From the TUC

Nadine Dorries’ abortion amendments: Sound reasonable?

08 Apr 2011, by Guest in Politics

In the pro-choice movement, it is fairly common to be told that we are promoting murder, eugenics, racism and social ills of all kinds.  In some ways it’s easy to dismiss this kind of accusation: most reasonable people, in the UK at least, broadly support a woman’s right to choose abortion and are able to distinguish between extremist viewpoints and rational debate on the subject.

That’s why the abortion-related amendments to the Health and Social Care bill recently tabled by Nadine Dorries and Frank Field are more problematic – because superficially they sound reasonable.

The amendments propose that women seeking abortion should receive counselling from an organisation that does not itself provide terminations, and that the body charged with drawing up clinical guidelines for abortion care should not itself be linked to abortion-providers.  Counselling for women with unplanned pregnancy? Good idea.  Unbiased clinical guidelines? Of course.

Anti-choice campaigners aren’t stupid.  They know from the experience of their American counterparts that hardline anti-abortion measures couched in moderate language have greater resonance with the public.  Later term abortion in the US? Re-christened ‘partial-birth abortion’ and promptly banned.

So Nadine Dorries tells us she is neither pro-choice nor ‘pro-life’ but simply ‘pro-woman’.  Her campaign around these amendments is called Right to Know.  Women have a right to know the ‘real risks’, both physical and mental, associated with abortion which, it is claimed, are currently being deliberately withheld from them by the abortion-industry.  The Royal College of Obstetricians and Gynaecologists’ clinical guidelines on the care of women seeking abortion cannot be trusted because it too is part of this ‘industry’. Everyone, it seems, has a vested interest in encouraging more women to have more abortions.

But the boring fact of the matter is that none of this is actually true. Informed consent from the patient is required before any medical procedure, including abortion, can be carried out.  Clinicians are required to discuss all potential risks and complications, both physical and psychological.  Abortion in the UK is already thoroughly regulated – let’s not forget, it’s the only procedure that requires the permission of two doctors before it can go ahead.

Bpas (the British Pregnancy Advisory Service), which is one of the UK’s largest abortion-providers and therefore the main target of Ms Dorries ire, reports that around 20% of women decide not to go ahead with termination following the counselling they receive.  It’s also a registered charity which carries out 90% of its procedures under contract to the NHS, and is licensed by the Secretary of State for Health to do so.

The problem facing anti-choice campaigners such as Dorries is that the clinical facts about the ‘real risks’ of abortion do not accord with their view of what women should be told about the procedure.  When carried out legally in a clinical setting, as it is the in the UK, abortion is a very safe procedure; the risks of complication are small, but women are still informed about them, as they should be.  In terms of mental health, the Royal College of Obstetricians and Gynaecologists finds (in its new draft guidelines) that “the great majority of women who have abortions do not experience adverse psychological [consequences]”.

It is not unreasonable to trust the members of the RCOG to have used the most up-to-date evidence at their disposal and to have the best interests of their patients at heart.  Nor is it unreasonable for those drawing up such guidelines to themselves be involved with the provision of abortion.  In fact, I rather hope that they would be involved.

Advice provided by medical bodies about other types of procedure does not attract this kind of criticism.  Private healthcare providers in other areas of medicine are accepted as offering unbiased opinion, although they most certainly do so in a for-profit capacity (in fact the Conservative Party actually seems quite keen on seeing more of this).

Requiring women to undergo further mandatory counselling, is both unnecessary and insulting to women.  It presumes that women are incapable of making up their own minds when presented with the clinically relevant facts and ultimately seeks to delay and deter women from having abortion.

What does ‘independent advice and counselling’ as sought by Dorries et al actually mean? Where will it come from? In the United States, compulsory counselling means that in some areas women are given grossly inaccurate information about abortion’s links to breast cancer and infertility, some are required to listen to a detailed description of the foetus or view ultrasound pictures before they are allowed to proceed.  Counselling at the hands of anti-choice Crisis Pregnancy Centres most certainly will not result in genuinely ‘informed’ consent.

Debate on abortion is not solely driven by scientific evidence on either side.  The pro-choice movement deals with human and gender rights, bodily autonomy, need and circumstance. But here we are talking simply about what women should be told before having an abortion, and if we ignore mainstream medical opinion because it does not tally with our personal ideological viewpoint, and then seek to enact those views into law, then we are in dangerous, and not at all reasonable, territory.

GUEST POST: Darinka Aleksic is campaign co-ordinator of Abortion Rights, the national pro-choice campaign for the UK.

