Will modernising Guernsey’s abortion laws provide women with the care they require?

Pregnant women deserve the highest standards of medical, financial and emotional support, at a time of great vulnerability. Every woman knows that reproductive events have a profound impact upon her life, reverberating well beyond the physical and into her psychological health and wellbeing. It is a remarkable failure of imagination and empathy to have nothing to offer women but more abortion.

One of Deputy Soulsby’s modernising ideas is for women to have abortions alone at home with the use of abortion-inducing drugs. While perhaps common elsewhere, performing a medical abortion at home is a lonely, hugely traumatic, and painful experience for women, who can face heavy blood loss, extreme pain and the disposal of their aborted baby. Is this ‘the care they require’?

At present, in Guernsey and in the UK, a woman seeking an abortion must have her decision approved by two medical practitioners before referral to a gynaecologist. Deputy Soulsby’s ‘modernisation’ removes this requirement. In her view, it would seem, medical specialists are, in the context of pregnancy, a barrier to care. It would be hard to think of another medical procedure of such psychological and physical significance where this would be the case. Is this ‘the care they require’?

Another remarkable feature of Deputy Soulsby’s ‘modernisation’ is the introduction of abortion up to birth for disabled babies (referred to as having ‘foetal abnormalities’). The current limited protections offered to disabled people are swept away by these proposals. If Deputy Soulsby truly believes in inclusivity, why single out the disabled for abortion up to birth? Moreover, numerous studies show that late-term abortions significantly increase the risk of post-abortion psychological trauma and depression for the mother in these circumstances. Is this ‘the care they require’?

Whilst streamlining the abortion process in the name of ‘modernisation’, Deputy Soulsby fails to acknowledge that no woman wants to have an abortion and an understanding of the complex reasons women seek abortions is entirely missing from her proposals and, at present, from the wider debate. The great irony is that women seeking abortion do so because they feel they have no choice: because they fear loss of income or opportunity; intimidation or abuse from partners or family members; or the pressure exerted when a disability is detected, in many cases wrongly so. Is Deputy Soulsby interested in removing these barriers? Is this ‘the care they require’?

Since the Steele Act of 1967 (UK), and Roe vs Wade in 1973 (USA), enormous amounts of research have been carried out into the impact of abortion on women’s lives. Does Deputy Soulsby’s ‘modernisation’ take any of this into account? Is aligning Guernsey’s law with a legal compromise dating back to 1967 really ‘modernisation’, and does it do anything to protect women or care for them?

MARIA O’BRIEN, MTHEOL FCP

Address withheld.

Editor’s footnote: the Committee for Health & Social Care (Deputy Heidi Soulsby, Deputy Rhian Tooley, Deputy Emilie McSwiggan, Deputy Rob Prow and Deputy Dawn Tindall) replies:

Thank you for providing the opportunity to respond to your reader’s letter regarding our proposals to modernise Guernsey’s Abortion Law. These proposals have been developed by the committee as a whole and they are based on evidence and feedback from professionals. They do not represent the view of our president alone.

The proposals which led to Guernsey’s current Abortion Law were debated in 1996. We unanimously believe that it is appropriate, a quarter of a century later, to review the law to ensure that it reflects good clinical practice and continues to provide effective and safe standards for the care of women who seek abortions. Our recommendations are designed to increase the law’s clarity and improve equity of care.

The proposals are not a radical liberalisation of the Abortion Law. They would bring Guernsey in line with other jurisdictions within the British Isles and ensure that local women have access to comparable care. To take the specific points of your reader’s letter in turn:

l Abortions at home

Guidance produced by Nice (the National Institute for Health and Care Excellence), designed to ensure that women get safe and effective care, recommends that women should be given the option to return home if they are having a medical (non-surgical) abortion. This respects individual choice and recognises that many women would prefer to be at home. Unless a haematological disorder is present, in which case an abortion at home would not be appropriate, heavy bleeding is not associated with early medical abortion. The pain relief medication which is used during abortion procedures in hospital can also be taken at home.

The proposals give women the choice to stay at home, in certain cases. It does not oblige them to do so. Women who prefer to remain at the PEH for their procedure will be able to continue to do so.

l Consultation with two medical practitioners

There is no other situation where an individual requires permission from two healthcare professionals before making a personal healthcare decision. Nor is there any evidence that this provides any meaningful use for women. The legal requirement to consult with two medical practitioners in the case of abortion is described as anachronistic by the Royal College of Obstetricians and Gynaecologists (the medical speciality under which abortion care is provided). Any woman who wishes to consult with her doctor more than once, before making a decision, will still be free to do so. The proposals simply remove the legal requirement.

l Foetal anomalies

Under section 3(1)(c) of the law, an abortion may take place on the basis that an abnormality has been diagnosed in the foetus. This is the correct medical terminology to use. Foetal abnormalities include various conditions which are not compatible with life; where the alternative to abortion would be to require a woman to complete a pregnancy, knowing that she will give birth to a dead or dying child. It also includes life-limiting conditions, where a child may be in need of constant medical intervention.

Diagnosing foetal abnormalities, and establishing a prognosis, is not always straightforward during the early stages of pregnancy. Later tests can be more effective at confirming the presence of foetal abnormalities – but also their absence. Removing the current threshold of 24 weeks means that women are not rushed into a decision. This is, of course, an exceptionally sensitive area, and one that the committee has given much consideration; recognising that this is not an easy decision, nor one that anyone would take lightly.

l Reasons why women have abortions

Throughout this term, the committee has sought to address the ‘upstream’ issues which might avoid women being faced with the question of abortion. We have invested in sexual and reproductive health services, and provided free contraception for young women under age 21. HSC’s Children and Family Services provide support to families with complex challenges, including domestic abuse, which can be a cause of unplanned pregnancies.

A fair and modern Abortion Law, which does not subject women to undue financial barriers or force them into making a rushed decision because of strict time pressures, remains an important part of the provision of care for women who still find themselves faced with the question of needing to end a pregnancy. For some women, the reason as to why they wish to have an abortion may be particularly complex. It is for this reason, among others, that the recommendations to modernise the law have been made. Ultimately, for women to be able to make a choice, safe and equitable abortion services must operate in parallel to the wider services which exist in Guernsey.