Is it time for abortion to return to the political agenda?
Anti-choice lobbyists are gearing up as the new coalition government settles in. We should not let them define the terms of debate, says Lisa Ansell, instead we should push for women's right to access abortion to be shored up
I take for granted the right to autonomy over my body. I have grown up secure in the knowledge that, should I ever find myself pregnant, the law is unlikely to force me to continue a pregnancy against my will. I am part of a generation of British women who look at the rhetoric of the debate around women's healthcare issues in the US and count our blessings that we are so progressive that our 'right' to safe, legal termination of a pregnancy is not threatened.
It seems that my complacency is shared. In the run up to the election - often described as the 'Mumsnet' election - there was little discussion of abortion. The Fawcett Society established the position of each political party on issues affecting women and did not mention it. We take for granted access to safe, legal terminations.
In 2008, a series of challenges to the current upper-time-limit for abortions of 24 weeks was tacked on to the Human Fertilisation and Embryology Bill, I was gratified to see the overwhelming majority of MP's vote the proposals down.
But in an interview with The Catholic Herald two days after the General Election was called, David Cameron made sure abortion was a political issue again, with his renewed commitment to cut the upper time limit to 20 weeks. A pledge made as part of a 'moral' agenda which served to placate the Christian right, who have been busy establishing themselves within his party.
His new Equalities Minister, Theresa May, has long since backed a cut to the time limit, and the make-up of the House of Commons has dramatically changed, with little information available about the views of new MPs on this issue.
The lack of legal clarity on the importance of a women's autonomy over her body leaves the door wide open for repeated challenges to fragile abortion legislation
The abortion 'rights' I took for granted are beginning to look very fragile. Perhaps it is time to welcome a re-emergence of abortion onto the political agenda, as an opportunity to establish our rights once and for all.
My complacency about the security of my own 'right' not to be forced into going through a pregnancy against my will has been based on a notion that this 'right' has been won.
In England, difficulty obtaining appropriate medical services is a major factor in delaying terminations being carried out. An increasing number of terminations are carried out by the private sector, under contract to the NHS, and doctors say that services are limited, especially for procedures carried out later in pregnancy. Stories about medical professionals refusing to offer reproductive health services are being heard with increasing regularity and this objection is being guided and celebrated by anti-abortion groups.
The Northern Ireland Offences against the Person Act 1861 underpins a legal tangle of legislation governing access to safe, legal abortion for women in Northern Ireland. It is not so much a legislative framework as a web ensuring that, even in 2010, Northern Irish women are forced to travel to the British mainland and pay for legal terminations, or seek out unsafe alternatives.
Under current abortion legislation, I still require two doctors to agree that my reasons for not wanting a pregnancy to proceed are adequate. My complacency about my 'right' to make that decision is the product of a culture where doctors interpret legislation liberally.
What value does a woman's autonomy and capacity have?
The moral implications of restricting the autonomy of people to consent to, or refuse, medical treatment when their capacity is limited by age or illness are critical in health policy. The finer points of these ethical debates are fought out in a blaze of publicity in our highest courts. Your right to make decisions about medical treatment is usually assumed - unless there is reason to believe you are unable to understand the implications of it, if you lack capacity.
In UK law there is no question of a foetus or embryo having a legal interest which can be represented in court, and during childbirth the moral responsibility to my unborn child is mine. Treatment is dictated by me as the patient. If I understand the implications, I can refuse treatment. Even if a doctor thinks a C-section is in the best interests of my baby, I can't be forced to have the surgery against my will.
There is no other area of medicine where we start off with the assumption that the patient is not competent to understand the moral implications of their treatment. This is the only area of medicine where evidence of reduced capacity isn't required before a patient's wishes can be ignored.
The current starting point for debate is - when is it permissible for a woman to end a pregnancy? In any other area of medicine the question would be: when is it acceptable to withhold an available treatment for a diagnosed condition, or force her to become a mother against her will?
The lack of legal clarity on the importance of a women's autonomy over her body leaves the door wide open for repeated challenges to fragile abortion legislation.
Why the 24 week limit?
We have seen repeated attacks on the upper-time-limit of 24 weeks, and these offer a perfect example of how emotive rhetoric is used to obfuscate basic legal, medical and scientific principles.
We see claims that the survival of babies at younger and younger gestations has brought to light new information which means we need to reform abortion legislation.
It is true that technology has given us the means to save babies born at ever younger gestational ages. When the Nuffield Council of Bioethics explored the issues raised by these advances, they showed that there were stark ethical questions involved in the treatment of these infants.
