Motion made, and Question proposed, That this House do now adjourn.—(Nigel Adams.)
Fifty years ago, the noble Lord Steel and thousands of brave campaigners brought about a momentous change in women’s reproductive rights. It is hard to overstate the benefits that their campaign brought to women. Abortion has gone from being a leading cause of maternal mortality, shockingly responsible for 14% of maternal deaths—a fact that organisations such as the Society for the Protection of Unborn Children do not address when they call for the abolition of the 1967 Act—to being the most common medical or surgical procedure in the UK, one that a third of women will have had by the time they reach 45. We used to be a country where an estimated 87,000 to 100,000 illegal abortions took place every year and where unwanted pregnancies changed the lives of desperate women. Now, 200,000 women a year can access safe, free and legal services on the NHS.
The 1967 Act was a landmark piece of legislation. For a time, it made Britain one of the world leaders in reproductive rights, when this Parliament introduced a humane piece of law. I am disappointed that no Minister from the Department of Health or the Government Equalities Office has attended any of the events marking the enactment of this piece of legislation. I am also disappointed that Ministers have chosen to award funding raised from the tampon tax to Life, which argues for restricting women’s choices on reproductive rights, when so many wonderful charities could have benefited and used the money to empower women and support their choices.
I thank my hon. Friend for securing this important debate. When I debated with the pro-life charity Life on the radio recently, I was told that if a women it was helping went on to decide to have a termination, it would withdraw support, including housing, from that women. Does she agree that that is incredibly concerning?
Yes, that is incredibly concerning and I think it is a really bad decision of the Government to award money from the tampon tax to that organisation.
As this House tonight rightly marks the milestone of the Abortion Act, we should also reflect on whether the Act is still fit for purpose. The Abortion Act was never intended to be the end of the campaign for women’s reproductive rights. That point was put succinctly by the late Madeleine Simms, a former campaigner at the Abortion Law Reform Association and one of the architects of the original law. She said:
“The 1967 Abortion Act was a half-way house. It handed the abortion decision to the medical profession. The next stage is to hand this very personal decision to the woman herself.”
I want to turn to why the abortion law needs reforming. Britain’s abortion laws are governed not just by that 50-year-old Act, but by the 88-year-old Infant Life (Preservation) Act 1929 and the 156-year-old Offences Against the Person Act 1861. Taken together, this is the oldest legal framework for any healthcare procedure in the UK. It is a framework that, astonishingly, still treats the act of abortion as inherently criminal and punishable by life imprisonment. As I have mentioned, one third of women, and the healthcare professionals who support them, are stigmatised by these laws. As Madeleine Simms highlighted, the 1967 Act did not give women authority over their own abortions; it merely handed that authority to the medical profession, subject to the consent of two doctors. No other medical procedure requires the sign-off of two doctors, and nor does that requirement exist in most other countries in which abortion is legal.
While other healthcare areas have moved towards more patient-centred provision, with a better doctor-patient relationship, the provisions of the 1967 Act are, despite the best efforts of healthcare professionals, holding back similar progress in reproductive healthcare. Furthermore, as Professor Lesley Regan of the Royal College of Obstetricians and Gynaecologists said:
“No other medical procedure in the UK is so out of step with clinical and technological developments”.
Since 2014, the majority of abortions in England and Wales have been carried out medically, using pills. The 1967 Act was not designed with medical abortions in mind; it was passed when the overwhelming majority of abortions were carried out through surgical techniques.
I regret the fact that, in the 50 years since the Abortion Act was passed, Parliament has mostly shied away from debating issues such as those I have just set out. In March, the House of Commons heard the First Reading of my ten-minute rule Bill on the decriminalisation of abortion in England and Wales. In the 50 years before I introduced the Bill, previous MPs had introduced 11 Bills to amend our abortion laws—seven were private Members’ Bills and four were, like mine, ten-minute rule Bills. All 11 attempted to restrict abortion in some way; not a single one was about improving provision or better supporting women. It seems peculiar that for a procedure so common—one that affects a third of women—the overwhelming parliamentary focus has been on ways to restrict the practice. Had this procedure affected a third of men, it is hard to imagine that we would have debated it in the same way.
I congratulate my hon. Friend on securing this debate. Does she agree that parliamentary opinion on this matter is massively out of step with public opinion? The vast majority of people in this country favour safe and legal abortion.
My hon. Friend makes an important point, although the House did give my ten-minute rule Bill to decriminalise abortion its First Reading. It will be interesting to see the result if it is debated again in the new Parliament.
I am very impressed by the hon. Lady, as she knows because I spoke to her before the debate to ask to intervene. She knows my opinion on these matters. I understand that she is going to bring some things forward, which would be a help, but at the same time we are meant to believe that abortion is somehow an expression of women’s rights, but, on the contrary, some of us believe that it is so often the means by which vulnerable young women are themselves destroyed by the sorrow it can naturally engender. Even when abortion itself does not cause the destruction of women, their mistreatment by the industry that provides abortion daily in this country clearly can.
