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Abortion is a fact of life
Article from 'Last Magazine'

The following article, together with many other thought-provoking pieces, appears in 'Last Magazine'. To order a copy call 020 269 9222 or mail sallym@jpgraphics.co.uk

Abortion is a fact of life

An advert designed to bring abortion out of the closet landed Ann Furedi in the middle of controversy. Why?

It is not difficult to get an abortion in Britain. This is a cause of distress for the minority who think the procedure should be banned, but a source of immense relief for sexually active women who do not want to be pregnant.

The legitimacy of abortion, at least in early pregnancy, is now largely accepted. The law that still forbids abortion unless two doctors confirm that a woman meets medical criteria is interpreted liberally by most medical practitioners. They understandably believe that forcing a woman to continue with an unwanted pregnancy is likely to be detrimental to her health.

It is a problem that the procedure may not always be free: a quarter of women find that although they meet the legal criteria for abortion, they do not meet local NHS funding criteria. NHS rationing policies tend to favour the provision of free care to those who most need economic assistance. But abortions are usually affordable for those excluded from NHS funding. The 40 000 or so women who pay for their own abortions usually receive care from the providers that operate on a not-for-profit basis.

Abortion services may not always be available locally; often, local hospitals provide a limited service causing women to travel to specialist clinics. But a woman determined to end her pregnancy will invariably find a safe, legal, affordable means to do so. The abortion service today is tightly regulated and closely inspected by health officials. This, and the existence of the charitable providers, has meant that there is no profiteering private sector making money from women¹s misery.

There seems to be no public will to restrict abortion. Opinion polls repeatedly show that public opinion favours legal abortion and that support for it has increased during the past decade. Most people agree, in principle, that women should be able to control their fertility. Indeed, most people believe that couples should limit their families to the number of children they can support and care for. Parenting is seen as a challenging and responsible task that requires preparation and motivation. This does not sit easily with demanding that women be forced to have and care for children they do not want.

There is little significant pressure on policymakers to make abortion harder to access, and there has been considerable professional pressure to reduce some bureaucratic barriers that have for years compromised the quality of abortion care. Last year the Department of Health quietly revised the regulations governing practice by specialist providers of abortion services, so as to allow more women to have day-care procedures. Earlier this year the Royal College of Obstetricians and Gynaecologists, with funding from the Department of Health, produced national guidelines to shape clinical practice. The document makes it emphatically clear that abortion should be regarded as central to reproductive healthcare services.

Conservative politicians and policymakers may not like the idea of abortion, they may wish it wasn¹t necessary, but, as it obviously is, the overwhelming majority accept it. Occasional calls to restrict the abortion law are met by most with embarrassment. The policy implications of compelling women to carry unwanted pregnancies to term are mind-boggling. Think of all the social support these unwilling mothers would need. Of course there are some shrill voices, primed and ready to denounce abortion as murder, but they are rarely taken seriously outside their circles of supporters. Even many of those who have moral objections to the ending of fetal life tend to draw back at imposing their views on others.

Abortion is undeniably a fact of life in modern Britain. Around 190 000 pregnancies are terminated here every year. Many of these women will have done their utmost to prevent the pregnancy by using contraception, giving the lie to the claim that abortions could be prevented by better contraceptive practice. The numbers might be reduced if we all approached sex with the detached rationality required to keep in mind safer sex advice every time we felt lusty. But even then, unwanted pregnancies would occur. You might feel safe using oral contraception with its one-in-a-hundred failure rate (when used precisely according to the instructions). Yet when you consider that three million women use the pill, that still adds up to 30 000 unplanned pregnancies to goody-two-shoes pill takers. As for the more normal scatterbrains who forget to take it every now and again, or the many who prefer other, less reliable, contraceptive methods, the odds are stacked much higher. If you have sex, but you don't want a baby, your chances of meeting an abortion doctor some time in your life are pretty high. Official estimates suggest that four women out of every 10 use an abortion service to end a pregnancy. For the overwhelming majority it is an episode under which they draw a line and after which they move their lives on.

