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bpas Reproductive Review en Copyright 2015 2015-10-22T07:31:54+00:00 Why the fight for women’s choice matters Autonomy must be at the heart of advocacy, writes Ann Furedi. Abortion Ann Furedi is the CEO of British Pregnancy Advisory Service. This is the speech she gave to the US Medical Students for Choice conference in Philadelphia on Saturday 17 October, 2015.

There are many debates about the language that is used in reproductive healthcare. But most of them don’t matter very much. Should we talk about ‘termination of pregnancy’ or abortion? About a fetus or a baby? Most of the time we are led by the language used by our patients. We adapt to how they view their procedures.

When it comes to advocacy, however, language does matter. Because when we change our language, we are changing our ideas, we are changing what we say. Today, some of our sisters are arguing that we should drop the term ‘reproductive choice’ and replace it with reproductive health or justice. And I want to give a personal account of why I don’t agree, and why I am delighted that you, the Medical Students for Choice, have asked me to talk on ‘Why the Fight for Reproductive Choice Matters’.

For me, there is a difference between supporting women’s choice and supporting their reproductive health. It can be the same sometimes, yes; but it can also be very different. I witnessed this for the first time when I was living in east London about 30 years ago, in an area known as Tower Hamlets, which had a large Bangladeshi population. This was a time when there was a significant level of racist attacks, and I was one of the organisers of a group called East London Workers Against Racism. We helped to organise community defence against physical attacks by activists from the far-right National Front.

As it turned out, while we were focused on this explicit racism, the women of the community were being subjected to a more insidious form of racism. It was being perpetrated, not by skinheads with knives and bottles, but by liberal doctors, very like ourselves, motivated by (probably genuine) concern for the health and wellbeing of the community.

They held the view that women must be feeling exhausted by their large families, that children suffered from overcrowding in small flats, and that women would therefore benefit from better contraception. Depo-Provera injections seemed a good solution. There were no complicated instructions to confuse women who had low literacy skills, and controlling husbands didn’t need to know about it. The main problem was that in the desire to get women to do what the reproductive-health doctors thought best for them, little attention was paid to making sure the women knew exactly what the injections were for. And it gradually emerged that many of these women, given long-acting injectable contraception, thought that they were receiving vitamins or being immunised against disease. No one had asked them about their preference. Their decision – their choice – about childbearing had been taken out of their hands, in the interests of public health and a doctor’s opinion about what was most beneficial for the community.

The treatment may have been well intentioned. Some of the doctors involved may have thought they were helping women who were powerless and uneducated and unable to take control of their lives. But in truth, they were taking control away from the women. They treated these women like children, incapable of making choices for themselves. Actually, they treated them like animals, as less than human.

To stay with reproductive health in the UK: compared to the US, much of what we have in Britain is good. We benefit from a National Health Service that pays for abortion for almost all British residents. And those abortion services are safe and regulated. But, here’s the rub: no woman can freely decide of her own volition to end her pregnancy. Two doctors must certify that she meets the legal grounds for abortion, which are that the abortion will be better for her health than having a child would be, or that there is a substantial risk of serious birth defects. The law is interpreted liberally, but still, granting an abortion is in the doctor’s gift. In effect, women can only obtain an abortion by claiming that they can’t cope with a child. It’s degrading and demeaning, and it denies the woman control over her body.

There is no recognition in the law that women are competent to decide by themselves if they wish to be pregnant. There is no respect for a woman’s autonomy, or for her moral determination about what is right or wrong for her or her family. The most personal, intimate decision – whether or not to have a child – is taken out of her hands. The law works to protect reproductive health, but it denies women the ability to make their own choices. It has no respect for women’s dignity.

We need to think carefully about what we advocate for. What kind of laws do women want and need? This question is posed starkly in the Republic of Ireland, where there will soon be a referendum that is likely to remove the constitutional ban on abortion. But what should it be replaced by? Unless we start to build a case that women can be trusted, and that abortion can and should be left out of criminal statutes and treated as a private decision, as a matter of ‘choice’, then it is likely that the British ‘health’ model will be adopted in Ireland, with all of its limitations but perhaps without the will to work around them.

So why is it so difficult to accept that the idea of choice should be defended? Why the rush among even those who support the provision of abortion services to replace ‘choice’ with the rallying cries of ‘justice’ or ‘health’? Does choice seem too whimsical? Are we afraid that, left to themselves, women will make a ‘wrong decision’? But who can make a better decision than the woman herself about her own circumstances? And, crucially, if she doesn’t make the decision, how can she take responsibility for it?

I’ve been told that women cannot make choices freely; that women do not choose abortion, but are driven to it; that women say they have ‘no option’. But this doesn’t really make sense, in anything other than a rhetorical fashion anyway. Because different women make different decisions, even when they are in the same circumstances. Not every woman with a fetal diagnosis of Down’s syndrome chooses abortion. Some will see it as an opportunity to bring a different kind of person into their family. Some women deserted by their partners may hate the idea of their baby; others will see the baby as a legacy of the love two people once shared. We are not determined by our circumstances. Our social circumstances shape us, for sure, but they don’t determine what we do. We choose differently.

I’ve been told that choice is a too consumerist phrase, that it’s an economic term. Who made this up? Look up choice in Webster’s Dictionary, and you will see it defined as a ‘preferential determinant between things proposed’. The Oxford English Dictionary puts it even more simply: choice is ‘a decision between two or more things’. There is nothing consumerist about the word choice. If people believe this word is trivialising, what they’re really saying is that there is no value in decision-making — and we need to put them right on that.

Of course, the choice between having a child and having an abortion is not the same as a choice between two pairs of shoes, or between a latte and an espresso. But surely we believe that it’s not beyond understanding that all sorts of choices in life are different, and that some are more serious than others — and indeed that some are brutally difficult, with neither option being what you want. Women know this, and they cope with it because this is the context of many decisions in life.

I’ve also been told that choice is ‘privileged’. That only privileged women are concerned with choice, and only privileged women can exercise choice. Well, tell that to the Bangladeshi women in east London who were presumably seen as too underprivileged to appreciate the choice not to accept Depo-Provera. Tell that to the abused woman who has chosen to leave her husband, or indeed the one who chooses to stay for the sake of her children. Because sometimes, knowing that you personally have made a decision is what gives you the courage to follow it through.

I cannot think of a more patronising, degrading way to talk about oppressed and marginalised people than to say that they have no choice about their pregnancy. What choice will we next decide they ‘can’t exercise’?
We need to make a stand for choice, for our ability to state a preference. Making choices, and trying to make our choice a reality, is one thing that, as individuals, we all share. When we acknowledge the importance of choice, it shows that we respect people for the individual, rational and reasonable creatures they are. It shows that we ‘trust women’, as the great Dr George Tiller advised us to. And that we trust them, not in an empty, rhetorical way, but because we see them as individuals who can make decisions, take responsibility, and determine their destinies.

Abortion is still illegal in the UK, thanks to this Victorian law Sally Sheldon, Professor of Law at the University of Kent and a founding member of Lawyers for Choice, writes on The Conversation. Abortion, Abortion laws, Decriminalisation You probably know that abortion services are available in Britain on the National Health Service. What you may not know is that abortion is still potentially punishable by life imprisonment. That includes terminations very early in a pregnancy.

Abortion is still a criminal offence in the UK under the Offences Against the Person Act 1861. It is legal only when carried out under conditions of strict medical control.

As things stand, a terrified teenager, who takes abortion drugs that she has bought over the internet rather than tell anyone that she is pregnant, is committing a crime that is punishable by life imprisonment.

The 1861 act is an archaic, badly flawed piece of legislation, which is ripe for reform. It includes specific offence such as failing to feed one’s servants properly.

Reviewing an archaic act.

The act is so widely recognised as out of date that the Law Commission is conducting a major review of its content. Yet this review does not include those sections of the act that deal with abortion.

Victorian rules

The 1861 act is grounded in the moral concerns and medical realities of mid-Victorian Britain. It was the product of an all-male parliament and was passed almost 60 years before the first women won the right to vote. This was a time when the mere fact of publishing a book on contraception was reason enough for a woman to be deemed morally unsuitable as a mother and to have her child removed from her care.

This effects of this harsh, punitive statute have been mitigated by legislation introduced in 1967, which permits abortions under medical control, but this second law is out of date too. It imposes a range of clinically unjustifiable restrictions on women seeking an abortion – most notably by requiring two doctors, rather than the pregnant woman herself, to decide if an abortion is justified. It also fails to offer any protection to the terrified teenager described above.

It is true that women are seldom charged for getting an abortion – but the fact that an archaic law is not enforced is not justification for retaining it.

Time for change

It is high time abortion was decriminalised in the UK. That would not leave abortion services unregulated. Non-consensual, dangerous or negligent practice would be caught by the same mass of criminal, civil, administrative and disciplinary provisions that regulate other areas of medical practice.

But it would mean recognising that the threat of prison is no fit response to the pregnant teenager above or, indeed, to any woman who feels unable to access formal health care services. Neither are these provisions the best way of policing the boundaries of acceptable medical practice.

Sweeping away criminal prohibitions on abortion would also begin to address the stigma associated with a procedure sought by one in three British women at some point in their lives, and the health professionals that care for them.

It would offer the chance to remove clinically unnecessary barriers to the provision of high quality, compassionate services. It would address the curious legal anomaly that requires doctors in all contexts save for this one, to recognise that patients are adults, capable of “accepting responsibility for the taking of risks affecting their own lives, and living with the consequences of their choices”.

Removing criminal prohibitions on abortion would undoubtedly be fiercely opposed by those who believe that the embryo or fetus is a full moral person, of equal worth to the woman who carries it.  But very few modern Britons (including those who identify as Christian) appear to take this extreme view. And while the moral beliefs of the minority should be respected in making decisions about their own healthcare, they should not dictate the shape of services for the majority.

Today, 92% of abortions are performed in the first 12 weeks of pregnancy. Most British people believe that, at least in these very early stages, it is up to the woman to decide whether or not to continue a pregnancy. Most also believe that the government has no business interfering with that right.

For many of us, this is not because we believe that the growing, human fetus has no moral significance. It is because we trust women to make morally significant decisions. And we understand that women cannot participate equally in society unless we have the fundamental right to control our own fertility.

The onus should be on those who wish to retain the threat of a prison sentence to explain why criminal sanction offers a useful and appropriate part of a modern response to addressing the problem of unwanted pregnancy.

It is almost 100 years since the British parliament recognised that women should have the right to vote. Now it should recognise that they should equally have the right to make fundamental decisions about their own fertility.

This piece is based on Professor Sheldon’s longer article, ‘The Decriminalisation of Abortion: An Argument for Modernisation’, published in the Oxford Journal of Legal Studies and available to read in full here.

The Conversation

This article was originally published on The Conversation. Read the original article.

Visit the Lawyers for Choice website.

Policing Pregnancy A one-day conference on maternal autonomy, risk and responsibility, organised jointly by BPAS, the Centre for Parenting Culture Studies, and Birthrights. Royal College of Physicians, London; Wednesday 13 April 2016. Events and resources ‘The case for abstinence is not based on evidence. It is based on the logic of better safe than sorry. It is tempting, especially for an expectant mother, to say that any risk, however small or theoretical, is too great. But that is absurd. Everything about light drinking during pregnancy makes it the kind of theoretical risk that Americans are unlikely to evaluate sensibly. Doctors are innately cautious and made more so by lawyers hovering overhead with malpractice lawsuits.’

The comment above appeared in a feature article in The Guardian newspaper in 1991, discussing advice given to American women about drinking and pregnancy. Twenty-five years later official opinion in Britain – and many other countries – has shifted to accept everything the author of this comment decried as ‘absurd’. ‘Better safe than sorry’ has become the central plank of advice to women.

This conference provides the opportunity for those concerned about the organisation of advice and also provision of care to pregnant women around this motto, to come together and discuss the issues raised.

A key observation made by those who have already raised concerns about risk-consciousness and pregnancy is that ‘better safe than sorry’ often brings with it a powerful impulse both to moralise about the behaviour and attitudes of pregnant woman, and also bring in new forms of regulation and oversight of pregnant women. The US sociologist Howard Becker wrote that moralisation is followed by policing, and a central aim of this event is to bring to light and assess the tension that exists between efforts to promote awareness of risk and the resultant policing of pregnancy, and the autonomy of pregnant woman.

The topic of drinking and pregnancy forms the starting point for event, and discussion will cover developments in countries that have conventionally been thought of as the cultural and policy opposite to the United States, for example Scandinavia. We are delighted to welcome Lynn Paltrow to open the Symposium, with a lecture on the policing of pregnant women in the US, which will discuss alcohol and other drugs.

Afternoon sessions will consider topics where relate trends seem apparent and consider how developments contest the principle of autonomy. A roundtable session will discuss how food intake has become a locus for policy making through elevated concerns about overweight and obesity, and the conference will end with a discussion about the ways in which women’s birth choices and experiences are increasingly heavily policed.

The Policing Pregnancy conference is a collaboration between British Pregnancy Advisory Service (BPAS), Birthrights and the Centre for Parenting Culture Studies. The event is of interest to practitioners, advocates, academics, policy makers, journalists – and anyone else who is concerned about the expansion of risk thinking and its effects for the autonomy and choice-making ability of women. See here for more information, and to book a place.

Event Programme

9-9.30am Registration

9.30-11am Keynote Lecture: Policing pregnant women in the United States of America

Lynne Paltrow, Executive Director, National Advocates for Pregnant Women

Respondent: Dr Ellie Lee, Reader in Social Policy, University of Kent

Chair: Clare Murphy, Director of External Affairs, bpas

11-11.20am Coffee

11.20am - 1pm ‘No drinking’ policy and advocacy: perspectives from Europe

- Dr Anna Leppo, University of Helsinki
- Professor Robbie Sutton, Professor of Social Psychology, University of Kent
- Dr Raphael P Hammer, Haute Ecole de Sante Vaud, Institute of Health Research, Lausanne, Switzerland

Chair: Dr Jan Macvarish, University of Kent

1-1.45pm - Lunch

1.45-3pm Policing obesity in pregnancy: roundtable discussion

- Dr Pam Lowe, Senior Lecturer in Sociology, Aston University
- Dr Rachel M. Calogero, Reader in Psychology, University of Kent

3-3.30pm - Coffee

3.30-4.30pm Policing Birth

- Rebecca Schiller, Birthrights
- Elizabeth Prochaska, Birthrights
- Kirstie Coxon, Senior Lecturer in Nursing and Midwifery, Kings College London
- Jennie Bristow, Lecturer in Sociology, Canterbury Christ Church University

4.30-4.45pm Closing remarks

See here for more information, and to book a place.

The regulatory cliff edge between contraception and abortion Professor Sally Sheldon discusses the legal and moral significance of implantation. Abortion, Abortion laws We tend to talk about contraception and abortion as if they were two separate and readily distinguishable practices, the former preventing pregnancy and the latter ending it. This understanding has a very important effect in current British law, where a relatively permissive approach to the availability of contraception stands in stark contrast to the morally grounded, onerous criminal sanctions against abortion. Yet is the distinction between abortion and contraception really so clear cut? How and why do we make it? And is the line that we have drawn between the two morally defensible?

As a matter of biological fact, the development of human life is not characterised by bright lines. As the eminent lawyer Glanville Williams once put it ‘abstract human life does not “begin”; it just keeps going.’ A seamless biological continuum exists through the production of sperm and egg, their joining together in a process of fertilisation, the gradual development of the new entity thus created throughout pregnancy, birth, subsequent growth, eventual death and ensuing decay of the body. Defining what happens along the way as an ‘embryo’, ‘fetus’, ‘person’, ‘adult’, or ‘corpse’ requires an attempt to draw lines on the basis of criteria selected as holding significance for legal or other purposes.  How and where we draw such lines is a tricky business, involving careful moral reflection informed by medical fact. 

The ‘regulatory cliff edge’ between the relatively permissive regulation of contraception and the criminal prohibition of abortion relies on a line drawn on the basis of the biological event of implantation, where the fertilised egg physically attaches itself to the wall of the womb some six to twelve days after ovulation. Yet while enormous legal weight has been placed upon it, little consideration seems to have been given as to why implantation matters morally.  The voluminous philosophical literature on the ethical status of the human embryo and fetus offers little support for the view that implantation is an important marker. 

Further, while it might once have been suggested that implantation offers a conveniently timed moment for a necessary gear change between the appropriate regulation of contraception and abortion, this argument is difficult to sustain in the light of modern medical science. Notably, the development of new ‘contragestive’ techniques that operate around or shortly after the moment of implantation serves to muddy any clear water that might have once have been believed to lie between contraceptives and abortifacients. For example, researchers have raised the possibility of developing treatments that a woman might potentially use on a planned schedule only once in each menstrual cycle, no matter how many prior coital acts she had had over that period. Such drugs might potentially act either before or after implantation. A further possibility might be to limit the use of drugs to a few times a year, when a woman’s menstrual period is late.

While significant work remains to be done in establishing the clinical safety, efficacy and acceptability of such treatments, there are good clinical reasons to pursue this work. However, such research would be blocked by current UK law. Where drugs potentially operate after implantation, offering or using them would be likely to constitute a serious criminal offence and, if such drugs could be offered at all, they would fall within the strict requirements of our abortion law. The potential convenience and simplicity of a regimen where women could have drugs in their bathroom cabinet, ready to be used when necessary would be lost. 

It might be suggested, of course, that this is all for the good: that terminating even a very early pregnancy should be treated as a morally serious matter and one that is rightly subject to strict control. However, an issue of this significance to women’s reproductive health should be decided on the basis of democratic debate, informed by current medical understandings of reproductive biology and careful reflection on the moral significance of implantation in the process of embryonic and fetal development. The current legal basis for distinguishing between contraception and abortion falls woefully short of meeting this test. Rather it is a consequence of a statutory phrase, prohibiting the ‘unlawful procurement of miscarriage’, contained in the Offences Against the Person Act (1861). 

An archaic law, passed by a mid-Victorian Parliament within which women had no voice, is an indefensible basis for the regulation of health services that matter so intimately to modern women. That it should potentially operate, some one hundred and fifty years after its passage, to block the development and use of safe, effective, modern forms of fertility control provides a compelling argument for a fundamental review of this aspect of its operation. There are strong reproductive health arguments in favour of facilitating access to safe, effective technologies that operate at early gestational ages. As such, within any such review, the onus should be on those who support the use of criminal sanction to justify its deployment in this context and, specifically, to explain why it offers an appropriate response at such an early stage of pregnancy. 

Access Professor Sheldon’s full paper, in in the Journal of Medical Ethics, here.

Abortion: Trusting women to decide, and doctors to practise This new BPAS publication lays out the case for why we need to re-think Britain's abortion law. Abortion, Abortion laws, Decriminalisation Executive summary

• Britain’s abortion law will be 50 years old in 2017. While it has served women well, its provisions are increasingly out of touch with the reality of women’s lives, and with best practice in abortion care.

• Abortion in Britain today is a normal fact of life. There are around 200,000 abortions a year. One in three women will have an abortion in her lifetime. Sexual health policy supports the provision of abortion, and 98% of abortions are funded by the National Health Service.

• Developments in services, pregnancy testing, and medical abortion, mean that an increasingly large proportion of abortions take place under 10 weeks’ gestation. Early procedures are safer, more straightforward, and better for women. This also creates a significant role for nurses and midwives. First trimester abortions increasingly use the medical method (the abortion pill).

• A small proportion of women (8%) will continue to need access to abortion in the second trimester of pregnancy, for many reasons. These may be very young women who hid their pregnancy, or perimenopausal women who did not suspect they were pregnant. They may be women whose contraception failed without their knowledge. Abortions may be requested when a relationship has broken down, an existing child has become seriously ill, or a fetal anomaly has been detected. Women may need time following a later diagnosis to make the decision that is right for them. It is crucial that the abortion service continues to provide care for these women.

• Less than 0.1% of all abortions take place after 24 weeks’ gestation, mainly for reasons of fetal anomaly. This reflects the fact that anomalies cannot always be detected until later in pregnancy, and that women need time to make what is often a very difficult decision to end a much-wanted pregnancy.

• The expectation that safe, legal abortion care can be accessed when needed underpins significant social and cultural changes with regard to women’s equality. Without the ability to control their fertility, women would have not achieved the level of educational and workplace equality that younger generations can rightly take for granted. Abortion cannot solve all the problems of gender inequality; but without the ability to exercise reproductive choice, all problems of inequality are made worse.

• Given the role played by abortion in mainstream healthcare today, the fact that it remains situated within the criminal law is an anomaly. Under the 1861 Offences Against the Person Act (OAPA), having or performing an abortion is a criminal offence that carries a lengthy jail sentence. This Victorian piece of legislation fossilises values well out of step with those cherished today.

• The 1967 Abortion Act provides a therapeutic exemption to the offences under the OAPA, and makes abortion legal provided that women and doctors meet certain requirements. But the 1967 Act is also the product of a very different era to now. The legislation was crafted to regulate different clinical techniques, in a climate where the biggest threat to women’s health from abortion came from illegal, backstreet abortions.

• The 1967 Act was also developed in a context where public opinion was far more ambivalent about abortion than it is today. Two thirds of people today say that abortion should be allowed according to a woman’s choice, compared to 37% in 1983.

The very provisions of the Abortion Act that sought to protect women’s health are today preventing the provision of modern, evidence-based clinical care. These provisions include:

- The arcane requirement that two doctors must authorise each abortion;
- The fact that women are prevented from taking the ‘abortion pill’ (early medical abortion) at home;
- The way that nurses and midwives are prevented from playing a full role in the straightforward abortion cases.

• Under the 1967 Abortion Act, a woman cannot decide for herself to have an abortion: this decision has to be made on her behalf, by two doctors. This paternalistic approach sits at odds with other clinical procedures, and with the equal status accorded to women in most other areas of life.

• One of the aims of the Abortion Act was to protect doctors from prosecution when performing legal abortions. But the discordance between the law and best standards of clinical practice has exposed doctors to the ‘chilling effect’ of smear campaigns and legal misinterpretations imposed by opponents of abortion.

• Other jurisdictions, in Australia and Canada, have successfully removed abortion from the criminal statute, in order to regulate it with laws more appropriate to a mainstream healthcare procedure. This has not caused an increase in numbers or rates of abortion, and has provided a more constructive platform to consider how abortion can best be provided.

• In addition to the criminal law. abortion in Britain is tightly regulated as a healthcare procedure. Clinics are inspected by the Care Quality Commission (CQC), and healthcare workers are bound by their professional bodies, the General Medical Council (GMC) and the Nursing and Midwifery Council (NMC). Healthcare teams work to detailed evidence-based guidance produced by the eminent Royal College of Obstetricians and Gynaecologists (RCOG).

• The word ‘decriminalisation’ immediately implies that there is something wrong with abortion; that maybe it should be criminal. Our aim here is to present a positive case for why we need regulation that meets women’s needs. We believe that the time has come to remove abortion from the criminal law, and to regulate the service according to standards of best clinical care.

Download the full publication for free here.

Abortion law reform in Britain 1964-2003 A personal account, by David Paintin. Abortion, Abortion laws David Paintin is Emeritus Reader in obstetrics and gynaecology at the University of London. From 1963-91, based at St Mary’s Hospital Medical School, he organised the teaching of medical students and, as an honorary consultant, provided NHS services for Paddington and North Kensington. He joined the Abortion Law Reform Association (ALRA) in 1963, and was one of the gynaecologists who advised Lord Silkin and David Steel, now Lord Steel of Aikwood, during the parliamentary debates that resulted in the 1967 Abortion Act. He was chairman of the Birth Control Trust (1981-98), and a trustee of Pregnancy Advisory Service (1981-96) and British Pregnancy Advisory Service (1996-2003).

In this new book, David Paintin reflects on the legal debates leading up to the 1967 Abortion Act and its subsequent implementation, and Parliamentary attempts to undermine and restrict Britain’s abortion law in the 1970s and 1980s.

Download Abortion law reform in Britain 1964-2003: A personal account for free here.


- Foreword. By Ann Furedi, Chief Executive, British Pregnancy Advisory Service

- Chapter 1. Forming an opinion, 1955 – 1963

- Chapter 2. Lord Silkin’s Medical Termination of Pregnancy Bills, 1965 – 1966

- Chapter 3. Supporting David Steel’s Abortion Bill, 1966 – 1968

- Chapter 4. Implementing the Act

- Chapter 5: The origins of the pregnancy advisory services

- Chapter 6. Birth Control Campaign and Birth Control Trust

- Chapter 7. Parliamentary reaction to the effects of the Abortion Act

- Chapter 8. Lord Houghton improves the Abortion Act 1987-90

Download Abortion law reform in Britain 1964-2003: A personal account for free here.

England and Wales: Abortion statistics for 2014 published The Department of Health statistics, published on 9 June, show that the abortion rate is stable, and more than half of women ending pregnancies are already mothers. Abortion The abortion rate for England and Wales was 15.9 per 1,000 women aged 15-44 in 2014. Rates fell slightly among all age groups under 25, and remained stable or rose marginally among women over 25.  56% of abortions in England and Wales were performed on women over the age of 25 in 2014.

More than half (54%) of women ending pregnancies had already given birth, up from 47% a decade ago.

The vast majority of abortions are performed at under 13 weeks (92% in 2014), with a continuing increase in the proportion carried out under 10 weeks. Access to Early Medical Abortion, where pills are taken to induce a miscarriage, has played an important role in the numbers of women able to access early procedures. A small number of women will need access to services after 20 weeks (2%) due to later detection of pregnancy, dramatic changes in personal circumstances, or because a problem has been diagnosed with a wanted pregnancy.

The repeat abortion rate remains stable, with 37% of all abortions provided to women who have had a previous procedure. This rate is in keeping with those in comparable developed countries such as France and Sweden. Given that women are fertile for more than 30 years, it is unsurprising that women may experience an unplanned pregnancy or a pregnancy they cannot carry to term on more than one occasion.

Much work has been done to improve contraceptive services for younger women, and it is important to ensure older women have the same access to convenient, high quality services. The British Pregnancy Advisory Services believes more in particular could be done to support women’s contraceptive needs in the postnatal period, as we regularly see women experiencing unwanted pregnancy in the period after giving birth. 

bpas chief executive Ann Furedi said:

“No form of contraception is 100% effective, and women will always need straightforward access to abortion services as a back-up if they are to plan their lives and families in the way they see fit. Having done so much to improve contraceptive services for younger women, we must also ensure the needs of older women are met.

“One in three women will have an abortion in her lifetime. It is a fundamental part of women’s reproductive healthcare, as these statistics demonstrate. It makes no sense that abortion remains within the criminal law in this country, and that women still the need authorisation of 2 doctors before they can end their own pregnancy. It also remains a travesty that in 2015, women from Northern Ireland are unable to access the care they need at home. The time really has come to decriminalise abortion across the UK and regulate it like every other women’s healthcare procedure.”

The Department of Health report Abortion Statistics, England and Wales: 2014, can be found online here.

Also read:

Why Are We Surprised That More Than Half of Women Ending Pregnancies Are Already Mothers? By Clare Murphy. Huffington Post, 10 June 2015

The rise of the career woman abortion as teen terminations fall: Women in early 30s now more likely to have abortions. Daily Mail, 9 June 2015

UK: Once-a-month pill thwarted by abortion law A new survey conducted for British Pregnancy Advisory Service has found that 48% of women would consider a once-a-month pill to stop development of early pregnancy. But archaic abortion laws stand in its way. Abortion, Abortion laws, Contraception The survey of more than 1,000 women found that half (48.4%) would consider a once-a-month pill that would detach any fertilised egg from the lining of the womb, while only a quarter (25.6%) said they would not, with the remainder (26%) unsure.

Such a method is scientifically possible. However abortion laws, which in the UK strip a woman of any legal right to end a pregnancy from the moment of implantation, are preventing what would be an important and positive development in women’s reproductive healthcare.

Currently available methods of contraception work either by preventing the sperm reaching the egg or by preventing a fertilised egg attaching to the lining of the womb. Under British law, the moment of implantation is the legal boundary between contraception and abortion. Therefore any medication which would stop the development of a pregnancy after implantation had occurred would be classed as an abortifacient and restricted in line with current abortion laws. Any woman who tries to end a pregnancy at any gestation without meeting the exemptions set out by the 1967 Abortion Act commits a criminal offence and can be imprisoned for 12 years.

There are many reasons women may want to consider using a once-a-month pill.  Some women suffer significant side-effects from existing methods, such as persistent bleeding and cramping. For those who are not having regular sex, it may be preferable as it would need only be taken if they had had sex in that month.

Other women might also wish to avoid taking medication continuously as they must do currently with a daily pill or hormonal long acting reversible contraceptive, like the implant or coil. This pill in principle could only be used if her period is late, so potentially could be taken just a couple of times a year.

Experts are confident that with adequate funding and support, a post-implantation pill could be developed, yet strict abortion laws and the political climate around the issue act as a barrier to new research. 

Ann Furedi, bpas Chief Executive, said:

‘There has been little innovation in contraception and many women struggle to find a method that suits them. Many women don’t like taking daily pills, or find the side-effects of some of the long acting methods like the coil intolerable. ‎ Women need new ways to plan their families that fit in with their lives in the 21st Century.

‘The fact that so many women would be interested in a pill that works post-implantation is important. It is further evidence that our abortion laws, which strip a woman of legal rights over her own body the moment implantation takes place, are out of step with the times. We should be finding new ways to help women control their fertility in the way that works best for them, and consigning laws which restrict women’s reproductive choice to the history books where they belong.’ 

bpas is holding a joint meeting with the Royal Society of Medicine (RSM), Decriminalisation and Demedicalisation: Rethinking Family Planning for the Twenty-first Century, in London on Wednesday 10 June, exploring how attitudes to contraception have shifted and the ways in which women’s reproductive choices could be better supported. 

The survey was conducted by Censuswide from 5-9 March 2015. 1003 women aged 16-45 who are sexually active with a male partner were surveyed. The survey question read:

It is scientifically possible to create a once monthly pill that would detach any fertilised egg that had implanted in the lining of the womb. Currently contraceptives can only prevent fertilised eggs from implanting, but do not work after implantation. (Legally, a pregnancy begins once a fertilised egg has implanted in the lining of the womb.) This monthly pill could be used in place of your regular contraceptive method, and you would only need to take it if you had sex that month. Is this a form of contraception you would consider?

Also read:

Half of women would consider a MONTHLY pill to stop development of early pregnancy - but ‘archaic abortion laws stand in its way’. Daily Mail, 4 June 2015

Half of women would consider taking once-a-month contraceptive pill but abortion laws preventing development, say experts. Independent, 4 June 2015


An International Summit on Reproductive Choice At the Lisbon 2014 summit, more than 70 advocates, service providers and academics from across the globe discussed how best to defend and advance women’s reproductive choices. This publication offers perspectives on thorny issues such as later abortion, fetal pain, sex selection and fetal anomaly. Abortion, Contraception, Essays and analysis, Maternity The summit was organised by Catholics for Choice and British Pregnancy Advisory Service, with Portugal’s Associação para o Planeamento da Família. Speakers debated the difficult issues that have long challenged those in the domestic and international reproductive health field.

Articles in the publication include:

Is One of These Things Not Just Like the Other? Why Abortion Can’t Be Separated from Contraception. Beverly Winikoff, Gynuity Health Projects, US.

Later Abortion: What Makes It Difficult? Ellie Lee, University of Kent, UK.

Fetal Pain: What We Know, What We Believe, And What This Means For Abortion. Stuart Derbyshire, National University of Singapore.

Selective Abortion For Fetal Anomaly: The Perspective Of A Support Organisation. Jane Fisher, Antenatal Results & Choices, UK.

Sex Selection: The Uneasy Choice. Suchitra Dalvie, Asia Safe Abortion Partnership, India.

Replacing Myths With Facts: Sex-Selective Abortion Laws In The United States. Miriam Yeung, National Asian Pacific American Women’s Forum, US.

Not Only Abortion: Wider Reproductive Choice Issues. Marlene Gerber Fried, Hampshire College, US.

An online copy of Select Proceedings from the International Summit on Reproductive Choice is available in full here. If you would like to receive a printed copy of the publication, please contact at Catholics for Choice.

Abortion in context: Law, ethics and practice A stimulating seminar series running through May and June at Oxford University, convened by Dr Kate Greasley and Professor Carol Sanger. Abortion The series examines issues of abortion from a variety of disciplinary perspectives. For more information contact , or see the Facebook page.

Week 1: Wednesday, April 29th
Abortion and Reasonable Disagreement
Dr Jeremy Williams, Research Fellow in Philosophy, Birmingham University

Week 2: Wednesday, May 6th
Abortion, Sex-Selection, and the Law
Dr Ellie Lee, Reader in Social Policy, Kent University

Week 3: Wednesday May 13th
Medically v Morally Informed Consent
Professor Carol Sanger, Rothermere American Institute/Mansfield College, Oxford/Columbia Law School
Dr Kate Greasley, University College, Oxford

Week 4: Wednesday, May 20th
The Decriminalisation of Abortion: An Argument for Modernisation
Professor Sally Sheldon, Kent Law School

Week 5: Wednesday, May 27th
On the Failure of the Best Argument Against Prenatal Personhood: Why Conscious Desires Do Not Establish the Right to Life
Professor Christopher Kaczor, Visiting Fellow in Religion and Public Life, Princeton University

Week 6: Wednesday, June 3rd
Special Panel: Abortion Practice
Ms. Ann Furedi, Chief Executive of British Pregnancy Advisory Service
Ms. Jennie Bristow, Publications Manager, British Pregnancy Advisory Service
Dr Richard Lyus, Treatment Doctor, British Pregnancy Advisory Service

Week 7: Wednesday, June 10th
Abortion, Infanticide and Moral Consistency
Professor Jeff McMahan, Whites Professor of Moral Philosophy, Corpus Christi College, Oxford

Week 8: Wednesday, June 17th
Conscientious Objection to Abortion Provision
Professor Carolyn McLeod, Associate Professor of Philosophy, Western University