If you’ve been awake and living in Northern Ireland this week you’ll have done well to miss this story.
Marie Stopes is to open a private abortion clinic in Belfast this week. The clinic which will also provide advice and treatment for sexually transmitted disease and reproductive health will operate within the current framework of the law in Northern Ireland to provide abortions privately up to 9 weeks of gestation of pregnancy.
Understandably there has been much debate about this in the media and the usual polarised arguments of pro-choicers versus pro-lifers have been debated. I don’t really want to get into the usual debate about abortion but in the discussions I have heard and read since the announcement by Marie Stopes, it seems to me that the right questions have not been asked and important points have not been made. So that is what I hope to do now.
The Law
Our Health Minister Edwin Poots has been quoted as saying “I note that Marie Stopes International state very clearly that they will work within the law.” So what does that actually mean?
First of all lets look at the rest of the UK. Abortion is legal under certain circumstances in England, Scotland and Wales. The Abortion Act 1967 states:
Subject to the provisions of this section, a person shall not be guilty of an offence under
the law relating to abortion when a pregnancy is terminated by a registered medical
practitioner if two registered medical practitioners are of the opinion, formed in good faith –
(a) that the pregnancy has not exceeded its twenty-fourth week and that the continuance
of the pregnancy would involve risk, greater than if the pregnancy were terminated, of
injury to the physical or mental health of the pregnant woman or any existing children of
her family; or
(b) that the termination of the pregnancy is necessary to prevent grave permanent injury to
the physical or mental health of the pregnant woman; or
(c) that the continuance of the pregnancy would involve risk to the life of the pregnant
woman, greater than if the pregnancy were terminated
(d) that there is a substantial risk that if the child were born it would suffer from such
physical or mental abnormalities as to be seriously handicapped.
Now read a summary of the law in Northern Ireland:
The Infant Life (Preservation) Act 1929 allows abortion when necessary to protect the
mother’s physical and mental health. But, performing an abortion in Northern Ireland is an
offence except in specific cases. Abortion in Northern Ireland is only legal in
exceptional circumstances where the life of the pregnant woman is at immediate risk and if
there is a long term or permanent risk to her physical or mental health.
What strikes me about these two quotations is that on the face of it, apart from the clause relating to abortion being allowed for probable severe handicap and the requirement for abortions to be carried out before 24 weeks of gestation, there actually seems to be little difference.
Both laws allow for abortion where there is significant risk to the mother’s physical or mental health. So this being the case let’s look at the statistics for abortions performed.
- The number of abortions carried out in England and Wales in 2011 was 196,082.
- The number of abortions carried out in Northern Ireland between 2005 – 2010 was 394.
I think it’s worth pausing here. I find these statistics staggering and deeply upsetting, especially when you look at the birth statistics for England and Wales:
England and Wales 2009-2010 (12 month period)
- 723,165 babies were born alive
- 3,714 babies were stillborn
- Around 35,253 babies were born preterm
- Around 241,055 women lost a baby during pregnancy or birth
The abortion figures for 2009-2010 were similar to 2011. So basically this seems to suggest that approximately 1 in 6 pregnancies in England and Wales are aborted. So here’s my question:
WTF?
Seriously, what is going on? How can this be? And when only 1% of abortions in England and Wales are performed because of the risk of serious disability of the child, this means the majority have been judged to be necessary to protect the mother’s physical or mental health or that of the other children in the family.
What is happening in England and Wales that is putting pregnant mums-to-be at such risk? Surely these risk factors will be similar in Northern Ireland. And yet I am not aware of any statistics that suggest higher rates of morbidity or mortality for women during or after pregnancy in Northern Ireland compared to England and Wales. Of course some women in Northern Ireland do travel to England and Wales to have abortions but these numbers are relatively low (approximately 1000 in 2011).
Getting to the point….
So here are my concerns about Marie Stopes:
1. Subjectivity of the law
The above statistics suggest to me that abortion can be deemed legal because of the way in which the law can be interpreted. There seems to be a great degree of subjectivity in deciding what constitutes ‘grave permanent injury to the physical or mental health of the woman’. I have been a doctor for 12 years and I don’t remember seeing a single patient who I feel would have met these criteria (according to my interpretation of the law). I have however known patients who have travelled to England for an abortion. The main reasons expressed have usually been because of the inconvenience or disruption that a child (or another child) will bring to their life. These women have been able to make a case of there being significant risk to their mental health. But who am I, you might ask, to make a judgement about these women’s lives and the distress and burden that bringing a child into the world might bring? Well, I could be a doctor in the Marie Stopes clinic. Are the doctors in the Marie Stopes clinic going to apply the same subjectivity to interpreting the law in Northern Ireland as it would appear is done in England and Wales? If 2 doctors (as is required by law) decide that there is permanent risk to a mother’s mental health, how is anyone going to challenge that?
2. Can a private provider be truly objective?
This is my concern about private providers of healthcare and I think one of the great advantages of the NHS. In the NHS there is no incentive for me to perform unnecessary expensive procedures or tests on you unless I feel they are in your best interests. However I believe once you introduce money into the equation, this objectivity at least to a small degree is lost. Can we expect and trust a doctor whose salary is dependent on the way he interprets the law regarding abortion in Northern Ireland to be the same as one who has no financial gain in the matter?
3. Why 9 weeks?
Marie Stopes plan to offer abortions up to 9 weeks of gestation. This might seem a bit arbitrary, and actually I think it is. The reason for this is mainly due to the fact that in pregnancies up to 9 weeks of gestation they can offer ‘medical’ abortions. This avoids the need for a surgical procedure and a whole range of clinical governances and procedures. And to be fair it is therefore safer. But my question is that if Marie Stopes are going to operate under the law as it exists in Northern Ireland (and continue to interpret it in the way that it has been interpreted up to now), how many abortions do they expect to be performing? Which leads me on the my next question:
4. Why offer abortions at all?
Under Northern Irish law how many women at 9 weeks gestation can be judged to be at significant risk of physical or mental harm due to their pregnancy. For the vast majority of women who might be at physical risk due to pregnancy, this is rarely apparent in the early stages of pregnancy. In terms of the risk of harm to mental health, many women only discover they are pregnant between 6-8 weeks of gestation which hardly gives them much time to mentally process the implications of their pregnancy, let alone give time for a doctor (or two) to make a clinical judgement.
Furthermore if only approximately 80 abortions are performed legally on the NHS in Northern Ireland, why does Marie Stopes feel there is a need for this service. And why would any woman pay to go a private clinic when she can get treatment for free on the NHS? My only conclusion is that Marie Stopes expect to be doing more abortions in Northern Ireland than are currently done here and in order for this to happen they will be applying a different interpretation of the law.
And that in my opinion cannot be a good thing!
Final thoughts
I feel it necessary as I finish to point out that I do believe there are circumstances where abortion is acceptable and when it may even be the best available option. I’m not going to specify what those circumstances are because individual cases need to be evaluated according to the specific circumstances.
So I am not completely ‘anti-choice’. But I do worry that the debate around abortion is talked about in terms of being pro or anti choice as if that’s all there is to it. I worry that as a society we seem obsessed with choice generally. We expect and demand the right to make choices about anything that affects us. This to me seems unhealthy. Maybe sometimes in difficult situations having less choice might actually make things easier. And maybe sometimes the more choices you have, the more likely you are to make a wrong one.
Kicked by an elephant 