Clearly, 50 years ago Parliament took the view that it was going to allow abortions to take place in certain circumstances. It is right and proper that there is strict regulation around abortion. When I discussed decriminalisation earlier in the year, I talked about decriminalising, not deregulating. All providers have to provide the highest-quality care to women.
Successive British Governments have failed to act to improve abortion provision. They have sometimes hidden behind the false pretext that issues of provision are issues of conscience, thereby setting the issue aside as too difficult to tackle. In the months before and since I introduced my ten-minute rule Bill, yet more compelling evidence has demonstrated the need for long overdue changes to our abortion laws. Women, including desperate victims of domestic abuse, are increasingly ill-served by our current laws and criminalised for buying abortion pills online.
Waiting times for abortion services appear to be on the rise. Recently, figures obtained by investigative journalists at “The Debrief” showed that in 76% of the clinical commissioning groups and NHS trusts they surveyed, average abortion waiting times in 2016 were higher than they were in 2013. The Family Planning Association tells women that they should have to wait only 10 working days for an abortion, but a quarter of CCGs and trusts have average waiting times longer than that. In my local CCG in Hull, waiting times have jumped 6.7 days in just a year—one of the highest jumps identified.
The number of abortion pills seized by the Medicines and Healthcare Products Regulatory Agency posted to addresses in Britain has risen seventy-fivefold, from just five in 2013 to 375 in 2016. From November 2016 to February 2017, Women on Web, an international organisation that prescribes abortion pills in countries where abortion is illegal, monitored the number of British women who sought help on its website. In the space of just four months, the number seeking help had doubled.
Those figures point to this conclusion: there is a rising, and unmet, demand for better abortion provision in this country.
Will the hon. Lady give way?
I am going to carry on, because I am conscious of time.
The personal cases of these women are often deeply moving. A recent study of Women on Web’s services, published in September, has provided unprecedented insight into the challenges that British women face in accessing abortion services. Of the women who approached its service, nearly one in five did so because of “controlling circumstances” at home—from abusive partners to intolerant families. As one woman told the service:
“I’m in a controlling relationship, he watches my every move. I’m so scared he will find out, I believe he’s trying to trap me and will hurt me. I can’t breathe. If he finds out, he wouldn’t let me go ahead, then I will be trapped forever. I cannot live my life like this.”
“I’m never allowed to go anywhere without my husband or a member of his family escorting me. I don’t have a normal life since getting married. Abortion is against his family’s religion and I’m very worried what would happen if I was caught.”
For many women, making two trips to an abortion clinic, as is currently required, is simply not an option. A range of practical factors—the distance they live from a clinic, delays in accessing support, and childcare and work commitments—prevent them from making those trips. Yet each time these women purchase pills online, they are committing a criminal act, and because Women on Web does not prescribe pills in the UK, they are forced to turn to other providers, some of which may not be legitimate.
We are now in the position where the Royal College of Obstetricians and Gynaecologists, the British Medical Association and the Royal College of Midwives, plus the noble Lord Steel all agree that the law needs to be updated, and that abortion should be decriminalised. It is now time for Parliament to act on this. Shortly, I will be publishing the text of a Bill to decriminalise abortion in England and Wales. I am currently working on the Bill with legal experts and professional healthcare organisations. The Bill will contain the same safeguards and regulations as those that I set out in March this year.
Most importantly, it will take women out of the criminal law altogether. Healthcare professionals who assist in abortions before 24 weeks’ gestation will also be decriminalised, and they will receive further protections after 24 weeks. It will also allow us to make the best possible provision for the women who have early medical abortions. We need to look at the requirement to obtain two doctors’ signatures. We should also ask whether the second abortion pill could not be taken at home should women wish to do so, just as it is in the United States, France, Sweden and, as announced recently, Scotland.
Will the hon. Lady give way?
I will carry on, because I am conscious that the Minister has to respond.
I want to make the point that decriminalisation will not mean deregulation. The 24-week time limit will not be changed, and the conditions for accessing abortions post-24 weeks will not change either, but I do want to see stronger protection for women from non-consensual abortions—whether by assaulting pregnant women, or deceiving women into taking abortion medication.
I have a few requests for the Minister. It is time that we acknowledged that abortion provision is not a conscience issue. Access to abortion services is a core part of women’s healthcare. It should be debated in a grown-up way, and Health Ministers should be held accountable for the quality of our abortion services. First, will the Department of Health look into the problems that women are facing in accessing abortions? The Department should be regularly assessing the problem of abortion waiting times. It should be looking to identify local areas where there is poor provision. The problems that extremely vulnerable women face in accessing abortion care should also be investigated.
