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27 February 2012

Sex selection and the abortion counselling conspiracy

The Daily Telegraph’s allegations about sex selective abortion are part of a shameless attempt to discredit abortion providers and provide a justification for the Department of Health’s reforms to abortion counselling services, argues Jennie Bristow.

Are women in Britain flocking to abortion clinics to commit ‘gendercide’ of female fetuses? Of course they aren’t. When the Daily Telegraph newspaper, well known for its anti-abortion stance, conducted a sting operation last week designed to uncover the scale of ‘sex-selective abortion’, its major ‘abortion investigation’ claimed to find ‘some doctors willing to falsify official paperwork to arrange what would be illegal activity’ – and ‘others who refused to countenance any such request’.

Beneath the overblown hyperbole, what did the investigation actually find? Undercover journalists for the Telegraph visited a small number of clinics, of which at least six were run by the charity British Pregnancy Advisory Service (BPAS), requesting an abortion because the fetus was a girl, or in some cases a boy.  They were denied an abortion at all of the BPAS clinics, and found three doctors in private practice who indicated that they would arrange the procedure. No abortions actually took place.

Nonetheless, Health Secretary Andrew Lansley wasted no time in declaring that police investigations would follow, and the Chief Medical Officer immediately wrote to all abortion providers to clarify their obligations under the 1967 Abortion Act. A chill has settled over those working in abortion services about the extent to which doctors are given license to interpret the Abortion Act, without falling foul of the misinterpretations of the antics of undercover journalists with a political agenda. As Nadine Dorries, maverick MP for mid-Bedfordshire, crowed in a blog entry on ConservativeHome on 26 February, ‘The spotlight is full on abortion practice’.

How can a story like this, which comes out of nowhere and is based on so little, develop so much momentum in the space of a few days? The answer is that this story did not come out of nowhere, and it has nothing to do with sex selection. Rather, it looks like the result of a concerted campaign to smear and discredit abortion providers, in order to pave the way for a politically-motivated reform of the abortion service.

Abortion counselling, and the Dorries amendment

The Daily Telegraph published its sex selection investigation just as a cross-party group of MPs is busily discussing options for changing the way abortion counselling is provided. The call for reform originated from an amendment laid down by Nadine Dorries MP, with Frank Field MP, to the Health and Social Care Bill last year.

Dorries’s proposal, to strip abortion providers of the ability to provide women with information, advice and counselling before abortion and to transfer this function to ‘independent counsellors’, was spectacularly defeated in a Parliamentary debate, by 368 votes to 118. However, during this debate Public Health Minister Anne Milton formally opposed the Dorries amendment and announced the Department of Health’s intention to launch a consultation on the question of abortion counselling.

This consultation is currently taking place, and it is likely to result in the creation of an official ‘register’ of pregnancy counsellors. One result of this may be to open up the commissioning of pregnancy counselling services to organisations beyond the registered Pregnancy Advisory Bureaux, which currently offer this service and refer women for abortions. There has been concern that the new layer of pregnancy counsellors involved in this proposed system may include organisations that have an in-principle objection to abortion; there is also a worry about the consequences for women’s speed and ease of access to abortion, if pregnancy counselling is to be provided separately to abortion referral.

Politically, some have raised serious objections to the way that this consultation has proceeded despite the proposal having been debated and categorically rejected by Parliament. The pro-choice MP Diane Abbott went so far as to resign from the consultation group, complaining that the process was a ‘stitch-up’.

What has any of this to do with sex selection? Nothing at all. But it is striking that, within a day of the Telegraph publishing its investigation, Health Secretary Andrew Lansley wrote an article in that newspaper, arguing:

‘Deciding to have an abortion is a life-changing decision. The law makes clear that health professionals need to support women in taking this decision. We will not only uphold that law, but it is why – in discussion with all main parties – we are planning to consult on counselling arrangements for women seeking an abortion. All women seeking an abortion should have the opportunity, if they so choose, to discuss at length and in detail with a professional their decision and the impact it may have. Whatever the outcome of our consultation on counselling, our laws will remain the same unless, and until, Parliament decides otherwise.’

This quote is revealing, for a number of reasons. First of all, it links the spurious fears about sex selection with an existing government initiative about abortion counselling, though on the face of it there is no link at all between a doctor’s preparedness to ‘flout the law’, and whether counselling is provided by somebody who also provides abortion or is formally ‘independent’.

Lansley sees a link however, and this is presumably because he has accepted the scurrilous allegations made by Dorries and Field in proposing their abortion counselling amendment to Parliament – that the problem with abortion providers providing pregnancy counselling is that they have a ‘vested interest’ in encouraging women to have abortions, because they receive fees or NHS funding to carry out the procedures. Or to put it another way – abortion providers are prepared to terminate pregnancies on the grounds of fetal sex just because they want the money.

