Philobiblon

Spent this evening at a powerful and thought-provoking Pro-Choice Public Meeting organised by Voice for Choice. Here are some of my notes..

Dr Patricia Lohr, BPAS medical director, who first trained and worked in America, said of that experience with regard to the sometimes deadly attacks on doctors who perform abortions:  “I realised you had to accept the risk and then ignore it. … I even had patients who could not understand how I could do this work.”

Of working in the UK in comparison, she said:  “We are extremely fortunate to work in a space where is debate but not violence, and instead of focusing on making abortion available can focus on providing best posssible abortion servcies.”

She said abortions should be provided: “as early as possible and as late as necessary”.

Dr Evan Harris, BMA Ethics Committee, former Liberal Democrat MP

He said we were seeing US tactics coming over here and even more so US money.

He said of the recent Nadine Dorries amendment (on which I spoke at an Abortion Rights press conference) that it wasn’t a total victory for the pro-choice side, but as a total defeat for the anti-abortion movement. It was disappointing that the medical profession, particularly the Royal College, had not been louder in its defence of the professional standards they established and supported.

Being, he said, “deliberately a little provocative”, he added: “From 1997 to 2010 we wasted the first properly prochoice majority we ever had.  We still have a 1967 Act, which good as it was at the time, still means (paternalistically) women still have to get the permission of two doctors to have a treatment which is in patent’s own interests; that a  procedure that could be safely and appropriately done by nurses stil has to be done by doctors. Abortions are not allowed to be done in the primary care setting, even thought  politicians have been trying to make more local provisions and move out of hospital many other procedures. Early medical abortion has to be done in a clinic and hospital. when it would be a better service if women were able to take at least second dose at home. The government says we need a British trial when many other countries have found this approach safe and effective – as if there is something in the British air that makes abortions different here, but they stopped only British trial half way through saying that it was illegal.”

He said that a lot of pro-choice strategy previously been to stop debate. “I really do think once in every five years a parliamentary debate should be allowed. … Most of the top Tory people realise they can’t be associated with antiabortion extremists.”

“The House of Lords has a big prochoice majority. They listen to their doctors and their nurses.”

“We need to rejoice in our victories, need to show we have the public support that we know we have. There are pro-choice MPs in marginal seats who are scared to speak out.”

Marge Berer, editor, Reproductive Health Matters, noted that the current law was passed after 35 years of campaigning (partly interrupted by WWII). What had been achieved in the 45 years since then in Britain was that unsafe, unhygenic abortions had ended, and with a complication rate for abortions of only two per thousand, the quality of abortion services should be a source of pride. Abortions are also being done earlier – under 10 weeks was 57% of the total in the early Nineties, now 73%, with 91% under 12 weeks.

Until the nid Nineties only about 45% were provided on the NHS, but that had now risen to 98% (with most of the rest of the patients being women from Ireland and Northern Ireland), but the number of abortions performed by the NHS, rather than contracted out, had fallen significantly.

“We have progressed far more slowly fun other states in Europe part in moving abortions out of hospitals and very early use of medical abortion as soon as a woman misses her period. There is a huge problem because we have allowed the NHS to opt out of providing abortions, while if they had remained in the NHS it would have been  much more likely to move services to to nurse-provided and primary care facilites. Scotland has a higher rate of medical abortions than England and Wales.” (Although she did note that the service provided by the charities was very good.)

Astonishingly, she said there’s no data on social deprivation and various aspects of abortion in England and Wales. In Scotland, the abortion rate in the most deprived areas is double that of the wealthiest. “We need to spend more time looking at these figures in England and Wales.”

On campaigning issues, she said that the public health issues were proven beyond question, and serious attempts  to end access to abortion stopped with Corrie bill in 1979. “We haven’t however won general acceptance of the moral right for women to control their bodies.”

What is the right number of abortions? The number of abortions women need. One in three British woman will have an abortion during her reproductive life.

She had some fascinating figures showing how fertility regulation is an integral part of a woman’s life. In an average of 36 years of fertile life, a woman will ovulate about 408 times – “that means women have an average failure rate per ovulation of unwanted pregnancy of 0.22%.

Going a little Swiftian, she noted that the only way to stop abortions would be stop women having sex with men, and to sterilise all adolescents before they start having sex with a reversible, perfect contraceptive.

… or you could begin to reduce poverty and exclusion.

Marge said that the first order of businsess should be to decriminalise abortion. Canada had done it, as had several states in Australia. There is no reason for abortion to be in criminal law. “The desire to tinker may be holding us back.”

There was then a very interesting contribution from two young women, Lucy and Jacina (sp?), from Brook.

Jacina said that young people had insufficient information and had insufficient education to help them make choices and access services. “Little more than a year I did not know about Brook. There are biased services that won’t obviously be biased to young people.

“I worked with others to create the Sex Positive campaign. It is unacceptable that we have to teach ourselves in a culture or negativity and misinformation.”

“It is a daunting time to be pro-choice. The anti-choice people get equsa space in media and government. Pro-choice is seen as biased when this is unbiased information.”

Lucy said that antichoice campaigners were using “big sister” language, suggesting “cooling off periods” or “mnore counselling” which seemed helpful and friendly, but reduced women and girls’ options. “They are potentially more dangerous than protesters outside clinics. Young people need confidential, nonjudgmental services.”

Some final thoughts from the discussion:

“Abortions should be rare” is dangerous. The right number of abortions is the number women need. Abortion is a normal part of many women’s reproductive lifetimes.

Policymakers see longacting contraceptices as a magic bullet. and ask why aren’t people using more implants? Medicial people are obsessed with effectiveness, but patients think about a whole lot of other things – they don’t want to use implant, they don’t want people to be able to see it in their arm, we don’t want to have to have a doctor take it out – and anyway one in four is removed for intractible bleeding.