Sex-selective abortion in the news

Health Secretary Jeremy Hunt is upset that the two doctors involved in the Telegraph’s 2012 sex-selective abortion ‘sting’ have not been prosecuted, and is seeking ‘urgent clarification’ on the case. The Crown Prosecution Service (CPS) has stated that it is not in the public interest to prosecute the doctors and has referred the case on to the General Medical Council (GMC). As far as we know the doctors have already had conditions put on their registration to prevent them from work involving abortion.

Over in the Telegraph’s ‘Wonder Women’ section, journalist Cathy Newman claims that “wherever you stand on abortion, it's extremely hard to understand why the Crown Prosecution Service has decided not to press criminal charges against doctors who agreed to arrange terminations because of the sex of the unborn baby.” Both Newman and Hunt forcefully assert that "sex-selection abortion is banned in the UK under the terms of the 1967 Abortion Act" and is "against the law". Newman goes on to claim that “there's growing evidence (sex selective abortion is) also carried out illegally in communities in this country.” 

So, what is the law around sex selective abortion? And is it happening in the UK? Why haven’t these doctors been thrown in jail?

First of all, it’s important to note that these cases were not of women actually requesting sex-selective abortions. This was an artificial situation set up by the Telegraph, where undercover journalists underwent consultations and filmed the results, something the CPS seem to have taken into account: “in these cases no abortions took place or would have taken place.”

Secondly, the law around abortion and sex-selection is a lot more complicated than these articles imply. As our blog from last year points out, the 1967 Abortion Act does not specifically prohibit abortion for this reason. However, abortion is a criminal act unless certain grounds are met. The majority of abortions in the UK are performed under Ground C: ‘the continuation of the pregnancy would involve risk, greater than if the pregnancy were terminated, of injury to the physical or mental health of the pregnant woman.’ This ground could cover a number of individual circumstances and it is left to doctors to decide which of these satisfy the legal criteria for abortion. As legal abortion is statistically safer than childbirth, some doctors may consider this ground legitimate for women who do not provide further ‘reasons’ for their abortion, other than a desire to end the pregnancy. There is more information about the law in this article by Professor of Law Sally Sheldon.

Thirdly, it is not clear what ‘evidence’ there is of sex-selective abortion happening in the UK. Certainly two journalists requesting abortions they don’t intend to have is not evidence that women in the UK are actually having abortions due to sex selection. The Government’s investigation into the issue showed that the UK’s "gender ratio" is "well within the normal boundaries for populations".

In an older article for the Wonder Women section of the Telegraph Emma Barnett explores this very difficult issue and concludes that, "abortion laws don't need to change: attitudes towards girls do... it’s so important that abortion remains legal, above board and crucially transparent...Pushing abortion into the backstreets would help no one." We need to remain aware of the nuance in this debate and avoid sliding into anti-choice rhetoric which in reality does not support women to make the decision to have an abortion in any circumstance.

For more information, read the EFC blog on this issue from last year, when the allegations first arose.

'Women with money have options, women without money have babies'

This is a guest blog from Mara Clarke, founder and director of the Abortion Support Network.

What would you do if the condom broke? If your pill hadn't worked? If you had been raped? If you were faced with an unplanned, unwanted pregnancy? What would you do?

If you lived in England, Scotland or Wales, you could go to your GP or your local sexual health clinic, and get a referral for an abortion. You could do this regardless of your race, class, financial situation, or age. You could make this decision on your own, or with the support of your parents, or friends.

But what if you lived in a country where abortion was illegal? And you couldn't tell your parents? And your boyfriend threatened to paint “murderer” on your house, if you had a boyfriend? And you had no money? And no credit card, passport or photo ID?

Abortion is virtually against the law in Ireland and Northern Ireland. This is the case whether you are pregnant as a result of rape, whether the foetus has catastrophic abnormalities, if the woman involved is 14, or if, like most women having abortions, it simply isn't the right time to have a baby. But of course as we all know, making abortion against the law doesn't stop abortion from happening. It just means that, when faced with an unplanned, unwanted pregnancy, women with money have options and women without money have babies – or do dangerous and desperate things.