Each time this is discussed in Parliament, the discussion about the medical ethics of abortion is over quickly, while the contributions of those who oppose abortion on the grounds of their own moral beliefs swallow up parliamentary time
This view was shared by the House of Commons' former Science and Technology Committee, the Royal College of Nursing, the Royal College of Obstetricians and Gynaecologists, the Faculty for Sexual & Reproductive Healthcare, and the British Association of Perinatal Medicine. They have all been repeatedly very clear: there is no new evidence to suggest we should review the 24-week-limit for abortions, and there is nothing to suggest that medical ethics should not apply here.
Emotion not evidence
In the absence of scientific evidence, footage produced by new technologies like 3/4D scans adds emotional weight to calls for this cut. Loops of footage are created, to give the impression of a foetus expressing human emotion, or 'playing' in utero. This footage is offered to illustrate the argument for a review of the 24-week limit. Nadine Dorries notoriously posted on her website a misrepresention of the testimony of a doctor involved in a late-term abortion, and fictional anecdotes about botched abortions, and foetuses grasping hands are a recurring feature of 'pro-life' mythology.
This claim of 'new' evidence is usually contextualised by comment about a rising problem of 'social abortion' at 26 weeks. This is in spite of the fact that even the briefest analysis of the number of abortions carried out in the UK shows that late-term abortions are a tiny percentage of abortions as a whole, and that a handful are carried out for so-called social reasons. Social does not mean frivolous.
Evidence of doctors like Professor John Wyatt is offered as a clear sign that the medical establishment is divided on abortion, with little mention that he is a member of the Christian Medical fellowship, or the fact that his argument is not a medical one, but a moral one.
We know that the rate of late-term abortions is consistently low. We have clear evidence that placing further restrictions and delays on this process would adversely affect the tiny number of women who have had to grapple with heartbreaking decisions already. When one thinks about the physical trauma alone it is blindingly obvious that this is no easy option.
The attack on the 24-week limit directly affects a handful of vulnerable women - but it establishes the principle that the moral concern of a minority is enough to override basic medical ethics in 'debates' about restricting essential health services to women.
Emotive propaganda defines the 'debate'
The power of branding a movement which is about restriction of medical services at a cost of 68,000 lives every year, as 'pro-life', is not to be underestimated.
Public discussions around abortion have been successfully framed as a 'moral debate' - with protection of a hypothetical 'baby' at the centre. Debate about health services is dominated by discussion of a 'person' who doesn't exist legally, or medically. The issues of capacity and autonomy of the living patient, which would form the basis of any other discussion of medical ethics, are lost amidst the din. Each time this is discussed in Parliament, the discussion about the medical ethics of abortion is over quickly, while the contributions of those who oppose abortion on the grounds of their own moral beliefs swallow up parliamentary time.
In recent political history, there has been little desire among the majority of politicians and pro-choice groups for abortion to become a political issue - anti-abortion lobby groups have pushed it back onto the political agenda
There will never be a satisfactory conclusion to the question of where life begins - it is a moral question of opinion and belief.
Women are deemed ethically competent to understand the moral implications of their treatment in every other area of medicine: why not here? The barrages of anecdotes offered by the anti-abortion movement about people who use late-term abortion frivolously aren't reflected in British abortion figures.
If women's access to essential health services is to be restricted on the basis of the moral beliefs of the minority, shouldn't there be some evidence to support those views? Shouldn't there be some evidence that women are not ethically competent to decide for themselves, that medical ethics should no longer apply?
Political will for abortion reform?
Even before the election, there were signs that there was increasing political will for abortion to return to the political agenda.
Pressure to devolve legislation governing reproductive health services in Northern Ireland was mounted on the back of a continued platform of abortion restriction, similar pressure has been increasing in Scotland, where the argument for devolving decision-making around women's reproductive health service has been pinned onto this 'need' to reduce the 24-week upper-time-limit on abortions.
We have an All Party Pro Life Group within the House of Commons, whose administrator is funded by the innocuous sounding CARE.
CARE is one of a number of Christian lobby groups within Parliament. 'Christian Action, Research and Education' has been described as 'architects' of various attempts to restrict abortion provision, and its establishment of a presence in Parliament has come under scrutiny from the Charities Commission. Its annual report shows that it has had 20 interns working within the House of Commons, at a cost of £70000, even though it is prohibited from political lobbying. Its interns are present in the offices of senior members of the Conservative party, in the office of a backbench Labour MP and the offices of several Liberal Democrat spokespeople. 'Christian Concern for our Nation' spends a great deal of time and money supporting MPs who will further its cause.
