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Termination of Pregnancy (Information Provided)

Volume 517: debated on Tuesday 2 November 2010

Motion made, and Question proposed, That this House do now adjourn.—(Mr Vara).

Although the abortion figures for last year were slightly reduced by 3.2%, there were still 200,000 abortions carried out in the UK last year—572 per day. Abortion in this country is an industry from which a small number of organisations and individuals make vast amounts of money. No sensible person would condone this. In examining the legislative abortion procedures of European countries with far lower numbers than ours, it occurred to me that for those countries in which informed consent before an abortion takes place is enshrined in law—Germany, France, Belgium, Finland and others—the abortion rate was much lower. I have deliberately excluded countries with religious and cultural influences, such as Italy, Spain and Portugal from that analysis. It also appears to me that in those countries, the abortion procedure is a far kinder one, which takes much more account of the vulnerable position a woman might be in at the time of her request for an abortion and provides her with alternatives to consider and a cooling-down time in order to think, breathe and take stock of what is happening.

All those countries with good informed consent legislation had significantly lower than average daily abortion rates than the countries that do not have such informed consent legislation. Although a causal link is impossible to prove, these figures suggest that informed consent legislation might prove a good way of reducing Britain’s abortion figures. I think that all Members of all parties are agreed that we want to see that happen.

In this country, if a woman requests a termination from her GP, no questions are asked. I have spoken to numerous GPs and posed this question to them: “When a woman sits in your surgery and asks for a termination, what do you say?” The answer I frequently receive is that the GP does not say anything, but writes a referral letter. That is the process at the GP stage. A referral is made to a hospital or clinic and the abortion is performed, for the woman’s sake, as quickly as possible and without fuss.

Minimal counselling or no counselling is provided in some NHS hospitals and some clinics. Minimal counselling is provided by BPAS—the British Pregnancy Advisory Service—which carries out a large number of abortions on behalf of the NHS. However, BPAS carries out some counselling, but also carries out the abortion, so there is a clear conflict of interest there.

I understand that the counselling provided by abortion providers is Government funded only if the abortion goes ahead. Does my hon. Friend share my concern about that?

I am going to come to that very point a little later in my speech. It is one of the main concerns, mainly because no alternative counselling is provided to negate that option.

We all know that when it comes to abortion, the law is indeed an ass. It has no application whatever. We know that the law prohibits social termination—two doctors’ signatures are required—but none of that is ever taken into account. Abortion clinics freely admit that consent forms pile up in their offices, waiting for the second signature, long after the event has taken place.

A woman has an assumed right to choose. However, she apparently has no right whatever to any information on which to make that choice. If any of us were referred to a hospital today for a minor procedure such as an operation for an in-growing toenail, the procedure would be explained to us in detail. We would be made aware of the level of pain we might experience; we would be told exactly what would happen while we were under the anaesthetic; we would be given follow-up appointments to check on the progress of our healing; we would have our dressings changed and have checks for infection. A woman who has an abortion has none of that.

At the end of the day, the woman is discharged out on to the street and left to come to terms with the rollercoaster emotional journey of which she will still be in the midst. Before the woman received the procedure, she might have felt coerced, pressurised or bullied into the abortion. To her, it might have been a life or the beginning of a life—depending on her perspective. She might have had a seed of doubt, but once she was on the conveyor belt to the clinic, she might have felt helpless and unable to step off.

Make no mistake: abortion is not a medical procedure. It is not an in-growing toenail. Abortion is about the ending of a life, or a potential life. It is about a death which is final, and from which there is no going back. The abortion of a baby does not abort the seed of doubt or misgivings that may have been present at the time; that still remains.

Many consultant psychiatrists from the Royal College of Psychiatrists are becoming increasingly concerned about the number of women who are presenting with mental health issues directly linked to previous abortions. A major longitudinal 30-year survey published in The British Journal of Psychiatry in 2008 showed clearly—after adjustment for confounding variables—that women who had had abortions had rates of mental disorder 30% higher than women who had not. The Royal College of Psychiatrists said that, following its position statement on abortion and mental health,

“healthcare professionals who assess or refer women who are requesting an abortion should assess for mental health disorder and for risk factors that may be associated with its subsequent development”.