This is even more true for young women living in Ireland and Northern Ireland who need abortions. Because of the stigma, many of these young women aren't able to tell friends or family members. And yet somehow they need to raise the £400 to £2000 it can cost to travel and pay privately for an abortion.

Abortion Support Network is a charity that provides financial assistance, accommodation and confidential, practical information to women from Ireland and Northern Ireland forced to travel to access a safe, legal abortion. Since launching in October of 2009, we have heard from almost 1,000 women. More than 250 of those calls have been from women and girls under the age of 25. At least 30 of those were aged 16 or under.

Here’s an example of what these young women have told us:

“I can’t have this baby, I've been trying to get money together and I told the father and he left me. I'm in college and have no money. I depended on my parents and they will disown me if they knew I was pregnant. I'm getting really worried and I don’t know what to do. Anything will help. I know my time is nearly up so I'm beginning to really worry, I know I shouldn't have left it this long but this is my last option and I can’t have this baby.”

“If my parents find out I've had sex, they’ll kill me. I'm not kidding.”

A young teenager whose mother called us in desperation. The pregnancy was a result of rape and her daughter was severely self-harming.

“I'm 19 and a student and I'm approximately 18 weeks pregnant. I can’t financially and emotionally support a child so I'm planning on having an abortion. The problem is my partner and I have both been saving and scraping money together but we’re still short. I was enquiring as to whether we could get any assistance, be it monetary or just providing us with somewhere to stay when we get there.”

A young teenager with medical complications that could have been compromised by continuing her pregnancy. She and her boyfriend both sold their electronics in order to raise £100.

“I'm a college student and I'm pregnant. I can’t tell a soul and I'm devastated. My parents work so hard to put me through college that I can’t drop out to have a child. Never mind afford to support a child, nor necessarily want one at this stage in my life. Is there any assistance I could have or even an ear?”

A young teenager with an abusive ex-boyfriend. He was threatening her, to try and make her continue with the pregnancy. Her family were not in a position to provide support, emotionally or financially, a family friend put herself in debt to help with the costs but was still unable to provide the full cost.

“I'm growing more desperate by the week. I'm 6 weeks pregnant with an unwanted baby that I cannot have for financial and personal reasons. My boyfriend is unwilling to help with the costs of the abortion, as are my parents and his family. I have to cover this entire cost by myself and I am an unemployed student who will probably be homeless before long. Please let me know if there is anything you can do to help.”

These young women came from all parts of Ireland and Northern Ireland. Some had support and others didn't. Many had to delay their abortions as they tried to raise the necessary funds, causing even more expense as the price of abortion rises with gestation.

But what did these women have in common?

They were pregnant.
They didn't want to be pregnant.
They were poor.
And not a single one of them thought they would ever be in a position where they would have to call a total stranger in another country to ask for money for an abortion.

Mara Clarke is the founder of Abortion Support Network, an almost entirely volunteer run charity that helps women travelling from Ireland and Northern Ireland to access a safe and legal abortion. To find out how you can help or to sign up for their monthly eNewsletter visit www.abortionsupport.org.uk or follow @AbortionSupport on Twitter.

Feminism, Catholicism and Abortion

This post is a response to the interview with Caroline Farrow, a ‘pro-life feminist’ on the Faith in Feminism blog.

We are always interested to hear from people of faith on the ways in which their religion or spirituality plays into their thoughts on abortion and reproductive rights in general. In the pro-choice movement, people are often too quick to assume that all Christians, or all Muslims would automatically be against abortion. In fact, religious teachings vary, with many allowing for abortion in certain circumstances (and nearly always with regards to protecting the pregnant person’s health).

The Catholic Church however does prohibit abortion in all circumstances. Abortion, along with contraception and masturbation is forbidden by the church. However, this doesn't mean that Catholics do not masturbate, access abortion or use contraception to control their reproduction.

