The Human Tissue and Embryos Bill expected in the next parliamentary session will provide the first opportunity since 1990 to amend the law on abortion. One aspect grabbing headlines is gestational age limits. The Alive and Kicking Campaign has the near-term objective of halving the yearly number of abortions, and as one part of its strategy demands ‘an immediate, substantial reduction in the upper age limit for abortion’.
Since 1990, 24 weeks is the upper limit of gestational age at which abortions can legally be performed on grounds of risk to the physical or mental health of the pregnant woman and risk to the physical or mental health of any existing children she has. 98% of the 200,000 or so annual abortions in the UK are performed on these grounds.
Review of this limit is urgently necessary for two reasons. First, many more babies born at 24 weeks or a little less survive now, and this has ethical implications. A foetus at 23 weeks and 6 days can legally be aborted for what are in reality social reasons, while in the same hospital, doctors and nurses are fighting to save the life of a baby born pre-term at the same gestation. What is the difference? One baby is not ‘wanted’ while the other is.
There is also mounting medical evidence that the foetus may be aware of pain at less than 24 weeks and this adds to the abhorrence a growing number feel about late abortion. At the very least, society should give the foetus the benefit of any doubt.
Foetal viability is changing. Although mortality and morbidity remain relatively high, survival has improved steadily year-on-year for extremely preterm infants born at 24 weeks’ gestation or less. Whilst the widely quoted 1995 EPICure study in the UK and Ireland showed that average survival to discharge was only 11% for babies born live at 23 weeks and 26% at 24 weeks, by contrast Hoekstra et al’s data published in 2004 for outcomes in a 15-year study of infants born between 23 and 26 weeks’ gestation at one US specialist neonatal centre show a consistent year-on-year improvement.
Between 1996 and 2000 there was an overall survival rate of 66% at 23 weeks and 81% at 24 weeks’ gestation. A prospective long-term follow-up study at University College London Hospital has shown survival rates in 1996-2000 of 42% at 23 weeks and 72% at 24 weeks.
Long-term follow-up shows a minority of extremely preterm survivors have some neurodevelopmental impairment, with significant disability identified in 15-20%, and this is used as an argument against neonatal care at these ages and, by implication, for abortion up to 24 weeks. However, by their very nature, such long-term studies represent the outcome following a now outdated standard of care – EPICure, for example, tells us about infants born in 1995.
Obstetric and neonatal care are changing and improving rapidly. There are better facilities, staff training is improving, and more at risk babies are being transferred in-utero, before delivery, to major perinatal centres. After discharge there are more therapeutic resources, and better educational and behavioural care are available. For these reasons, historical data should not be allowed to dominate consideration for children born now, and to be born in the future, and should not bias the debate about age limits for abortion.
For these two reasons, it is time for change. Parliament must review the 24-week upper time limit. A reduction would be in line with parliamentary, public and professional opinion:
63% of MPs support a reduction in the 24-week upper age limit
Nearly two-thirds of the public want the 24-week limit reduced
More than three-quarters of women support a reduction
65% of GPs would welcome a reduction