) is against abortion in ALL circumstances, and even believes that certain forms of contraception cause abortion. Members of SPUC Evangelicals believe that "the widespread abuse and destruction of unborn children [therefore] constitutes a flagrant offence against almighty God." So, although Montgomerie talks about lowering the time limit, or changing the law around termination on grounds of fetal abnormality it would seem his greater desire would in fact be to ban abortion completely (or he should have a re-read of the SPUC manifesto he endorses).

So let's look at some of the arguments he puts forward for 'tighter laws'. First, Montgomerie claims that 2013 "was the year when the reality of foetal “gendercide” within Britain surfaced — the deliberate, discriminatory termination of unborn baby girls". We've written about this before, but the 'reality' of 'gendercide' within Britain did not in fact surface. What surfaced was a 'sting' set up by the Telegraph where no abortions were actually performed. The Department of Health has reported a normal sex ratio for births in the UK.

Then, Montgomerie drags out an old Christopher Hitchens quote (also used by Mehdi Hasan in his anti-abortion piece last year, yawn) to argue that the public is becoming more 'concerned' about abortion:

“In order to terminate a pregnancy,” he said in 1989, “you have to still a heartbeat, switch off a developing brain, and, whatever the method, break some bones and rupture some organs.”

Well, not quite Hitcho. As we know, the majority of abortions in this country are carried out early on in pregnancy, when this simply isn't the case. We liked Edinburgh Eye's take on this:

Yes, that’s sometimes true. Of course, the earlier an abortion takes place, the less likely that it will be: the heart may not have developed, the brain may not yet exist, the bones and organs may still be so undeveloped that there is nothing there to break or rupture. But yes: terminating a pregnancy kills the foetus. 

But it’s also true that anywhere girls and women are denied the right to choose abortion, that denial of termination ensures that heartbeats are stilled, a brain is switched off, organs are ruptured: women die. As a woman I know wrote wistfully once, “Do you suppose if we pointed out that we have dear little faces and actual fingernails on our hands, that they’d care that we die?”

With regards to UK law, Montgomerie appears to support a reduction in the legal time limit for abortion:

"Others want a still earlier limit because of research that shows that even if the foetus is not viable outside the womb it can still feel pain."

In fact, the current time limit remains at 24 weeks because experts concluded that this is the limit of viability and that the best medical evidence does not support lowering this limit. The BBC reports on the Royal College of Obstetricians and Gynaecologist's findings that there is no fetal pain before 24 weeks gestation here.

Montgomerie tweeted "I don't think abortion should ever be 'easy'". In the article he suggests introducing 'fully informed consent' by showing women scans or images of fetuses: 

'A Michigan law based on this principle requires pregnant mothers to inspect “depictions, illustrations or photographs of foetal development”. Women are still in charge but are helped to fully understand what they’re choosing'.

Thanks Tim! Women (sorry, 'pregnant mothers' ) should be given picture books to fully understand what abortion is. Because, you see, they don't understand what they're choosing, but Tim does. Tim thinks some women should be allowed to have abortions (someone tell SPUC!) but only if it was made as difficult as possible for them, and it wasn't after 12 weeks, and the decision wasn't made due to a diagnosis of fetal abnormality.

He claims that the 'exception' in the UK law which allows for abortion after 24 weeks due to fetal abnormality "has produced an alliance between anti-abortion and disability rights campaigners". Perhaps we're reading the wrong blogs but we haven't seen evidence of this. In fact, many disability rights campaigners have stated their disgust with groups like SPUC co-opting disability rights campaigns to argue against a woman's right to access abortion. 

Either Tim Montgomerie should be more honest about his desire to make abortion completely illegal, or we would suggest that his reconsider his allegiance to SPUC, a group which aims to do just that.