These last few days have seen the media splashed with articles about an impending crisis in the UK’s National Health Service, suggesting fewer doctors are willing to perform abortions, either for ethical reasons or because they prefer to specialize in other areas, while demand for terminations is greater than ever.
The issue has been highlighted by a comment from the Royal College of Obstetricians and Gynaecologists (RCOG) that it was concerned about what it saw as a “slow but growing problem”.
The RCOG said it recognizes that abortion is an essential part of women’s healthcare and should be adequately resourced. But they have noticed trainees are “opting out” of doing terminations and this will result in a shortage of doctors to meet demand in the future.
The RCOG acknowledges the right of doctors to object to performing abortion, and emphasizes the importance of having a workforce in this essential area of sexual healthcare that is sympathetic and supportive toward its women patients, most of whom do not make the decision to terminate a pregnancy lightly.
As far as we know nobody has systematically studied why doctors appear to be opting out of this area of healthcare provision and how this will impact the NHS and over what timescale.
Many people are speculating as to what the reasons might be, both within and outside the medical profession. Blogs and online commentaries are flooded with with passionate and sanguine opinions and observations.
The issues that many comments are focusing on include:
— A generation of doctors who remember what it was like in the days before the UK’s 1967 act legalized abortion are approaching retirement or have already stopped practising.
— Many (younger) doctors have no first hand experience of back street or self-induced abortions and the damage they inflict.
— Changes in training and working hours are causing trainee doctors to choose areas that will boost their career, whereas performing terminations is just bog standard practice.
— Admitting to being an abortionist is a conversation stopper, reflecting what is perhaps a growing social distaste for this darker and less glamourous side of medicine.
— Unwanted pregnancies and the demand for terminations is increasing, in spite of the number and ease of contraceptive options available.
— There will always be women who will do anything to stop an unwanted pregnancy, including seeking illegal means if the legal ones are denied to them.
BPAS, one of the UK’s leading charities specializing in sexual healthcare and abortion services, released a statement from its chairman, Ann Furedi that said the NHS and charities like BPAS had been providing safe abortions since it became legal in 1967.
She said today’s medical students in the UK are too young to have witnessed women dying slowly and painfully after self-induced and unsafe abortion, but if they were to travel to other countries where abortion is still illegal they would.
Ann Furedi said that:
“Abortion is an absolutely essential, life-saving part of medical care.”
“It may not be the most glamorous medical speciality on the face of it, compared to stem cell research or neurosurgery, but it is seen as heroic work by the women that it helps,” she added.
Dr Kate Paterson is a consultant obstetrician in abortion care for BPAS and the NHS. She has been working within abortion, maternity care and contraceptive services for the last 20 years and said she does the job because:
“Becoming pregnant is either the best, or the worst thing that can happen to a woman.”
“There are an awful lot of doctors already working helping women to get pregnant in the NHS and in the private IVF sector. There are a hell of a lot less, who want to help women when they are pregnant and can’t cope,” she said.
She talks about her sympathy for women who are already struggling to cope with their lives and for whom becoming pregnant is the last straw. There could be many reasons why they feel they just can’t have the baby: health, family, too many children, bad housing and poverty.
Dr Paterson mentions she has seen women who have been raped who are trying to come to terms with the trauma and who just can’t cope with the prospect of having a baby as well.
She compares her experience of working in maternity with that of helping women who come for help to discuss abortion. She said the women who come to talk about abortion are more grateful for her help and the most likely to say a genuine “thank you” afterwards.
“There is a desperate need for this kind of work and women can be in really extreme situations. So I do feel pleased that I can help them and that I do a job that is very, very useful to people,” said Dr Paterson.
For many doctors the ethical issues are not straightforward or black and white. If no doctors performed terminations, this would cause desperate women to pursue unsafe and sometimes fatal options, which in one sense is contrary to a doctor’s belief that medicine should save lives.
And an increasing number of doctors appear to view abortion itself not as a life saving act but one of terminating life.
It cannot be easy to come to terms with the fact that medical technology may soon reach the stage where a fetus scheduled for termination in one part of the hospital is the same age as one born prematurely and on life support in the ward next door.
Marie Stopes International, the UK’s largest provider of family planning and abortion services outside the NHS and operating in 40 countries, is holding a conference in London on 23-24 October 2007 that will focus on abortion.
It is planned to coincide with the 40th anniversary of the UK’s 1967 abortion act, on which Liz Davies, Director of UK Operations made the following comment in November last year when the conference was announced:
“In this day and age, the 1967 Act is an anachronism. It is a paternalistic piece of legislation that denies women the right to decide for themselves whether or not to have an abortion. We will use this conference as a platform to advocate for much needed law reform.”
It would seem that this issue is not going to fade, but if anything, will gather in pace as that date approaches.
Click here for more information on abortion from NHS direct.
Click here for a range of resources on abortion and ethics (University of San Diego).
Written by: Catharine Paddock
Writer: Medical News Today