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Transcript of Rt Hon Dawn Primarolo MP's speech to open BPAS conference 'Future of abortion- Controversies and Care', 25 June 2008

Published 25 June 2008

Transcript of Public Health Minister's opening address to the BPAS Conference, entitled 'The Future of Abortion'– Controversies & Care' at 9.15am on 25 June 2008.

The Minister was introduced by Ian Hammond, Chair of BPAS and used her speech to announce a new allocation of £6 Million towards sexual health provision in further education sites over 3 years to better target and improve sexual health care in relevant communities.

 The Minister's speech is as follows:

'Ian, thank you very much for the introduction and thank you for inviting me to open the Conference today in what is a rather historic year for the Abortion Act.  I want, in the course of what I say, to focus on abortion, but I would like also to set this in the wider context of sexual health, and to some extent our broader Government agenda as a whole.  Not only is it the 40th Anniversary of the Act but there has been a lot of debate in Parliament and in the media of late and this has particularly been triggered by the amendments laid during the passage of the Human Fertilisation and Embryology Bill.

The Government’s view is that the Abortion Act works as Parliament intended. The evidence from the floor of the House to date is that Parliament supports this view.Amendments including those to reduce the upper gestational time limit from 24 weeks were all either withdrawn or defeated by a large majority when they were debated on the floor of the House on a free vote on the 20th of May this year.  

As the Bill is still before Parliament this debate will continue. Ideas for changes to the law on abortion come from back-bench members, and MPs vote according to their conscience on the basis of a free vote.  I know that further amendments have been laid aiming to make it unnecessary for two doctors to agree to an abortion, and to allow nurses to perform both medical and surgical abortions. These, along with any other amendments that have yet to be tabled, will be debated at report stage on the floor of the House of Commons, probably in early July. I know that BPAS and many other organisations have played their part in lobbying Parliament ahead of the vote in May and will continue to do so in advance of the debate in July, clearly putting across the challenges and issues faced by women. 

Abortion is of course a very highly-charged and sensitive subject, and people will always have conflicting views. Obviously we speak as individual members of parliament as well and my personal view is that the Act works as it is. There are those who want to restrict the Act further and those who want it to be made more liberal. And I think we need to be clear, particularly with those who want to restrict the Act, the basis for our views. The scientific evidence put before me, and the advice I have received, is that on balance the Act has stood the test of time and continues to keep women safe whilst not unduly preventing them from getting the services which they need. 

In fact the latest data for 2007 shows that we have made excellent progress without changes to legislation, with higher proportions of abortions being performed at earlier stages in pregnancy than ever before - 90% of all abortions in 2007 were carried out at under 13 weeks and 70% at under 10 weeks. What is more, an ever increasing number were funded by the NHS: 89% in 2007 compared with 51% in 2002 when the Sexual Health Strategy was launched by the Government.

Changes have been made to services to reduce barriers to access, and this is reflected in the number of women able to have their abortions earlier. This shift has also allowed women more choice of method of abortion with 35% of all abortions in 2007 being early medical abortions, and the figure continues to rise. This reinforces the relevance of the work we are doing on early medical abortion services in non-traditional settings.   

As you know the evaluation report was published in May, and found that early medical abortions carried out in community medical settings are safe, effective and acceptable. I understand that some of you think that we are being too cautious.  After all, this is already being practiced elsewhere in the world. But at every point the safety of women must come first. So we will not move forward with this work until we are sure that, not only will this speed up and improve access to EMA services but, more importantly, that women really want this and would feel safe having an EMA outside of hospital. For this reason we will be seeking views on this, and on a draft protocol with service providers and users, before we move ahead.

But despite the progress we have made on earlier access and increasing the number of medical abortions there is still a lot of work to be done.  The greatest increase in the number abortions in 2007 is in young women below the age of 20 with over 42,000 young women last year having an abortion.  This is unacceptable and we must continue to work together to reduce the number of teenage conceptions. We need to continue to reduce the number of young women having unplanned pregnancies which lead to abortion, and we also need to continue to tackle the rising trends in the number of repeat and late abortions. 

Teenage pregnancy does not occur in isolation from the rest of a young person’s life.  That is why good sex and relationships education, and Personal, Social and Health Education, will help to tackle the key underlying issues linked to teenage pregnancy: self esteem and emotional resilience. The National Healthy Schools Programme ensures that pupils attending healthy schools receive sex and relationships education within the PHSE framework.  

