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Baroness Bennett of Manor Castle (GP)
My Lords, the Committee may be pleased to know that I plan to be comparatively brief.
Before the dinner break, the noble Baroness, Lady Maclean, asked how many people in your Lordships’ House have had abortions. Of course I cannot answer that question, but it is worth putting on the record the fact that one in three British women will have an abortion during their reproductive life. That is the reality for very many women in the UK today. They will need this reproductive healthcare.
I will not go over what has been said before, but I want to respond to some of the things that have already been said that need a response, and I will raise a point that has not been raised but which is important for contextualising our debate. It relates to a comment made by the noble and learned Baroness, Lady Butler-Sloss, about why we have seen an increase in investigations into what are often entirely natural miscarriages and late-term apparent or possible abortions. We have not discussed how the global political context has changed. There is an extremely well-funded global campaign around the world that is seeking to reduce women’s reproductive rights. For context on that, I went to the website of the Organization of American Historians and read an article by the historian Jennifer L Holland. She notes that,
“the antiabortion movement, in its many iterations, has radically transformed Americans’ ideas about women’s bodies, reproduction, feminist politics, and of course, fetal life. In the two centuries the movement has existed, its constituencies, tactics, and tools have all changed. But what has remained is the effect this movement has had on women’s lives”.
She adds that the movement
“transformed ideas as it also restricted the … ability of American women to access reproductive healthcare”.
The article goes on to note that, until around the 1840s, having an abortion in America was an unexceptional and “largely stigma-free” practice. That was because it had inherited the law from the UK that regarded anything before quickening as not being an issue; that is usually regarded as four to six months of gestation.
There is a reason why the law that we keep referring back to is from the 1860s. That was when we started to see a global movement, particularly an American-driven movement, which is now here in the UK, through very well-funded organisations and with millions of pounds coming from the US, through the huge power of social media, having an impact on whether people will think about these issues—whether they are a medical practitioner, police officer, et cetera. When we look at why we have seen an increase, we really have to consider the framework in which this debate is being conducted.
A long time ago now, the noble Viscount, Lord Hailsham, who is not in his place, said that
“all investigations in this matter should be conducted with great sensitivity”.
What has become clear from our debate is just how invasive and damaging investigations are. I will not go through the cases that have been rehearsed here today. There have been GCSE students who have had their phones taken away and their lives totally disrupted—it is absolute chaos. That is the reality. I do not think it is possible to do this sensitively.
I will briefly address the amendments that seek to attack—and we have heard a concerted attack on it today—telemedicine. I link the remarks of the noble Baronesses, Lady Gerada and Lady Fox, who both, in very different tones, perhaps, made it very clear that this has been an extremely successful delivery of healthcare. This is a safe and convenient way that has seen the average gestation at treatment for abortion fall substantially, with more than half of all abortions now taking place before seven weeks’ gestation.
If we were to stop telemedicine, as quite a number of noble Lords have called for, there would be a drastic increase in waiting times, women would have to travel long distances for care—even at the earliest gestations—and many women would be driven to buying pills online through legal, quasi-legal or simply illegal sources because of the lack of availability of that provision.
This brings me to respond to the noble Lord, Lord Jackson, who spoke about the number of abortions occurring in the UK. I hope the noble Lord and, indeed, the entire Committee would agree that that figure is a reflection of the inadequacy of contraceptive provision in the UK. I hope we can all agree that we want better contraceptive provision and therefore that would be a way to reduce the number of abortions.
I note that a study from BPAS found that nearly half of women found it difficult to access contraception because of long wait times, difficulty in securing appointments, and financial hurdles when they went to secure their preferred method of abortion.
I have two more brief points—
Lord Jackson of Peterborough (Con)
I hear what the noble Baroness is saying. Is she aware that the World Health Organization defines a safe abortion as
“meaning that they are carried out using a method recommended by WHO, appropriate to the gestational age, and by someone with the necessary skills”,
and that recommendation 30 in its safe abortion guide states that medical abortion at 12 weeks or greater should be managed only by doctors in a healthcare setting—in other words, a self-managed medical abortion from 12 weeks’ gestation is deemed to be “unsafe” by the WHO?
Baroness Bennett of Manor Castle (GP)
The noble Lord has very powerfully made the case for ensuring that we are able to make that provision as early as possible.
I particularly want to address one amendment that we have only really heard the presenter address. Amendment 461B from the noble Lord, Lord Bailey, would subject any female accessing legal abortion under the age of 16 to a mandatory investigation by police and child protection agencies. It is worth stressing that since 1985 it has been the law in England and Wales that under-16s can access contraception, abortion and sexual health care confidentially.
Lord Hogan-Howe (CB)
My Lords, first, I ought to say how I approach this debate. I had not intended to speak. The issue—passionate though people feel about it on both sides of the argument—is one that I hope I have always approached with an open mind. Abortion is a terrible thing in contemplation for anybody concerned, but it is a practical necessity for some. That is something that I have always felt strongly about.
One of the things that we could have been confused about in hearing the debate today is that the police are investigating every stillbirth and every miscarriage, which is not the case. If the death takes place or the child’s life is lost in a medical setting, usually the police are never involved. The time when the police become involved is either when there is a medical referral because there is a concern by medics or, alternatively, when there is an emergency at home or somewhere else.
I mention this because we have to be realistic, whatever the decisions made about Clause 191, about how the police respond. There are some ways the police response could be improved, but we have to give some understanding to the officers who deal with these emergencies, say, in a home or at a place of work. It could be a public toilet, or it could be that something is discovered in the middle of a field. At the beginning, the officers do not know whether they are dealing with a baby, a late-term foetus or a child who might have taken a breath or not; they have a very confused situation, and they cannot just walk away from it.
My first point is that there has to be some sensitivity. At a far earlier stage in the debate, I think the noble Baroness, Lady Lawlor, raised sudden death syndrome for babies. The police have got far better at dealing with that sort of situation, because 30 years ago we did not know that sudden death syndrome happened. Now we do, so it is dealt with in a different way from how it was 20 or 30 years ago.
