4 April 2014
April digest: Supporting women’s pregnancy choices, trusting women to decide
The recent top stories on Reproductive Review.
Jennie Bristow writes:
‘At British Pregnancy Advisory Service (bpas), we support women’s pregnancy choices, and we trust women to decide. When it comes to abortion, this really matters. No woman should be forced to have an abortion – and no woman should be forced to continue with a pregnancy that she does not want. The only person who can make that decision – and the only person who should make that decision – is the woman herself.
‘This is a simple, straightforward philosophy. But we have been providing abortion advice and care for nearly 50 years, and we know that not everyone agrees with this woman-centred approach. Legally, a woman’s choice about abortion has to be authorised by two doctors, who will certify that this is in the best interests of her physical or mental health. Politically, the debate over how much control there should be over women’s abortion choices continues to rage, often in indirect ways.
‘In Britain, we have not seen the legislative assault on abortion that has characterised the debate in the USA, or the moves to an outright ban in some European countries – most recently and strikingly, in Spain. But we have seen a number of attempts to impugn the motives of women seeking abortion, and the doctors and nurses who treat them. And we know that reproductive choice is being undermined, not only in relation to abortion, but in relation to preconception, pregnancy and birth…’
Clare Murphy writes:
‘Every day, women find themselves in the tragic situation of being told their pregnancy is affected by a neural tube defect (NTD) such as spina bifida or anencephaly. Spina bifida causes serious lifelong disability while anencephaly, where the baby’s skull and brain do not form properly, is always fatal. This country has one of the highest rates of these conditions in the European Union, resulting in an estimated 1,000 cases per year, not including those that end in miscarriage.
‘The most effective way to reduce NTDs is for women to take a supplement of folic acid in the months before they start trying for a baby, as the neural tube develops in the very early stages of pregnancy - before a woman often knows she’s expecting. But as we in our service know only too well, pregnancies happen when women are often least expecting them. Two thirds of the women we see with an unplanned pregnancy report using contraception when they conceived.
‘We believe it’s simply unrealistic to expect women who are not planning a pregnancy to be taking folic acid supplements on the basis that they might conceive. Fortifying our flour with folic acid would mean that this vital nutrient entered everyday foods widely consumed by women of childbearing age, whether they were trying for a baby or not, and prevent hundreds of cases of spina bifida and anencephaly a year.
‘It could spare a couple a day from the heartbreaking decision to end what was a much wanted pregnancy. These cases are among the saddest we see in our clinics…’
British Pregnancy Advisory Service is urging the government to fortify flour with folic acid to reduce the risk of babies developing defects such as spina bifida.
Professor Carol Sanger, Barbara Aronstein Black Professor of Law, Columbia Law School, will be giving a public lecture at Birmingham Law School on 29 April 2014, hosted by the Centre for Health Law, Science and Policy and the Public Law Research Cluster, Birmingham Law School.
New guidance issued by the National Institute for Health and Care Excellence (NICE), aimed at reducing unwanted teenage pregnancies, states that there should be greater access to emergency contraception, including pills and the IUD (intrauterine device, or coil), and condoms for under-25s.
Ann Furedi, bpas chief executive said:
‘We support NICE’s call for young women to be given oral emergency contraception in advance of need. The emergency contraceptive pill is more effective the earlier it is taken, so it makes sense for young women to keep it at home so it’s there if they need it.
‘Ideally we would like women of all ages to be able to either keep the emergency pill at home or obtain it free of charge from their local pharmacy. At present there’s wide variation in women’s access to this form of contraception, which is an essential back-up for when their regular method lets them down.
‘Sadly emergency contraception remains highly stigmatised, and is often seen as a marker of irresponsibility. In fact the opposite is true – and no woman, whatever her age, should feel ashamed or embarrassed of obtaining it when she needs it.’
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FROM THE JOURNALS
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From Perspectives on Sexual and Reproductive Health.
From American Journal of Law and Medicine.
From Israel Medical Association Journal.
From Journal of Medical Ethics.
From Women’s Health Issues.
From Medical Journal of Australia.
From Journal of Obstetrics and Gynaecology Canada.
From Social Science and Medicine.
From Acta Obstetricia Gynecologica Scandinavica.
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