Abortion In England Research Articles

Irish Women Who Seek Abortions in England

In 1991 4158 women from Ireland and 1766 from Northern Ireland traveled to England for abortions. This situation has been ignored by Irish authorities. The 1992 case of the 14-year old seeking an abortion in England finally caught legal attention. This study attempts to help define who these abortion seekers are. Questionnaires from 200 Irish abortion seeking women attending private Marie Stopes clinics in London and the British Pregnancy Advisory Services clinic in Liverpool between September 1988 and December 1990 were analyzed. Findings pertain to demographic characteristics characteristics of first intercourse family discussion of sexual activity and contraceptive use. From this limited sample it appears that Irish women are sexually reserved and without access to modern methods of birth control and abortion. Sex is associated with shame and guilt. 23% had intercourse before the age of 18 years and 42% after the age of 20. 76% were single and 16% were currently married. 95% were Catholic; 33% had been to church the preceding Sunday and 68% within the past month. Basic information about menstruation is also limited and procedures such as dilatation and curettage may be performed selectively. 28% of married women were uninformed about menstruation prior to its onset. Only 24% had been using birth control around the time of pregnancy. The reason for nonuse was frequently the unexpectedness of intercourse. 62% of adults and 66% of women believe in legalizing abortion in Ireland. British groups have tried to break through the abortion information ban by sending telephone numbers of abortion clinics to Irish firms for distribution to employees. On November 25 1992 in the general election there was approval of constitutional amendments guaranteeing the right to travel for abortions and to receive information on abortion access. The amendment to allow abortion to save the life of the mother was not accepted.

The Puzzle of the Permanently Unconscious

The Laws of Ireland The Republic of Ireland has been the last country in the European Community legally to prohibit abortion, specifying no permissible exceptions. An amendment to the Irish Constitution, passed by national referendum in 1983, recognized a right to life of the unborn "with due regard to the equal right to life of the mother." But on 5 March 1992 the Supreme Court held that abortion is legal in Ireland in limited cases. The Supreme Court judgment followed after the Attorney General enjoined a fourteen-year-old rape victim from leaving Ireland to get an abortion in England. Her intention became known to the police because the girl's family asked them the official procedure for procuring DNA samples from fetal cell tissue for use as evidence against the alleged rapist. Once they knew of the girl's intention to get an abortion, and given the 1983 amendment for protection of fetal life, the police felt obliged to inform the Director of Public Prosecution, who in turn notified the Attorney General's office. A high court judgment upheld the Attorney General's injunction: the right to life of the fetus was granted priority over the girl's right of freedom to travel for legal abortion services elsewhere. The Supreme Court judgment, however, overturned the high court by a vote of 4 to 1, interpreting the 1983 amendment with reference to the girl's age and the evidence that there was a "substantial risk of suicide" following her rape, coupled with severe depression brought on by the injunction preventing her from traveling outside Ireland for an abortion. The Court's judgment has placed an onerous responsibility on legislators to specify more precisely the conditions under which abortion may be permitted in Ireland. Doctors and hospitals are already contemplating the ethical implications and practical consequences for health care institutions that might result from any forth-coming abortion legislation. The abortion debate in Ireland has now entered a new era, in which its terms have changed radically. There is considerable uncertainty about legislative outcome.--Dolores Dooley, University College, Cork, Ireland. Are treatment decisions for the permanently unconscious patient a central issue or a peculiar obsession in bio-ethics? Are the permanently unconscious "severely disabled" under the terms of the Americans with Disabilities Act? Can the courts pronounce permanently unconscious patients dead, thereby making their organs available for transplant? Ought legislatures to redefine death so that the permanently unconscious are included under neurological criteria for death? Ought legislatures to redefine "terminal illness" to include permanent unconsciousness? Do physicians--or hospitals--have to provide ICU care for permanently unconscious patients if they believe that doing so is professionally wrong? Not in the best interests of the patient? Not in the best interests of the health care system or the institution from a financial perspective? Is providing treatment for a permanently unconscious patients even if their advance directives say they want treatment no matter how dire their condition? Are permanently unconscious patients 'persons' in a philosophical sense? What do we know about these patients and their condition? If continued treatment is a problem, how big a problem is it? Customary (and unreferenced) estimates are that there are 5,000-10,000 permanently unconscious patients in the U.S. The American Medical Association estimated, in 1990, that there were 15,000-25,000 patients in persistent vegetative state (PVS) in the U.S.A. 1992 research study found 3 percent of the 1,611 patients in four Milwaukee nursing homes in persistent vegetative state. Three percent of the 1.3 million nursing home residents in the U.S. translates to 39,000 patients in PVS. Why are these 5,000 to 39,000 patients who are permanently unconscious continuing to receive treatment? …

Gynaecologists' abortion practice.

