The topic of abortion has been in the news this week. It is the 50th anniversary of the Abortion Act in the UK and President Trump bought in legislation a few days ago to stop Government funds going to any organisation that provides counselling for abortion. This would stop funds going to most NGO s all over the world that are involved in women’s health and provide contraception, pregnancy and obstetric services and HIV aid for women. Changes in the funding of US health care agencies such as Planned Parenthood will also make obtaining contraception and legal abortion harder in the USA, particularly for the poor.
The Rebuplicans won both houses of Congress and Trump has said that he would nominate ‘pro-life justices’ [there are likely to be as many as three vacancies] to the Supreme Court. Even one pro-life justice appointment may change the present balance and lead to the over throw of the court’s landmark 1972 Roe v Wade decision that established a woman’s right to an abortion in the US.
We know that bans on abortion do not work. Paradoxically countries that have strict bans on abortion tend to have the highest abortion rates because of widespread illegal abortions and often poorer access to contraception. Western Europe has the world’s lowest abortion rates despite having better access to abortion. In countries with bans, women who can afford to pay still manage to find doctors willing to carry out abortions, usually for large sums of money and the poor resort to dangerous ‘back street’ abortions. When the Steel Bill that established the Abortion Act in the UK was bought in, the number one cause of maternal mortality [women dying in pregnancy] was illegal abortions.
Abortion is a very emotional subject. It is the only procedure that a doctor can opt out off in the UK. When taking about abortion remember that your personal beliefs should not affect your treatment of a patient. Even if you disagree with a patient who requests an abortion the GMC makes it clear 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 she has the freedom to make her own mind up and there 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 1967 [UK] makes abortion legal if the following criteria are agreed by 2 doctors.
1 If the pregnancy has not reached 24 weeks and there is greater physical or mental risk of harm to the mother or her existing children and family 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 are 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.