Abortion: Forty years of the woman's right to choose

The days of brutal back-street terminations are long gone, but debate still rages over the legal time limit

Helena has just murdered her unborn child. Or simply prevented a baby from happening, by ending her pregnancy before life began. It depends on your personal point of view. Either way, it was Helena's decision. "I had to do this," says the 26-year-old as she prepares to leave the clinic. "I cannot have a baby. It is not possible."

So she caught the Tube this morning, walked down a quiet street in the West End of London and pressed the buzzer of a terraced house, an unremarkable place except for the historic blue plaque on the wall outside. This is Marie Stopes House, former home of the great pioneer of contraception and sexual freedom.

"They gave me a pill that stops the blood supply to the ... I don't know, whatever you want to call it," says Helena. Tomorrow she will return for more pills that will cause the tiny seven-week-old foetus to be expelled from her body. "They say the miscarriage might begin within the hour."

This is what termination is like for some women now, 40 years after an Act of Parliament made it legal and ended the brutal practice of backstreet abortions. Last year, there were just over 200,000 safe and legal procedures in Britain. The official rate has more than doubled since 1967 – now 18 women of childbearing age out of every 1,000 choose to end an unwanted pregnancy – but nobody knows how many dangerous, secret procedures were performed back then.

The anniversary is next Saturday. It comes as MPs are investigating whether the limit for abortions should be reduced from 24 weeks, because of medical and scientific advances. The pro-choice movement says no, but does want the law changed to allow easier access to abortion. The group Abortion Rights is screening Mike Leigh's film Vera Drake in London to remind people what it was like in the bad old days. Deadly, for some women then; far better to take a pill in a quiet, clean clinic with nurses in white tunics who smile a lot.

"They asked me to pay first," says Helena. The father is a performer with no regular income. They have not been together long and this was not supposed to happen: a condom burst, then – worse – the morning-after pill did not work. Somehow he came up with the money: £70 for a consultation and £395 for the tablets that make up a medical abortion. Helena's will is strong, yet as she talks her chin begins to wobble. Her eyes are watering. "You have mixed emotions," she says, as if talking about somebody else. "Your head is telling you that you just can't entertain the idea of being pregnant. Your heart is telling you it's an amazing thing to happen, the most important thing anyone can do in their life ..."

Her head won, then. Just. Was it close? "Uh-huh," she says quietly, and nods.

A miscarriage is unpleasant even when it's by choice. But there are other far more dramatic kinds of abortions for women who leave it later than Helena. Some of them are happening down in the basement of the centre as she speaks. If you are squeamish, prepare yourself: we're going down there in a moment.

Last Wednesday a Dispatches programme on Channel 4 showed shocking images of the remains of foetuses pulled or sucked from the womb in bits: long, slick trails of blood and jelly-like tissue containing a tiny foot here, or a hand with five translucent fingers there. "We are quieter than usual today," says the clinic manager, who says women have cancelled after seeing the film. "They will probably ring us again, though, in a couple of days."

The images were given to Channel 4 by the anti-abortion (or pro-life) movement, which is using the anniversary to campaign for a reduction in the legal time limit. Campaigners say there is growing evidence that the foetus can feel pain by 24 weeks or earlier, and that advances in medical science mean more babies born very prematurely are surviving.

Increasing numbers of doctors and nurses are refusing to take part in abortions towards the upper end of the legal limit, deciding for themselves where to draw the line. The Royal College of Obstetricians and Gynaecologists has warned of a looming shortage of people willing to carry out the procedures. A survey last week showed that two-thirds of GPs want the limit reduced. But more than half would also like to make abortion easier for women by removing the requirement for women to obtain permission from two doctors first.

The pro-choice lobby – including the charity Marie Stopes International, which runs the clinic where Helena has come – says there is no hard scientific proof about pain, and disputes the evidence for survival rates. Liz Davies, head of Marie Stopes in the UK, says the two-doctor rule should go but the legal limit should stay. "The needs of the woman are paramount. Not the needs of the foetus."

That's not what they think outside the clinics, where protesters regularly stand with placards and kneel to pray. Hundreds will gather outside the QE2 Centre in London on Wednesday when MSI hosts the Global Safe Abortion conference.

Meanwhile, the cross-party group of MPs on the Commons science and technology committee has been hearing from both sides. Their inquiry was partly provoked by the astonishingly detailed "4D" scan pictures of young foetuses made by Professor Stuart Campbell, who says they appear to suck their thumbs and make faces in reaction to movement.

"I found them shocking," says Helena. "If I had been 13 or 14 weeks gone, after seeing them, I don't know what I would have done."

The radio is playing from unseen speakers, partly to distract anxious women and partly to mask the conversation at the front desk. Nobody seems to notice the song that is playing, with brutal irony. The chorus says, "Baby, can I hold you tonight?"

No. Not tonight. Not here. There are no babies in the language of this clinic, only neutral words like foetal tissue. "We do everything we can to demedicalise this place," says Deanna, the centre manager. "These women are not sick; they have come here for a procedure. We don't want it to look or feel or smell like a hospital."

