Abortion: The minister and the moral minefield
Maria Miller wants to roll back abortion rights because 'the science has moved on'. Does she have a point?
Jeremy Laurance is a writer on health issues. He is former health editor of The Independent and the i and has covered the specialism for more than 20 years. He thinks the harm medicine does is under-appreciated, the harm it prevents over-rated, and that cycling works better than most drugs. He was named Specialist Journalist of the Year in the 2011 British Press Awards.
Thursday 04 October 2012
Maria Miller will have known that her comments yesterday on the abortion time limit would hit a nerve. No other issue generates more hand-wringing than the question of when it is too late to terminate a pregnancy.
The new women's minister declared in a newspaper interview that it was "common sense" to lower the limit from 24 weeks to 22 weeks because medical science had "moved on" and babies were surviving at ever-younger gestational ages.
Describing herself as a "very modern feminist", she insisted this was not a snub to women's rights, but added she was "riven by the very practical impact that late-term abortion has on women".
"You have got to look at these matters in a very common sense way. I looked at it from the very important stance of the impact on women and children. What we are trying to do here is not put obstacles in people's way but to reflect the way medical science has moved on."
Yesterday experts challenged her claims on both grounds: that advancing medical science had altered the landscape of abortion and that she knew enough about the impact of late abortion on women.
In 2011, 2,729 abortions were performed in England and Wales on women between 20 and 24 weeks pregnant, 1.4 per cent of the total of almost 190,000. Almost all of these late abortions were carried out by the charity BPAS (formerly the British Pregnancy Advisory Service) but a spokesperson said Ms Miller had never visited the charity or discussed with it the likely impact of removing the right to abortion for these women.
Ann Furedi, chief executive of BPAS, said: "Scientific evidence does not show that survival rates before 24 weeks have improved in recent years, as the minister seems to believe. But it is also important for a women's minister to recognise that every year a small number of women in often very difficult and unenviable circumstances will need to end a pregnancy after 20 weeks.
"Mrs Miller says she is driven by the impact abortion has on women. Staff at BPAS would be pleased to meet her and explain to her exactly what impact restricting abortion would have on the women we care for and their families."
Ms Miller backed a Commons move to reduce the legal limit for abortion to 20 weeks in 2008 and said she would vote the same way again today. Her comments come shortly after David Cameron appointed Jeremy Hunt as Health Secretary; Mr Hunt also backed moves to cut the limit to 20 weeks in 2008.
But is she right that medical science has "moved on" since 2008? Improvements in obstetric and neonatal care have certainly boosted the survival chances of premature babies over the last 30 years. Where once babies born at less than 30 weeks gestation struggled to survive, 54 per cent of those born at 24 weeks now live.
When the Abortion Act was introduced by the Liberal MP David Steel in 1967, it set an upper time limit of 28 weeks based on the assumption in the Infant Life Preservation Act of 1929 that this was the limit of viability – the lowest gestational age at which a foetus could survive outside the womb.
In 1990 the act was reviewed as the Human Fertilisation and Embryology Act was going through Parliament and the limit was reduced to 24 weeks.
Advances in medicine since 1990 have enabled babies to survive at 23 weeks and, very rarely, at 22 weeks. But the outcome for these extremely premature babies is often poor, with many suffering multiple mental and physical disabilities, suggesting the limits of viability have been reached.
A review of the abortion limit by the Royal College of Obstetricians and Gynaecologists in 2010 concluded there was no scientific evidence to justify a lower limit. Yesterday, a spokesperson said the College's view had not changed.
A spokesman for the British Medical Association said yesterday: "The BMA does not believe there is any scientific justification to reduce the abortion limit from 24 to 20 weeks. We will not be lobbying for any reduction."
Yet the survival of a handful of babies at 23 and 22 weeks has fuelled one of the most emotive debates in medicine: when does a foetus become a sentient being?
The issue was dramatically re-opened in 2005 with the publication of a book of 3D scanning images showing babies in the womb apparently "jumping" at 12 weeks, opening their eyes at 18 weeks and "smiling" at 22 weeks.
The photographs helped sway medical and lay opinion, leading in 2008 to an attempt in the Commons to reduce the abortion time limit to 20 weeks. The attempt failed, but pro-choice groups fear a new attempt could be made.
Timeline: Abortion in England & Wales
1967 The Abortion Act makes it legal to terminate pregnancies up to a limit of 28 weeks, to protect the woman concerned (or existing children) from death or grave permanent physical or mental injury, or if there is a significant risk that the child would be severely handicapped.
1968 22,332 legal terminations are carried out on women resident in England and Wales.
1971 94,570 legal terminations.
1975-87 Four different private members' Bills fail to result in any change to the law.
1981 128,581 terminations.
1990 Human Fertilisation and Embryology Act reduces upper limit to 24 weeks and removes link to the 1929 Preservation of Infant Life Act, which forbade terminations if the embryo was "capable of being born alive".
1991 167,376 terminations.
1995 35 per cent of babies born at 24 weeks, and 54 per cent born at 25 weeks, survive.
2001 176,364 terminations.
2006 47 per cent born at 24 weeks, and 67 per cent born at 25 weeks, survive.
2011 189,931 terminations for women in England and Wales. Of these, 78 per cent were at less than 10 weeks – and 1.4 per cent were at 20 to 24 weeks.
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