26 October 2007 Forty years old and creaking The foundations of the abortion act should be left alone, but it needs more than a lick of paint, wr By Evan Harris The 1967 Abortion Act is like a house. A shelter for the hundreds of thousands of women in this country who would otherwise be faced with the chill winds of unwanted pregnancy or the night in the blizzard represented by a backstreet abortion. It has done great work but it is in real need of repair. After all the decorators have been in only once – at the age of 23 – and that was to just to reduce its capacity and to pledge to make it more comfortable. In 1990 the Human Fertilisation and Embryology Act reduced the legal time limit for most abortions from 28 weeks to 24 weeks in line with the generally agreed view that babies born before this point did not have a reasonable chance of surviving – even with intensive care – without significant impairment. In addition, Parliament gave the Government the power to classify women’s own homes as a suitable place where, in an early medical abortion, the second pill or pessary could be taken instead of women having to stay in hospital or rush home after hospital administration. Seventeen years later, those regulations have still not been implemented so British women – unlike their US counterparts - have to make two trips into the hospital and risk the miscarriage taking place on the bus home. The forthcoming Human Tissue and Embryo Bill appears to be an appropriate parliamentary opportunity for the 1967 Act to be updated. On the question of time limits the British Association of Peri-natal Medicine (the experts in foetal viability) have told the Science and Technology Select Committee that emerging findings from a 2006 national multi-centre study suggested that while survival at 24 weeks had improved there were no significant increases in outcomes for premature babies born below that time. In other words that age of viability had not reduced since 1990. The BMA and the Royal College of Obstetrics and Gynaecology share this view. The Government and most MPs will take medical advice on this one, surely. The BMA now believe that the need for a woman to get the “permission” of two doctors before having an abortion is unnecessary and fails to respect the autonomy of the woman, and should be abolished – at least for first trimester abortions. The RCOG agree. That requirement was symbolic of the era when the Abortion Act was drafted. Presumably the feeling was that pregnant women were more irrational and needed the protection of doctors from themselves or perhaps David (now Lord) Steel saw the move as the only way to get the men in Parliament to pass the law. What was then a pragmatic perceived safeguard is now an throw back to a time when informed consent of autonomous adults in health care decisions was revolutionary talk. In 1967 nurses were handmaidens to doctors and the idea that they would – forty years later – be operating in theatre or prescribing medication was unthinkable. The RCOG now agrees with the Royal College of Nursing that appropriate training will enable nurses to perform early medical and early surgical abortions. The statutory restriction in the 1967 Act to doctors surely can not survive new Parliamentary scrutiny. The Government have just reminded the political leadership of a devolved part of the UK that abortion law is a matter reserved to the Westminster and told him firmly that it would be preposterous to have different abortion laws across different parts of the NHS or the country. Alex Salmond was suitably chastened. The Government have said nothing similar to Ian Paisley. The 1967 Act was never extended to Northern Ireland. Women there have to come to the mainland. They have to pay their airfare and their medical costs as the NHS will not pay. That means they come later pregnancy and that the poor, young and vulnerable do not come at all. One female Labour MP bravely advocated extension to Northern Ireland in 1990 but was frustrated by a conservative House of Commons. Presumably, after 17 more years of inequity and denial of health rights to women in the province, that MP will support another attempt. After all Harriet Harman is now Leader of that less conservative House. It looks like the refurbishment of the Act will take place next year. It’s foundations should be left alone but it needs more than a lick of paint.