In February the Royal College of General Practitioners (RCGP) announced their support for the decriminalisation of abortion. This decision was based on a poll, which only 8.2% of their 53,724 members responded to. 62% of those responding said they supported decriminalisation.
The RCGP now joins the British Medical Association, Royal College of Obstetricians and Gynaecologists, Royal College of Nurses, Faculty of Sexual and Reproductive Health and Royal College of Midwives who have proclaimed their support for decimalisation.
The RCGP states that supporting decriminalisation ‘is about providing non-judgemental care to our patients’ so ‘women who face the difficult decision to proceed with an abortion are not disadvantaged by the legal system.’
Abortion in the UK is illegal by way of sections 58 and 59 of the Offences Against the Person Act 1861 (OAPA). However, the Abortion Act 1967 allows for abortion in Great Britain (it does not extend to Northern Ireland) up to 24 weeks for certain criteria, as assessed by two medical doctors, the Abortion Act also has specific provisions for conscientious objection. Decriminalisation aims to remove sections 58 and 59 of the OAPA, this will mean that there is no requirement for the Abortion Act, including its conscientious objection clauses. Berer, a keen advocate for abortion, links criminalisation to the ‘glorification of the fetus’, in a ‘male dominated society’ that ultimately ‘aims to control women’. For Berer the argument is simple – improve access to abortion, reduce maternal deaths and physical harm. There is no place in her argument for any competing interest of the fetus or any other risks or morbidity associated with abortion. Yet even Berer recognises that except for Canada, ‘no other country, no matter how liberal its law reform, has been willing to take abortion completely out of the law that delimits it’.
The law therefore does serve a purpose: to deter and balance the needs of the baby with that of the woman as well as providing legal sanctions.
Much has been made about the punitive effects of the current law which pro abortionists say risks both women and doctors being prosecuted. Sally Sheldon, another strong pro abortion voice, concedes that: ‘Sections 58–60 of the OAPA are infrequently charged. Police statistics record fewer than ten prosecutions per year under ss 58 and 59 combined in England and Wales, the great majority of which would appear to have been brought in the context of assaults on a pregnant woman or the non-consensual administration of abortifacients. [There have been] just two convictions of women who have unlawfully procured miscarriages in the last ten years (each acting well after viability), and no convictions of clinicians…acting in a professional role.’
This suggests the law is both useful and not unfairly punitive.
If one wants to consider the deterrent effects of the OAPA then one only needs to consider Northern Ireland where the Abortion Act does not apply. Two things are striking about Northern Ireland:
- Despite its restrictive abortion laws there have been no headline grabbing cases of botched abortions or deaths. (Arguably, if we want to read about these we need to go to England and look to providers such as Marie Stopes who have been involved in both poor care as identified by CQC and maternal death.)
- The Northern Ireland group ‘Both lives matter’ assert that 100,000 lives have been saved who would have been otherwise aborted if they had Great Britain’s abortion laws. This assertion was upheld as valid by the advertising standards authority.
There are other things the profession needs to consider before calling for the removal of the deterrent effects of the law.
The profession needs to be mindful that the link between abortion and mental health has not been clarified and certainly one cannot say that access to abortion reduces the chance of mental health problems from an unwanted pregnancy. Abortion pills used for early abortion are not risk free: the FDA reported that mifepristone was associated with 22 deaths in the US in 2017. In addition there is little to suggest that the liberal abortion provisions in Great Britain have done anything to stop women risking their lives acquiring abortion pills illegally on line, so it is hard to argue that decriminalisation will improve these numbers.
The strongest push for decriminalisation comes from the abortion industry itself. British Pregnancy Advisory Service is the largest providers of abortion services in England and Wales (the financial interest of abortion services in wanting to see a change in the law should not be disregarded). Their 2017 -2018 report (on page 9 ) states their ‘We Trust Women’ campaign resulted in the Reproductive Health (Access to Terminations) Bill 2017 -2018, and the ‘We Trust Women’ campaign continues to strongly advocate for decriminalisation both in Great Britain and N Ireland. Not surprisingly, BPAS have welcomed the RCGP move.
It seems that the RCGP has jumped on the bandwagon of abortion decriminalisation. Yet it is unclear why the law needs scrapping.
Dr Rosemarie Anthony-Pillai