Abortion has been very much in the news in the last week with Jeremy Hunt [the new Health Minister] saying that he believed the limit for legal abortion should be lowered from the 24th week of pregnancy to the 12th and the President of the Royal College of Obstetricians and Gynaecologists replying that his comments were ‘an insult to women.’ A Dutch abortion ship ‘Women on Waves’ anchored last week near Morocco, in order to provide the service for Moroccan women.

Abortion is, as always an issue in the American Presidential election as seen in the picture above.

Abortion is a very emotional subject. It is the only procedure that a doctor can opt out off. But always remember that your personal beliefs should not affect your treatment of a patient. Even if you disagree with a patient who requests an abortion that patient should be treated with consideration and empathy. It may be reasonable to ask her to consider other options if she does not seem completely sure but that should not result in any significant delay. The patient should be quickly referred to a colleague who is willing to help her.

The Abortion Act makes abortion legal up to 24 weeks gestation,

1 If there is greater physical or mental risk or harm to the mother by continuing the pregnancy.

2. At any stage if there is serious risk to the health of the mother

3. At any stage if the foetus is likely to be born with severe physical or mental abnormalities.

Pregnancy and delivery is more dangerous than a termination so reason number one suggests that provided the pregnancy has not gone far there is effectively abortion on demand. However late terminations, beyond 12 weeks are rare. 90% are before 12 weeks in the UK.

The major organs are formed by 12 weeks. We think that the foetus may begin to feel pain at 20 weeks when the nervous system begins to mature. When recognisably human life truly begins is very controversial.

Some candidates show their ignorance by suggesting that late terminations are the likely result of stupidity – how can a woman not know she is pregnant so late on?
It is important to remember that up to one in five women have irregular periods often not having a period for months and menstrual irregularity is common in those who have recently started periods and coming up to the menopause. The Down’s Syndrome screening test is done at 12 weeks and the main scan at 20 weeks; these may lead to late terminations if abnormalities are found. No contraceptive is 100% effective and the contraceptive injection, implant, coil and mini pill often cause absent periods and so a pregnancy can be missed. Denial is a common feature in many conditions in medicine. It is an important coping mechanism for many. Most women requesting an abortion in my experience are scared and desperate. Abortion is rarely used as a ‘contraceptive’.

Another item in the news this week [in Friday’s BMJ] was a published study that showed free access to contraceptives in the USA led to a very large drop in the abortion rate in those areas. President Obama’s health care bill will lead to free contraceptives for those presently uninsured. Paradoxically a Democrat win in the election may lead to a lower abortion rate than a Republican win!

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