Is abortion too easy? (From York Press)

Is abortion too easy?

10:26am Thursday 6th December 2007

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Should women be able to get an abortion at the local GP surgery? STEPHEN LEWIS reports.

THE Government is considering making abortions available at GP practices.

Two pilot studies have been set up to investigate the possibility of allowing women to have "early stage abortions" using drugs in doctors' surgeries and other "non-traditional settings".

The Department of Health stressed no decision has yet been made. Evaluation of the pilot studies would be completed early next year, a spokeswoman said. "We will consider the results carefully before reaching a decision," she added.

In October, an influential group of MPs issued a report calling for women to be given easier access to abortions.

The Science and Technology Committee, which found no scientific justification for lowering the 24-week legal limit, said women were experiencing unnecessary delays.

MPs called for the requirement for two doctors to sign forms before an abortion could go ahead to be scrapped.

They also said nurses and midwives with suitable training and professional guidance should not be prevented from carrying out all stages of early medical abortions (involving the use of drugs) and early surgical abortions.

The committee's chairman, Harrogate MP Phil Willis, said he was in favour of the pilot studies going ahead.

"I am certainly in favour of women always having choice in terms of where they can have a procedure, particularly if it is safe and meets good care guidelines," he said.

But York grandmother Heather Causnett, who is opposed to abortions, said there was a danger that the procedure would become so easy women would regard it as little more than a form of late contraception.

"It would be a bit like going to the dentist to have a tooth removed. Women would be going to the doctor to have a baby taken away," she said. "It needs to be given more thought than that."

So should abortion be available on demand from your GP or practice nurse?

The midwife

PRIVATE midwife Chris Warren, of Yorkshire Storks, has no problem with the idea of early-stage abortion being available from your GP practice. She doesn't think it would be a case of making abortion too easy.

What would worry her, however, would be the availability of proper counselling.

Having an abortion, she says, is a huge decision for a woman to make. Most women go through a great deal of soul-searching before arriving at such a decision, she said - and the consequences often live with them for the rest of their lives. "They will remember when the baby's birthday would have been - and go through real heartache."

So it is vital that women who are considering an abortion do have the opportunity to talk things through properly with a trained counsellor, she said. Your GP or practice nurse wouldn't necessarily have the right training. "I don't think you can say just because a practice nurse is available she is necessarily a suitable person to be a counsellor."

The GP

COPMANTHORPE GP Dr John Iredale doubts whether a GP practice is the right place for a woman to have an abortion.

"We don't really have enough information at the moment to know how it would work," he said. "But as far as I know, there are no facilities for doing terminations in primary care."

Surgical terminations would be out, he said. It might be possible for a GP to offer an early medical termination. That would involve prescribing a pill, which a woman could take and then go home, where she would effectively have a miscarriage. But even that would be problematic, Dr Iredale said.

Some women could bleed quite heavily. It was impossible to know how quickly the bleeding would begin. "Would it begin on the bus on the way home?"

There is also the issue of proper counselling, he said. It is essential that any woman considering an abortion should be given plenty of time to think over their plans, he said - and that they have access to proper counselling.

That just may not be possible at a GP surgery.

"We have about ten minutes with each patient - 15 minutes at the most," he said. "They would need longer than that. Ideally, they would need at least half an hour with a trained counsellor, so they could go through in some detail all the options and help people come to terms with the decision they are making. It is a big decision."

The abortion clinic

TONY Kerridge, of Marie Stopes International, which has a clinic in Leeds, says anything which offers women greater choice is to be welcomed.

He does have some concerns, however, that by offering women an abortion at their GP practice, their choice might in fact be reduced.

If a woman comes to a Marie Stopes clinic, they are offered a range of different options, he says - including the abortion pill, but also a surgical procedure. If she were in future to go to a GP surgery, the only option may be the pill.

There is also an issue over back-up care, he said. Marie Stopes has nurses on call 24/7 that patients can telephone for advice or reassurance.

Up to three-quarters of all women who have taken an abortion pill do call a nurse afterwards, he said - usually just to get some reassurance. He is not convinced this level of service would be on offer from a GP.

However, there is one advantage your local GP would offer, he says. Since it is a local service, there would be little or no risk of bleeding or period pains starting before a patient got safely home.

It is difficult to predict how quickly the pill will work, he said - but it usually takes between two to six hours before the first blood comes.

Mr Kerridge is, however, delighted that MPs on the House of Commons Science and Technology Committee called for the requirement for two doctors to sign forms before an abortion could go ahead to be scrapped.

That was a paternalistic law coined at a time when the status of women was very different, he said. "It has to be a woman's decision."

The traditionalist

YORK grandmother Heather Causnett is vehemently opposed to abortion, which she regards as a form of legalised murder.

Yes, she accepts, it should clearly be possible for women who have been raped to have an abortion. She also accepts that young girls sometimes make mistakes that lead to them becoming pregnant. In such cases, abortion just might be preferable to having an unwanted and unloved child brought into the world.

But she definitely believes abortion should not be made too easy. "Young girls can sometimes make mistakes," she said. "But you also have women in their thirties who think abortion is like the morning-after pill. That is totally wrong."

Much of the stigma of having an abortion has disappeared over the years, "And people often feel they can do exactly what they want."

So she is against anything that would make getting an abortion easier than it already is - including allowing women to have them at their local surgery.

"I don't think that would be the right place for it," she said. "There is not the surrounding support, for a start - but also it would make it too convenient. It would be a bit like going to the dentist to have a tooth removed. Women would be going to the doctor to have a baby taken away. It needs to be given more thought than that."

The MP

HARROGATE MP Phil Willis, who is chair of the House of Commons Science and Technology Committee, says that 40 years after the Abortion Act came into force, it is right that the Government should be looking again at the way in which women could be offered an early abortion.

Some women, particularly vulnerable young women, can find it difficult having to go to hospital to have an abortion, he said.

He does not necessarily believe that GPs should suddenly find themselves burdened with a whole new area of responsibility.

"But I am certainly in favour of the trials going ahead and I am certainly in favour of women always having choice in terms of where they can have a procedure, particularly if it is safe and meets good care guidelines."

Fact file

What is early medical abortion?

EARLY medical abortion, or the abortion pill, is a procedure that can be used in the first nine weeks of pregnancy. It effectively causes a woman to have a miscarriage.

Two different pills are given - the second a day after the first. This usually begins to cause heavy bleeding and period pains any time from two to six hours after being taken.

Early surgical abortion can be carried out at up to 12 weeks. This involves the use of gentle suction to remove the foetus.

Abortion law

UNDER the Abortion Act 1967, abortion is legal up to the 24th week of pregnancy. If there is a substantial risk to a woman's life or if there are foetal abnormalities, however, there is no time limit. To comply with the 1967 Act, two doctors must give their consent.

An abortion (surgical or medical) can only be performed in a hospital or in an approved independent sector place, such as a private clinic.

Section 1(3A) of the Act, however, also gives the Health Secretary powers to approve other places to perform medical abortions, which could enable them to be available in a wider range of settings.

This has not yet been used in England.

Abortion statistics

A TOTAL of 193,737 women in England and Wales had an abortion last year. Of these, 57,437 had a medical abortion using the abortion pill.

In the North Yorkshire and York PCT area, 1,757 women had an abortion last year. The figure for Yorkshire and the Humber as a whole was 15,971

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