Nothing remotely like that happens. No consideration whatsoever is taken of the state of a mother’s mental health when she asks for an abortion. If she asks for an abortion, she is given one.

Given the disregard that we have for women seeking this procedure, I am surprised that that figure stands at only 30%. We push vulnerable women through a clinical procedure at great speed to end a life—or, as I said, a potential life—that is growing within them, and we wonder why only 30% have problems in later life. Those are the women who are diagnosed. They are the women who seek help, and whom we know about. We do not know about the others. Is it not time that we started to treat women a little better than this?

I am very pleased that my hon. Friend has raised the issue of the rights of women in this context, but what about the fathers? I hope she agrees with me that the law needs to be examined to ensure that the rights of the potential father are taken into consideration.

I thank my hon. Friend for his contribution, but I am afraid that I must stick to the point of the debate, because otherwise we shall run out of time.

Does not the way in which abortions are carried out in this country today almost amount to abuse? We need to take lessons from our European neighbours. In Germany, women are offered counselling and a cooling-off period. That gives them a chance to breathe and think. It gives them support. They are informed about the procedure, and of the possible consequences. They are provided with alternative routes other than the surgical removal of a life. They are given information about adoption—and yes, I know that people throw up their hands in horror when that is mentioned, but it is not our pregnancy, and it is not our baby.

We have no right to institutionalise and frame a decision-making process that is void of choice for the women who seek information. It is a woman’s right to choose, and women should have the right to be given every shred of information that we have and every alternative option. If a woman wants to continue with her pregnancy and deliver her baby for adoption, she should have the right to choose to do so. If she does not, at least she can emerge from the abortion process feeling that she made an informed decision. She can emerge feeling that she went in empowered and not helpless, strong and not vulnerable, and believing that she did the best thing because she knew exactly what she was doing and had full knowledge of every available option. She will be able to draw strength from that in future.

Women are entitled to an option. They are entitled to give informed consent, which should be explicitly supported by pro-choice and pro-life campaigners. When it comes to a decision of such magnitude, it is vital for women to receive information that is absolutely accurate and is given calmly, without coercion or a principled bias and, in particular, without political ideology. Last month ComRes, the pollsters, revealed after an extensive survey that 89% of people agreed with that. They think that women should be entitled to have more information when requesting an abortion. Given that overwhelmingly high figure, it is time that this House paid some attention. I hope the Minister agrees that it is time that we took a little more care of women undergoing such a procedure. It is time that we introduced a statutory process of informed consent and a cooling-off period. The European evidence shows that that could provide us with a considerable reduction in the number of abortions, and everyone would surely welcome that.

I shall finish by mentioning a book which is to be launched this month. It is published by the charity Forsaken, which is neither pro-life nor pro-choice: it is pro-women. For two years, the charity has put together the stories of women suffering from post-abortion syndrome. Reading the book is so heart-wrenching that we just want to reach out and take their pain away, but we cannot. There is no going back. We cannot make it better; abortion is a procedure to end life—it is final.

The women interviewed for this book feel that talking about abortion is taboo. That forces them into silence, leaving them unable to express their suffering. Abortion really is a taboo subject. We will never see an abortion filmed on television; we will never see that screened. It is still the taboo subject that we do not talk about.

One woman in the book describes how even when she told the anaesthetist that she was changing her mind and was having doubts, he pushed her to go ahead. He did so because, if she changed her mind, he would not have been paid. There is the same process as for the counselling. If the woman does not go ahead with the abortion, the clinics are not paid for the counselling, and therefore they need to know that she is going ahead before she is given the counselling—and we can imagine the process that ensues.

I will conclude by reading a paragraph from the book, giving a young girl’s account:

“An uncle dropped me off at the clinic with a letter to give to them. I don’t know what that letter was. At this point, I was holding onto the thought that they were only checking me. The staff at the clinic were very nice there, seemingly courteous and kind. It was not my usual surgery, I did not realise it was an abortion clinic until I was shown into a counsellor’s room. When I went to the counsellor’s room, I was asked: ‘Why don’t you want to keep this pregnancy?’

