More recently, the Health Secretary, Andrew Lansley ordered the Care Quality Commission (CQC) to carry out urgent spot checks on more than 300 abortion clinics in England after it came to his attention that nearly a fifth of them were pre-signing consent forms for abortions to be carried out. Currently, the law says that two doctors have to approve an abortion and that, although the doctors do not have to see the woman, they must confirm that they are aware of her circumstances and of the reason(s) she wants to terminate her pregnancy.
The checks carried out by the CQC cost approximately £1m and, according to a letter to the Department of Health from the CQC's chair, Dame Jo Williams, had a considerable impact on [the CQC's] capacity to deliver [its] annual targets.
Approximately four days into the CQC's inspections, and before the checks were complete, Mr. Lansley leaked some of the CQC's early, non-published findings to the press which prompted the shadow health secretary, Andy Burnham to accuse Mr. Lansley of 'chasing headlines'.
The facts are not in dispute; some abortion providers absolutely do pre-sign consent forms and this is, technically, illegal. So why are they doing it?
Section 1 (1) of the Abortion Act 1967 says this:
Subject to the provisions of this section, a person shall not be guilty of an offence under the law relating to abortion when a pregnancy is terminated by a registered medical practitioner if two registered medical practitioners are of the opinion, formed in good faith -
- (a) that the pregnancy has not exceeded its twenty-fourth week and that the continuance of the pregnancy would involve risk, greater than if the pregnancy were terminated, of injury to the physical or mental health of the pregnant woman or any existing children of her family; or
- (b) that the termination of the pregnancy is necessary to prevent grave permanent injury to the physical or mental health of the pregnant woman; or
- (c) that the continuance of the pregnancy would involve risk to the life of the pregnant woman, greater than if the pregnancy were terminated
- (d) that there is a substantial risk that if the child were born it would suffer from such physical or mental abnormalities as to be seriously handicapped
Abortion is legal up until the 24th week of pregnancy (although there are exceptions) but most abortions are carried out much earlier than this (98% are performed before 20 weeks). A woman who wants to find out the sex of her baby cannot do so before her 20 week scan. In 96% of cases, the reason for an abortion is given as (a) from the above list. This is the thing that two doctors have to agree on. And it's these agreements that some abortion clinics have been pre-signing.
When a woman seeks an abortion, she is saying, 'I am pregnant but I don't want to be.' There is a huge amount of talk about what a difficult and traumatic decision this is to make. Yes, sometimes the circumstances surrounding a woman's decision to have an abortion are harrowing; she may have been raped, she may be homeless or addicted to drugs, she may have mental or physical health problems that would make her vulnerable in pregnancy. She may have had a totally shit life. But, more often than not, a woman wants an abortion because she has become pregnant and simply doesn't want a baby.
The procedure - the actual abortion - is unpleasant. It's an operation and, like most operations, it's painful, bloody, uncomfortable and scary. And it hurts quite a lot afterwards. For a lot of women, this is the most frightening thing about abortion; the anticipation of physical pain and discomfort.
Most women who seek an abortion have decided they want a termination as soon as they have found out they are pregnant. There is usually not that much to-ing and fro-ing. In other words, the decision to have a termination is usually an easy one. Yes, it's difficult and emotional to talk about, but when a woman doesn't want a baby, she is usually steadfast in her decision from the outset.
This is why doctors are pre-signing consent forms; because they know that most women have made up their minds about wanting an abortion long before they even meet with a doctor to arrange it; because the reason for most abortions is, simply, an unwanted pregnancy.
Why isn't there a clause in the Abortion Act that provides for this? Why isn't there another line in Section 1 (1) of the Act that says, 'the pregnancy has not exceeded its twenty-fourth week and is unwanted'? This is why most abortions are carried out and doctors know it. And these abortions almost always take place before the 13th weekf of pregnancy. It's offensive that most women have to rely on the provision that the continuance of the pregnancy would involve risk, greater than if the pregnancy were terminated, of injury to the physical or mental health of the pregnant woman. It's almost always much more simple than that; the woman doesn't want a baby. Why do two doctors have to agree to this? And, if it's so important for two doctors to give consent, why is it acceptable for them not to have to meet with the woman in question?
The reason is that we're still offended by the notion of an 'unwanted pregnancy'. We still feel that there has to be another, more emotionally fraught reason for a woman to want to end a pregnancy; that her circumstances must be dire and that an abortion should be an absolute last resort. We think that if consent forms are being pre-signed, that doctors are handing out abortions willy-nilly.
Nearly all abortions are carried out during the very early stages of pregnancy for women who have decided they do not want a child. Doctors are pre-signing consent forms for abortions because they trust women. They know that for a woman to not want a baby is a sufficient reason for an abortion to take place before the 24th week of pregnancy.
Andrew Lansley has said he is concerned about doctors agreeing to abortions for women based on the sex of their baby. He has politicised this hugely and has made it seem much more clear cut than it actually is. The issue of abortions based on the sex of a foetus is very different to that of consent forms for abortions being pre-signed and should be treated as such. Mr. Lansley's agenda around abortion is sinister and frightening and he is using his 'concerns' as a smoke screen for misogyny and to drive the abortion debate dangerously back in time.