abortion: the answer to unplanned pregnancy?

by Jo Carlowe

abortion debate | help and info

There were almost 194,000 terminations in England and Wales last year, rising to over 200,000 when women coming over from Northern Ireland and the Irish republic are included. The figure is almost 4 per cent up on the previous year, with abortions among teenagers the fastest rising group. The numbers are astounding, given the existence of 14 different methods of contraception and the publication of the National Strategy of Sexual Health in 2001, in which the government promised to tackle the problem.

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So what is going wrong? Is the message about contraception not getting through or are the available methods unreliable? And what happens when a woman is faced with an unplanned pregnancy – is impartial advice, accessible services and adequate support available or can she anticipate harsh judgements, patchy services and limited choice?

Sexual health experts say the answers are complex. When looking at the high abortion rate, Tony Kerridge, spokesperson for Marie Stopes International (MSI), says economic factors play a part – fewer people can afford to keep a child conceived by accident.

"The cost of childcare has risen dramatically. Combined with the rising costs of mortgages, which often dictate that both partners need to be in fulltime employment, such factors may play a decisive part in decisions about when, or even if, to start a family."

The fpa (formerly the Family Planning Association) says the problem is also cultural – we British aren't terribly good at talking about sex. There's a reticence right across the board from educators through to health professionals – as a result most people know a fraction of the available facts, and where information is available (see help and info) it is not always impartial.

"The prudish British attitude makes it difficult for people to seek advice. Sex needs to be less stigmatised," says an fpa spokesperson. "The need for information is constant – from school and throughout adult life."

Young people agree – a recent survey showed that 62 per cent of 18 to 24 year olds said they did not have enough information about the risks of unprotected sex.

MSI and the fpa would like to see compulsory comprehensive sex and life skills education on the national curriculum. As things currently stand sex education is included in PSHE (personal, social and health education) but inclusion of contraceptive advice is non-statutory, and while some schools provide excellent information in this areas, others do almost nothing at all.

In addition, the organisation wants family planning advice to be more accessible – preferably through specialist centres in schools and youth clubs. Currently 80 per cent of women get their contraception from their GP surgery. In the last four years or so, some schools have set-up drop-in services where pupils can access contraception and sexual health advice but such services are by no means common.

"Young people have consistently said that they do not like seeking out family planning advice from their family GP," says Kerridge.

Moreover, GP consultation times are limited and as a result many doctors only offer one or two favoured inexpensive methods of contraception.

"Newer, more effective methods such as contraceptive implants, patches and injections tend to be more expensive to prescribe for budget conscious practitioners," says Kerridge.

Half of all pregnancies are unplanned, and yet these methods could reduce the number considerably. People want both information and contraception – the fpa receives 60,000 inquiries a year from callers seeking advice on sexual health and contraception. In fact, according to some data only three per cent of women with unplanned pregnancies have used no contraception. A fifth of unplanned pregnancies are due to condom failure and nearly two-thirds because of problems with the pill. Around a quarter of women on the pill say they miss at least one a month – these women are not always told about alternative methods such as contraceptive patches (see the future of contraception).

There is also some ignorance about the methods of emergency contraception that are available. In 2006 six per cent of women used the 'morning after pill' and less than one per cent had an emergency IUD fitted (a contraceptive device fitted inside the uterus which can prevent pregnancy if inserted up to five days after having sex).

The fpa wants emergency contraceptive pills to be made available in advance to women, a move termed 'access through the bathroom cabinet'. Some GP practices and walk-in centres are willing to do this but not all. The fpa says women should persist in asking, although inevitably some women will acquire pills by pretending that they have had unprotected sex and could be pregnant.

Deception in relation to sexual health is nothing new. For decades women have been forced to be surreptitious about their sexual practices. When in 1803 abortion was made a criminal offence – with a penalty of up to life imprisonment – women opted for backstreet abortions. By the time the Abortion Act 1967 legalised terminations, it is thought 120,000 women a year, were resorting to this desperate measure.

Even today (unlike in other European countries) abortion is still not available on request. Instead two doctors must give their written consent before the abortion can proceed (for more information see our article on abortion). In Autumn last year (2007) the House of Commons Science and Technology Committee recommended that only one doctor's signature should be necessary, so changes may be afoot, although amendments to the Abortion Act have yet to go through Parliament.

The fpa, however, continue to lobby for legislation to enable abortion on request without the need for a doctor's signature at all.

Even assuming a woman qualifies for an abortion, she then faces a 'NHS lottery'. In 2001, 79 per cent of women in North East Lincolnshire obtained an abortion before ten weeks compared to just 26 per cent in Great Yarmouth. And while nearly nine out of 10 (87 per cent) abortions in England and Wales in 2006 were either provided or funded by the National Health Service (NHS), compared with 84 per cent in 2005, provision varied between primary care organisations and ranged from 57 per cent to 97 per cent. Women in Scotland fared better with nearly all abortions (99.3 per cent) funded by the NHS and carried out on NHS premises.

The government's Sexual Health Strategy specifies that women shouldn't wait for more than three weeks from consultation to having an abortion but a survey carried out in 2004 and published by the All Party Parliamentary Pro-Choice & Sexual Health Group found that although 75 per cent of Primary Care Trusts (PCTs) had set a maximum waiting time for abortion of 21 days, only 52 per cent consistently met this target. A further 27 per cent of PCTs reported waiting times of more than 21 days, with 11 per cent reporting waits of between 5 and 8 weeks.

MSI would like to see additional legislation permitting nurse practitioners (as opposed to doctors) to provide first trimester non-general anaesthetic abortion procedures to help reduce waiting times. This topic is likely to be debated when amendments to the Abortion Act 1967 come up for discussion in Parliament, and the law may well change to accommodate this.

However, for some women abortion will always be taboo. If they can't keep the child then adoption is the only option. It is a choice that is not always presented and seldom taken. Experts estimate that as few as 150 unplanned pregnancies a year end in adoption.

Kerridge of MSI, says adoption is a difficult choice for women because of the 'overt visibility of a continued pregnancy when compared to the privacy of an abortion.'

The British Association for Adoption and Fostering (BAAF) would like to see information on adoption made available in antenatal clinics and GP surgeries (see our article on adoption).

Whatever decision is made, it is one that is rarely taken lightly. People faced with an unexpected pregnancy need better access to services and greater support. More crucially the information gap needs to be tackled. A greater readiness to discuss rather than walk away from the topic of sexual health could arm people with the knowledge they need to avoid ever going through the emotional wringer of an unplanned pregnancy.

(April 2004, updated February 2008)

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