Not only is this argument an insult to the professional judgement of the doctors and nurses who work in abortion care, it also makes little sense. Abortion doctors realise that making a fast buck by providing a service that falls outside of the law can carry enormous costs to one’s career and reputation. That is why most doctors – and the majority of the clinics that the Daily Telegraph tried to ‘sting’ – operate within the law, even if they disagree with some of its restrictions. For example, many abortion doctors would actually prefer a situation where women were provided with abortions on request, or at least with the approval of one doctor (rather than two, as is currently the case); but they comply with the law nonetheless.

More importantly, those who work in abortion services do not have a desire to terminate pregnancies as might, for example, those who work in cancer services have a desire to eradicate tumours. Abortion doctors recognise that pregnancy is not an illness and that the fetus has a moral status; their commitment to abortion rests on the knowledge of what nurturing the fetus to birth and beyond means to the pregnant woman. 

Abortion services exist to enable individual women to act on their choice regarding their pregnancy. This means that it is only in the abortion doctor’s interest to terminate a pregnancy if a woman wants it to be terminated, and the doctor feels this is in her interests. The idea that abortion services are on some kind of mission to terminate wanted pregnancies is, quite simply, bizarre. Yet the notion of ‘vested interests’ encapsulates this idea.

The counsellor as ‘gatekeeper’

The second aspect of Lansley’s quote that deserves attention is the role he ascribes to the abortion counsellor. Noting that ‘Deciding to have an abortion is a life-changing decision’, he goes on to talk about why women should be able to discuss their decision in detail. Existing arrangements already provide women with that opportunity, should they want it, so what is different about what Lansley is proposing?

The framework to be established by a new, ‘independent’ abortion counselling structure clearly sees a very different role for counsellors that that which has been historically established. The pregnancy options discussion was incorporated into the abortion service in order to give women the space to work through whether abortion was the right decision for them, and the role of counselling was to ensure that they understood what the procedure entailed and that they were not being somehow coerced into their request.

The role envisaged for pregnancy counselling by Lansley, Milton and Dorries seems to be a rather more structured ‘gatekeeping’ function, where women are to account for their decisions and, potentially, have these decisions challenged. Why else would abortion counselling be flagged up in relation to a woman’s request to abort her fetus on the grounds of its sex, if it were not to indicate the need for someone to tell her why this is a bad reason for seeking abortion?

Here we get into very muddy waters indeed. Fetal sex is not a legal ground for abortion - that is true. But neither is any other ‘choice’ ground for a woman seeking abortion, from whether a woman wants an abortion because she has been raped to whether she wants an abortion because it will impede her ability to qualify for her degree.

A doctor’s judgement, in all these circumstances, rests on the extent to which he or she genuinely believes that an abortion will be less damaging to a woman’s mental health than carrying the pregnancy to term. In this regard, a doctor who genuinely believes that a voluntary termination of an unwanted pregnancy will have no negative impact on a woman’s mental health, but that having to give birth to a child will cause her some problems – for whatever reason – can make that good faith judgment. 

The question is not, and cannot be, the content of the choice itself – a doctor cannot decide what the ‘right’ reason for an abortion is, not least because no such provision exists in our law. The only question is whether the woman feels that it is the best choice for her to make.

The tenor of Lansley’s argument contradicts this subtle understanding of the British abortion law. He seems to recognise only that ‘abortion is a life-changing decision’, rather than understanding that abortion exists because bearing a child is a life-changing decision, and it is only through access to contraception and abortion that it is a decision at all, rather than simply a woman’s fate.

Furthermore, his palpable distrust of doctors’ role in negotiating the contours of the abortion law – summed up in his statement that for doctors ‘simply’ to ‘flout’ the abortion laws ‘in a belief that they know better is unacceptable’ – presumes that it should be doctors’ role to prevent women from making bad (or, in the case of sex selection, ‘morally repugnant’ ) choices. According to this view, when health professionals ‘support women in taking this decision’, they should be checking that their decisions are good ones; and because doctors apparently cannot be trusted, ‘it is why ... we are planning to consult on counselling arrangements for women seeking an abortion’.

These proposals are anathema to the spirit of non-directive counselling that has informed abortion care since the 1967 Act. Not only do they seek to make abortion decisions the preserve of healthcare professionals rather than the woman herself, but they seek to replace the clinical judgement of doctors with a gatekeeping role imposed by a new layer of more loosely-qualified counsellors, operating outside of the abortion service.

If the goal of this initiative is to make it more difficult for women to access abortions, it may well succeed. But it will be at the expense of clinical judgement, genuinely non-directive advice, and women’s decision-making.
Also read:

Spare me this faux outrage at sex-selected abortion. By Dominic Lawson. Independent, 28 February 2012

Abortion for reason of sex: correcting some basic misunderstandings of the law. By Sally Sheldon, Professor of Medical Law at the University of Kent. Abortion Review, 1 March 2012

Abortion Review topic archive: Abortion counselling