The Parliamentary Under-Secretary of State for Health (Jackie Doyle-Price)
I congratulate the hon. Member for Kingston upon Hull North (Diana Johnson) on securing this debate to mark an historic occasion: the fiftieth anniversary of the passing of the Abortion Act 1967. As the hon. Lady explained, the Act was introduced as a private Member’s Bill by the then hon. Member for Roxburgh, Selkirk and Peebles—now the right hon. the Lord Steel of Aikwood—and clearly defines the grounds under which an abortion may be carried out in England.
With the exception of emergencies, when it is necessary to perform an abortion to save the life of the woman, two doctors must certify that, in their opinion, which must be formed in good faith, a request for an abortion meets at least one ground set out in the Act, and they should be in agreement as to which ground this is. The hon. Lady asked whether it should remain the case that the opinions of two doctors are required. Well, as long as that remains the law—clearly it is—my emphasis, from a Minister’s perspective, is on delivering the safest possible treatment for women in accordance with that law. The hon. Lady also raised some important issues regarding waiting times, which I would like to go away and reflect on. I am sure that everyone in this House agrees that no woman undertakes a termination lightly. For many, it is extremely traumatic, so it is incumbent on all of us to make that experience the least painful and least traumatic it can be, and as safe as possible. Central to being as safe as possible is that it takes place as early as possible.
Fiona Bruce
The Minister is talking about the requirement for two medical practitioners to give their agreement. A ComRes poll of 2,000 adults last week showed that 72% of the public think that abortions should continue to be subject to that legal requirement, because it ensures protection for women, particularly for those in an abusive relationship. It might be the opportunity they have to talk to someone in a safe environment about the pressure that they might be being put under to have an abortion.
Jackie Doyle-Price
Central to this is that Parliament needs to be satisfied that the regime is safe for women. The law has been on the statute book for 50 years, and until Parliament decides to change that, that is the law that I will implement as safely as possible. I hear many polls quoted but, frankly, when it comes to this issue, on which people have very strong views, we need to ensure that we maintain the law with integrity.
Thanks to the dedication, hard work and expertise of the doctors and nurses working in abortion clinics, termination of pregnancy is now an extremely safe procedure. In marked contrast to some of the statistics before the Act, which the hon. Member for Kingston upon Hull North outlined, data for 2016 show a complication rate of just one in every 630 abortions, which is substantially lower than just 10 years ago, when the rate was one in 500. The choice of early medical abortion, which is less invasive than a surgical procedure and does not involve use of anaesthetics, has helped to increase the overall percentage of abortions performed at under ten weeks gestation from 68% in 2006 to 81% in 2016. Clearly, the more we can encourage that, the better it will be for the welfare of women undertaking terminations.
Mary Glindon (North Tyneside) (Lab)
I congratulate my hon. Friend the Member for Kingston upon Hull North (Diana Johnson) on securing the debate. The Minister is talking about what happens to women during the procedure and about how much care should be taken. However, does she share my concern that, as the report “Abortion and Women’s Health” from the Society for the Protection of Unborn Children highlighted last week, counselling and support for women who suffer mental distress after they have had an abortion is seriously lacking in this country?
Jackie Doyle-Price
At the risk of being really controversial, I think there are lots of elements of counselling for women that are seriously lacking. That possibly reflects the fact that decisions about the welfare of women have generally been taken by men. It is great that there are now lots more women in this House able to influence exactly that.
Paula Sherriff
Does the Minister agree that it is imperative that we offer women choice in the decisions they take about their body? Will she give an undertaking this evening to investigate why the Government thought it was appropriate to award the largest sum from the tampon tax fund to an anti-choice organisation?
Jackie Doyle-Price
I understand that the hon. Lady feels strongly about this issue, and nobody can doubt her passion and commitment to women’s welfare. My understanding of the grant she referred to is that it went strictly towards the support of women who chose to go through with the birth. I am happy to look at that further. I am not entirely sure it was the largest donation, but I am happy to look into that. However, the hon. Lady is right when she says there should be genuine choice. We do not want anyone to feel that they cannot have an abortion, any more than we want them to feel that they have to have one. We really want women to be able to make informed choices and to feel empowered to have the child, if that is what they would like to do. The important thing is that we empower women. That is the whole purpose of what we are trying to do here—to empower women and allow them to make choices that are safe for them.