Secondly, what concrete steps will the Government take to improve abortion provision? A court judgment in 2011 established that the Health Secretary could allow home use of the second abortion pill without the need for new legislation. In the light of that and of what has happened in Scotland, what are the Government planning to do? Furthermore, an increasing number of experts have questioned the two doctor requirement for early stage abortion. Will the Minister comment on that?
Thirdly, how will the Government respond to the calls to decriminalise abortion, supported by three professional medical bodies? Will the Government consider acting on these calls? Finally, we must also recognise the situation in a country where the Abortion Act does not apply. In Northern Ireland, abortion is highly restricted and criminal, even in cases of rape, incest or fatal foetal abnormality. The ongoing Supreme Court case raises the prospect that this may soon go beyond a devolved matter and become a broader human rights matter. What steps are the Government taking for that to be dealt with by the Secretary of State for Northern Ireland?
In conclusion, the House should mark the anniversary of the Abortion Act—not just because of what we have achieved, but to look forward to what we need now. In the face of threats to women’s reproductive rights at home and abroad, the answer is not to become timid and to remain defensive. The answer is to be bolder, to go beyond merely defending what we currently have, and to make a positive case for stronger rights and better women-centred provision. The ’67 Act made Britain a world leader in women’s reproductive rights, but it is time that we took the steps now to ensure that, once again, Britain reassumes this world-leading position.
I congratulate the hon. Member for Kingston upon Hull North (Diana Johnson) on securing this debate to mark an historic occasion: the fiftieth anniversary of the passing of the Abortion Act 1967. As the hon. Lady explained, the Act was introduced as a private Member’s Bill by the then hon. Member for Roxburgh, Selkirk and Peebles—now the right hon. the Lord Steel of Aikwood—and clearly defines the grounds under which an abortion may be carried out in England.
With the exception of emergencies, when it is necessary to perform an abortion to save the life of the woman, two doctors must certify that, in their opinion, which must be formed in good faith, a request for an abortion meets at least one ground set out in the Act, and they should be in agreement as to which ground this is. The hon. Lady asked whether it should remain the case that the opinions of two doctors are required. Well, as long as that remains the law—clearly it is—my emphasis, from a Minister’s perspective, is on delivering the safest possible treatment for women in accordance with that law. The hon. Lady also raised some important issues regarding waiting times, which I would like to go away and reflect on. I am sure that everyone in this House agrees that no woman undertakes a termination lightly. For many, it is extremely traumatic, so it is incumbent on all of us to make that experience the least painful and least traumatic it can be, and as safe as possible. Central to being as safe as possible is that it takes place as early as possible.
The Minister is talking about the requirement for two medical practitioners to give their agreement. A ComRes poll of 2,000 adults last week showed that 72% of the public think that abortions should continue to be subject to that legal requirement, because it ensures protection for women, particularly for those in an abusive relationship. It might be the opportunity they have to talk to someone in a safe environment about the pressure that they might be being put under to have an abortion.
Central to this is that Parliament needs to be satisfied that the regime is safe for women. The law has been on the statute book for 50 years, and until Parliament decides to change that, that is the law that I will implement as safely as possible. I hear many polls quoted but, frankly, when it comes to this issue, on which people have very strong views, we need to ensure that we maintain the law with integrity.
Thanks to the dedication, hard work and expertise of the doctors and nurses working in abortion clinics, termination of pregnancy is now an extremely safe procedure. In marked contrast to some of the statistics before the Act, which the hon. Member for Kingston upon Hull North outlined, data for 2016 show a complication rate of just one in every 630 abortions, which is substantially lower than just 10 years ago, when the rate was one in 500. The choice of early medical abortion, which is less invasive than a surgical procedure and does not involve use of anaesthetics, has helped to increase the overall percentage of abortions performed at under ten weeks gestation from 68% in 2006 to 81% in 2016. Clearly, the more we can encourage that, the better it will be for the welfare of women undertaking terminations.
I congratulate my hon. Friend the Member for Kingston upon Hull North (Diana Johnson) on securing the debate. The Minister is talking about what happens to women during the procedure and about how much care should be taken. However, does she share my concern that, as the report “Abortion and Women’s Health” from the Society for the Protection of Unborn Children highlighted last week, counselling and support for women who suffer mental distress after they have had an abortion is seriously lacking in this country?
At the risk of being really controversial, I think there are lots of elements of counselling for women that are seriously lacking. That possibly reflects the fact that decisions about the welfare of women have generally been taken by men. It is great that there are now lots more women in this House able to influence exactly that.
Does the Minister agree that it is imperative that we offer women choice in the decisions they take about their body? Will she give an undertaking this evening to investigate why the Government thought it was appropriate to award the largest sum from the tampon tax fund to an anti-choice organisation?