Perversely, it is more like a fertility clinic. The same scents of air freshener, antiseptic, latex and something darker and the same body language in the waiting room: a woman flicking through OK!, clearly distracted by worry; her partner trying to be the big man, staring into space, saying nothing. There are fewer couples here. And on the whole, the women are younger.

"After the fees room you go for a scan," says Helena. What did she see? "It was a shape that was just beginning to elongate, on its way to becoming like a kidney bean." Her parents do not know what she is doing. "They are Victorian about these things. They would say I am being irresponsible."

This centre will terminate only up to 12 weeks. After that, you have to go to one of the bigger centres. They see 500 people a month here, of whom the majority – 62 per cent – have a termination with conscious sedation. That means they are awake, although drowsy and relaxed, as they lie with their feet apart and knees up on a gynaecological couch and a doctor extracts the foetus from the womb, using a suction pump.

That happens down in the basement where partners – those few that come – are never allowed. It is too small, too crowded and too private. In the recovery room are a dozen navy-blue recliner chairs arranged with their backs to the walls, as in a beauty spa, but nobody has cucumbers over their lids. One of the women has bloodshot eyes that look like they have cried today, but she quickly turns away. Another returns my look with confidence. She is smiling, as she lies back with her feet up on the end of the chair, knees up and a heated strip of material across her stomach. The leaflets say it will hurt; there's no point pretending otherwise.

The gynaecologist on duty today is a softly spoken man whose accent suggests he comes from a French-speaking part of West Africa. He doesn't want to be named. "This is a five-minute procedure," he says. A nurse explains what is happening as the cervix is dilated. "It is like having a smear test," says the gynaecologist, but that's not quite true, is it? He works with what looks like a giant syringe (with no sharp end), pulling it back to suck the foetal tissue from the womb.

"In some cases there may be some retained products," he says, meaning something left behind which can cause infection, "but that is very rare."

His colleague Dr John Spencer, senior clinical director for Marie Stopes, was quoted by Dispatches describing what it was like to abort a foetus that was much older and larger, when it could not be removed like this or even all in one piece. "The foetal parts are soft enough to break apart as they are being removed," he said. Using an ultrasound as guidance he was seen using forceps to pull out the body parts bit by bit, describing those which were too big. "Those parts are the skull and then the spine and pelvis and in fact they are crushed."

Liz Davies says Dispatches showed pro-life propaganda, namely a whole foetus being wrapped in plastic. She thinks it was a stillbirth, not an abortion. But what about her own doctor's words? Were they exaggeration?

"These are the bald facts of abortion," she admits flatly. "We make no attempt to hide from them. The foetus is not removed whole in late abortion. We give a general anaesthetic. Death of the foetus is instantaneous at the commencement of the procedure. The purpose of abortion is to bring about the demise of a foetus for the betterment of a woman's life."

Marie Stopes International runs 38 clinics in Britain and the profits from them go to fund its work in developing countries. The charity was started in honour of Stopes, voted Woman of the Century in a poll in 1999. Its research shows women have "compelling" reasons for leaving it late, says Ms Davies. Some may not know they're pregnant, if they're used to menstrual cramps or weight gain. Some take a long time to act. "If the limit were lowered it would rush them into an abortion that was not actually right for them."

When the procedure is over, what happens to the foetus? That is not something they like to talk about. "We don't want the pro-lifers getting hold of this stuff," says Liz Davies. But she also insists they have having nothing to hide, so describes how the "foetal tissue" is put into a large plastic tub, along with all the other "products" of the rest of a day's work at the clinic. The tub is sealed and securely stored by the clinic until it is taken away by a specialist clinical waste firm to be incinerated.

As patients feel able, they stand and dress and go to the recovery room. Within a day or so they will start to bleed heavily for a while, far more than a period, and may experience contractions. Before they leave, Marie Stopes offers counselling and painkillers.

Helena does not need them. She has acted quickly and avoided the suction pump and the recovery room. This time. "I might as well tell you," she says, "since this is anonymous. This is not my first time." She had an abortion four years ago and it was later, a messier business. "The second time is harder, though," she says. "You are older and more aware of the missing piece in your life. Children can be that.

"I do want children, one day, and I dread the idea that by doing this I might somehow bring something dreadful on myself and it won't be possible. There are times when I feel, 'Wow this is a lovely feeling.' But I know that it can't last."

Helena rises and pulls on her coat. "Look, if I could I would have it, absolutely. I can't though. Financially, I would not feel in a position to do that."

Cramps have made it impossible to ignore what has been happening to her. "I do feel I have a relationship with ... I don't know what to call it. Definitely." That surprises her, she admits as she leaves, going back to a sofa, a hot chocolate and a favourite film. "I'm not sure what to think. It's not a person though because it has not formed enough and not taken on an identity," she says tentatively. "It's still special, though. It's still something. It's not nothing, is it?"