The bottom line is that there is a requirement to freeze the scene in terms of evidence, because it is no good two or three weeks after the event when a judge, a coroner or someone turns around and says, “Well, you must have seen this at the scene and gained the evidence”, and they say, “Well, actually we did not seize it; we did not freeze it”. There is a difference between starting an investigation and freezing the scene and making sure you have as much evidence as is available, without too much intrusion, at that first point.
It is really important to be clear about this. If we set off and say that Clause 191 will come into effect and there will certainly not be a criminal investigation into the mother, that does not stop the need to collect evidence right at the beginning, when no one is sure. I think we have to be a little realistic about this.
On improving the police investigation process, there are two things that would be really helpful. Number one is that a senior detective with some experience attends the scene as soon as possible—I would say within an hour—to see what they are dealing with, so that if there is evidence to be seized, it is done sensitively and the family are protected as much as possible. Probably as importantly, unless there is an immediate need to start an investigation—for example, we could imagine that there might be injury to a child or a foetus that is not possible to explain by what appears to have happened to it medically, for example a knife or something else—you need to consider that set of circumstances. But generally, within a period of time—let us say 48 hours—the police must seek medical advice about how this child or foetus died and what, if anything, should happen thereafter. That starts to create a process that we could all objectively rely on.
My second point is that there has been a little confusion about the fact that, if the woman is coerced, Clause 191 does not mean that the coercer is innocent. It has nothing to do with that at all. It is only about the mother, if it is decided that that should go ahead.
I would like to make two final points. I just want to sit here and learn, but one thing I have not heard addressed in the debate—the problem, it seems to me—is that there are some women who, at 24 weeks and onward, need help. Whether the state says they can have an abortion or not, they might take that decision. Where do they go? We all agree that a back street abortionist is not a good idea. They cannot go to a medical professional, who would then be complicit in providing the abortion, perhaps, that they cannot legally have. If they end up with these online tablets designed for those under 10 weeks, that is not a good outcome. But I am not sure that what the state says—what we say—will help them in that terrible dilemma, because the need that they feel to have that abortion beyond 24 weeks has not gone away. If we abandon them to that decision alone, I do not think we help anyone. I would like to understand this myself, regardless of the decision about Clause 191: how do women in this position get some help?
With an open mind, there were three points that I do not think we have yet clarified. One thing that I was really interested to hear was that the pills designed for under 10 weeks are available online for people beyond that, and it seems as though that is not a good idea. They are designed for people under 10 weeks because that is when they work best. At 24 weeks and beyond they sound like an awful option—but what if they are your only option? How are we going to deal with control of those pills? I do not understand, from Clause 191 or the existing law, what we intend to do about that.
The second point, from the noble and learned Baroness, Lady Butler-Sloss, was that there is this fundamental dilemma: the woman has not committed a criminal offence, but the people who enable her to do this act do commit an offence. I am not a lawyer, but that sounds like a contradiction. I think there has to be some explanation of how that gets remedied.
On the final point that was raised, I am not sure about the answers. The noble Baroness, Lady Fox, did not think it relevant, but the point about sex determination as a reason for abortion seems to me a real risk. I do not know whether Clause 191 makes it more or less likely to happen, but it is a risk and nobody should allow that. It happens now, potentially, but if Clause 191 makes it more likely, what is the mitigation of that risk? I have not heard it. That needs to be addressed if Clauses 191 is to remain.
Lord Weir of Ballyholme (DUP)
My Lords, for the benefit of the absent noble Lord, Lord Russell, I will attempt to speak in a paperless fashion, which means that if I engage in verbal streams of consciousness I hope that the Committee will forgive me. There is a range of amendments in this group, many of which I support, a number of which I have sympathy with and a few that I oppose. That is perhaps natural, given the fact that a number of amendments in this group pull in completely opposite directions.
Of the amendments that I support, I draw particular attention to Amendment 460, which would require that before an abortion could take place there is at least a clinical appointment, that guidance is given and that it is done through that route. Noble Lords have come up with a range of solutions to what we all appreciate is a sensitive situation and have tried to square the circle. The evidence from prosecutions that have taken place, and where there have been convictions, is that in almost every case there has been an absence of clinical support and someone has, in effect, gone on a form of solo run. Albeit that it may well have been in very difficult circumstances and taken with a heavy heart, nevertheless that is the route down which they have gone.
In the limited time available, I will concentrate on supporting the Clause 191 stand part notice from the noble Baroness, Lady Monckton, because, with respect to those who drafted Clause 191, it is somewhat disingenuous, radical in its implications and dangerous, particularly for women. Let me explain why.
Mention has been made that it does not legally change the time limits. In a strict legal sense, that is true, but it does turn those time limits into a façade. If you have a situation in which an act that remains illegal can be carried out but the person who carries it out is immune and protected from prosecution in all circumstances—in blanket circumstances—you have a law that is utterly ineffective. It is the equivalent of saying that we will retain speed limits on motorways but anyone found driving on a motorway beyond that speed limit will not be prosecuted. It is somewhat disingenuous. A more honest approach would have been an amendment that simply said, “We want to move the time limit to the point of birth”. That is, in effect, what Clause 191 does, but the changes that it makes are disguised as the mirage that has been put in front of us.
This is a radical change. Within this Committee and society as a whole, there is a wide spectrum of views on the issue of abortion. Some, and I am one, would take a much more restrictive approach towards abortion and feel that with our current laws the balance is wrong. Others take a much more liberal or permissive view. The settled compromise between those positions is to say that, at present, the determining line between what is legal and what is not is whether a child can be born and viable at the point of birth. The point has been made that that line has shifted from 28 weeks to 24 weeks. There is a good argument that it should come down a little bit more. But Clause 191 will, in effect, shift the ground in some cases to a situation in which that abortion can take place up until the day of birth. That is a radical step that is out of sync with public feeling.
Lord Alton of Liverpool (CB)
My Lords, I support the mitigating amendments from a number of noble Lords, but I particularly support the proposition from the noble Baroness, Lady Monckton, that Clause 191 should not stand part of the Bill. I do so for a number of reasons; some are to do with principle and some to do with parliamentary procedure. Listening just now to the noble Lord, Lord Weir, and before that to the noble Lord, Lord Hogan-Howe, I think that there are plenty of reasons why this deserves the kind of detailed examination that we have been giving it on the Floor of your Lordships’ House today, whatever our personal views may be.