A 2011 report by Catholics For Choice showed that 98% of Catholic women in the U.S have used a form of contraception banned by the Vatican. Catholic women have abortions at the same rate as non-Catholics, and 86% of those surveyed disagreed with the church’s teaching on abortion.

These figures show us that individuals use their own personal conscience to make decisions which affect their lives, and their families. Farrow makes a convincing case for ‘Natural Family Planning’ (NFP) (which is indeed extremely effective if practised properly) and this may well be a favourable option for those who wish to avoid pregnancy without using condoms or hormonal methods of birth control. However, clearly, for many Catholic women other forms of contraception have proven to be a better fit for their lifestyles.  A pro-choice point of view would acknowledge the importance of allowing these women to make the choice which is right for them. If they wish to follow the church’s teachings and practice NFP, great, let’s make sure they have the support and information they need to do so. If they want to try other methods, or use condoms to help protect against STIs, then this should also be accessible for them.

Unfortunately a pro-life perspective tends to mean that this choice (which many make already, regardless of what their religion teaches) is disregarded and taken away. A ‘pro-life’ point of view holds that doctors were right to deny Savita an abortion because “it is not ethical to induce delivery of an unborn child if there is no prospect of the child surviving outside the womb”. An individual might decide that they would never have an abortion in any circumstance, but as soon as this decision is projected and extended to others it limits human rights. It limits women’s rights.

Farrow herself is extremely supportive of the 40 Days for Life ‘vigils’, which aim to shut down abortion clinics and therefore restrict women's access to abortion. Standing outside abortion clinics praying for women who have made a decision, which may or may not have been difficult for them, smacks of a desire to project one’s own position onto others, believing them unfit to decide for themselves. 

"How to get rid of a pregnancy"

Having seen people tweeting about the weird and wonderful ways readers reach their blogs, we decided to delve into our own statistics to see what people have been typing into Google to end up at this blog. 

Although of course plenty reached the EFC blog through links on other sites, or searches like 'abortion education in schools', one of the most common searches was the phrase 'how to get rid of a pregnancy'. Other popular searches included variations on 'pills to get rid of pregnancy'. Further investigation showed that quite a few people reached the EFC blog through a link on Ask.com which lead to this Mythbusting Monday post about medical abortion, explaining why the phrase 'abortion pill' can be misleading (Early Medical Abortion is actually a process involving two lots of medication, and two to three visits to a clinic, rather than just 'taking a pill').

It was sobering to realise that many people visiting this blog are not just looking for general information related to work or study but are likely themselves facing an unwanted pregnancy and unable to access the medical support they need to have an abortion. Sobering, but not all that surprising when you know that a decent proportion of visitors to this blog are from the USA and Ireland.

As you may know, although abortion is legal in the United States, access is severely restricted in some areas, meaning that those seeking abortion (especially poorer women) may look for 'cheaper' methods of ending a pregnancy, such as buying medication online. This graphic shows the varying levels of abortion access in the U.S - with mandatory waiting periods or insurance restrictions being enforced in many States, access to safe, legal abortion can be difficult.

Ireland, in turn, has one of the world's most restrictive abortion laws. Abortion is only available to save a pregnant person's life. Last year, almost 4000 women travelled from Ireland to England and Wales to have an abortion. Again, these women will have needed the financial means to pay for the procedure itself as well as transport and associated costs. Although the Abortion Support Network has been set up to help these women pay for the procedure, it can't support everyone. A recent article in Vice argued that more and more Irish women are turning to the internet to purchase abortion medication to administer themselves. The article points out that women taking this route are not recorded in the official statistics, although with hundreds of packages of such medication being seized every year, the number is clearly significant. 

