Abortion: A briefing document on why access to late abortions needs to be defended
July 16, 2004
The Bishop of Oxford is putting forward a question on late abortion for discussion in the House on the 20th July.
The majority of discussion to date on late abortions has been within the media and much of the comment has been ill informed. Below is a series of notes from the Chief Executives office at the UK’s largest abortion provider bpas (abortion care) that will hopefully help to inform the debate.
bpas (abortion care) provides just over 2000 abortions between 20 and 24 weeks gestation each year. In 2002, the last year for which figures are available, bpas saw 2,146 out of the 2,753 abortions between 20 and 24 weeks. That places our staff in a unique position to understand why access to late abortions needs to be defended. We are currently surveying why these terminations are requested at such an advanced stage of pregnancy.
Reasons for late abortions
We do not yet have collected data to inform the debate but in the last couple of weeks Ann Furedi, bpas Chief Executive, has visited 3 of the bpas clinics that offer these procedures and discussed the matter with the staff.
From these conversations she has made the following observations:
- Improving access to early abortion will not have a significant affect on the number of women requiring late procedures. In the 1980s studies showed that many women were pushed into second trimester procedures because of waiting lists. This has changed as access to early termination has improved. The reasons why women present late now seem to be the following:
- Denial/refusal to face up to the pregnancy: many of clients are young teenagers who have put off telling anyone about their condition in the hope that the problem will go away. One clinic had 2 x 14 year olds and a 12 year old on one of its 'late lists'.
- Discovery of fetal abnormality
- Break up of relationship leading to a wanted pregnancy becoming unwanted.
- Ambivalence - it takes quite a few women a long time to make up their minds that they really do want abortions.
- Wanted pregnancy where a woman has been trying (but failed) to change her circumstances to enable her to have the baby (often she has been trying to persuade her partner)
- Need to save up the money to pay for care because the woman is ineligible for NHS care - often from Ireland.
- Undetected pregnancy. One clinic had a woman who had been on the pill and had continued to have monthly bleeds. Therefore she had no pregnancy symptoms and so didn't realise she was pregnant until her boyfriend started joking that her tummy looked a bit pregnant.
- Technology has advanced but it is still unusual for a premature baby at less than 24 weeks to survive without serious long-term disability.
- The law has only a small part to play in the regulation of late abortion. The numbers are already small (less than 3,000 a year are between 0-24 weeks). Mainly this is because women don't request late abortion without grave consideration. The procedure is unpleasant; it usually involves labour and women often find that their attitude to the pregnancy changes when they begin to experience fetal movement. Doctors and nursing staff are reluctant to perform late procedures. Even within bpas, many doctors establish their own time limits and will not be involved in procedures after, say, 16 or 18 weeks. Many NHS services already limit their service to procedures under 12 or 14 weeks. This has led to a situation where bpas provides 78% of all post 20 week abortions.
- bpas has no commercial interest in defending the legal limit. In many ways it would be easier if the law was to change. Late abortions are expensive to provide as it is an inpatient procedure requiring clinics to be open over night. Staff are difficult to recruit. The risk of complications is higher. We struggle to continue to provide a service because we're committed to the clients.
- Clinic staff say the worst moments in their job is when they have to tell women that they are 'too late' for an abortion. We turn away about 100 women a year who are beyond the gestational limit. They beg and sometimes try to bribe staff. We are able to provide women with details of clinics abroad where post 24 week abortions are permitted, but this is often prohibitively expensive.
- Our staff feel that the debate on abortion is too abstract and detached from the context in which abortion happens. Many of our clients feel that abortion is wrong, but that it is the right thing for them because of their own circumstances.
We hope this briefing has been of assistance. If you would like to discuss the content of this document or would like further background information please do call bpas press officer Zoe Coward on 01564 796 103 or 07788 725 185.