Abortion is not just a medical procedure. It is not just about choice; it ends the life of a nascent human being. As the noble Viscount, Lord Hailsham, said early in our debate, it is about the sanctity of human life. That is one of the key questions that we must always wrestle with when we come to this issue.
Since 1967, when Parliament permitted what were supposed to be terminations carried out in rare and exceptional cases, there have been more than 11 million abortions in the United Kingdom. That is one life taken across the UK every two minutes. Since 1990, we have permitted eugenic abortions on the ground of disability right up to birth. That includes things such as cleft palate or club foot; 90% of all babies with Down syndrome are now aborted in the United Kingdom, according to NHS figures.
Laws have profound consequences. We are not a debating society but we do send signals. Laws, to some extent, are like semaphore: they send a signal to society. They have profound consequences—social, personal, economic and demographic—and not just for the unborn child. Clearly, from what noble Lords have said this afternoon, there are consequences for the women and everybody else who is involved. The amendments in the names of the noble Baronesses, Lady Maclean, Lady Meyer, Lady Lawlor, Lady Coffey, Lady Stroud, Lady Foster and Lady Eaton, and my noble friend Lady O’Loan, make it clear that this has profound consequences for women. We should take that into account as well.
Some noble Lords have touched on the question of law and whether international norms require us to do this. I remind the Committee that there is no such recognised right as the right to abortion in the European Convention on Human Rights. Decisions from the European Court of Human Rights have confirmed that the convention does not guarantee a right to have an abortion, nor does it guarantee a right to perform abortions. The court has also been clear that Article 8, which guarantees the right to private and family life, does not confer a right to abortion. The court has ruled that domestic laws that prohibit abortion do not violate Article 8. In contrast, human rights laws grant protection to the unborn. The preamble to the United Nations Convention on the Rights of the Child, to which the United Kingdom is a signatory, states that the child
“needs special safeguards and care, including appropriate legal protection, before as well as after birth”.
We need to ask ourselves, when we talk about conforming with what other jurisdictions do, how well we conform to those norms as well.
Things have changed as a result of the Health and Care Act 2022. I took part in the proceedings on that legislation. On the fourth day, an amendment was brought forward to make permanent the Covid arrangements permitting at-home abortions. Let me remind the Committee of the words of the then Health Minister, the noble Lord, Lord Kamall, who told the House, when announcing the end of the policy in February 2022,
“that it was always intended to be a temporary measure”.—[Official Report, 10/2/22; col. 1820.]
Too often, though, temporary measures become permanent and new arguments are brought forward to justify them.
One of the key arguments put forward in support of Clause 191 today is the alleged rise in the prosecution of women in recent years. If there has been a rise, that is intrinsically linked to abortion pills by post. I was particularly struck that Jonathan Lord, now of the Royal College of Obstetricians and Gynaecologists and a former medical director of Marie Stopes, acknowledged that for the 160 years prior to 2022,
“only three women have ever been on trial”.
Between 1 January 2012 and 31 July 2022, data from the Metropolitan Police shows that of 42 arrests under Sections 58 and 59 of the Offences against the Persons Act and the Infant Life (Preservation) Act, 34 of those arrested were men, and that of the seven who were ultimately charged, none of them were women. Prosecutions of women, I am glad to say, remain very rare indeed.
I know that there is agreement across the Committee, because we have all said it during the debate today, that any investigation of a woman following a pregnancy loss is a matter that requires deep compassion and sensitivity. Like others who have spoken in the debate, those of us who are fathers may have experienced the loss of a child as a result of miscarriage. We know what that means for men, as well as for women—what it means for everyone. It is the loss of a new child. Either life begins at conception or it does not. If it does, then the sanctity of human life that the noble Viscount, Lord Hailsham, described earlier surely must be a consideration.
I acknowledge that there may be circumstances in which accessing care and support may be less straightforward, but that does not justify the removal of in-person clinical safeguards altogether, particularly where there are well-documented risks around gestational error, coercion and missed complications. A compassionate and appropriate response would surely be to address access problems through properly funded, local, in-person services and targeted support for vulnerable women who may be coerced or even trafficked, rather than relying on a remote model that prioritises speed and convenience over safety.
There are radical alternatives to the defeat. As many have said in this debate, wherever we come from on the substantive issue, abortion itself is not something that is good or desirable; we must do all we can to try to find alternatives to it. Instead of asking a Select Committee to examine the sorts of arguments we have heard, instead of pre-legislative scrutiny, instead of examining the dangers to women or the inevitable increase in the number of terminations, instead of looking for alternatives which promote the well-being of both mother and child, instead of—as one noble Lord rightly referred to earlier—an impact assessment or any of the normal requirements in promoting legislation, this new clause was added simply as a Back-Bench amendment at a late stage of a Bill which is not primarily about abortion, and it was given a cursory 46 minutes of Back-Bench debate in the House of Commons. That would not have happened in my day in the House of Commons. This is no way to make law. The Government would be well advised to withdraw this clause, pending further consideration of the practical issues that it raises.
The uncomfortable truth which all of us must wrestle with, irrespective of our in-principle views on abortion, is that with Clause 191 on the statute book, if a woman intentionally induces an abortion at a very late stage and the baby dies in utero or during the process and is not born alive, there would be no criminal offence available in respect of her actions, regardless of gestation.
Abortion pills are powerful drugs. They can involve significant bleeding, pain and complications, and they can be tragically misused. The purpose of an in-person consultation is not delay or obstruction but to provide a vital clinical and safeguarding checkpoint. I urge noble Lords, even if they cannot support the substantive objections that I have made to Clause 191 in supporting the noble Baroness, Lady Monckton, to at least support Amendment 460, spoken to by the noble Baroness, Lady Foster, in the name of the noble Baroness, Lady Stroud. I hope that, when we return to this question on Report, there may have been some movement in that direction.
Baroness Coffey (Con)
My Lords, I tabled Amendment 461A, which would amend the Abortion Act. It is worth briefly stepping back. I completely understand why people have very different views on whether this is right or wrong or similar, or whether this is a healthcare treatment, but we have a law in place that puts restrictions on when abortions can happen.
