Published: 14/04/2005, Volume II5, No. 5951 Page 18 19 20
With abortion firmly back on the political agenda, the British Pregnancy Advisory Service provides a handy scapegoat for press and politicians campaigning against late terminations.
But under-fire chief executive Ann Furedi is in no mood for apologies Late abortion is a choice too far for NHS funding - at least according to a Sunday Telegraph 'exposé' of the British Pregnancy Advisory Service.
Its claim in October that an undercover journalist was told how to have an abortion in Spain when she was past the UK legal limit of 24 weeks has led to a Department of Health inquiry.
With abortion higher up the political agenda than it has been for 15 years, and BPAS responsible for 83 per cent of NHS-funded terminations past 20 weeks, chief executive Ann Furedi is firmly in the spotlight.
As BPAS operates under licence from the DoH, the worst-case scenario would be that it is shut down - though quite how the NHS would cope without it is not clear.
She says the inquiry is 'completely understandable' given the gravity of allegations that an NHS-funded body is sending women for illegal foreign abortions - 'although it is more usual to be a little more guarded before looking at the facts of the case'.
She is referring to health secretary John Reid's robust comments at the time of the story about the 'serious situation'. Government action since has been noticeably more reticent.
Ms Furedi met chief medical officer Professor Sir Liam Donaldson before Christmas. The report was due in December, then January and now publication this side of the election looks unlikely.
Ms Furedi says: 'We are extremely keen to see this published.
Allegations of impropriety have been made and we are very confident that no evidence of that will be found. So the sooner it is published the happier we will be.' She adds: 'There will inevitably be people who think there is no smoke without fire. It would be naive for me to say our reputation hasn't been damaged. That is why I find the delay in publication unacceptable.' Ms Furedi is adamant that none of BPAS's actions are unlawful.
Its position is that it is not illegal to give information, and that this does not amount to a referral. The Sunday Telegraph's argument was that BPAS gave information knowing that the termination in Spain would be illegal under Spanish law.
In Spain, abortions are only legal over 22 weeks to prevent damage to the woman. But Ms Furedi says:
'There is an issue about how doctors in Spain interpret that risk to physical and mental health and it has always been our understanding that clinics in Spain have been able to provide treatment at a later stage then in the UK - doctors have been able to interpret the law to provide legal abortion for women.'
Ms Furedi says BPAS is contacted by about a hundred women every year who are past the 24-week limit - and a few of these are so determined to get an abortion they are prepared to travel. She says giving telephone numbers ('these are not referrals') for clinics in Spain and the US has happened for many years.
'This is not something we have kept secret - the DoH has been aware of it. As far as we are concerned it was an appropriate thing to do for those women.' She says investigations by Spanish authorities concluded that the Barcelona clinic recommended by BPAS, which offered the Telegraph's undercover reporter an abortion at 26 weeks, had acted 'entirely appropriately'. And BPAS has not stopped giving phone numbers (in fact the Sunday Mirror ran a nearidentical 'exposé' last month).
'At no time have we ever been asked to cease this practice. And when we saw the CMO we made it clear that at no time had we been asked to - the CMO did not make that request then or since. You can draw what conclusions you wish to from that.' Ms Furedi says one of the positive aspects of the controversy is that 'it has highlighted the fact that demand for abortion services in the final weeks of legality significantly exceeds the number of beds available to treat women. And part of the discussion with policy-makers has been about why women are contacting us beyond the limit and what's pushed them into that.' She says women make late decisions about abortions for many reasons and will continue to do so.
But getting an abortion is more and more difficult as the NHS increasingly 'washes its hands of its responsibilities' of providing abortion past 12 weeks.
'There is an obligation on the NHS to provide a service to those women who meet legal requirements. That means there needs to be a discussion among policy-makers and an appreciation by purchasers that they cannot bury their heads in the sand and hope this problem will go away. They will not resolve the demand for late abortion simply by making early abortion easier.