Of course, ordering and using this medication is illegal in Ireland. But it seems that some are desperate enough to try to end a pregnancy even via methods which could put them in prison. And this is not just true of women in Ireland, or the U.S, but anywhere where abortion is illegal or restricted. And as the Guttmacher Institute makes clear, this method can be safer than traditional 'backstreet abortions' performed in unsanitary conditions: "In settings where abortion is illegal or highly restricted, it (abortion medication) has provided many women for the first time with a safe and discreet means for early termination of unwanted pregnancy." Safe Abortion Hotlines in places such as Chile, Poland and Kenya show that  where abortion is illegal or very severely restricted, there will still be women who find ways to end their pregnancies.

Unfortunately we were not surprised to see that some of these women had found their way to our site through searches for information on unwanted pregnancies which they cannot end in registered medical establishments, either due to legal, practical or economic constraints.

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.

2012 Abortion Statistics

The latest statistics on abortions carried out in England and Wales were released today. The main findings are summarised below but you can view full information (including data tables) here. This year, the Department of Health also carried out a consultation on changes to the publication of abortion statistics, the results of which can be found here.

•    The 2012 abortion rate for all ages is 16.5 per 1,000 women – the lowest rate since 1997 and 6% lower than in 2011. The abortion rate was highest for women aged 21 (31 per 1000 women).

•    The under 16 and under 18 abortion rates were slightly lower than in 2011 (3 per 1000 and 12.8 per 1000 respectively).

•    The number of abortions taking place under 13 weeks gestation remains at 91%, and 97% of abortions were funded by the NHS. The percentage of medical abortions also remains consistent, at 48% (47% in 2011).

•    In 2012, 52% of women undergoing abortions had one or more previous pregnancies that resulted in a live or stillbirth.

A significant difference from 2011’s data is the number of non-resident women accessing abortion in England and Wales:

•    In 2012, there were 5,850 abortions for non-residents versus 6151 in 2011. The 2012 total is the lowest in any year since 1969.

The majority of non-residents accessing abortion in England and Wales are from the Republic of Ireland and Northern Ireland (making up 83.6% of the total number of non-residents in 2012). It’s unclear as to why this figure is lower than it has ever been but it’s possible that more women in Ireland are accessing medical abortion online; rising awareness of services like Women on Web through public campaigns may mean that more Irish women are using illegal methods to end their pregnancies rather than face the cost and difficulty of travelling abroad to do so.

Another interesting statistic which deserves to be unpicked is the over-representation of certain ethnic groups in the abortion statistics, particularly with regards to those women who have more than one abortion.

As you can see from the table, women who are of Black or Mixed ethnicity are more likely to have had one or more previous abortions than women of other ethnic backgrounds. The statistics do not tell us why this is, but we might question if the information provided to particular communities on contraception and abortion is relevant and accessible. We know that there are links between ethnicity and deprivation, and between deprivation and unintended pregnancy so this too might be a factor. More research is clearly needed  into the intersections between ethnicity, unintended pregnancy and abortion, but in the meantime, it is crucial to note that women from all backgrounds can and do experience unintended pregnancy and abortion and we should not shy away from providing culturally appropriate, evidence-based information in every setting.

As a result of the consultation on the publication of abortion statistics a few changes have been made, the most significant of which being local level statistics being presented by CCG (clinical commissioning groups) rather than PCT (primary care trust) data due to the changes to the health system.

One interesting aspect of the consultation was to see the number of anti-abortion groups which had responded, a number of whom requested information on fetal sex to be represented in the abortion data. This is presumably a response to recent scaremongering suggesting that 'sex selective abortions’ were taking place in the UK (despite the Department of Health’s own 2013 report finding that the UK’s ‘gender ratio’ is "well within the normal boundaries for populations").

The response to the consultation gives a firm response to this request:

"Information about the sex of the foetus and NHS number are not currently collected on  the HSA4 form. To collect such information would require changes to the  legislation, in  particular the Abortion Regulations 1991, as well as to clinical practice. This is not in the scope of this consultation. The majority of abortions take place before 10 weeks gestation and it is not currently possible to identify a foetus’s gender at that stage. Identifying the gender of aborted foetuses over 10 weeks’ gestation raises ethical and clinical issues. The Government has no plans to introduce such a practice."