It might perhaps feel that those restrictions are really just lip service. I say that because, in 2013 and 2016, the number of abortions was about 185,000 in England and Wales. It is now 278,000. A particular change started to happen in the statistics back in 2019, as, for the first time, people were allowed to take the second abortion pill at home. The first pill had to be taken in some kind of clinical setting, and then people could take the second pill at home. We saw a jump at that point, to about 207,000. I think I am right that 36% of abortions were taken at that point—that is about 75,000—where we saw the second pill be taken at home. We are now in a situation where, with the significant increase—a 50% uplift from a decade ago—72% of abortions are undertaken by both pills being taken at home. That is about 200,000 abortions in the year 2023, so there has been a significant change.
For what it is worth, I think that that is quite a sad figure. I appreciate that there will be people in this Committee who do not care what the number is—it is a woman’s right to choose. I do not agree with, or even respect, that point of view, but I understand it.
As has already been eloquently pointed out, we are now in a situation where Parliament still agrees that a crime may have been committed, but that, through Clause 191, the person carrying the foetus cannot be held responsible in any way. Therefore, the point of my amendment is to suggest that, instead of relying on good faith from the providers, we move to beyond reasonable doubt. I think that there is an element of my noble friend’s Amendment 461K, which proposes a new clause to make sure that the services provided are done in a lawful way.
Lord Patel (CB)
Can the noble Baroness help me by clarifying what her amendment would mean? Currently, a provider, or anybody who counsels a woman seeking abortion, will take in good faith what the woman might say to them about her gestation. But the noble Baroness’s amendment would move that to “beyond reasonable doubt”, which is at the level of a criminal court and not a social justice or civil court. That would mean that, in every case, the health professional who counsels the woman would have to provide evidence that they believed her beyond reasonable doubt. That would mean that there would have to be evidence beyond reasonable doubt.
Baroness Coffey (Con)
My Lords, one reason why I have chosen that phrase particularly at this stage—I might reconsider it for Report—is we are talking about a crime. If this happens beyond the terms which the law sets, it is a crime. This is about the change that happened, moving from taking the second pill at home to then just having both pills wherever. The case to which the noble Baroness, Lady Falkner, referred earlier was one in which another lady got the pills and gave them to the chap. They were then applied unlawfully, obviously, and the other lady was also convicted—admittedly, it was a suspended sentence. But there was accountability.
Viscount Hailsham (Con)
Is it not the problem that in criminal cases where the reasonable doubt test applies, you often have external evidence, such as witnesses or documents? What my noble friend is talking about here is really an oral conversation, and the only material available to the service provider will be what the prospective mother has to say. It is very difficult on that basis to come to a conclusion beyond a reasonable doubt.
Baroness Coffey (Con)
That is why I am not convinced that the situation that we have is satisfactory to uphold the law.
The other reason why noble Lords are concerned about Clause 191 is that Tonia Antoniazzi, who put this measure forward, has said publicly that she is very comfortable with abortions happening at 37 weeks—she has no problem with it at all. But I appreciate that that is not what everybody is in favour of.
I ask the noble Lord, Lord Patel, to forgive me: I want to speak to a few other amendments, and I am conscious of the time.
The other thing that I am keen to mention is in relation to Amendment 459 in the name of my noble friend Lady Eaton. It is specific to Clause 191. The issue was debated in the Commons in 2014, and the House said then that it was informed that it was completely unlawful. Of course, in the situation we have, you cannot use sex as a reason for an abortion; that would be unlawful. But one way in which this often get used is that someone might say that it would cause huge harm or distress if they were to have a boy or a girl contrary to the wishes of their family. It can be used as an alternative reason to access the various grounds in that regard.
Obviously, we are covering a lot of issues in this one group, which might be a reminder to people that it they could be spread over a few more groups. But we need to tread carefully. I am conscious that the Commons passed this by a huge majority, but I felt that it was just very blanket—almost like they wanted to decriminalise abortion entirely. That was how it came across. Nevertheless, it is our role to consider whether this is where we want to head, or do we actually want to find a better way of upholding the law than we have today, without the unnecessary affliction that some expectant mothers may fear?
Baroness Berridge (Con)
I shall speak very briefly to Amendments 456 and 460. I have been saddened by the lack of appreciation of the protective role that the criminal law brings, and I appreciated the comments of the noble and learned Baroness, Lady Butler-Sloss. But it is important to consider some of the cases that have resulted in convictions and have not been controversial.
Sarah Catt, as reported by the BBC on 17 September 2012, aborted her baby at 39 weeks. She was prosecuted and sentenced for eight years; the body was never found—she disposed of it. The authorities realised because she had been for certain hospital appointments and no birth was registered; they went and investigated, and she said that she had had a legitimate abortion. It turned out that, when they searched her computer, because it was 2012, she had got pills from Mumbai and took those pills, and her husband knew nothing of what was happening. It is important to note that she was sentenced for eight years, and that is important particularly in relation to the amendments that seek to retrospectively pardon people. How will those connected to that lady, grandparents and potentially her husband, feel if that was no longer an offence because it was not controversial at the time? That is what we are dealing with here, that it would no longer be a crime at 39 weeks.
Having listened through many hours of debate now, I am unsure about the clarity and process of the law here. We have seen much suggestion that the pills by post are causing more investigations and heard about the nature of those investigations, but we need more detail and more evidence to legislate properly. Many noble Lords have tried to predict, “Women’s behaviour will do this” or “Women’s behaviour will do that” or “Things on the street”, as the noble Lord, Lord Bailey, said, “will be different”. But we do not know that because we have not had that really important pre-legislative process.
We have also had evidence that there is, in fact, sex-selective abortion going on, and we have had no equality impact assessment. I think that is a big flaw if we legislate on this. However, we do know from evidence in New Zealand that there could be an increase in late-term abortions, and we know that there have been more emergency calls as a result of more complications when the pills are taken after the 10-week window.