'No-one likes the idea of late abortions - the women who have them, the doctors who do them. The issue is why they are necessary. One of the problems is that there are two separate discussions: one about morals and ethics, and a more pragmatic one about the reality of women's lives. Many of the women we see in late gestation believe abortion is wrong - but they think it is the right thing for them in their own circumstances.' Ms Furedi suggests that services are being eroded without a change in the law. 'On paper the law is the same at 22 weeks as 10 weeks - in practice we do have abortion on request at very early pregnancy but when it comes to the second trimester there is a world of difference.' Given that travelling for abortions is very common (thousands of women from Ireland use BPAS clinics every year) and that the numbers who travel to Spain are so tiny, what is the real issue? It seems no coincidence that the press assault on BPAS comes as the wider debate on abortion rights hots up.
Ms Furedi says: 'BPAS has been put in the frame because it is an organisation that is very unapologetic about the services it provides. Some people think we are frankly quite evil.' One of the characteristics of many of the calls for reducing the current 24-week limit is that they are often made, not by the zealot invoking their deity, but by humanists quoting science. The most common argument is that paediatric advances have increased the survival chances of very premature babies - often supplemented by new ultrasound techniques that show the foetus more clearly.
Ms Furedi accepts that the public finds it difficult to reconcile abortion after a point when a foetus could live outside the womb. But she argues the advances have been exaggerated.
'Viability has increased exponentially at 24, 25, 26 weeks, but That is not an abortion issue. Before 24 weeks survival chances remain marginal.
In fact, studies show parents now have unrealistic expectations about survival of very premature babies without severe disability.
'It is always important to review the evidence but I've read nothing to convince me that the limit should be dropped.' And she dismisses the impact of so-called 4D ultrasound that has so excited many older, male journalists - 'this supposed discovery that the foetus looks like a baby. Women do not need a scan to know that. It does not tell us anything we do not know - we know a foetus looks like a tiny baby, we know it moves but there are big issues about what that movement represents.' From feminist Naomi Wolf to celebrity Jodie Marsh, the media is full of women saying late abortion is a bad thing. Lord Steel, the former Liberal leader who as a 28-year-old MP introduced the controversial bill that led to the landmark 1967 legislation decriminalising abortion, wants to reduce the legal limit from 24 weeks to 22 (it dropped from 28 weeks in 1990).
An inevitable conclusion?
Of the three party leaders, Michael Howard and Charles Kennedy moot a reduction while the prime minister remains firmly ambiguous on the subject. From all corners of society, the drums are getting louder. It seems very likely that the next Parliament will debate a reduction to 20 weeks.
It is difficult to see it not winning enough support. Does Ms Furedi feel isolated? 'Society is entirely reconciled to early abortion. Opinion polls suggest that and even the prolife organisations' statements in the last few weeks seem to suggest this.
This is not the US, where opinion is much more polarised.
'But in late gestation, people find the issue increasingly difficult.
People will feel that if it is more easily available earlier, and if contraception is easily available, there should not be a need for this.
I've spoken to postgrad doctors who say: 'I do not see why I should do this.' It comes down to misunderstanding the dynamics of unplanned pregnancy.' Almost 30 years after the 1967 Abortion Act, one of the problems is that memories of criminalisation have faded. 'Vera Drake has done us a service in reminding us of that.
Ironically in the light of our own controversy, if the time limit was reduced, I think there would be a significant number of women who would be so determined to end their pregnancy that they would travel abroad.
'Criminalising abortion does not end it, it just displaces it - the abortion rate in Ireland is not dissimilar to that of Britain. It is just made much more difficult and traumatic.' .
The British Pregnancy Advisory Service is the UK's biggest abortion provider, treating 50,000 women per year.
BPAS was established as a registered charity in 1968, shortly after abortion was legalised.
The NHS was unable to meet demand then, as is still the case today.
In 2002, the latest figures available, 175,600 abortions were carried out on UK residents, a fall of 0.5 per cent on 2001.
In 2002, of the total number of abortions performed, 87 per cent were carried out at under 13 weeks' gestation.
BPAS also provides emergency contraception, vasectomy and sterilisation services.