AbortionAbortion

Aug 2008Aug 2008

The history of British abortion The history of British abortion lawlaw

Made Illegal in the 19th century. Before then Common Law had allowed Made Illegal in the 19th century. Before then Common Law had allowed abortion before quickening. Abortions performed after quickening an abortion before quickening. Abortions performed after quickening an offence under Common Law but no fixed penalties and the woman having offence under Common Law but no fixed penalties and the woman having the abortion was not necessarily held responsible. In 1803 the law changed the abortion was not necessarily held responsible. In 1803 the law changed and abortion became a criminal offence from the time of conception with and abortion became a criminal offence from the time of conception with penalties of up to life imprisonment for both the pregnant woman and the penalties of up to life imprisonment for both the pregnant woman and the abortionist.abortionist.

The Offences against the Person Act 1861The Offences against the Person Act 1861 Section 58 made abortion a criminal offence punishable by imprisonment Section 58 made abortion a criminal offence punishable by imprisonment

from three years to life, even when performed for medical reasons. The from three years to life, even when performed for medical reasons. The Offences Against the Person Act is still in place and the current law simply Offences Against the Person Act is still in place and the current law simply provides exceptions to the 1861 law by clarifying when an abortion can be provides exceptions to the 1861 law by clarifying when an abortion can be legal. legal.

The Infant Life Preservation Act 1929The Infant Life Preservation Act 1929 Amended the law so that abortion would no longer be Amended the law so that abortion would no longer be

regarded as a felony if it was carried out in good faith for the regarded as a felony if it was carried out in good faith for the sole purpose of preserving the life of the mother. sole purpose of preserving the life of the mother.

Made it illegal to kill a child 'capable of being born live', and Made it illegal to kill a child 'capable of being born live', and set 28 weeks as the age at which a fetus was assumed to be set 28 weeks as the age at which a fetus was assumed to be able to survive. able to survive.

The Infant Life Preservation Act has never applied in The Infant Life Preservation Act has never applied in Scotland. Scotland.

The 'Bourne Judgement' 1938The 'Bourne Judgement' 1938 In 1938, Dr Alex Bourne performed an abortion on a 14-year-In 1938, Dr Alex Bourne performed an abortion on a 14-year-

old girl after a gang of soldiers had raped her. Dr Bourne old girl after a gang of soldiers had raped her. Dr Bourne informed the police and was prosecuted. In court, the judge informed the police and was prosecuted. In court, the judge ruled that Dr Bourne had acted in the 'honest belief' that the ruled that Dr Bourne had acted in the 'honest belief' that the abortion would 'preserve the life of the mother'. abortion would 'preserve the life of the mother'.

The Abortion Act 1967The Abortion Act 1967

The Abortion Act 1967 came into effect on 27 April 1968 The Abortion Act 1967 came into effect on 27 April 1968

and permits termination of pregnancy subject to certain and permits termination of pregnancy subject to certain conditions. Abortions must be performed by a registered conditions. Abortions must be performed by a registered practitioner in a National Health Service hospital or in a practitioner in a National Health Service hospital or in a location that has been specially approved by the location that has been specially approved by the Department of Health Department of Health

Human Fertilisation and Embryology Act 1990Human Fertilisation and Embryology Act 1990 Section 37 of the Human Fertilisation and Embryology Act Section 37 of the Human Fertilisation and Embryology Act

made changes to the Abortion Act. It introduced a time made changes to the Abortion Act. It introduced a time limit of 24 weeks for grounds 3 and 4. Grounds 1, 2 and 5 limit of 24 weeks for grounds 3 and 4. Grounds 1, 2 and 5 are now without limit. Before this change, a 28-week limit are now without limit. Before this change, a 28-week limit had applied for all grounds. had applied for all grounds.

The Human Fertilisation and Embryology Act also The Human Fertilisation and Embryology Act also confirmed that when a woman had a multiple pregnancy it confirmed that when a woman had a multiple pregnancy it was legal for a doctor to terminate the life of one or more was legal for a doctor to terminate the life of one or more fetuses leaving others alive. fetuses leaving others alive.

The Abortion Act 1967 and Section 37 of the Human The Abortion Act 1967 and Section 37 of the Human Fertilisation and Embryology Act 1990 do not apply to Fertilisation and Embryology Act 1990 do not apply to Northern Ireland.Northern Ireland.

An abortion may be approved providing two doctors agree in good An abortion may be approved providing two doctors agree in good

faith that one or more of the following criteria apply: faith that one or more of the following criteria apply:

the continuance of the pregnancy would involve risk, the continuance of the pregnancy would involve risk, greater than if the pregnancy were terminated, of injury to greater than if the pregnancy were terminated, of injury to the physical or mental health of the pregnant woman; the physical or mental health of the pregnant woman;

the continuance of the pregnancy would involve risk, the continuance of the pregnancy would involve risk, greater than if the pregnancy were terminated, of injury to greater than if the pregnancy were terminated, of injury to the physical or mental health of any existing child(ren) of the physical or mental health of any existing child(ren) of the family of the pregnant woman; the family of the pregnant woman;

there is a substantial risk that if the child were born it would there is a substantial risk that if the child were born it would suffer from such physical or mental abnormalities as to be suffer from such physical or mental abnormalities as to be seriously handicapped; seriously handicapped;

or in an emergency, certified by the operating practitioner or in an emergency, certified by the operating practitioner alone, as immediately necessary: alone, as immediately necessary:

to save the life of the pregnant woman; or to save the life of the pregnant woman; or to prevent grave permanent injury to the physical or mental health to prevent grave permanent injury to the physical or mental health

of the pregnant woman. of the pregnant woman.