One point that has not been covered is that, obviously, the ambulance crew are often the first people through the door, so I would be grateful if the Minister could actually give some clarity and restate what the law is for those emergency providers faced with that situation. Concepts like birth, born alive and the first breath are not that easy to apply in this scenario. If you look at the Medical Law Review, there is a very interesting article by Elizabeth Romanis, in the winter 2020 edition, looking at advances in medical technology which mean that you can now operate on a foetus and there is a potential for having artificial wombs so this legal personality at the first breath might not be so easy to apply. Do the ambulance crew need to use all of their professional skills to ensure that that baby is born alive or not?
Also, the Nursing and Midwifery Order 2001, in Article 45, is very strict, unless it is a matter urgency or necessity, to ensure that people who are not medically qualified do not intervene in the birth of a baby; it is actually a criminal offence to do that. So I think we need to know from the Minister the boundary there as well, if there might be people with the woman as she is taking the pills in a late-stage abortion.
Finally, many noble Lords have said that this only had 46 minutes of Back-Bench time in the other place. I have pondered whether there is an opposite to the word “filibuster”, because I think it applies to this particular situation. It is a sadness now, I think, when one looks at Parliament’s granting of conscience issues to MPs and Peers, that somehow we have ended up in the position where these issues have lacked the pre-legislative scrutiny and consultation that are vital to ensure that we pass good laws. I do not think this one is fit, at the moment, without the involvement of the public in consultation, a White Paper, et cetera.
Baroness Spielman (Con)
My Lords, the debates today are of tremendous importance and, I think, of comparable difficulty to the painful debate about assisted dying, though that other Bill has rather overshadowed this clause. However, I think, in effect, that what we are talking about here does have some of the characteristics of a Trojan horse. It is a bit like a Private Member’s Bill hidden inside a government Bill. We have got just one day to consider the clause and to try to put some sensible restrictions and safeguards on what is clearly a risky proposal. I think the comments of many noble Lords have shown this.
I spent seven years responsible for Ofsted’s inspections of social services for children, and I saw a lot of the very worst of what parents, both male and female, will do to their children. On the Bill on that subject, debates have often been dominated by justified concerns for children’s welfare and safety, yet this clause goes the other way in explicitly legitimising the ultimate harm of killing a viable child if it is done by the mother, even where there is clear dishonesty or other wrongdoing by the mother and no mitigating circumstances whatever. I am not sure that that is a position that the majority of the public will ever see as progressive, inevitable or the way that the country should go.
It is, as various people have pointed out, a de facto removal of the term limit on abortion. With telemedicine coupled with self-declaration, what we have is something that is, I believe, really quite significantly unsafe. We simply do not have either the data or the monitoring systems to have the level of confidence that we should. By the way, I think we know that self-declaration and trust is not working as well as had been hoped in quite a number of Covid-era programmes where decisions are made remotely off the back of self-declaration. Some of the country’s woes come down to needing to find the political courage to say so and deal with that.
Baroness Sugg (Con)
My Lords, we have all received briefings on this clause, telling us that, unamended, it would allow abortion up to birth. I will address that in two ways. First, Clause 191 does not fully decriminalise abortion or alter the legal time limits. The legal framework remains for medical staff, which the noble Baroness, Lady Fox, set out very clearly. It has the advantage of stopping women facing investigation after miscarriage or a stillbirth, as the noble Lord, Lord Pannick, set out, but it would also ensure that the very small number of women who have ended their own pregnancies outside the law receive healthcare, mental health support and referral to appropriate support services rather than facing year-long police investigations. That is what Clause 191 sets out to do.
Secondly, I understand that some are concerned that this change in the law may increase later-term abortions. Clearly, later-term abortions have higher rates of complications than abortions at earlier gestation, but that still remains relatively low. We can, however, look at evidence from other jurisdictions. Although the noble Lord, Lord Weir, is right to point out that there are lots of different gestation limits across Europe, bringing women into the decriminalisation zone would bring us in line with 50 other jurisdictions, including France, New Zealand, Australia and the whole of the United States, where no women can be prosecuted for having her own abortion.
Evidence from these other jurisdictions shows that abortion law does not affect the likelihood of later-term abortions, and decriminalising abortion does not cause or correlate with any increase in third-trimester abortions. That is confirmed by the WHO and robust global evidence from countries including Canada, New Zealand and Northern Ireland, as the noble Baroness, Lady Miller, pointed out.
Looking at those in a little more detail—I am aware that it is late—in Canada, abortion was completely decriminalised in 1988. It is regulated as a health service with no criminal law or gestational limits, which goes much further that Clause 191 does. Over decades, data shows a stable pattern of early abortion and no increase in later abortion, despite that complete decriminalisation. In Northern Ireland, where abortion was decriminalised in 2019, almost nine in 10 abortions happened before 10 weeks, and there have been no reported cases of women ending their pregnancy at late gestations outside of medical frameworks.
Lord Weir of Ballyholme (DUP)
I appreciate the point the noble Baroness is making, but would she accept that the telemedicine is illegal in Northern Ireland? Pills by post is not an option, so the only route that any woman in Northern Ireland can use is the clinical route and within the timeframe. It is pretty obvious why there have not been any prosecutions; it is because there has not been a situation arising out of that.
Baroness Sugg (Con)
It is not the prosecutions that I am referring to, it is the cases themselves. I absolutely acknowledge that telemedicine is not available through medical services in Northern Ireland, but the pills are available illegally online and people are purchasing them. However, because women are decriminalised, they are never prosecuted for taking them.
The proportion of abortion procedures carried out before nine weeks’ gestation has increased in most countries with more liberal abortion laws. As explained by the noble Baroness, Lady Gerada, that is why this change is so strongly supported by the Royal College of Obstetricians and Gynaecologists, the Royal College of Nursing, the Royal College of Midwives, the Royal College of General Practitioners, and the Royal College of Psychiatrists, and many other health experts. I agree with the noble Baroness, Lady Thornton, that the meeting with these experts was really helpful. Perhaps we could do another one of those before Report so that noble Lords who have further medical questions can ask them.
Amendments 455, 456, 456B, 456C and 461F would retain the criminalisation of women in relation to abortion law, and women would still face arrest, investigation and prosecution under the law. I very much appreciate the efforts to find some compromise in Amendments 456 and 456C, and it is important to discuss whether this is possible. However, the harm that Clause 191 seeks to address would remain if those amendments were to be included in the Bill, as investigations would still be ongoing and we would still see women being pulled into the criminal justice system, as the noble Lord, Lord Pannick, set out.
