Devolution of abortion by Debra Storr

December 16, 2015

Reproductive Rights

This article was originally published in the 2015 Autumn edition of Humanitie magazine.

Devolution of abortion: no threat -but is there a will to revisit practise?

by Debra Storr

ThirdForceNews reported 17 individuals from a range of organisations as having concerns over the devolution of abortion to Scotland and citing the iniquitous position of women from Northern Ireland seeking abortions in the UK. This was reported in Humanitie under the headline ‘A Humanist View on the Devolution of Abortion Legislation’.

I’m not so sure this is a Humanist view and it certainly seems to be based on a fear of more restrictive legislation in Scotland emerging.

That in turn seems to reflect a perception that late terminations are restricted in Scotland, presumably leading to a fear that the perceived low rate may lead to pressure for a reduction in the upper gestation limit for Category C (psychosocial) terminations.

Devolution of these powers makes this issue more acute: restricted legislative time at Westminster means that revisiting abortion legislation is much more likely at Holyrood.

Access to services

The perception that late terminations are rare amongst Scottish residents is correct with just 0.5% of all terminations at over 20 weeks gestation compared to 1.5% England and Wales (Department of Health, 2015). Both jurisdictions perform around 80% of terminations at or before nine weeks.

There is a legitimate concern relating to late abortions in Scotland where there are reports of doctors being unwilling to perform late Category C (psychosocial) terminations and informal limits operating at Health Boards. For example, Greater Glasgow states that terminations beyond 16 weeks are rare and that such will be arranged via BPAS (British Pregnancy Advisory Service) in England (Greater Glasgow Health Board, 2008).

The reasons for Greater Glasgow, one of the larger Health Boards, being unable/unwilling to perform terminations beyond 16 weeks is unclear but there is some history of resistance to supporting abortion services from NHS staff in Glasgow (Wale, 2015; Robinson, 2014).

This issue is not, however, confined to Scotland, with one survey reporting a GP as saying ‘Until recently, no gynaecologist at the local Tameside General Hospital performed abortions. Still most consultants conscientiously object’ (Marie Stopes International, 2007).

This reluctance affects a few hundred Scottish residents whose abortions are performed in England each year (162 in 2014). This is a serious issue for those women, who, at a time that is already of significant stress, also need to arrange travel and accommodation and fund such in advance (with the NHS only reimbursing later). But, oddly, only 81 of these ‘exported’ terminations are over 13 weeks. Clearly some later abortions are performed in Scotland and indeed Purcell (2014) mentions several women as having had late abortions locally.

Nonetheless, clearly there is an issue regarding access to late terminations that needs to be addressed with research finding that ‘Unlike women in other contexts who are forced to travel for an abortion, women from Scotland must do so not because later abortion is prohibited; nor do they generally experience the “cycle of increasing cost and delay” found in the United States. Rather, the women we interviewed faced travel solely because they presented later (largely, as we have shown, for unavoidable reasons), and because local gestational limits with unclear justifications precluded local treatment.’ (Purcell, 2014).

Support for abortion

There is little reason to believe that Scotland as a whole is less liberal on socio-medical issues such as abortion and euthanasia that the UK.

In September, Westminster rejected an Assisted Dying Bill, the first such to be discussed for 20 years by a margin of three to one (Bingham, 2015). Holyrood has discussed voluntary euthanasia twice in five years, with the latest Bill defeated 82 votes to 36, a ratio of just over two to one (Brooks, 2015).

Amongst MSPs, John Mason appears to be a lone voice promoting the rights of ‘babies before birth’ (Motion S4M-14542) heavily outweighed by other voices committed to defending women’s access to safe and legal abortion (Motion S4M-14524).

The First Minister, Nicola Sturgeon’s position is clear: ‘The Scottish Government and I have no intention of legislating to change the current time limits for abortion,’ and she offered to meet concerned groups to allay any fears (Scottish Parliament, 2015).

The most recent Survation polling put support for the current law at three-quarters of the Scottish population (Brown, 2015). While pro-life groups should not be complacent, this combination of strong popular and political support for the current law provides a significant degree of confidence that devolution of powers in this area poses no threat.

But key to the implementation of policy are the views of practitioners. A Marie Stopes survey of 7000 GPs in 2007 was encouraging with over 80% regarding themselves as pro-choice and even a fifth of those who were themselves anti-abortion still supporting a woman’s right to choose with an overall trend towards more liberal policies from the 1999 survey (Marie Stopes International, 2007).

Less encouraging are reports on consultant views which demonstrate significant ambivalence. The most striking finding was that the proportion of gynaecologists who thought women should have the right to have an abortion at 20 weeks’ gestation and over was almost 90 per cent, three times the proportion of gynaecologists who would personally perform an abortion at this stage.’ (Savage, 2008).

I would always respect deeply health conscientious objections. But perhaps some practitioners need to be reminded of their duty to patients as expressed by the BMA: ‘doctors should have a right to conscientiously object to participation in abortion, fertility treatment and the withdrawal of life-sustaining treatment, where there is another doctor willing to take over the patient’s care’ (my emphasis) (British Medical Association, 2008)

I would hope that the justice of Scottish women being able to fully access services locally, including for late terminations, will be focus of attention for campaigners and the Scottish Government.

The Scottish Government may find that they are pushing at an open door, at least with the key GP gatekeepers to services but consultants may require a reminder that their duty is to ensure that any conscientious objection does not disadvantage patients.

Availability of late abortion services may require the Scottish Government to have a robust discussion with practitioners and action to ensure that training is available.

Changing practise to provide decent access to legal abortion in Scotland does not require any legislative change, just the political will to change the culture within the NHS.