Since the Act was passed, there have been regular calls from all sides of the debate for changes to the legislation, and the hon. Member for Kingston upon Hull North has outlined her views clearly today. As she said, this Government and previous ones have always viewed legislative change as a matter for the House to take a view on, and there are no plans to change that.
The Act was last amended in 1991 by the Human Fertilisation and Embryology Act 1990. This reduced the time limit for most abortions from 28 weeks to 24 weeks. No time limit applies where there is a substantial risk that the child will suffer from a serious handicap or that the pregnancy would cause grave permanent injury to the physical or mental health of the mother or put her life at risk. So amendments are possible, and it is ultimately Parliament that decides the circumstances under which abortion can be legally undertaken. The Government will always ensure that regulation works to make that as safe as possible.
The hon. Lady outlined clearly her belief that abortion should be decriminalised, and the Government will no doubt take a view as and when she brings forward her Bill, as indeed will the rest of the House. It is true that any abortions conducted outside the grounds in the 1967 Act currently remain a criminal offence, and there is no intention for that issue to be dealt with by anything other than a free vote.
Turning to the impact of the Act in practice, it is important that we remember that, in the years before the Act, abortion was, indeed, the leading cause of maternal mortality in England and Wales. For example, the first confidential inquiry into maternal deaths in 1952, reported 153 deaths from abortion alone. The most recent confidential inquiry report found there were 81 reported deaths in 2012-14 for all direct causes of maternal mortality, such as obstetric complications, interventions and omissions. So since the Act came into force, women in Great Britain have had access to legal and safe abortion services.
Jim Shannon
Does that figure include those who committed suicide as a result of having an abortion and the effect it had on them?
Jackie Doyle-Price
The figures include those who have died as a result of maternal complications. I am not aware of any figures that detail suicide. However, we need to look at the whole issue of counselling for women who are facing any kind of unwanted pregnancy.
In 2016, 98% of abortions were funded by the NHS, whereas in 2006 just 87% were NHS-funded. That shows that the NHS is providing more and more of this service. Ninety-two per cent. of abortions were carried out at under 13 weeks’ gestation, and 81% were carried out at under 10 weeks, illustrating the fact that the procedure is becoming safer. Sixty-two per cent. were medical abortions, more than double the proportion in 2006—again, a good sign of progress. This data clearly shows that improving access and choice within the existing framework can be achieved. I am sure that all hon. Members will welcome the fact that the vast majority of abortions are taking place at earlier gestation times, which is safer for women and offers increased choice of medical abortion.
On home use, abortions in England can be performed only in an NHS facility or in a place approved by the Secretary of State for Health. At present, a patient’s home is not an approved place for abortion. I am aware that the Scottish Government have recently granted approval for the second stage of early medical abortion treatment to be undertaken in a patient’s home in certain circumstances. As I have said repeatedly, our overriding principle is that all women who require abortion services in England should have access to high-quality and safe care. We will continue to engage with women and with stakeholders on ways to make our safe and regulated services even more effective.
A key part of an abortion service is providing information and services to enable women to make informed decisions and to support good sexual health. This includes information about, and provision of, contraception and testing for sexually transmitted infections. Abortion providers should be able to supply all reversible methods of contraception—including long-acting reversible methods, which are the most effective—and offer testing for sexually transmitted infections as appropriate. Before the woman is discharged, future contraception should have been discussed and, as far as possible, the chosen method should be initiated immediately. All women should be offered testing for chlamydia and offered a risk assessment for other sexually transmitted infections such as HIV and syphilis. Provision of effective contraception is essential if we are to make progress towards our ambition to reduce unintended pregnancies in women of all ages. For women aged 24 and under, we have seen significant reductions in the abortion rate, most notably in under-18s, where the rate has reduced from 18.2 per 1,000 in 2006 to just 8.9 per 1,000 in 2016. Rates in women aged over 24 have remained stable or increased slightly. We know that we have more work to do to ensure that we see improvements across all age groups.
Over the past 50 years, there have been significant improvements in women’s health, in the regulation of abortion, and in the safety of abortion. It is appropriate that we look back, take stock, and congratulate ourselves on that, and that we continue to ensure that the way in which we allow for legal abortion makes it, at all times, safe and well regulated.
Question put and agreed to.