I will briefly touch on vulnerable women. It is important to consider how this clause and the amendments would impact those women, who could be in a situation of abuse or coercion. Noble Lords have rightly raised concerns around this. Importantly, non-consensual abortion would remain a crime under Clause 191, including in the terrible case that the noble Baroness, Lady Falkner, referred to.
Experts in this area have been really clear that the clause will be beneficial to women in this situation. The threat of criminal sanctioning can dissuade women from seeking help or even telling anybody what has happened to them. That is why it is supported by so many violence against women and girls groups, including the End Violence Against Women Coalition, Refuge, Rape Crisis, Karma Nirvana and many more. These groups came and did a very helpful briefing to noble Lords; perhaps we could replicate that again before Report. I understand noble Lords’ concern around coercion, but we should listen carefully to the experts in this area.
I will address telemedicine and Amendment 460, which would repeal its provision. Like other noble Lords, I was here for the legislation on its introduction, and I will present what has happened since. A large national cohort study undertaken in England and Wales published in the International Journal of Gynaecology & Obstetrics found that telemedical abortion is
“safe, effective and improves care”,
and is preferred by women. Full telemedicine is now essential for abortion provision and is being used by over 100,000 women every year in England and Wales. It has meant that once a woman decides she wants an abortion, she is able to access it more quickly and, therefore, more safely. Since the introduction of telemedicine, as the noble Baroness said, we have seen the average gestation at treatment for abortion falling substantially, with more than half of all abortions now taking place before seven weeks’ gestation. As we know, it is much safer to have an abortion as early as possible.
Telemedicine also provides a safe and confidential way for women in abusive and controlling relationships to receive abortion care. Safeguarding is an essential part of abortion care provision. Any patient that causes professional concern is provided with a full safeguarding assessment, and pre- and post-abortion support and counselling is available to all patients. Abortion providers are regulated by the Care Quality Commission, NHS England commissioners and the Department of Health and Social Care, which all have regulatory oversight.
I will address the medical complications point, which a number of noble Lords have raised. There have been 54,000 complications to medical abortion over the past five years, but that covers all gestations for all forms of medical abortion—in clinic, at home, telemedical or in person, scan or no scan, and at any gestation. Those complications are not reflective of pre 10-week medical abortion and are not exclusive to telemedical abortion care. No information has been included before 2021, when telemedicine was launched, so there is no analysis to see what has happened since then.
This also looks at the basic numbers of complications rather than rate, so it is an incomplete picture. As noble Lords have mentioned, over 1 million abortions have taken place in that five-year period. The number of abortions has gone up, which means the number of medical abortions has gone up. Therefore, sadly, the number of complications has gone up. But rather than looking just at the total figures, when you look at the rates shown by the latest abortion statistics and the hospital episode statistics, the rate of complications for medical abortion has fallen by 25% since telemedicine was introduced. That is why telemedicine is supported so strongly by medical professionals. Put simply, it is better care for women.
Telemedicine is a choice for clinically eligible women, not a requirement. A woman can always choose—
Baroness O’Loan (CB)
The noble Baroness talks about the number of complications being reduced in telemedical abortions, but the NHS statistics have shown a rise in the number of complications following the use of telemedical abortions, such that 12,000 people presented to hospital last year. Is the noble Baroness also aware that there is no collection of any statistics in Northern Ireland other than statistics delivered in accordance with the law? There are statistics on medical abortions and on surgical abortions, and that is it. There are no other statistics. I do not see where she is getting the evidence to support what she is saying in reference to abortion being decriminalised in Northern Ireland.
Baroness Sugg (Con)
On the noble Baroness’s first point, as I said, I acknowledge that the number of complications has gone up, but we have actually seen that the rate has gone down, because the number of abortions has increased. Even though that number has gone up, the actual rate has dropped by 25%. I am very happy to share the figures.
On the Northern Ireland statistics, that comes from the Northern Ireland medical association that provides the abortions. I completely agree that the more statistics and information we can have on this the better, so we are able to make fully informed decisions. Again, I am very happy to share that with the noble Baroness.
Baroness O’Loan (CB)
The statistics in Northern Ireland are collected from the health trusts that deliver the abortions; they are not collected from anyone else.
Baroness Sugg (Con)
Yes, from the people who provide the abortions. As I say, I am very happy to share that information with the noble Baroness.
Telemedicine is a choice—
Baroness Berridge (Con)
I am aware of the time, but can the noble Baroness, in the information she provides, please comment on the November 2023 government review, which says that the complication rate is higher when you are over 20 weeks’ gestation?
Baroness Sugg (Con)
I am specifically referring to telemedicine here, which is provided under 10 weeks. That is what I am talking about when I refer to complication rates. I have absolutely already acknowledged that later medical abortions have a higher rate of complications. That is why telemedicine is a good thing, because it brings the abortions earlier. As we heard, over half now are under seven weeks’ gestation.
I am running out of time, so I will stop there on telemedicine, but maintaining the option of telemedicine up to 10 weeks’ gestation for women who want it is safe, effective and helps ensure that women who have made the decision to have an abortion can access it as early as possible.
Baroness Falkner of Margravine (CB)
The noble Baroness has invoked foreign jurisdictions a lot, but is she aware that a lot of them, as the noble Lord, Lord Weir, explained, have lower term limits whereby an abortion might be legal? She mentioned the United States, where she said there was no prosecution for abortion at all. Is she aware of how many states in the United States simply do not allow abortion? It is hardly surprising that there are no prosecutions if you do not allow abortion at all.
Baroness Sugg (Con)
I hear what the noble Baroness is saying. I was talking about the decriminalisation of women. Those are the jurisdictions which never prosecute a woman for ending her own pregnancy. I acknowledge, as I did previously, that gestational limits differ and whether medical professionals are included in decriminalisation varies, but in over 50 states, including all the United States, even those with the strictest abortion law, no woman is ever prosecuted for ending her pregnancy. That is important to acknowledge when people say that this is a huge change which is going to impact behaviour. Our law dates from 1967 and lots of people who made abortion legal after that never criminalise women.