To ascertain the relation between gynaecologists' opinions on the provision of abortion and the service provided by the Health Service in their district and to investigate the methods used for second trimester abortion. A postal questionnaire sent three times to a 50% random sample of gynaecologists practising in the National Health Service (NHS) in 1989 in Great Britain. 343 of 396 practising gynaecologists, 87% of those selected. Proportion of gynaecologists holding views or reporting practice. Although only 11% actually performed abortions beyond 20 weeks, 57% approved later operations in cases of rape and 85% for a threat to the woman's health; only 47% approved late abortion for schoolgirls under 16 years. Dilatation and evacuation was used by only 1% of NHS gynaecologists even though from 13 to 16 weeks it is a safe and efficient method. Although Government statistics report that vacuum aspiration is used in over one third of second trimester abortions, this is technically unlikely and was not confirmed by this study. Less than 50% of abortions in England and Wales are performed in the NHS yet fewer than 40% of gynaecologists reported problems in providing an abortion service. Overall 21% thought they were providing abortions for over 90% of the women resident in their districts, whereas only 2% of districts achieve this proportion in their home regional health authority. Overall 60% supported separating abortion work from general gynaecology, and 45% would like regional abortion units. Only 27% supported fertility control acquiring the status of a subspecialty. Accepting these suggestions would improve the service, reduce regional variations in provision, provide opportunities for research and could have an important effect in helping slow the world population increase.

Abortion in England, 1900-1967. Barbara BrookesAbortion, Doctors, and the Law: Some Aspects of the Legal Regulation of Abortion in England from 1803 to 1982. John Keown

<i>Abortion in England, 1900-1967</i>. Barbara Brookes<i>Abortion, Doctors, and the Law: Some Aspects of the Legal Regulation of Abortion in England from 1803 to 1982</i>. John Keown

Abortion, Doctors and the Law: Some Aspects of the Legal Regulation of Abortion in England from 1803 to 1982

Abortion, Doctors and the Law: Some Aspects of the Legal Regulation of Abortion in England from 1803 to 1982

History of Science and Technology Abortion, Doctors, and the Law: Some Aspects of the Legal Regulation of Abortion in England from 1803 to 1982, John Keown. 1988. Cambridge University Press, New York. 212 pages. ISBN: 0-521-34574-X. $NA

History of Science and Technology Abortion, Doctors, and the Law: Some Aspects of the Legal Regulation of Abortion in England from 1803 to 1982, John Keown. 1988. Cambridge University Press, New York. 212 pages. ISBN: 0-521-34574-X. $NA

Reviews and Short Notices

Reviews and Short Notices

John Keown, Abortion, Doctors and the Law, Sorne aspects of the legal regulation of abortion in England from 1803 to 1982. Cambridge etc., Cambridge Universily Press, 1988. 212 S. (Cambridge Ilistory of Medicine).

John Keown, Abortion, Doctors and the Law, Sorne aspects of the legal regulation of abortion in England from 1803 to 1982. Cambridge etc., Cambridge Universily Press, 1988. 212 S. (Cambridge Ilistory of Medicine).

Twenty one years of legal abortion.

The effects of the 1967 Abortion Act, legislation which extends to women living in England, Wales, and Scotland, are reviewed. The Act was not backed by any specific allocation of money for facilities or staff within the National Health Service and the service provided has varied from district to district. Yet, the number of abortions increased rapidly in the late 1960s and early 1970s. This process had slowed down by 1974, when the number of abortions dropped for the 1st time. The introduction of free contraception seems to have had an important effect; the number of abortions declined by nearly 9000 from 1973-76, and the abortion rate fell from 11.4 to 10.5/1000 women aged 15-44. The number increased in 1977 and 1978, possibly because of adverse publicity about the side effects of oral contraception (OC). The rate of abortion in Scotland, although lower than the rate in England and Wales, has risen steadily since 1969. An important effect of the 1967 Act has been to reduce the number of deaths due to illegal abortions. In the 1st decade of legal abortion, the proportion of all maternal deaths that were due to abortion dropped from 25% to 7%. The number of recorded deaths due to abortion declined from 160 during 1961-63 to 9 during 1982-84. There were 7 deaths after legal abortions during 1982-84 and 4 during 1985-87. 21 years after the passage of the Act half of all women having legal abortions pay for them. The regional differences in the provision of abortion services have persisted since 1968. The proportion of abortions performed in the 1st trimester increased from 66% in 1969 to 86% in 1987, yet the proportions of early abortions in Britain still compare poorly with other countries. In the US, women have been able to request abortion in the 1st trimester since 1974; by 1977 this led to 91% of abortions being performed in this period. Regional differences in the surgical methods persist, and there may be considerable delays between a woman asking for an abortion and the procedure being performed. A Marplan poll conducted in 1988 reported that 80% of those surveyed thought that women should have the right to choose an abortion in the 1st few months of pregnancy; 15% disagreed, and 5% did not know or did not respond. The number of women coming to Britain for abortions peaked in 1973, when 56,000 came. The rate of abortion per 1000 women in England and Wales is 14.8, a moderate figure when compared to other nations -- rates range from 5.6 in the Netherlands to 181 in the USSR.

