I personally know just how dangerous and humiliating illegal abortions were here in the UK.(1) See ‘Needs Must’. Kansans clearly understand that overturning Roe v Wade simply bans safe abortions – rather than stopping the need for abortion.(2)
This issue is much more than a chance for celebrities to speak out.(3)
Across the UK, women are still treated like naughty children, with abortion the only procedure that requires the ‘permission’ of two doctors.
Now, two years after abortion was legalised in Northern Ireland, local services are still limited.(4) In Scotland, there is no provision for the small numbers of women needing later abortions (usually for catastrophic anomalies diagnosed at routine later scans): one Scottish woman a week is “shipped” across the border.(5)
Its positive that the ‘temporary’ ruling that women can take both abortion medications at home, without the need to first attend a hospital or clinic, has been made permanent. We didn’t need COVID to tell us this – it was suggested twenty years ago.(7)
As a clinician, I’ve never met a woman for whom abortion was an easy decision. So why do numbers continue to increase?(8) (Fig 6)
Let’s start with some data.
It’s encouraging that the vast majority – and increasing numbers – of abortions are for pregnancies under 10 weeks: 89% (Fig 10). And that abortions for teenagers – and especially under 16s – continue to decline (Figs 3 and 7)
I’m not surprised that women living in the most deprived areas of England are more than twice as likely to have abortions than women living in the least deprived areas. (Figs 14-17) That’s how I know so much about illegal abortions. Deprivation doesn’t make women feckless. Especially in times of austerity, it makes them desperate.
Emergency contraception and – at last – Progesterone Only Pills are available from pharmacies. But it’s still a cost for women who may well be struggling to afford eating and/or heating.
One practical option is offering better services to the 43% of women undergoing an abortion who have had one or more previous abortions. The large variation in repeat abortion rates across local authorities (29% City of London to 54% Knowsley) suggests that something could be done about this. Since the NHS increasingly buys abortions from the private sector (Figs 4 and 9) rather than providing them as part of an integrated service, this may be a steep hill to climb.
Surely, though, we should be arguing for a woman’s right to easily accessible holistic contraceptive services – as well as our right to choose?
1. Caroline Mawer. Feb 2020. Desperate Measures. What happens when abortion services aren’t available. https://www.kevinmd.com/2020/02/what-happens-when-abortion-services-aren…. I originally wrote this for Pulse – they agreed i could write anonymously explicitly to underline the risks doctors in the US face in providing abortions. Pulse have since removed my piece from their archives.
2. Conservative Kansas votes strongly in favour of abortion rights. BMJ 2022;378:o1970
3. Independent. 28 June 2022. Which celebrities have spoken out against the Supreme Court’s decision on Roe v Wade? https://www.independent.co.uk/life-style/roe-v-wade-celebrities-supreme-…
5. Rory Carroll 4 may 2022. Abortion services in Northern Ireland almost nonexistent despite legalisation. https://www.theguardian.com/world/2022/may/04/abortion-services-in-north…
6. Lucy Grieve. 5 june 2022. The Scottish Government is failing women when it comes to abortion – https://www.scotsman.com/health/the-scottish-government-is-failing-women…
7. Caroline Mawer, Margaret McGovern. 2003. FPA. Early abortions: promoting real choice for women
8. Office for Health Improvement and Disparities. 21 June 2022. Abortion statistics, England and Wales: 2021. I’ve included specific details from this reference in the text below.