Baroness Barker (LD)
My Lords, I start by thanking the noble Baroness, Lady Bennett of Manor Castle, for setting out the context behind this debate, which takes place against a backdrop in this country of large-scale funding by anti-abortion groups across the piece and almost daily articles in our newspapers about anti-abortion. That is one of the reasons why we have seen an increase in women being arrested. Noble Lords were very careful in the statistics they selected. Some chose to talk about 2018-22. It is undeniable that in the last three or four years there has been a huge increase in the number of women being investigated.
There are three groups of people in your Lordships’ House. There are those who are fundamentally opposed to abortion, and we have heard from many of them today speaking to many of the amendments. There are those who, like me in speaking to my Amendment 459C, support a woman’s right to make informed choices and who, for the last 10 years, have followed this debate about decriminalisation. To those who say that this was brought in as a measure by the back door, suddenly sprung on the House of Commons, that is wrong. For 10 years we have been discussing decriminalisation. Dame Diana Johnson brought Bills before another place. We have had a great deal of discussion about it at different stages. Then there is a third group: the people who have doubts. The speeches of the noble and learned Baroness, Lady Butler-Sloss, and the noble Lord, Lord Hogan-Howe, typified some of them. They are the people who I want to talk to today, because they have some concern that this is not right.
In my preparation for today’s debate, which I have been thinking about for several weeks, I thought about a parallel and I went to the point that the noble Lord, Lord Pannick, went to, so I am sorry he is not in his place. I went to the fact that in 1961—a very good year in my opinion—this House debated the decriminalisation of suicide. I went, with the assistance of the Library, to look through the Hansard reports of that debate and the parallels are striking. At the point when it came into Parliament, what was the first criticism? That this had been sprung on us and was too big an issue to be brought in in this way. Yet there had been 10 years of debate prior to that by people who thought this was not the right way to deal with this issue. People in the Church had great debates about it. I suggest noble Lords read those Hansard reports, because the debates both here and in the House of Commons are profound. They are succinct, which is perhaps something we should relearn, because it is quite clear that there is no correlation between length of debate and quality of debate. These were people who were profoundly concerned about a moral issue and about what signal Parliament would be giving out were it to take this very grave step.
I will quote just one speech that took place not in the House of Lords but in the House of Commons. At Third Reading, the Conservative Minister Charles Fletcher-Cooke said:
“Because we have taken the view, as Parliament and the Government have taken, that the treatment of people who attempt to commit suicide should no longer be through the criminal courts, it in no way lessens, nor should it lessen, the respect for the sanctity of human life which we all share. It must not be thought that because we are changing the method of treatment for those unfortunate people we seek to depreciate the gravity of the action of anyone who tries to commit suicide”.
I suggest that there is a very strong and clear parallel with our debate. As the noble Lord, Lord Pannick, said, there are two evils here, and we have to decide between them.
Charles Fletcher-Cooke went on:
“One of the consequences of removing from the ambit of the criminal law this hitherto crime of attempted suicide is that it may be feared that some people may not be reached through the Mental Health Act; that there will be some who will not submit themselves to voluntary treatment, and cannot be persuaded by then medical advisers or members of their family to receive treatment. It may be apprehended that some gap in the welfare of the country may follow from that”.
He then said:
“We would all agree that it would be quite wrong either to keep the present criminal structure or to impose a new one purely for what we believe to be a very small minority. But we shall watch the situation and the Government will keep an open mind. We will see whether that small number increases and if a proposal not involving the odour of criminality is put forward to meet the situation, we shall certainly look at it again”.—[Official Report, Commons, 28/7/61; cols. 822-23.]
Two noble Lords talked about deterrence. Behind our deliberations today has been a fear that, if we cease to treat these women under the criminal justice system, we are somehow saying that what they do is less grave. I do not agree with that. I hope that, if I had taken part in that debate in 1961, I would have understood the point that they were making then, which is the same as the one we are making now: if somebody is so desperate that they would do this, they will not be in the right place if they end up in the criminal justice system. This is a medical issue.
In all the speeches we have heard today from noble Lords trying to chip away at telemedicine, the one thing that they have not dealt with is the point made to us by the people who see these desperate women: if we do anything to stop them being in contact with the medical profession, we put them in danger, and we will never get them out. In listening to the noble Lord, Lord Hogan-Howe, I wondered whether police officers find themselves in other situations where someone has done something illegal that might have had a profound effect on their health. Is the first thing that comes into the police officer’s mind that the person should go to the criminal justice system, rather than making sure that they are medically safe? That is what we are doing throughout this debate: we are treating these women as being exceptional.
We should do what we have been doing for the past 10 years. The noble Baroness, Lady Fox, is right that Clause 191 could be far more radical than it is. It is not radical; it is a very small adjustment to say that, if women are that desperate, they deserve medical treatment. All the amendments that have been debated today are just barriers in the way of that happening. I hope that people in this House, just as has been done at the other end, will realise that we are back to the same dilemma we had in 1961 and that we should do the right thing by desperate people.
Lord Cameron of Lochiel (Con)
My Lords, this has been a full, difficult and passionate debate, and I thank all noble Lords who have taken part. I know that issues of conscience such as this arouse very strong feelings, but I am pleased that we have managed to keep the debate respectful, as we always do in your Lordships’ House.
At the outset, I recognise that there are two aspects to this debate that we must firmly and definitively distinguish. The first is a matter of substance and the second is a matter of procedure. More specifically, the first is about the merits of the substance of Clause 191 and the second is about the process by which it became part of a government Bill.
On the first matter, that is an issue of conscience, and on this the Opposition do not and will not take an official position. I acknowledge that there is a multitude of views across the Committee, and indeed within my own party. That diversity of opinion is to be expected and welcome, but this is and always has been a matter of personal conscience.