I understand that the hon. Lady feels strongly about this issue, and nobody can doubt her passion and commitment to women’s welfare. My understanding of the grant she referred to is that it went strictly towards the support of women who chose to go through with the birth. I am happy to look at that further. I am not entirely sure it was the largest donation, but I am happy to look into that. However, the hon. Lady is right when she says there should be genuine choice. We do not want anyone to feel that they cannot have an abortion, any more than we want them to feel that they have to have one. We really want women to be able to make informed choices and to feel empowered to have the child, if that is what they would like to do. The important thing is that we empower women. That is the whole purpose of what we are trying to do here—to empower women and allow them to make choices that are safe for them.
Since the Act was passed, there have been regular calls from all sides of the debate for changes to the legislation, and the hon. Member for Kingston upon Hull North has outlined her views clearly today. As she said, this Government and previous ones have always viewed legislative change as a matter for the House to take a view on, and there are no plans to change that.
The Act was last amended in 1991 by the Human Fertilisation and Embryology Act 1990. This reduced the time limit for most abortions from 28 weeks to 24 weeks. No time limit applies where there is a substantial risk that the child will suffer from a serious handicap or that the pregnancy would cause grave permanent injury to the physical or mental health of the mother or put her life at risk. So amendments are possible, and it is ultimately Parliament that decides the circumstances under which abortion can be legally undertaken. The Government will always ensure that regulation works to make that as safe as possible.
The hon. Lady outlined clearly her belief that abortion should be decriminalised, and the Government will no doubt take a view as and when she brings forward her Bill, as indeed will the rest of the House. It is true that any abortions conducted outside the grounds in the 1967 Act currently remain a criminal offence, and there is no intention for that issue to be dealt with by anything other than a free vote.
Turning to the impact of the Act in practice, it is important that we remember that, in the years before the Act, abortion was, indeed, the leading cause of maternal mortality in England and Wales. For example, the first confidential inquiry into maternal deaths in 1952, reported 153 deaths from abortion alone. The most recent confidential inquiry report found there were 81 reported deaths in 2012-14 for all direct causes of maternal mortality, such as obstetric complications, interventions and omissions. So since the Act came into force, women in Great Britain have had access to legal and safe abortion services.
Does that figure include those who committed suicide as a result of having an abortion and the effect it had on them?
The figures include those who have died as a result of maternal complications. I am not aware of any figures that detail suicide. However, we need to look at the whole issue of counselling for women who are facing any kind of unwanted pregnancy.
In 2016, 98% of abortions were funded by the NHS, whereas in 2006 just 87% were NHS-funded. That shows that the NHS is providing more and more of this service. Ninety-two per cent. of abortions were carried out at under 13 weeks’ gestation, and 81% were carried out at under 10 weeks, illustrating the fact that the procedure is becoming safer. Sixty-two per cent. were medical abortions, more than double the proportion in 2006—again, a good sign of progress. This data clearly shows that improving access and choice within the existing framework can be achieved. I am sure that all hon. Members will welcome the fact that the vast majority of abortions are taking place at earlier gestation times, which is safer for women and offers increased choice of medical abortion.
On home use, abortions in England can be performed only in an NHS facility or in a place approved by the Secretary of State for Health. At present, a patient’s home is not an approved place for abortion. I am aware that the Scottish Government have recently granted approval for the second stage of early medical abortion treatment to be undertaken in a patient’s home in certain circumstances. As I have said repeatedly, our overriding principle is that all women who require abortion services in England should have access to high-quality and safe care. We will continue to engage with women and with stakeholders on ways to make our safe and regulated services even more effective.
A key part of an abortion service is providing information and services to enable women to make informed decisions and to support good sexual health. This includes information about, and provision of, contraception and testing for sexually transmitted infections. Abortion providers should be able to supply all reversible methods of contraception—including long-acting reversible methods, which are the most effective—and offer testing for sexually transmitted infections as appropriate. Before the woman is discharged, future contraception should have been discussed and, as far as possible, the chosen method should be initiated immediately. All women should be offered testing for chlamydia and offered a risk assessment for other sexually transmitted infections such as HIV and syphilis. Provision of effective contraception is essential if we are to make progress towards our ambition to reduce unintended pregnancies in women of all ages. For women aged 24 and under, we have seen significant reductions in the abortion rate, most notably in under-18s, where the rate has reduced from 18.2 per 1,000 in 2006 to just 8.9 per 1,000 in 2016. Rates in women aged over 24 have remained stable or increased slightly. We know that we have more work to do to ensure that we see improvements across all age groups.
Over the past 50 years, there have been significant improvements in women’s health, in the regulation of abortion, and in the safety of abortion. It is appropriate that we look back, take stock, and congratulate ourselves on that, and that we continue to ensure that the way in which we allow for legal abortion makes it, at all times, safe and well regulated.
Question put and agreed to.