Termination of Pregnancy (Information Provided)
(Limited Text - Ministerial Extracts only)
Read Full debate
The Parliamentary Under-Secretary of State for Health (Anne Milton)
I congratulate my hon. Friend the Member for Mid Bedfordshire (Nadine Dorries) on securing this debate on a subject in which I know she has had a long-standing interest. She rightly described it as a taboo subject, and the extract she read was moving, evocative and of concern to us all.
The debate comes at a welcome time for me, as I will be meeting representatives from the two biggest independent sector abortion providers later in the month to discuss how we might integrate contraception and wider sexual health provision into the services they provide. It will also be an opportunity for me to raise some of the issues my hon. Friend has highlighted tonight.
I also recently had a useful and productive conversation with a charity that supports young women and men in making informed sexual health decisions. For me and for the Government, reducing the abortion rate is an absolute priority, and to do that we have to ensure that women and men are given information and support to make responsible sexual health choices.
We have seen significant advances in the quality of abortion provision since the Abortion Act 1967 came into force. Early access to abortions has improved and evidence shows that the risk of complications increases the later the gestation. Currently, 75% of NHS-funded abortions take place at under 10 weeks, compared with 51% in 1992. Early abortion means that women have more choice as to the abortion method. Medical abortion using two tablets now accounts for 40% of the total number of abortions, as opposed to only 12% in 2001. However, abortion comes at the end of a failure of many other services in the lives of young women.
Independent sector abortion providers and those organisations that refer women for an abortion are hugely experienced, but are subject to Secretary of State approval and monitoring by the Care Quality Commission. That is why some of the issues that my hon. Friend raises are of considerable concern. We need to ensure that continued emphasis is placed on giving women and men advice and contraception, because it is needed. In the same way, women should be given access to tailored, appropriate and impartial advice on their pregnancy options.
The Government will be responding to the House of Commons Select Committee on Science and Technology recommendation to update advice on the mental health consequences of induced abortion. The Government have commissioned a systematic review of the evidence, and the report will be published in spring 2011.
Interestingly, we have recently seen a substantial increase in the number of men attending family planning clinics—there was a 16% increase in the number of young men attending clinics in 2009-10, with 162,000 attendances. That is a massive 93% increase on the figure in 1999-2000, when only 84,000 men attended. I welcome the fact that young men are taking the issue of sexual health and pregnancy more seriously; I hope that they are taking it as seriously as young women are.
There are some examples of truly excellent, innovative sexual health services that have grown up at local level. However, as my hon. Friend said, the total number of abortions currently being carried out is just over 189,000 a year. Since 1992, the number of abortions has steadily increased, with the exception of the past two years when there was a fall in the number, albeit small. Just under half of teenage conceptions end in an abortion. However, the trend in both teenage conceptions and births is downward and the teenage pregnancy rate for 2008 was the lowest annual rate for more than 20 years. We should welcome that, although we should never be complacent because that figure of 189,000 is still way too high.
Repeat abortion is a continuing issue. Some 34%—one third—of women undergoing abortions had one or more abortions, a figure that has risen from 29% in 1998. Some 25% of repeat abortions were to women under 25. There are also significant and concerning variations between primary care trusts in repeat abortion rates, with rates in some areas as high as 45%. Abortions are traumatic and stressful, and they are not a form of contraception, but sadly they are clearly used as such in some instances. Women are offered a follow-up appointment within two weeks of the abortion. That also provides an opportunity to have another conversation about contraception needs if the woman was unclear as to contraception requirements at the time of the abortion, but that is not always taken up.
Mr Stewart Jackson (Peterborough) (Con)
Is the Minister as concerned as I am that it is common practice for independent abortion providers to have their commercial relationship with PCTs and with other trusts in the health service hidden by the caveat of “commercial in confidence”? Therefore, people are not in a position to understand those providers’ commercial relationship with the NHS, and surely that offends against the principles of transparency in the NHS.