8 Responses to Nadine Dorries’ abortion amendments: Sound reasonable?

  1. links for 2011-04-11 « Embololalia
    Apr 11th 2011, 7:03 pm

    […] Nadine Dorries’ abortion amendments: Sound reasonable? | ToUChstone blog: A public policy blog fro… But the boring fact of the matter is that none of this is actually true. Informed consent from the patient is required before any medical procedure, including abortion, can be carried out. Clinicians are required to discuss all potential risks and complications, both physical and psychological. Abortion in the UK is already thoroughly regulated – let’s not forget, it’s the only procedure that requires the permission of two doctors before it can go ahead. (tags: nadine.dorries abortion uk) […]

  2. “Pro-life” « verschwindet
    Apr 14th 2011, 6:36 pm

    […] stupid proposal to force people to undergo compulsory counseling in order to be allowed to have an abortion is part of a larger plan. It’s real purpose is to […]

  3. Beware the anti-abortionists’ tiny steps towards reform | Libby Brooks | Birmingham Link
    Apr 15th 2011, 10:02 pm

    […] the tactic – which has proved highly successful in the US – of proposing incremental changes couched in moderate language to achieve hardline goals. While nobody would argue with the necessity of informed consent, the […]

  4. Dr AM Houghton
    May 5th 2011, 8:48 pm

    As a GP I’m afraid Miss Aleksic’s comments show a naive and misplaced trust in British doctors.
    Yes it is certainly true that a large number of obstetricians and GPs make a large amount of money from abortions. So they would say it’s safe wouldn’t they.
    Secondly, informed consent for women may be required in law, but for decades it has been desperately lacking in reality. It is a shameful experience as a doctor when a woman comes back from the abortion clinic. “I’ll never ever go near that place again,” are typical comments.
    Thirdly, as I wrote to the Royal College of Gen practitioners today, two doctors signing the abortion warrant is no guarantee that they saw any research. The law is simple: a woman can only have an abortion if that will be safer than having the baby. Several large studies show the woman is 2 or 3 three times more likely to die (from suicide, violence, accident, murder and medical complications) in the year after abortion than the year after having the baby. This makes most abortions technically illegal. But most doctors don’t know the evidence. ( Find it in Reardon D C et al. Deaths associated with pregnancy outcome: a record linkage study of low income women. Southern Medical Journal 2002; 95: 834-841)
    Also strong and widely accepted scientific evidence shows abortion causes premature birth. After an abortion the mother is up to twice as likely to have a premature baby. (See this in PS Shah,a,b J Zaoa on behalf of Knowledge Synthesis Group of Determinants of preterm/LBW births. Induced termination of pregnancy and low birth weight and preterm birth: a systematic
    review and meta-analyses. BJOG 2009; 116:1425–1442.)

    So of course women do deserve to have independent counselling away from the vested interests. Its their life at stake.

  5. Maggie
    May 7th 2011, 3:04 pm

    Dr Houghton, you ought to be ashamed of the sweeping generalisation you have just made.

    “It is a shameful experience as a doctor when a woman comes back from the abortion clinic. “I’ll never ever go near that place again,” are typical comments.”

    It is certainly a shame for your patients that you insist on referring them to what sounds like, at least going by your description, a terrible abortion clinic.

    It might interest you to know that the BPAS clinic I went to for my own abortion procedure made every effort to ensure my experience was as comfortable as it could have been. The nurses were sensitive, considerate, and dedicated. My feelings were always put first. Independent counselling was offered to me, but I turned it down since I really had no reason to have any. Being *offered* counselling is very important – there are many women that may be afraid to ask for it, of course. But the very idea of being *forced* to undergo counselling I neither wanted nor needed is ridiculous.

    How is it so difficult to understand that abortion is not some sort of sadistic, destructive procedure that no woman can endure without adverse consequences to her mental health? I was left far more affected and upset by my first gynecological examination and smear test – I had a very bad experience, and thinking about it still fills me with dread – but was offered no sympathy there. The point is that there are a vast number of medical procedures with the capacity to leave a patient feeling mentally and emotionally affected. Abortion, yes, is one of them. But all patients are different. You as a doctor should know this.

  6. Dr AM Houghton
    May 9th 2011, 7:16 am

    Maggie it was usually a BPAS clinic that caused these sad comments about inhuman treatment. I never refer to such clinics; but I do refer patients for second opinions on abortion requests. I am glad you were offered counselling and treated with respect.

    Noone can be forced to have counselling; we are still in a free country. But healthcare has checks and balances and abortion is one area where patients need a chat away from the provider who might get paid.

  7. Dlw
    Jun 4th 2011, 1:45 am

    AM – how on earth were the studies comparing suicide etc rates controlled for the fact that the women who chose to have a baby might well on average be in a different pschological and social position to those having an abortion – for one thing those who ex hypothesi have chosen to start a family might well be expected to be more financially secure and in a long term relationship. You could control for those things, but what about “happiness” at the point of making the decision? The welfare of those who choose to abort v that of those who choose to start a family is basically a dubious comparison. Do you have the stats on suicides etc comparing those who have abortions v who give up for adoption? Surely that’s a more meaningful test of the effects of abortion.

    Also, I’d be interested to know which categories of procedures you *do* and *don’t* think merit a compulsory “chat” to someone who doesn’t perform the procedure. Will you campaign for such third party advice for all surgery, say?