We must trust women on abortion, says midwives' leader
Decriminalising abortion will not lead to a surge in late terminations, argues Royal College of Midwives chief executive Cathy Warwick
The Royal College of Midwives’ decision to support a campaign to decriminalise abortion has come under fire this week.
According to some press coverage, the college is campaigning to legalise abortion on demand, at any time during pregnancy, for any reason. Midwives, who otherwise support a woman’s right to take control of her own fertility, are concerned. They worry they will be placed in the position of looking after women with healthy pregnanices having late terminations.
Let me put the record straight about what the RCM is actually supporting. We are in favour of decriminalising abortion. This is because we do not believe it is right that in the 21st century, women who choose to have an abortion can be criminalised.
Delays in treatment
Put simply, this means they can be sent to jail for having an abortion, unless it is within the very strict parameters of the 1967 Abortion Act which effectively gives others control. For example, it requires that two doctors approve a termination.
This can cause delays in treatment and prolong this difficult period for women. Provisions in the Act are also used to prevent women from taking the ‘abortion pill’ at home in their own time. Instead they are required to attend multiple clinic appointments, denying them choice over when the pregnancy is passed.
We do not believe late terminations will be a consequence of decriminalisation. Accordingly, the RCM took the decision to support the We Trust Women campaign started by the British Pregnancy Advisory Service, calling for the decriminalisation of abortion across the UK.
Not for or against
The campaign calls for every woman to be given the necessary information to make her own choice as to whether or not to continue with her pregnancy.
The RCM is not advocating for or against abortion, nor is the RCM arguing for a complete free for all, with no controls. Rather, we are recommending that abortion procedures be regulated in the same way as all others relating to women’s health care.
For those who are concerned about the removal of the 24-week time limit, this is a crucial issue. Fundamentally, we must trust that women do not want to terminate a normal, healthy pregnancy at a late stage, but professionals are required by their professional codes to act ethically.
Already a reality
And the evidence suggests that such trust is founded in fact. Decriminalisation is already a reality in Canada, where they decriminalised abortion more than 25 years ago. Their experience since decriminalisation is that over 90% of abortions are done in the first trimester, only 2-3% are done after 16 weeks, and no doctor does abortions past 20 or 21 weeks except for compelling health or genetic reasons.
Closer to home, Scotland did not have an upper limit on abortion until 1990. The rates of late termination were the same as in countries that did.
Removing the upper time limit should not be a cause for concern. What it will do is protect women.
Take the case of a very young girl who discovers she is pregnant. She is confused and scared and delays seeking help. She finally gets to an abortion service at 23 weeks plus six days and has her termination. Alternatively, she gets there at 24 weeks and two days. A termination would be illegal and so she has to continue with a pregnancy which is unwanted, impacts on her daily life and is far more risky for her than an abortion.
This situation is deeply frustrating for professionals wanting to act in the best interests of women. Given that this is what we are meant to do, it is imperative we change this situation.
I would also point to a recent case in Northern Ireland, where abortion is illegal. There, a woman was given a suspended jail sentence for taking abortion pills she had bought over the internet when she was 10-12 weeks pregnant. This can, and almost certainly will, happen again, and more women will be criminalised because of it.
I realise, of course, that the RCM’s 46,000 members will have a range of views and opinions. However, our position reaffirms our support for midwives to hold a position of conscientious objection to any direct involvement in termination of pregnancy. No one is being asked to go against their conscience, or their beliefs.
Respecting their choices
But this is not about what we personally believe. This is about the women we care for; it is about their lives and the choices they make. We will not have to live their lives once their decision is made.
As midwives, whose very title means ‘with women’, we are there to support them, whatever their choices.
I have read coverage recently saying that the essence of a midwife is to support the joyful arrival of a newborn baby into the world. Of course that is a huge part of our job, but it is much more than that: it is about being supportive of women and about respecting their choices regarding their bodies.
I would urge people to read, and consider, the arguments that we set out in our position statement, and those set out by the We Trust Women campaign.