Frankly, I think we still need to do more.However, as of the end of June, 9 out of 10 schools are participating in the Programme with 63% of schools achieving Healthy Schools status.But once young people decide that they are ready for a sexual relationship it is important that they can get access to contraception that is right for them and used in combination with condoms to help prevent them from contracting a sexually transmitted infection. That is why the Government gave £26.8m this year to improve the availability of contraception to women, and to help reduce the number of teenage pregnancies, abortions and repeat abortions.

£10 million of this money will be given directly by the Sexual Health team working with Strategic Health Authorities and will be used to tackle those areas with high levels of teenage pregnancy, abortion and repeat abortions.  And we are looking for new and innovative ways to provide those services and look out for these young people.. Of the remaining funding - £1.5m will used to support the NHS in providing young people-friendly services.

The ‘You’re Welcome’ quality criteria will help PCTs in transforming their health services in a way that makes young people, and other service users, feel comfortable.  Young people have told us that we need to do better to ensure confidentiality, respect, and provide more information in health settings.  None of this is earth shattering – but it does need a concerted effort to make health services more young people friendly. 

And when we achieve this we should see the improvements in the take up in contraception that we are particularly looking for.  And I am delighted to tell you today that we will be spending £2.0m a year for the next 3 years working with PCTs to develop health services in Further Education settings, to help provide advice and engagement for young people – reaching out to where they are.  Many Further Education settings have good health services already in place: we want to see these replicated across the sector, supported by collaborative working and the sharing of good practice to bring about sustainable high quality change.

The extra funding will continue over the next three years and will provide SHAs, PCTs and providers the opportunity to make a real difference.  We will make sure that agreements are in place with each SHA so that it is clear how the funding will be used, and we will evaluate this nationally to ensure we capture all new ideas and to share this good practice. We must make sure that this money is used effectively and produces results. We are not just throwing money at the problem in the hope that it will go away. 

Our approach is evidence-based. For example, recent work shows where teenage pregnancy rates fall, this is due to better use of contraception. Rates in the USA for women aged 15-19 years fell by 27% between 1991 and 2000,and nearly all of this decrease was down to better use of contraception rather than other measures. Teenage pregnancy rates in this country are falling steadily.  Between the 1998 baseline year and 2006, the under-18 conception rate fell by 13.3% to its lowest level for over 20 years.  The under-16 rate fell by 13% over the same period. 

But while there has been steady progress nationally, there is huge variation between local areas (and I know this from looking at my own constituency which is in the top 30 for abortion), and this shows that good local delivery is critically important.  This is why we have sent clear guidance to the NHS this week about the importance of high quality contraceptive provision in reducing abortions and teenage conceptions. 

We expect the NHS and Local Authorities to focus attention on the areas with the highest need. And next week I will be speaking at a conference in Bristol on exactly this point.As rates of unintended pregnancy tend to be highest in young people aged under 25, they are likely to be the ones who will benefit most.  But one of our main aims is to have a much more highly skilled workforce which is able to offer a range of contraceptive choices which will help  women of all ages.

One of our plans is for a project linking abortion services to Long Acting Reversible Contraception, and a LARC fitting service will be included in the new funding projects with the SHAs. In 2006 – 2007 LARC accounted for nearly 21% of primary methods of contraception in community contraceptive clinics, up from 15% in 2003 – 2004. This is a welcome increase which we expect to see continued.  Since women who have undergone abortion are more likely in the future to have unintended pregnancies, this will help to tackle the number of repeat abortions. 

The need to link contraceptive and abortion services with a clear and short patient pathway, is an example of our integrated approach to sexual health and is good clinical practice.  For this reason it will be stressed in the Good Practice Guidance for the Commissioning and Provision of Contraceptive and Abortion services.

Of course what we need to ensure is that all women have the contraception suited to them rather than having one method prescribed to them.

To conclude, the different components of sexual health such as abortion, contraception, teenage pregnancy and sexually transmitted infections are all interlinked and need to be dealt with as part of an overall holistic approach to sexual health. But how does this, in turn, link in with our overall approach to health and wellbeing? 

We need to work harder across all Government Departments to tackle child poverty, the poor educational attainment, and the low aspirations that perpetuate the cycle of deprivation which feeds poor sexual health.  We intend to give young people hope and belief in themselves: this is the surest way to safeguard their health and well being.

The simple fact is that we must work together to crack teenage pregnancy and reduce the number of abortions particularly in young women.  We all have a role to play and by raising our game – locally and nationally – I am confident we can continue to make faster progress in future.I want to assure you as a health minister and as a minister for public health that I will continue this activity because I believe that it is in the best interest of women and their young sons and daughters.'




for more information on this please contact the Department of Health Press office on 020 7210 5222.

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