The 50th Anniversary of the Abortion Act.

Abstract

The 1967 change in the law on abortion (therapeutic termination of pregnancy before viability, TOP) was driven both by the medical establishment and the Abortion Law Reform Association (ALRA). The doctors wanted confirmation that it was lawful for them to terminate a pregnancy that threatened the life of the woman or would result in grave injury to her health, and ALRA wanted a law that made safe termination by doctors so accessible that dangerous back-street TOPs would be eliminated. A new ‘Abortion Act’ would have to meet the aims of both. Happy chance led to the election to Parliament of David Steel at a time when several senior members of the Labour government were pro-choice, and ALRA, led by Vera Houghton, had an efficient lobby that had been actively supporting Lord Silkin's Abortion Reform Bill. Steel, a talented politician with a zeal for reform, agreed with ALRA that his legislation should aim to eliminate the need for women to seek help outside the law but realised that ALRA's proposals reflected the thinking of the 1930s: the incentive to seek clandestine TOP would be removed only if doctors were given discretion to provide TOPs when the women themselves considered it necessary. He realised that this would be possible if the object of his legislation was the protection of the future health of the women – Dugald Baird, Professor of Obstetrics & Gynaecology in Aberdeen, had convinced him of the close link between social circumstances, health and the need for TOP. This is why the Abortion Act 1967 requires ‘…two doctors, acting in good faith, to certify that the abortion is legal when a pregnancy of less than 24 weeks threatens the physical or mental health of the woman and her children, taking into account her actual or foreseeable environment’. The woman may be healthy at the time she is assessed – the indication for the TOP is ‘social factors threatening health’. Sadly, then as now, many MPs regard themselves as guardians of the morality of the Nation. Fearing that TOP would be used instead of contraception, they insisted on an onerous system of certification (with the signatures of two doctors required), together with statutory notification and the individual approval of clinics. Nonetheless, the Act was a success. Legal TOPs for women resident in England and Wales increased to about 110 000 in 1973 but rose no further until 1980. Deaths due to criminal abortion fell to 1 to 2 per decade and women no longer damaged their vision from quinine used as an abortifacient. Politicians and the media were horrified – ’women must be getting abortions far too liberally’. In fact, the number of legal TOPs was similar to estimates of those that would have occurred outside the law before the Act. Facilities that had been providing illegal TOP used the 6 months before the Act became effective to obtain approval from the Department of Health, and the charities, British Pregnancy Advisory Service and Pregnancy Advisory Service, opened their first clinics. Although women in the UK no longer had to seek help in the back-streets, and the Abortion Act has prevented thousands of deaths in the UK, sadly there are many countries globally where women still risk dying if they feel they cannot cope with an unwanted pregnancy. Modern medical methods of termination are so safe it seems criminal to deny them to women in countries where their reproductive rights are still not recognised. None declared. Completed disclosure of interests form available to view online as supporting information. Please note: The publisher is not responsible for the content or functionality of any supporting information supplied by the authors. Any queries (other than missing content) should be directed to the corresponding author for the article.