‘I want it but my family don’t want it,’ I replied, and promptly burst into tears. ‘They won’t support me and I can’t look after it myself.’

Nothing more was said that I remember...I was given a bed—there must have been 20 of us crowded into that ward. I was the first in line. As I waited, I scanned the corridors for some means of escape, but I was already wearing my hospital gown and no underwear. It wasn’t long before a man brought a wheelchair to take me to the operating theatre. For a brief moment I wondered if I had the strength to run away, but instead I sat obediently into the chair.”

That is a story of loneliness, suffering, emptiness and loss that many thousands of women live with day after day. It is they who become the 30%.

It is time for the UK to catch up with the rest of Europe and introduce informed consent in an attempt to ensure that stories like this become a rare exception. It is time for this country to start looking after our young girls and women at the most vulnerable time in their lives and treat them with some respect.

I congratulate my hon. Friend the Member for Mid Bedfordshire (Nadine Dorries) on securing this debate on a subject in which I know she has had a long-standing interest. She rightly described it as a taboo subject, and the extract she read was moving, evocative and of concern to us all.

The debate comes at a welcome time for me, as I will be meeting representatives from the two biggest independent sector abortion providers later in the month to discuss how we might integrate contraception and wider sexual health provision into the services they provide. It will also be an opportunity for me to raise some of the issues my hon. Friend has highlighted tonight.

I also recently had a useful and productive conversation with a charity that supports young women and men in making informed sexual health decisions. For me and for the Government, reducing the abortion rate is an absolute priority, and to do that we have to ensure that women and men are given information and support to make responsible sexual health choices.

We have seen significant advances in the quality of abortion provision since the Abortion Act 1967 came into force. Early access to abortions has improved and evidence shows that the risk of complications increases the later the gestation. Currently, 75% of NHS-funded abortions take place at under 10 weeks, compared with 51% in 1992. Early abortion means that women have more choice as to the abortion method. Medical abortion using two tablets now accounts for 40% of the total number of abortions, as opposed to only 12% in 2001. However, abortion comes at the end of a failure of many other services in the lives of young women.

Independent sector abortion providers and those organisations that refer women for an abortion are hugely experienced, but are subject to Secretary of State approval and monitoring by the Care Quality Commission. That is why some of the issues that my hon. Friend raises are of considerable concern. We need to ensure that continued emphasis is placed on giving women and men advice and contraception, because it is needed. In the same way, women should be given access to tailored, appropriate and impartial advice on their pregnancy options.

The Government will be responding to the House of Commons Select Committee on Science and Technology recommendation to update advice on the mental health consequences of induced abortion. The Government have commissioned a systematic review of the evidence, and the report will be published in spring 2011.

Interestingly, we have recently seen a substantial increase in the number of men attending family planning clinics—there was a 16% increase in the number of young men attending clinics in 2009-10, with 162,000 attendances. That is a massive 93% increase on the figure in 1999-2000, when only 84,000 men attended. I welcome the fact that young men are taking the issue of sexual health and pregnancy more seriously; I hope that they are taking it as seriously as young women are.

There are some examples of truly excellent, innovative sexual health services that have grown up at local level. However, as my hon. Friend said, the total number of abortions currently being carried out is just over 189,000 a year. Since 1992, the number of abortions has steadily increased, with the exception of the past two years when there was a fall in the number, albeit small. Just under half of teenage conceptions end in an abortion. However, the trend in both teenage conceptions and births is downward and the teenage pregnancy rate for 2008 was the lowest annual rate for more than 20 years. We should welcome that, although we should never be complacent because that figure of 189,000 is still way too high.

Repeat abortion is a continuing issue. Some 34%—one third—of women undergoing abortions had one or more abortions, a figure that has risen from 29% in 1998. Some 25% of repeat abortions were to women under 25. There are also significant and concerning variations between primary care trusts in repeat abortion rates, with rates in some areas as high as 45%. Abortions are traumatic and stressful, and they are not a form of contraception, but sadly they are clearly used as such in some instances. Women are offered a follow-up appointment within two weeks of the abortion. That also provides an opportunity to have another conversation about contraception needs if the woman was unclear as to contraception requirements at the time of the abortion, but that is not always taken up.

