BRITAIN’S ABORTION LAWS MANY UNANSWERED QUESTIONS AFTER FIRST YEAR’S WORK

Press, Volume CIX, Issue 31982, 8 May 1969, Page 14

BRITAIN’S ABORTION LAWS MANY UNANSWERED QUESTIONS AFTER FIRST YEAR’S WORK

<By

T. E. UTLEY

in the “Daily Telegraph”, London) (Reprinted by arrangement)

Almost a year after the Abortion Act came into force (on April 27, 1968) the task of interpreting what effects it has produced on British life remains intensely difficult.

The bare facts are clear, but what use are they for purposes of comparison? Some 32,213 legal abortions were performed up to the end of March. Of these 19,009 were done free on the National Health Service, compared with about 6000 in the last peak year before the Aet became law. But nobody knows how many illegal backstreet abortions there still are, and nobody knows how many private abortions (carried out with due legal precautions in the form of psychiatrists' certificates and so on) took place before the reform was introduced. Incomplete Records On the first point, many learned statistical speculations are continually being ventilated. Perforce, the State has no exhaustive record of criminal abortions, but it has a record of deaths resulting from abortion, which no doubt includes many brought about by illegal operations. These suggest that Lord Silkin’s original estimate of 100,000 back-street abortions a year (one of the great arguments for the Act) was either fantastically exaggerated, or that back-street abortionists are far more efficient than they have usually been supposed to be. On the second point—the relative figures before and after the Act of the costly private abortions in the clinics which have lately attracted the critical attention of the Minister of Health and Socal Security (Mr Crossman)—one fact seems scarcely to be contested: the price of these abortions has not declined and, therefore, presumably, fhe disparity between demand and supply has not been altered. Private abortionists, largely concentrated in and about Harley Street, continue to derive substantial rewards from the control of a near-monopoly in a still scarce commodity—medical flexibility. It may be that some girls who would have gone to the back-streets before Mr Steel’s Bill came into force are now being operated op in far more salubrious and controlled conditions by National Health surgeons. If so, the Bill would have achieved part of its main purpose. It may be that some girls, who in the past would have had to pay exorbitant prices in the private market, are now securing free abortions on the National Health. In that case, the continued pressure on the private sector (reflected in the prices which it can charge) might be explained by a general increase in the demand for abortion, arising possibly from the sanction which it has appeared to receive from the State.

It may be also that the figures have been substantially swollen in both private and public sectors by an influx of those seeking abortion from abroad. Certainly the British law is now, to all appearances, more permissive than that in any other Western European country. What is indisputable is that an immense extra burden, for which it was wholly unprepared, has been imposed on the National Health Service. If an abortion is to be carried out easily, without a major abdominal operation, it must be performed within the first 12 weeks of pregnancy. If a National Health surgeon feels that he has no ground for refusing a woman's request for abortion, he is inevitably inclined to give a high priority to her claim for a bed. In order to do so, he may be obliged to postpone some long overdue gynaecological operation of a more constructive kind. Talk about women actually dying in order to provide hospital space for incompetently promiscuous young women who wish to get rid of unwanted babies is almost certainly wildly exaggerated. National Health surgeons on the whole remain disinclined to abort frivolously. The main burden of the frustration arising from shortage of beds (I am convinced) is still borne by a woman seeking a free abortion rather than by the patient awaiting some other kind of treatment. Availability Of Beds Availability of National Health beds differs widely from one part of the country to another. So do the ethical views of those who control the disposal of these beds, though the contention that the stern approach of some Birmingham gynaecologists has virtually ruled out free abortion is not supported by the latest figures. The net result, as far as the N.H.S. is concerned, is that a right to free abortion any one of a number of vague and extremely comprehensive conditions is satisfied appears to have been granted. When it comes to the point, however, the right proves illusory and the girl claiming it goes, after a preliminary visit to a pregnancy advisory clinic, to one of the private establishments. There she is greeted in very much the same way as she always used to be. The atmosphere is brisk, jolly and, for the more sensitive type of young woman, a little too humorous. Although the new law has eliminated the element of “risk money,” the fee remains at somewhere between £lOO and £l5O. If National Health Service doctors have not already pro-

vided the girl with grounds, the costly declaration before two psychiatrists of an intention to commit suicide, which custom required before the Act, is no longer necessary; all that is now required is a similar declaration before two doctors, one of whom is normally the abortionist, while the other takes a fee of ten guineas. The price of the operation and the day or two’s confinement which it may involve is still often required in cash. What must at the very least be admitted is that a service which is in short supply and the accessibility of which should, by nearly everyone’s admission, be limited by some moral principle, is still being distributed in a grotesquely arbitrary manner, with money as the chief factor determining whether it can be got. Abortion in Harley Street remains relatively easy if you have the price. The truth is that under any conceivable definition of the law, the decision whether or not to authorise abortion in a particular case must finally be discretionary. At present, a surgeon may find himself confronted with a certificate, signed casually or venially, by two general practitioners but which confers a legal right to abortion. He may of course decline to do the operation on conscientious grounds, but if so he must be ready to defend those grounds in a court of law with the onus of proof resting on himself. The very least amendment in the law, which, in this respect, is needed, is surely a provision that no abortion would be carried out anywhere without the consent of at least one qualified gynaecologist employed and approved by the National Health Service, or without that of an officially appointed panel. National Policy Only some such concentration of discretionary power can produce a national policy on abortion. Only some such concentration also can do anything to stem the private abortion racket which causes Mr Crossman so much concern and which will only be mitigated, in its more serious aspect, by the higher standards he is imposing from now onwards on approved private clinics and nursing homes. Yet the central issue can-' not be evaded: what does the Government, the medical profession and the public at large think to be an adequate reason for killing life in the womb of a healthy woman? Because of the compromises which it embodied and the haste and incompetence with which it was drafted, Mr Steel’s Act largely evades this issue.

Its controversial social clause, permitting abortion in order to protect the physical and mental health of existing other children, is comparatively rarely invoked on its own, though it is often used in combination with other grounds. That clause, however, has done much to create the atmosphere in which the Act has operated, and, no doubt, to encourage a liberal interpretation of other clauses. A Repentance It is meat and drink to some private abortionists, but one National Health gynaecologist at any rate is still bitterly repenting the only operation which he agreed to perform under it—an abortion on a healthy and sane working-class woman oppressed by really serious financial cares. Within a week of losing her child this woman had to be given contant psychiatric treatment under which she still remains.

There is a large (probably overwhelming) body of reputable medical opinion to support the view that there are few if any legitimate cases for abortion which could not be justified under the general heading of a threat to the physical health of the prospective mother. If the grounds for legal abortion were limited to this (with the possible but controversial retention of the seldom invoked clause about potentially defective children) a heavy burden would be removed from the consciences of such doctors as have them. This, plus some limit of the quality and number of those entitled to authorise termination, would do much to render the law tolerable; at present it manifestly is not