Understanding 'late' abortion
By Ellie Lee
April 27, 2007
A new study has addressed an under-researched area of the experience of abortion; why women have abortions at 13-24 weeks. Dr Ellie Lee, senior lecturer in social policy at the University of Kent, worked on the study. Here she discusses the context for the research, and summarises some of its findings.
As recent articles on this site have noted, the abortion controversy has shifted more and more towards a focus on 'late' abortion. Ultrasound pictures of 'walking' fetuses, media reporting of 'miracle babies' born early at 22 weeks but surviving, and horror stories of 'botched abortions' where fetuses briefly show signs of life after late abortion procedures, have often set the terms of recent public debate. There has always been a host of myths and misconceptions about abortion, but these debates have added new ones to the list. These include misunderstandings about science, and what it tells us about fetal development. (See 'Science, smiling fetuses, and the abortion issue' http://www.prochoiceforum.org.uk/ocr_ethical_iss_2.php). They also include confusions about the circumstances and experiences of women who have late abortions.
All women who have abortions are the subject of widespread misunderstanding. Ignorance about their circumstances is reflected in negativity about abortion by commentators who indicate they cannot comprehend why a woman ever becomes pregnant when she does not plan too. This approach shows a profound lack of knowledge of contraceptive methods and their failure rates, and also lack of insight into the nature of sex and relationships. (For a recent example of this, see Libby Purves, 'A crisis brought on by our selfish desires' http://www.timesonline.co.uk/tol/comment/columnists/libby_purves/article1662848.ece). As a result, unfortunately, women who have abortions rarely appear in the public debate for what they are; ordinary women, from all walks of life, who most often seek abortion because they happen to have become pregnant accidentally through a contraceptive accident or its failure. Instead they are usually presented as possibly deserving victims (if pregnant from rape or incest for example). But if they are not pregnant as a result of circumstances of this kind, they are imagined to be 'selfish career women', or 'slappers' who 'use abortion as contraception'.
When it comes to late abortion, ignorance about the women concerned and the nature of their experiences seems even greater. This has been reflected in discussion of late abortion happening without reference to women at all; as if the 'walking fetuses' or 'born alive fetuses' were never inside a woman, who in turn played no significant part in their gestation or consideration of their future. Or, if the women concerned are brought into the picture, it is often with incomprehension - 'how could they possibly they end up five months into a pregnancy and not have sorted themselves out sooner?'
As a result, discussion of late abortion has tended to shed far more heat than light, a problem arguably compounded by the notion popularised by some who are pro-choice, that the 'problem' of late abortion could be made to 'go away'. If early abortion were made easier to access, some have argued, this could be the outcome, are argument that has tended to add to the perception that 'late abortion' is inherently problematic, and also purely a by-product of the way the abortion service is run. (See http://www.prochoiceforum.org.uk/ocrabortlaw8.php for comment on this approach).
In this context, I was delighted to have been recently involved in a research study that sought to examine the reasons why women have abortions at 13-24 weeks of pregnancy. 883 women participated. The study has raised a raft of interesting points, among which are the following:
- A major reason for delay in the pathway to abortion is due to women not realising that they are pregnant. Many women in the study thus reported this was the case for them, because they normally had irregular periods and so did not consider missing periods to be a sign of pregnancy. Many also reported what they considered to be 'continuing periods' (in fact probably light bleeding that did not progress further to lead to miscarriage). And for many women, the fact they were using contraception meant the possibility of falling pregnant was simply not on their mind. These were major reasons why half of the women questioned were already more than 13 weeks pregnant by the time they requested an abortion.
- After requesting an abortion, delays were partly service-related. Service-related reasons for delay at this stage included in particular delays in getting further appointments and confusion amongst doctors first approached about where a procedure should take place (mostly GPs). These sorts of confusions may be related to the fact that the abortion service in many areas has become complex. Primary Care Organisations, which are responsible for commissioning health services for the local area, are likely to purchase abortion services from a range of providers. NHS hospitals often look after women having abortions in early pregnancy, but in many areas it is more and more likely that later abortions are provided by independent abortion providers such as British Pregnancy Advisory Service (bpas). Unless measures have been taken to make sure relevant health professionals know how to refer women speedily to the right place, this context means confusions about where women need to go to obtain the abortion lead to delays.
- Forty one per cent of women in the study said that they were unsure about having an abortion and therefore it took some time to make up their minds. Many reported that various aspects of relationships with their partners and/or parents (especially for younger women) played a role in delays in their decision-making about whether to have an abortion. 23 per cent overall said that their relationship with their partners had broken down or changed following confirmation of the pregnancy. This indicates that, for some women, the decision to have an abortion is also a decision about whether to become a parent or have another child, and is dependent on broader changes and complications in their personal lives and relationships.
Overall, these findings can provide the basis for a more useful discussion of abortion than we have seen of late. They show, first, that there are 'service-related' reasons for abortion and so there can be practical measures that can and should be taken to help women seeking abortion obtain abortion as early as possible. In particular if effort was put into minimising delays at the point of referral for abortion, then gains could be made. If this very real, concrete problem leading to later abortion became a talking point and was addressed it would, in point of fact, make more difference to the incidence of late abortion than any amount of discussion about whether a fetus can or cannot smile.
They also show that there are many 'women related' reasons for late abortion, and these are more nuanced and harder to find a policy solution to. Contraception fails women, pregnancy symptoms are misidentified as such, and women's relationships are sometimes unpredictable and women respond and react accordingly. These sorts of reasons also indicate that late abortion is not an abstract moral problem, but a reflection of everyday, real life.
In the end, a key point to press is that women who have abortions at 13-24 weeks are just like the rest of us. How many of us can honestly say we cannot imagine misreading what is happening to our body when we are pregnant, especially if we have never been pregnant before? How many of us cannot put ourselves in the shoes of the woman who finds her partner does not react how she expected, and entirely happily, to her news that she is pregnant? How many of us who have children can say, hand on heart, that any and every future pregnancy, whatever our circumstances, would always be unequivocally welcome? To seek to understand the choice for abortion is to seek to understand the nature of very everyday, normal problems and experiences for women. It is to be hoped that more people engage with doing so in the future.
A summary of the research findings can be found at:
The full report can be found at: