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Criminalised abortion in UK obstructs reflective choice and best care

BMJ 2018; 362 doi: https://doi.org/10.1136/bmj.k2928 (Published 09 July 2018) Cite this as: BMJ 2018;362:k2928

Rapid Response:

Why Armchair Ethics Will Not Solve the UK's Abortion Divide

Whilst failing to appreciate how BPAS provide abortion care in the UK, and conjecturing on public opinion, Goldbeck-Wood S. et al argue for the “decriminalisation” of abortion.

I will share my experience from spending a day at a BPAS clinic to see vacuum aspiration procedures. I saw women receiving pre-procedure counselling, one-to-one nursing and post-procedure bedside monitoring in the recovery room, where a crash trolley was also present. Before discharge, patients were safety-netted for signs of infection, haemorrhage and retained products. Even purely medical abortions carry these risks. It is concerning therefore, that the author labels the provision of abortion in designated clinics as hypocritical and anachronistic, when any other way would undoubtedly compromise patient-safety. The solution to providing abortion services to the physically disabled is not reckless promotion of telemedicine self-abortion in a campaign of blind “decriminalisation”, neglecting that the main onus for the 1967 Abortion Act was the protection of maternal health.

All the women I saw at least that day stated not using contraception and unwanted pregnancy as the reason for abortion. In one encounter, the nurse volunteered to the patient whether she felt any emotional distress due to this, so that the required details could be entered onto an online system and certified by two remotely-located on-call physicians. Either way, the BMA holds that the relative risk of an unwanted pregnancy and childbirth will mean that legally, “there will always be medical grounds to justify termination in the first trimester” [1]. Thus, it is pure conjecture that risk to mental ill health must somehow be dubiously confirmed in order to access abortion.

The UK has the most liberal abortion provision in the EU, offering it on-request up till 24 weeks, resulting in 200,000 abortions per year. Whilst I appreciate the highly emotive nature of abortion for women, I remain unconvinced that decriminalisation is a solution to improving access. The author’s extrapolation of the Northern Irish issue to the whole of the UK is a clear fallacy.

References
[1] BMA, The Law and Ethics of Abortion, November 2014.

Competing interests: No competing interests

25 September 2018
Zain A Syed
Final year medical student
Medical School
University of Oxford, UK.