These groups are mirroring tactics of fundamentalist Christian groups in the US, with a concerted, long-term strategy of attacking gay rights and abortion. Their influence is being keenly felt within the Conservative party, and their presence is established in a House of Commons which has changed dramatically.
In recent political history, there has been little desire among the majority of politicians and pro-choice groups for abortion to become a political issue - these groups have pushed it back onto the political agenda.
Seventy one of the MPs who voted against the cut in the upper-time-limit for abortion stood down at the end of the last parliamentary session, and little is known about the views of the MP's who have just taken their seats. It may be tempting to dismiss Nadine Dorries MP when she says that "the real opportunity for abortion law reform would arise with a Conservative government", but pre-election polls showed a majority of Conservative MPs supported a cut in the 24-week limit.
Our Prime Minister and our Equalities Minister both support a cut in the 24-week limit, and regardless of Cameron's murmurings of 'abortion on demand', it seems likely that this issue will find itself discussed in Parliament sooner rather than later.
While it has always been an issue where MPs vote with their conscience, the fragile nature of our coalition government means that the need to support its policies could take precedence over legal, medical and scientific arguments which support a woman's right to autonomy over her own body.
But given the frailty of our legislative frameworks in the first place, is an opportunity to re-examine abortion law such a terrible thing?
Is the time right for abortion to return to the political agenda?
UK anti-abortion lobby groups have adopted the strategies of their US counterparts - these groups have an established a presence in the Houses of Parliament and have a political party which has demonstrated its willingness to push this agenda. We have a Prime Minister and an Equalities Minister who have pledged support for abortion restriction. But the picture is not as bleak as it first appears.
David Cameron's perfunctory nod of support for 'abortion on demand' shows that he at least recognises where public opinion lies on this issue.
We don't know yet what the views are of the 233 new MPs who took up their seats after the election, but websites like They Work for You make it very easy to ask
Whatever Dorries may believe, the Conservative party is far from united in its desire to cut the abortion limit, and senior figures like Boris Johnson and Oliver Letwin have been shown to be reluctant to embrace the agenda of the Christian Right. Support for abortion restriction is concentrated within the right of the Conservative party, and the need for David Cameron and Nick Clegg's coalition to reduce the influence of this faction is key to their government's survival.
Public opinion, even in the face of concerted strategies to frame this debate using 'pro-life' rhetoric, still overwhelmingly supports a woman's right to choose. As the main opposition, Labour are unlikely to disagree - preferring policy around reproductive health to be governed by the best available evidence. US President Barack Obama was met with global approval when he lifted the 'global gag rule', which stipulated aid could not given to organisations that funded or provided information about abortion.
High-profile cases of pregnant children being denied abortions, and the assassination of physician George Tiller have etched the dangers of abortion into the public consciousness. The 'moral authority' of the Catholic Church in particular has worn thin in the face of repeated demonstrations of how easily the suffering of real people is dismissed with the rhetoric of sexual morality and family values. Organisations like Catholics for Choice and senior individuals in many denominations of the Christian faith have shown that they do not believe that opposition to health services is synonymous with Christianity.
We don't know yet what the views are of the 233 new MPs who took up their seats after the election, but websites like They Work for You make it very easy to ask.
We do not need to mirror the tactics of the groups that seek to push abortion up the agenda; there is a reason they have to manufacture the appearance of public support and scientific evidence. The moral, scientific, medical and legal arguments against restriction of abortion speak for themselves. But the lesson we can take from these groups is the level of organisation and skill they employ.
The same groups who seek to attack abortion rights are the groups who sought to undermine equality legislation and gay rights, and the tireless campaigning by groups like Stonewall and the Gay Times has created an environment where David Cameron and Theresa May's political positions could only become tenable by renouncing previous positions on this issue.
Political will for abortion reform ultimately comes only with public support, and with this in mind, perhaps it is time to welcome abortions return to the political agenda. This time following the lead set out in the fight for LGBT equality, so that a minority who wish to impose their moral agenda on British women do not define the debate.
Photo of 'Trust Women' sign at a 2008 pro-choice protest by ge'shmally, photo of Ottawa pro-choice rally by Jenn Farr, photo of protest banner in Argentina by Gabby DC, photo of rally for George Tiller by Melissa Gira Grant, shared on Flickr under a Creative Commons license