• Research based on interviews with 14 experienced abortion doctors finds that those providing this care are strongly critical of current law and believe it forces them to provide care “in a way that departs from clinical practice with a clear negative impact on women’s experience.”
• The study finds that the “fear and insecurity” caused by the threat of prosecution has led to some doctors abandoning abortion provision and deters younger doctors from training in the field, which has significant implications for the future of services, particularly for women with complex medical conditions.
• Requirement that two doctors legally authorise every request for a termination creates an “access problem” that delays treatment and “compromises the service.”
• The study adds to growing calls from charities, medical bodies, and MPs for abortion to be removed from the criminal law and regulated in the same way as all other medical procedures to improve and safeguard the future of services.
• MPs have signalled there will be cross-party moves to decriminalise abortion up to 24 weeks of pregnancy during the forthcoming parliamentary session.
A study published in the September issue of the journal Social Science & Medicine has found that doctors working in abortion care services are highly critical of the current legal framework, and believe that is compromising the care they can provide to their patients.
The study involved face-to-face interviews with 14 experienced abortion care doctors, working both with NHS hospital settings and the not-for-profit independent sector, and explored their views on the impact of the abortion law on clinical practice.
Across the UK, abortion remains a criminal offence under sections 58 and 59 of the 1861 Offences Against the Person Act (and equivalent common law in Scotland.) The 1967 Abortion Act (which did not extend to Northern Ireland) did not repeal these sections, but provided legal exemptions for women and medical professionals if they meet certain grounds and only if the procedure is legally authorised by two doctors. Any medical professional who provides an abortion outside of the terms of the 67 Act risks criminal punishment. In recent years, anti-abortion campaigners and MPs have pushed for doctors to face prosecution, not for providing substandard care, but for incorrectly completing the legal paperwork required by the 67 Act.
Doctors interviewed for the study placed a strong emphasis on the “fear and insecurity” created by this threat of criminal sanction. One doctor also described the impact of the threat of prosecution on medical care:
“It sends fear… so it does disorganise and destabilise doctors who are functional people who wanted to do a specific task.”
Doctors stated that this “chill effect” has lead to some doctors abandoning abortion provision, and acts as a deterrent to younger doctors training in the field.
“All of the negative light that’s been shown on abortion… to see if doctors are breaking the law. I think those things are deterrents to junior doctors going into the field and wanting to get training.”
This has significant implications for the future of abortion services in the UK, particularly for women with complex medical conditions who require care within NHS hospital facilities. A report from bpas published earlier this year found that women in the UK with medical conditions including epilepsy, heart problems, and cancer struggle to obtain abortion care, even though the continuation of the pregnancy poses a significant threat to their health. Around once a week a woman with a medical conditions including epilepsy, heart problems, and cancer are unable to obtain abortion care, even though the continuance of the pregnancy poses a significant threat to their health. A decline in the numbers of doctors working in abortion would have a severe impact on this group of often very vulnerable women.
Those interviewed “strongly resented” the current legal requirement that two doctors approve an abortion and sign off an abortion certification form for each request, which is entirely separate to obtaining consent for treatment. This was described as ”ridiculous”, “unnecessary”, and “completely outdated.” Doctors stated that the requirement can create delays, particularly in rural areas:
“It does hold things up enormously, the second signatures.”
“It slows things down [the second signature]… it compromises the service.”
Overall, doctors felt that the law itself does not improve services or protect women, but is in fact an obstacle to providing optimum care. Services are not able to adapt to medical advances nor are doctors able to use their own clinical judgement, but instead must be governed by a law passed over fifty years ago.
“The regulation is about putting barriers rather than doing things that would benefit the individual in terms of quality.”
“I’m not saying [abortion] should be unregulated… but I’m saying it should be regulated in the same way as health generally.”
Leading medical bodies including the BMA, Royal College of Obstetricians and Gynaecologists, and the Royal College of Midwives have adopted policies in support of the decriminalisation of abortion. This would allow abortion to be regulated in the same way as all other routine medical procedures, improve care, and protect women and healthcare professionals from prosecution.
MPs led by Stella Creasy have signalled that there will be a cross-party amendment to the government’s forthcoming Domestic Abuse bill which would decriminalise abortion up to 24 weeks of pregnancy in England, Wales, and Northern Ireland, while Diana Johnson MP has also stated she will pursue a private members bill on the issue.
Ellie Lee, Professor at the University of Kent and co-author of the study, said:
“This research was with senior doctors most closely involved with providing abortion and developing this service. Providing abortion emerged from our interviews with them as a moral act that values women’s autonomy and makes an enormous contribution to women’s health. Their concerns were about the present legal arrangements preventing the exercise of medical professionalism. They want to obtain consent to treatment in line with generality of the provision of medical treatments; improve and develop the division of labour with nurses and midwives; and provide abortion and encourage younger doctors to do the same without the threat of criminal prosecution hanging over them.”
Commenting on the study, Dr Patricia Lohr, medical director at the British Pregnancy Advisory Service, said:
“This is an important study which shines a light on the challenges doctors working in abortion face, and the negative impact the criminal law has on their ability to provide women with optimum clinical care. Decriminalising abortion does not mean deregulating abortion, but it would mean that the service could be organised in the same way as other healthcare procedures, giving healthcare professionals the ability to provide women with the best possible care.”
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Notes to Editors:
bpas is a charity which sees more than 70,000 women a year and provides reproductive healthcare services including pregnancy counselling, abortion care, miscarriage management and contraception, at clinics across the UK. It supports and advocates for reproductive choice. More information can be found at bpas.org.