Yet despite its legality and its prevalence, abortion is still pretty much a taboo subject. The 'A' word is still avoided. In 1968, when British Pregnancy Advisory Service (BPAS), the charity that is now the largest single provider of abortions, was established, the Charity Commission would not permit it to use the word 'abortion' in its title. This year, more than three decades later, BPAS caused horrified mutterings when it decided to bring abortion out of the closet by splashing the word, and the number of women who needed abortion advice or care from its clinics, on billboard-sized ads on the London Underground. The ad campaign was slated in the Sunday Telegraph (edited by the notoriously anti-abortion Nigel Lawson), and featured in heated debates on London¹s radio stations.
Anti-abortion activists worked themselves into a lather and demonstrated their tactical nous by demanding the right to reply, suggesting posters of an equivalent size displaying a dismembered fetus aborted at 21 weeks.

But London Underground users took it in their stride. During the whole of the month's campaign the Advertising Standards Authority received just four complaints. BPAS received one angry email and several congratulatory phone calls. Abortion counsellors reported that women attending appointments at BPAS clinics thought the posters were great: strong and unashamed.

In Britain (things are very different in the USA) abortion per se no longer seems to be an issue of controversy. There are elements of the abortion debate that continue to arouse anxieties. Late abortion, particularly at gestations when a child can survive a premature birth, are a source of growing concern, especially with developments in fetal medicine. There is a relatively strong lobby of disabled people agitating for restrictions on abortion on grounds of fetal abnormality. But even their leading spokespersons go out of their way to claim that they are generally pro-choice.

Arguably, the largest remaining problem with the abortion debate is that those of us who firmly believe that it is a legitimate part of reproductive healthcare, and that the termination of a pregnancy can be a responsible and moral decision, tend to pussyfoot around the issues. Women trying to access abortion services want and need us to be strong and unashamed; instead we tend to be apologetic and defensive. We talk about the 'problem' of the relatively high abortion rate, and claim that we aspire to make abortion 'safe, legal and rare'. We talk about women seeking abortion because they cannot 'cope' with unwanted pregnancies, rather than look the truth in the eye and argue that many women requesting abortion simply do not want to be pregnant regardless of their ability to 'cope'.

If we believe that abortion is a legitimate option for women we should be bold enough to say so.

I recently found myself in a curious debate on Radio 4's Woman's Hour. I argued that a high abortion rate is in itself not a problem: abortion is the solution to the problem of unwanted pregnancy and a raised abortion rate may demonstrate that women are ambitious to remain in control of their lives and are not prepared to allow an unwanted pregnancy to propel them into unplanned motherhood. I had expected flak from opponents of legal abortion, but was surprised to find myself pitched against a pro-choice veteran concerned that such a statement might alienate support for legal abortion, which traditionally has been built on sympathy for 'deserving'women. Yet the image of the deserving victim does not represent abortion seekers in Britain today, and it is humiliating and insulting to women to continue the myth.

Opponents of legal abortion are wrong to suggest that a late-gestation fetus represents the everyday reality of abortion. It does not. But neither does the image of a sexually abused teenager or a woman struggling to cope with her existing family. The profile of women seeking to end unwanted pregnancies is much the same as that of women seeking to prevent their conception. We do not feel the need to justify a woman's decision to use the pill by eliciting public sympathy for her vulnerability, nor should we do so with women's decisions about abortion.

The abortion service has improved tremendously over the past decade, but it does not yet meet the needs of women. In effect, the law requires that a woman seeking an abortion pretends she is on the edge of a nervous breakdown, and it requires that her doctor pretends to believe her. If the law is to be changed to allow women the reproductive autonomy they require, we need to illustrate that it is anachronistic and absurd. The best way to do this is to demonstrate what the reality of abortion really is. It is a safe, legitimate, normal means of managing an unwanted pregnancy. Abortion is no big deal.

Ann Furedi is director of communications for BPAS

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