Intended for healthcare professionals

Opinion Last Orders

Rachel Clarke: Are women’s reproductive rights safe in the UK?

BMJ 2022; 379 doi: (Published 22 November 2022) Cite this as: BMJ 2022;379:o2789
  1. Rachel Clarke, specialty doctor in palliative medicine
  1. Oxfordshire
  1. rtsclarke{at}
    Follow Rachel on Twitter @doctor_oxford

Only six months ago this question might have seemed rhetorical or even outlandish, but then the unthinkable happened. In June 2022, the US Supreme Court made its seismic decision to overturn Roe v Wade. At one stroke, the nearly 50 year old constitutional right to abortion in the US was eliminated.

Like many in the UK, I found the news deeply disturbing. American women’s hard fought rights to bodily autonomy have been fatally imperilled by an unholy alliance of religious zealots and hard right forced birthers whose goal was not so much the promotion of “life” but the control of women’s bodies. Horror stories began to emerge, like that of a 10 year old girl in Ohio being impregnated by rape, then being forced to travel to neighbouring Indiana to have an abortion.1 But surely—like school shootings and reality show presidents—the lurid excesses of modern America could never happen here?

If only the facts inspired more confidence. Prime Minister Rishi Sunak has abstained on all votes relating to abortion in England since becoming an MP, including buffer zones and early medical abortion at home this year.2 He did, however, vote in favour of new powers to impose commissioning of abortion services in Northern Ireland.2 Key members of his cabinet—the chancellor, Jeremy Hunt; the home secretary, Suella Braverman; and the foreign secretary, James Cleverly—have also abstained or voted against all English abortion legislation since 2015.2 Hunt has spoken openly in interviews about his desire to halve the time limit until which women can have abortions from 24 weeks to 12 weeks, and he even broke the whip in 2008 to vote for an amendment to do precisely this.3

Then there is Maria Caulfield, the MP chosen by Sunak as his minister for women. In 2019 Caulfield voted against legalising abortion in Northern Ireland.4 She supports cutting the abortion time limit, and she used to be an officer in a parliamentary pro-life group.5 Incredibly, in interviews after her appointment, Caulfield doubled down on her opposition to the use of buffer zones around abortion clinics, claiming that protestors outside clinics might be there to “comfort” women attending the clinic.6 It’s almost as if Sunak is trolling us.

Contrary to popular belief, the right to abortion is not fully protected under UK law. The Abortion Act 1967 only partially decriminalises abortion, in cases where two doctors believe that continuing the pregnancy would be harmful to the physical or mental health of the woman or her existing children, an abortion would be less risky than continuing the pregnancy, or the risk is substantial that if the child was born it would suffer mental abnormality or serious physical disability.7 If these criteria are not met, women can—and are—still being actively prosecuted in the UK for having an abortion, with some even going to prison.8

I want to believe that a woman’s right to a safe and legal abortion is not under threat in the UK, but the degree of cabinet hostility to reproductive autonomy provokes deep and enduring unease in me.