Reviews

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The demand for abortion in England and Wales

The provision of abortion services in England and Wales is modelled with particular emphasis given to the relationship between the public and private sectors. The presence of excess demand in the public sector is established and its importance as a determinant of private demand is analysed. This study replicates the analysis and findings of one based on 1971 data with data for 1983. It is estimated that nearly one-half of the private sector demand arises as a result of excess demand in the public sector.

Contraceptive practice among women seeking legal abortion in the Scottish Highlands.

There has been a large increase in legal abortions in England in the last 10 years. The cause can be partially attributed to the decline in use of various contraceptive methods, particularly pills and IUD's. the statistics presented pertain to patients seeking abortion in the Scottish Highlands and include single and married women from 15-40 years of age. Of these women, 80% had 1st trimester abortions, and the other 20% had abortions between the 12-18 weeks of pregnancy. 25% were married, 13% divorced or separated, and 62% single. 64% of these women did not use any birth control method at the time of the unwanted pregnancies, and 74% were under 27 years of age. Fill failure occurred in 19% of cases and condom failure in 10%, with the remaining failures attributed to IUD's, caps, and diaphragms. Other factors causing increased numbers of abortions are economic conditions and reductions in family planning clinics. In this area local doctors are the main source of family planning information and services. Since most of these cases are young unmarried women, the need for better access to family planning education and birth control is obvious. The number of women of all ages not using contraceptives shows a need for reevaluation of family planning services for all age groups.

Barbara Brookes, Abortion in England 1900–1967, The Wellcome Institute Series in the History of Medicine, London, New York, and Sydney, Croom Helm, 1988, 8vo, pp. vi, 195, £27.50.

Barbara Brookes, Abortion in England 1900–1967, The Wellcome Institute Series in the History of Medicine, London, New York, and Sydney, Croom Helm, 1988, 8vo, pp. vi, 195, £27.50.

Fertility and legal abortion in England and Wales: performance indicators for family planning services.

The relation between fertility rates and legal abortion rates was investigated in a sample of health authorities in England and Wales to see how these varied. Total period fertility rates and total period legal abortion rates were derived from the average number of live births or legal abortions that would be experienced per woman if women experienced the age specific rates of the year in question throughout their childbearing years. The sample of 30 health authorities was selected by taking the districts with the highest and lowest fertility rates in each English region and in Wales in 1986. Total period fertility rates varied from 1.37 in Riverside to 2.42 in Tower Hamlets, while abortion rates varied from 0.25 in East Yorkshire to 0.99 in Riverside. When the two rates were added to provide a potential fertility rate it became clear that some districts with similar potential fertility rates had very different underlying component rates. Such comparisons can be used for service monitoring, indicating the need for better abortion and family planning services in districts with high fertility rates and for better family planning services in those with high abortion rates.

The Abortion Act Twenty Years On

The 20th anniversary of Great Britain's 1967 Abortion Act represents an opportunity for a critical reappraisal of this legislation. In 1986, 145,619 procedures were performed on British women, indicating that legal abortion has replaced criminal abortion. There have been no abortion-related deaths in the past 2 years. Less encouraging has been the failure of the National Health Service to make abortions easily available to poor women. Britain's National Health Service performs only 46% of all abortions in England and Wales, and there are long delays before the procedure can be scheduled. Although the Abortion Act does not define an upper limit after which abortion may not be performed, 24 weeks is generally regarded as the cut-off point. Almost yearly, attempts to repeal or restrict the Abortion Act occur. Pending is the Alton Bill, which seeks to introduce an upper time limit for abortion of the 18th week of gestation, except in cases where abortion is necessary to save the mother's life or if the fetus has abnormalities that would be incompatible with life.