Is the Minister as concerned as I am that it is common practice for independent abortion providers to have their commercial relationship with PCTs and with other trusts in the health service hidden by the caveat of “commercial in confidence”? Therefore, people are not in a position to understand those providers’ commercial relationship with the NHS, and surely that offends against the principles of transparency in the NHS.

Yes. I thank my hon. Friend for raising that point. The issues raised by conflicts of interest and hiding behind commercial sensitivity give rise to considerable concern. That is why I am pleased to be meeting some of the service providers in the next week or so to discuss those issues. It must be pointed out, with the greatest respect to my hon. Friend the Member for Mid Bedfordshire, that although the stories she talked about involved bad practice, there are a lot of instances of very good practice. We should not miss that in the discussion about where things are not going as well as they should be.

Contraception has been free for everyone and is readily available in the community from GPs, family planning clinics and abortion providers, but there are clearly barriers. Why are so many young women and men not using it? A number of factors can lead to risk-taking behaviour, such as sexual violence, alcohol, lack of contraception awareness and self-esteem. We need to use simple, effective messages about safe sex, sexually transmitted infections, condom use and contraception. We need to ensure that young people receive high quality education on relationships and sex and we need to tackle those issues in a holistic and effective way. We need to ensure that young people are equipped to make the choices and the sometimes challenging decisions that they face in their lives. Those decisions are increasingly challenging in this day and age.

Those thoughts from the Minister are all excellent, but it is my understanding that before the general election the now Prime Minister promised Government time so that the House could have an opportunity to have a free vote on legislation to change, for example, the upper limit. Will the Minister tell the House tonight whether the Government are still committed to providing time and, if so, when?

I thank the hon. Gentleman for his question. Others in this House might know more about parliamentary procedure than I do, but I understand that abortion is a matter that is usually raised by Back Benchers. He may look bemused, but that is what I have been told. It is usually raised by Back Benchers and the Government do not normally take a view on it. It is an ethical decision and there are usually free votes on it—I have witnessed them myself.

Young women and men need to think about contraception before having sex. People have busy lifestyles—and, in some instances, very chaotic lifestyles—and there are barriers to accessing contraception. However, with long-acting reversible contraceptives there are ways to prevent unwanted pregnancy for everyone, whatever their lifestyle. We need young women and men to be equipped with the information and knowledge to look after their physical, mental and sexual health so they are not put in this position in the first place.

Some £11.5 million has been invested this year and the sexual health charities Brook and the Family Planning Association, with funding from Government, have developed a new web-based contraception decision tool to help people to choose the best contraception for them. Launched on 14 July, the “My Contraception” tool asks users a range of questions about their health, lifestyle and contraceptive preferences and recommends a contraceptive method based on the results.

The Government’s “Sex. Worth talking about” national campaign has been quite well received and early indications suggest that it has prompted positive action. Local areas will now be able to use the “Sex. Worth talking about” campaign resources to support their local work. That is a development that I am sure we will all welcome. There are also pages on the NHS Choices website with a huge amount of information and a helpline for confidential advice.

Some advances have been made to ensure that women are able to have safe, legal abortions, but we need to stop the tide of unwanted pregnancies. That is the position that we want to be in. That will take an effort on a number of fronts, and later this year we will publish our White Paper on public health, which will set out our approach in a great deal more detail.

My hon. Friend the Member for Mid Bedfordshire rightly points out that a woman faced with an unwanted pregnancy is extremely vulnerable. She also rightly points out that the consequences of abortion can be traumatic and far reaching. I am pleased that my hon. Friend the Member for Shrewsbury and Atcham (Daniel Kawczynski) raised the issue of fathers, who are often forgotten in relation to this subject but who should not be forgotten in legislation and in the mechanisms we put in place to ensure that we not only prevent unwanted pregnancies but deal with their consequences.

I shall be very grateful for the continued support of my hon. Friends in making sure that we get the very best services available for women at this critical time. Anecdotal and individual Members’ experiences are vital to ensuring that we get those services right. Having in place informed consent, appropriate counselling and the right support for women at this vulnerable time will ensure that we do not fail them for the future.

Question put and agreed to.

House adjourned.