The doctor may take account of the pregnant woman's actual The doctor may take account of the pregnant woman's actual or reasonably foreseeable environment, including her or reasonably foreseeable environment, including her social and economic circumstances. social and economic circumstances.

Key Facts 2007Key Facts 2007 Total number of abortions was 198,500, Total number of abortions was 198,500,

compared with 193,700 in 2006, a rise of 2.5%   compared with 193,700 in 2006, a rise of 2.5%   Age-standardised abortion rate was 18.6 per Age-standardised abortion rate was 18.6 per

1,000 resident women aged 15-44, compared 1,000 resident women aged 15-44, compared with 18.3 in 2006   with 18.3 in 2006  

Rate was highest, at 36.0 per 1,000, for women Rate was highest, at 36.0 per 1,000, for women aged 19     aged 19    

Under-16 abortion rate was 4.4 and the under-Under-16 abortion rate was 4.4 and the under-18 rate was 19.8 per 1,000 women, both the 18 rate was 19.8 per 1,000 women, both the higher than in 2006.   higher than in 2006.  

Key Facts 2007Key Facts 2007

89% of abortions were funded by the NHS 89% of abortions were funded by the NHS (compared to 51% in 2002); of these, just over (compared to 51% in 2002); of these, just over half (57%) took place in the independent sector half (57%) took place in the independent sector under NHS contract   under NHS contract  

90% of abortions were carried out at under 13 90% of abortions were carried out at under 13 weeks gestation; 70% were at under 10 weeks   weeks gestation; 70% were at under 10 weeks  

medical abortions accounted for 35% of the total medical abortions accounted for 35% of the total compared with 30% in 2006 and 19% in 2004    compared with 30% in 2006 and 19% in 2004   

1,900 abortions (1%) were under ground E, risk 1,900 abortions (1%) were under ground E, risk that the child would be born handicapped  that the child would be born handicapped 

Previous terminations (2007)Previous terminations (2007) Number of previous terminations Number of previous terminations 0 0 134,269134,269 1 1 49,48449,484 2 2 11,13611,136 3 3 2,6052,605 4 4 740740 5 5 184184 6 6 52 52 7 7 2929

Total 198,449Total 198,449

In England, Wales and Scotland abortion is legal under 24 weeks of In England, Wales and Scotland abortion is legal under 24 weeks of

pregnancy if two doctors agree that it is necessary for one of the pregnancy if two doctors agree that it is necessary for one of the following reasons:following reasons:

having the baby would harm the woman's mental or physical health having the baby would harm the woman's mental or physical health more than having the abortion. more than having the abortion.

having the baby would harm the mental or physical health of any having the baby would harm the mental or physical health of any children she already has. children she already has.

An abortion is also legal at any time in pregnancy if two doctors An abortion is also legal at any time in pregnancy if two doctors agree that:agree that:

the abortion is necessary to save the woman's life or prevent the abortion is necessary to save the woman's life or prevent serious permanent harm to her mental or physical health, orserious permanent harm to her mental or physical health, or

there is a high risk that the baby would be seriously handicapped. there is a high risk that the baby would be seriously handicapped.

Note that the stage of pregnancy is calculated from the first day of the Note that the stage of pregnancy is calculated from the first day of the woman's last period. Note also that different woman's last period. Note also that different laws apply outside England, apply outside England, Wales and Scotland.Wales and Scotland.

Early medical abortionEarly medical abortion

Medical abortion can be performed in the Medical abortion can be performed in the first 9 weeks of pregnancy (higher risk of first 9 weeks of pregnancy (higher risk of haemorrhage at later gestations).haemorrhage at later gestations).

Oral mifepristoneOral mifepristone 36 to 48 hours later, vaginal prostaglandin.36 to 48 hours later, vaginal prostaglandin. These two drugs end most early These two drugs end most early

pregnancies within the following four pregnancies within the following four hours. It feels like having a heavy and hours. It feels like having a heavy and rather painful period.rather painful period.

Early MethodsEarly Methods

Vacuum aspiration (known as 'the suction Vacuum aspiration (known as 'the suction method')method')

Available up to 14/15 weeks of pregnancy.Available up to 14/15 weeks of pregnancy. General or local anaesthetic.General or local anaesthetic. The cervix (the entrance to the womb at the top The cervix (the entrance to the womb at the top

of the vagina) is gently stretched to allow a tube of the vagina) is gently stretched to allow a tube to pass through it into the uterus. Once the tube to pass through it into the uterus. Once the tube is inserted the pregnancy is removed by suction.is inserted the pregnancy is removed by suction.

Day case procedureDay case procedure

Late Methods (after 13 weeks)Late Methods (after 13 weeks)

MedicalMedical Vacuum AspirationVacuum Aspiration Dilatation and evacuationDilatation and evacuation Ultra late (1 or 2-stage) methodsUltra late (1 or 2-stage) methods

ComplicationsComplications

Incomplete evacuationIncomplete evacuation HaemorrhageHaemorrhage

Cervical injuryCervical injury PerforationPerforation Adherent placentaAdherent placenta

InfectionInfection

RCOG Guideline (revised 2004)RCOG Guideline (revised 2004)