The political implications of attitudes to abortion in Britain

Public opinion on the abortion issue exhibits a pattern that is remarkably consistent over time though in some respects complex. Its characteristics are not reflected in the way the issue is perceived or developed by politically active groups and institutions, raising questions about the way difficult issues are politically defined in our system. Age, sex and the interaction of the two are the best ‘predictors’ of attitudes; the nature of this variation and comparison of attitudes to abortion and pornography reveal further implications for the political system in general and the strategy of contemporary feminism in particular.

Legal abortion in England and Wales.

Ninety-eight per cent of abortions on British women resident in England or Wales are performed for social reasons. The Abortion Act (1967) insists on the opinion of two doctors but is broadly phrased and, by allowing that abortion can protect mental health, permits abortion when social factors are causing or likely to cause significant stress. The abortion rate has been stable at 11-12 per 1000 women aged 15-44 since 1973, suggesting that factors causing unplanned pregnancy are remaining constant for women in the fertile years and that, overall, the available facilities are adequate. However, only 49% of women obtain a free abortion in the National Health Service (NHS) and there are wide regional variations. Serious delays in the NHS are associated with inadequate access to pregnancy tests, attitudes of medical staff to abortion, and gynaecological units that are fully occupied with other problems. Women can choose to pay for abortions in services run either by charities or by commercial organizations. These services are used electively by a minority of women but most would prefer an NHS abortion if it was easily available. Women who seek help outside the NHS receive prompt and efficient management.

Trends in induced abortion in England and Wales.

Analysis of routinely published abortion and fertility data for England and Wales between 1968 and 1980 shows that the age-specific abortion rates increased from 1968 until about 1973 when the rates peaked for all ages; rates then declined until 1977 but have subsequently returned to higher levels. Two factors are implicated: (1) the recent changes are related to parallel changes in the fertility rate; but (2) there is also a tendency for recent cohorts of women to resort to abortion more readily. These relationships are derived from analyses of fertility rates and abortion ratios, the proportion of conceptions that result in abortions. The results are discussed in terms of attitudes and practices related to birth control.

Psychological and social aspects of induced abortion.

The literature concerning psychosocial aspects of induced abortion is reviewed. Key areas discussed are: the legal context of abortion in Britain, psychological characteristics of abortion-seekers, pre- and post-abortion contraceptive use, pre- and post-abortion counselling, the actual abortion and the effects of termination versus refused abortion. Women seeking termination are found to demonstrate more psychological disturbance than other women, however this is probably temporary and related to the short-term stresses of abortion. Inadequate contraception is frequent prior to abortion but improves afterwards. Few women find the decision to terminate easy and most welcome opportunities for non-judgemental counselling. Although some women experience adverse psychological sequelae after abortion the great majority do not. In contrast, refused abortion often results in psychological distress for the mother and an impoverished environment for the ensuing offspring.

Abortion (Amendment) Bill

Abortion (Amendment) Bill H C McLaren, frcog; J O'Melia, mrcpsych; A Pattison, frcs; D A Roche, mb; R McGlone; MBH Wilson, mb; R E J Ryder, mb; Anne M Bancewicz, mb; Elizabeth M Elliott, mb; D B Paintin, frcog; J C Miller, frcog; J Ashton, mrcpsych. 477 Legal abortion in England and Wales 1968-78 M J McCarthy, mfcm. 479 Improvements in obstetric anaesthetic services B M Hibbard, frcog, and others. 480 Treatment of infertility with levodopa F Lechin, md, and Bertha van der Dijs, md 480 Debendox and the media R Harris, frcp, and Dian Donnai, mrcp; R P Balfour, mrcog. 480 What the fetus feels A R Dewsbury, mrcgp. 481 Dislocated and dislocatable hip in the newborn D M Dunn, frcs, and S M O'Riordan, frcs. 481 Infant feeding in Chinese populations Fiona House, srd, and K M Goel, frcp. .. 481 Postoperative pain F H Creed, mrcpsych. 481 Guidelines to aid ethical committees considering research in children J J Corkery, frcs. 481 Depot medroxyprogesterone and vaginal bleeding in the puerperium M Thiery, phd, and others. 481 Cutaneous manifestations of hydrallazine toxicity A P Brooks, md, and J W Paulley, frcp ; R G Petty, MB, and D R K Medley, frcp_ 482 Phenobarbitone and epilepsy A Richens, mrcp, and J R Oxley, mrcp.482 Epileptic drugs and the police O M Jones. 483 Diabetic impotence J H J Bancroft, frcpsych, and F C-W Wu, mrcp . 483