Anne Milton
Yes. I thank my hon. Friend for raising that point. The issues raised by conflicts of interest and hiding behind commercial sensitivity give rise to considerable concern. That is why I am pleased to be meeting some of the service providers in the next week or so to discuss those issues. It must be pointed out, with the greatest respect to my hon. Friend the Member for Mid Bedfordshire, that although the stories she talked about involved bad practice, there are a lot of instances of very good practice. We should not miss that in the discussion about where things are not going as well as they should be.
Contraception has been free for everyone and is readily available in the community from GPs, family planning clinics and abortion providers, but there are clearly barriers. Why are so many young women and men not using it? A number of factors can lead to risk-taking behaviour, such as sexual violence, alcohol, lack of contraception awareness and self-esteem. We need to use simple, effective messages about safe sex, sexually transmitted infections, condom use and contraception. We need to ensure that young people receive high quality education on relationships and sex and we need to tackle those issues in a holistic and effective way. We need to ensure that young people are equipped to make the choices and the sometimes challenging decisions that they face in their lives. Those decisions are increasingly challenging in this day and age.
Thomas Docherty (Dunfermline and West Fife) (Lab)
Those thoughts from the Minister are all excellent, but it is my understanding that before the general election the now Prime Minister promised Government time so that the House could have an opportunity to have a free vote on legislation to change, for example, the upper limit. Will the Minister tell the House tonight whether the Government are still committed to providing time and, if so, when?
Anne Milton
I thank the hon. Gentleman for his question. Others in this House might know more about parliamentary procedure than I do, but I understand that abortion is a matter that is usually raised by Back Benchers. He may look bemused, but that is what I have been told. It is usually raised by Back Benchers and the Government do not normally take a view on it. It is an ethical decision and there are usually free votes on it—I have witnessed them myself.
Young women and men need to think about contraception before having sex. People have busy lifestyles—and, in some instances, very chaotic lifestyles—and there are barriers to accessing contraception. However, with long-acting reversible contraceptives there are ways to prevent unwanted pregnancy for everyone, whatever their lifestyle. We need young women and men to be equipped with the information and knowledge to look after their physical, mental and sexual health so they are not put in this position in the first place.
Some £11.5 million has been invested this year and the sexual health charities Brook and the Family Planning Association, with funding from Government, have developed a new web-based contraception decision tool to help people to choose the best contraception for them. Launched on 14 July, the “My Contraception” tool asks users a range of questions about their health, lifestyle and contraceptive preferences and recommends a contraceptive method based on the results.
The Government’s “Sex. Worth talking about” national campaign has been quite well received and early indications suggest that it has prompted positive action. Local areas will now be able to use the “Sex. Worth talking about” campaign resources to support their local work. That is a development that I am sure we will all welcome. There are also pages on the NHS Choices website with a huge amount of information and a helpline for confidential advice.
Some advances have been made to ensure that women are able to have safe, legal abortions, but we need to stop the tide of unwanted pregnancies. That is the position that we want to be in. That will take an effort on a number of fronts, and later this year we will publish our White Paper on public health, which will set out our approach in a great deal more detail.
My hon. Friend the Member for Mid Bedfordshire rightly points out that a woman faced with an unwanted pregnancy is extremely vulnerable. She also rightly points out that the consequences of abortion can be traumatic and far reaching. I am pleased that my hon. Friend the Member for Shrewsbury and Atcham (Daniel Kawczynski) raised the issue of fathers, who are often forgotten in relation to this subject but who should not be forgotten in legislation and in the mechanisms we put in place to ensure that we not only prevent unwanted pregnancies but deal with their consequences.
I shall be very grateful for the continued support of my hon. Friends in making sure that we get the very best services available for women at this critical time. Anecdotal and individual Members’ experiences are vital to ensuring that we get those services right. Having in place informed consent, appropriate counselling and the right support for women at this vulnerable time will ensure that we do not fail them for the future.
Question put and agreed to.