What the SPUC?

We regularly get requests from teachers across the country who are looking for a ‘pro-choice’ speaker to come in and balance out a talk on abortion from a ‘pro-life’ group. We’ve written before about EFC’s general concerns with this approach. Namely that a ‘debate’ around abortion can be confusing and stigmatising for young people, and rarely provides them with the factual information they need for living their lives (especially when we know that a third of women have an abortion).  This blog gives specific examples of the issues involved when inviting the most well-known anti-abortion group, SPUC, to a school. The teachers I speak to are rarely aware that SPUC runs an outspoken campaign against same-sex marriage and that the information they use regarding contraception and abortion is very often at odds with the medical establishment. So here is the lowdown:

•    Misinformation about abortion
SPUC’s educational materials make claims about abortion which are not supported by medical experts. For example, they link termination of pregnancy to ‘post-abortion trauma’, which is an invented medical condition, and claim in their student pack that 'the risk of ectopic pregnancy may increase up to 30% after a first abortion and 160% after two or more'. The Royal College of Obstetricians and Gynaecologists (who tend to know about such things) state that there is no evidence for a link between abortion and subsequent ectopic pregnancy. A SPUC speaker also made misleading links between abortion and breast cancer at a Cambridgeshire school last year.

•    Misinformation about contraception
SPUC’s booklet ‘Birth control methods which can cause abortion’ suggests that all forms of hormonal contraception can act as abortifacients. This is based on the belief that pregnancy begins at fertilisation, rather than implantation, which is unsupported by the law and established medical practice.

•    Stigmatisation of abortion and use of distressing images
The SPUC speaker in Cambridge told students that 'rape is the ultimate unplanned pregnancy...for some people who’ve been raped and had the baby, even if they don’t keep it, something positive comes out of that whole rape experience'. SPUC's student pack claims that 'pregnancy as a result of rape is extremely rare...the extreme physical and psychological trauma of being raped makes it difficult for fertilisation or implantation to occur.' This is untrue and may be upsetting for those who have experienced rape. SPUC has a history of presenting information to young people in a way which can be distressing. As far as we know, SPUC continues to use graphic images in its school workshops, and images of aborted fetuses remain on the ‘education’ section of the website, likely to be used by young people for school projects.

•    Stigmatisation of same-sex relationships and family units
SPUC currently runs a campaign against the legalisation of same-sex marriage, which it claims would increase numbers of abortions. John Smeaton, the director of SPUC, states the following on his blog:
“The fundamental argument against gay marriage is that homosexuality is disordered, as it is radically at variance with the truth and meaning of human sexuality ... Catholics must proclaim loud and clear that it is impossible for any homosexual relationship to be a marriage because genuine personal, sexual and spiritual union between persons of the same-sex is impossible.” SPUC has also made statements against same-sex couples adopting, claiming that ‘lesbian parentage is not in the best interests of children’.

•    Opposition to sex education
SPUC fronts the ‘Safe at School’ campaign which lobbies against so called ‘explicit’ sex education in schools. A recent blog claims that sex education lessons tackling pornography are ‘about dangling porn in front of young school pupils and encouraging them to embrace it in their lives.’ The group has expressed concern about sex education materials which ‘include explicit images of male and female sex organs, lessons on menstruation in mixed classes (boys and girls)’ and has labelled masturbation‘intrinsically unethical’.

SPUC are extremely well funded and do not charge for their schools work. They regularly contact schools with the offer of a free speaker on this tricky subject and it’s understandable that many teachers decide to run this lesson using an external organisation. However, we would advise all teachers to think carefully about how such an organisation might fit with their school’s SRE and equality and diversity policies, as well as their commitment to the well-being of their students, some of whom may already have experience of abortion, and many of whom will definitely go on to.

If SPUC has visited your school, we’d be interested in hearing what you thought about the lesson.

SPUC leaflet opposing same-sex marriage