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'.

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.

The ‘Parliamentary Inquiry’ on Abortion and Disability

Today, anti-choice MP Fiona Bruce launched a report entitled ‘Parliamentary Inquiry into Abortion on the Grounds of Disability’. This is an unofficial inquiry, not sanctioned by Parliament, but rather the outcome of a special interest group of anti-choice MPs getting together to discuss abortion on the grounds of fetal abnormality. Although evidence was accepted from a range of individuals and organisations (including Brook and fpa) that which is presented in the report, and the final recommendations, are heavily weighted towards those who would like to see the legal right to terminate a pregnancy due to serious fetal abnormality removed completely.

A quick glance at the list of written submissions tells you a great deal about the inherent bias in this inquiry. The majority are from ‘pro-life’ organisations which believe that abortion should be illegal in every circumstance - SPUC, Life, ProLife Alliance, No Less Human (which is actually SPUC, but hey, have two submissions guys!), Image and Pregnancy Helpline, Christian Medical Fellowship, and the list goes on. Throughout the report, submissions from individuals with no professional background, and from anti-abortion lobby groups are given greater emphasis than medical experts and respected bodies such as the British Medical Association, the Royal College of Nurses and the Royal College of Obstetricians and Gynaecologists. The report uses this biased presentation of evidence to argue that “allowing abortion up to birth on the grounds of disability is discriminatory” and recommends that Parliament considers reducing the time limit for abortion on the grounds of disability or repealing this ground completely.

There is a suggestion that the current law, which allows for abortion after 24 weeks where there is a substantial risk that if the child were born it would have serious physical or mental abnormalities, is "contrary to the Equality Act 2010". This is nonsense. The law does not consider a fetus to be a legal person until birth, so the Equality Act does not apply. The further ‘evidence’ is mostly a mixture of:

•    Dodgy statistics - anti-abortion campaigner Patricia Casey is quoted as saying that "at the time of abortion 40% of women will be experiencing mental health symptoms" and links abortion for fetal abnormality to depression and post traumatic stress disorder with no reference given for this claim.

•    Emotive, inappropriate language – phrases like “not allowing doctors to deliberately kill any baby after viability” pepper the report and are a sign that the focus is not on professional medical analysis of the complex facets of abortion law and practice.

•    Anti-abortion bias – this is not surprising in a report formed by groups and individuals opposed to abortion in every circumstance. Life’s written evidence that abortion for fetal abnormality "overlooks the fact that the unborn child is as much the doctor’s patient as is the mother" is included alongside personal testimonies from parents who claim they were pressurised into having an abortion, and received little support from medical professionals with their decision to continue the pregnancy.  The fact that one of these parents, Lynn Murray, has been a member of SPUC for over 18 years, is not declared. Many of the members of the Commission have a history of anti-abortion campaigning – one example is Lord McColl, a patron of the Centre for Bioethics and Public Policy which runs Abort67 in the UK, who you might know as the group which holds up gory posters of supposed aborted fetuses outside abortion clinics. Hmm.

So we’ve established that this is essentially the position of a minority group of anti-choice MPs and campaigning bodies, which does very little to present the views of the experts who work in this field with the necessary authority that they deserve. However, it’s already being reported as if it were a neutral cross-party inquiry with the backing of the BMA. It’s important that:

•    This is not regarded as an official parliamentary inquiry, which accurately reflects the views of a range of bodies involved in reproductive care, disability campaigning and fetal medicine.

•    It is not used as evidence that the right to abortion on the grounds of fetal abnormality is ‘discriminatory’ or causes discriminatory attitudes towards people with disabilities. There are some excellent blogs on this subject which you might want to have a look at for more discussion of this (Frances Ryan in The Guardian, and Nicky Clark’s blog are good places to start).

•    The real people making decisions about often much wanted pregnancies are not forgotten in this. Abortions performed after 24 weeks are extremely rare (they made up less than 0.1% of all abortions last year) and are a result of considered choices regarding health, quality of life, existing children and many other factors. One parent in the report says: “Please understand that finding out that your unborn baby has a serious disability is one of the hardest things that a parent can hear. Please don’t make it any harder by taking away our right to choose”.

•    Those who do choose abortion, and the doctors who support them are not demonised. Underlying this report is an implication that doctors are pressurising women into choosing abortion where there is a diagnosis of abnormality. We believe it is important to trust women making these tough decisions, and to trust doctors to give the information and support they require to make an informed choice. The wonderful Antenatal Results and Choices exists to provide further support to those individuals and couples faced with making such decisions.

For further information on this inquiry and the backgrounds of those involved, have a look at this blog from the Ministry of Truth.

The cost of balance

After 20 years of advocating for evidence-based abortion education EFC was pleased to see the front page of this weekend’s Guardian exposing a SPUC school presentation which delivered many of the false claims about abortion we take to task on this very blog. The talk at Comberton Village College in Cambridge contained misinformation about abortion, including claims that it can increase a woman’s risk of breast cancer, infertility and so called ‘post-abortion trauma’.

The public were rightfully outraged but unfortunately this isn’t a one-off. It’s not just SPUC giving misinformation and it’s not just at this school. We know, from contact with teachers across the country, that anti-abortion groups are speaking to young people regularly in a range of schools. Whether it’s Lovewise presenting at an Academy in Northumberland, or Life talking to Sixth Formers about sexual health at a Catholic school in Solihull we have a real concern that not all the information will be based on evidence. SPUC, Life and Lovewise all put out literature which gives misinformation about pregnancy, contraception and abortion.

We’ve written before about the problem of schools inviting in groups like this. But we’re still surprised when educators like the Principal at Comberton defend their decision to allow a group to mislead young people about their reproductive health in the interests of ensuring ‘proper balance’. Our criticism remains the same; these groups are entitled to hold a particular viewpoint, but not to use misinformation about a medical procedure to promote this viewpoint to children. ‘Abortion is morally wrong’ is a viewpoint, ‘Abortion causes breast cancer’ is simply unscientific misinformation.

The photo below is an example of a pamphlet provided by Life to a comprehensive school in Wiltshire.