New guidelines on termination of pregnancy, released today by NICE (the National Institute for Health and Care Excellence), make concerning recommendations which potentially rush women through the abortion process.
The guidelines are intended to be used by healthcare professionals, abortion service providers and NHS commissioning groups and set our recommendations as to how services should operate in future.
CARE had serious concerns about the draft guidelines and raised these with NICE during the consultation period. The majority of these were rejected, and our concerns remain about the following recommendations in the final guidelines:
Circumventing the requirement for women to consult with a GP before requesting an abortion, and instead encouraging women to be able to self-refer to abortion providers in order to speed up the abortion process. This is particularly concerning as a consultation with a GP allows for a woman to discuss her options, and it also acts as an extra layer of safeguarding for women who may be being coerced into having an abortion (which evidence shows is 1 in 7 women seeking terminations).
Recommending that NHS organisations move to phone consultation and the use of telemedicine where legal. This is concerning because it is harder to detect potential abuse without a face-to-face consultation.
Expanding services outside of registered hospitals and clinics, to operate more in community-based settings.
Circumventing the requirement for doctors to oversee abortions, and instead encouraging the use of midwives and nurses.
Instructing medical professionals to reassure women that there are no long term risks of health problems following an abortion, despite the fact there is evidence to the contrary, and this recommendation also contradicts the NHS website which points out some of the risks involved – such as the link between abortion and subsequent pre-term birth. Concerningly, NICE have made this recommendation despite the fact that ‘the evidence for long-term health risks was not formally reviewed’ as part of the guideline.
Not offering counselling at each stage of the care pathway, because of a concern that this will create negative feelings for women requesting termination, despite the fact that this is stipulated in statutory guidance from the department of health.
Aiming to increase the numbers of doctors providing abortions by moving from an opt-in to an opt-out system for abortion training in medical schools, thereby potentially creating pressure on medical students with a conscientious objection.
No information provided to women about alternative options at the information stage of the process, such as adoption or motherhood.
Some recommendations accepted
One of our chief concerns was that the guidelines treat abortion as a right, rather than a procedure that is only allowed under the law in certain circumstances. In light of this, we are pleased that the guidelines were updated to remind service providers of the imperative that they operate within the law under the Abortion Act 1967, and follow statutory guidelines in regard to abortion procedures.
We also raised concerns with recommendations that were anti-counselling, when counselling has been shown to be highly effective in aiding women in their decision-making process and this is especially important given the high degree of ambivalence amongst women considering abortion. We were pleased that NICE updated the guideline to reflect that women should be provided, or referred for, support if they request it prior to proceeding with a termination.
The future of abortion services?
These guidelines appear at a convenient time: just as we are about to face one of the biggest abortion battles in the past 50 years. They will sit well with a model of services where abortion is available on request, for any reason, up to 24 weeks – which is the outcome we can expect in Great Britain if the pro-abortion lobby are successful in seeing abortion decriminalised.
The recommendations create the sense of an abortion factory – where women are churned in and out as fast as possible, without sufficient time and support to consider their options and alternatives, without effective safeguarding from abuse, and without being informed of all the potential risks involved.
One of the most poignant recommendations states that medical professionals should describe what the ‘products of pregnancy will look like and whether there will be any movement’ for women having medical abortions at home.
This, in some ways, is a positive development. The committee made the recommendation based on evidence that found that many women were unaware of what they would find when they had an abortion at home. In several studies in the evidence base for the guidelines, women stated the following:
"I was not prepared for the "little human being" about 12 in.”
“was totally unprepared for seeing the embryo . . . became very sad . . . I could clearly see that it would be a human being”
“You could see fetus, where the ears were, the arms, I was really frightened”
The fact that many of these women were completely unaware of the humanity of their baby just goes to show how far we have suppressed the truth about abortion, until it really does seem like nothing more than ‘getting your bunions sorted’, as Lesley Regan of the RCOG famously commented.
The products of pregnancy, also known as human beings or people, were notably absent from the guidelines. They are notably absent from this debate altogether. It’s much easier to refer to them in euphemisms than to admit we are sanctioning the speed with which their lives are being eradicated. These guidelines reflect how little our culture cares for them, and how little we care for the women whose lives will be forever altered by their abortions.