However, the second matter is very different. Regardless of one’s views on the rights or wrongs of decriminalisation, the process by which Clause 191 was inserted into the Bill was, on any view, insufficient and, as a matter of procedure, deficient. The amendment was proposed on Report in the other place by Tonia Antoniazzi MP. It was not discussed in the Public Bill Committee or a Select Committee. As others have said this evening, it received 46 minutes of Back-Bench debate. Many Members in the other place were limited to less than five minutes of speaking time. On such an issue of profound social change, in no way can that be described as a full and proper debate—compare that to the vigorous debate we have had today.
Because this was an amendment to legislation brought in on Report and not part of the Bill as introduced or as amended in Committee, and because it was not government policy, this proposal has not undergone any of the usual stages of policy formation. As your Lordships will well know, where a major change to the law is proposed, the Government would normally publish a White Paper or Green Paper, commission an expert panel or review, gather evidence, conduct a public consultation, and publish an impact assessment and relevant supporting documents. The policy proposal would then be published as part of the Bill. It would be subject to detailed scrutiny in a Public Bill Committee, where witnesses would be invited to give evidence. None of these steps has been taken. Whatever one’s views on the merits of Clause 191, that is not a recipe for good law.
Let us just pause and reflect on the wide variety of issues that have arisen today—the amendments themselves cover a lot of ground. We have discussed issues of police procedure and investigation, a panoply of medical issues, and issues around potential coercion, telemedicine, prosecution policy and the vulnerability of women. There is a multitude of difficult and intricate issues to cover.
It is interesting that, when Parliament considered the Abortion Bill in 1967, the abolition of the death penalty and, more recently, the legalisation of gay marriage, all were introduced as separate Bills that underwent the full process of parliamentary scrutiny. Indeed, your Lordships Committee is currently considering another piece of social legislation, the Terminally Ill Adults (End of Life) Bill. Despite being a Private Member’s Bill, that Bill has been subject to a rather more robust process and more significant scrutiny than this clause before us today. Of course, that is absolutely right; these are matters that, if we get them wrong, could have severe and perverse consequences. Again, whether or not noble Lords support Clause 191, the Committee is being asked to pass judgment on a provision to alter fundamentally the legal status of abortion, for right or wrong, without the possession of all the necessary evidence.
Indeed, during the debate on the clause in the other place, when discussing wider abortion law reforms, Tonia Antoniazzi, who as we know proposed Clause 191, said:
“More comprehensive reform of abortion law is needed, but the right way to do that is through a future Bill, with considerable collaboration between providers, medical bodies and parliamentarians working together to secure the changes that are needed. That is what a change of this magnitude would require”.—[Official Report, Commons, 17/6/25; col. 305.]
I agree that these are changes of magnitude. A separate and distinct Bill would be a better way forward. Comprehensive reforms of legislation on social matters should have considerable collaboration between all relevant stakeholders. That has not happened with Clause 191. It is fair to say that, whatever one’s views on the moral element of the change, Clause 191 is so far-reaching, consequential and of such magnitude that it is questionable whether it is appropriate for it to be bolted on to the side of a crime and policing Bill.
Finally, I turn to the approach of the Government to Clause 191. Ultimately, this is now a clause in a government Bill. The Government may or may not have wanted it in the Bill, but, regardless of their neutrality, this clause is now in their Bill. If the Bill passes with Clause 191 remaining, it will be the Government’s job to implement it. It will unequivocally be government legislation.
Baroness Thornton (Lab)
Does the noble Lord believe that the 379 MPs who voted for this were duped into it in some way?
Lord Cameron of Lochiel (Con)
I do not think I suggested that for a moment—I do not accept that at all. I am pointing to the fact that this is a government Bill. It may not be the Government’s place to take a view on issues of conscience such as this, but it is their role and duty to ensure the coherence of the statute book and general good governance, and, of course, to implement the law of the land. I therefore have a couple of questions for the Minister. Are the Government satisfied with the process by which Clause 191 has been included in their Bill, and, if not, do they have any concerns whatever about that process? Further, the Government now face a binary choice: either they want the clause to remain in the Bill or they do not. It is not enough, with the greatest respect, for the Government to sit on the fence. I ask the Minister to answer that question as well.
In conclusion, on behalf of the Official Opposition, we take no view on the substantive issues of conscience here, but we have concerns about the process. This reform should have been subject to the usual consultations. It is a hugely complex, controversial, intricate area of policy-making, which deserves the fullest legislative process possible, and it has not had the usual procedures and rigorous scrutiny from start to finish of the legislative process. That is a matter of very great regret.
The Parliamentary Under-Secretary of State, Ministry of Justice (Baroness Levitt) (Lab)
My Lords, the Government recognise that there are strongly held views across your Lordships’ Committee on this very sensitive issue. The noble Lord, Lord Cameron of Lochiel, is of course correct that the Government maintain a neutral stance on abortion in England and Wales. We remain of the view that it is for Parliament to decide whether it is in favour of this or not. That is not sitting on the fence—that is actually deferring to the will of Parliament. It is for Parliament to decide the circumstances under which abortion should take place, allowing your Lordships to vote according to conscience. The Government will not stand in the way of change, if that is what Parliament decides.
The noble Lords, Lord Bailey and Lord Jackson of Peterborough, and the noble Baroness, Lady O’Loan, asked what the Government intend to do in certain situations. I remind your Lordships that this was not a government amendment, and therefore it is a matter for your Lordships. If this is the will of Parliament, the Government will ensure that the law is enacted.
That said, the Government must of course comment on the practical effects, workability and coherence with the statute book of any proposed legislative amendments. On 17 June last year, the Minister for Victims and Violence Against Women and Girls set out in the other place observations on what is now Clause 191. As this is already a matter of public record, I hope that your Lordships will forgive me for not repeating what she said, save that I have been asked the specific question by the noble Baronesses, Lady Ludford and Lady Falkner, about the effect of Clause 191 on the Abortion Act in how it deals with offences. The legal position is that the Abortion Act is unaffected by Clause 191. What Clause 191 does is to disapply the offences created by Sections 58 and 59 of the Offences against the Person Act 1861 and the Infant Life (Preservation) Act 1929, but only for a woman who acts in relation to her own pregnancy. The offences still apply to third parties. I reassure the noble Baroness, Lady Falkner, that any man behaving in the way she described would still be potentially committing an offence.
In order to avoid repeating myself later in this debate, I reiterate that the Government’s neutral position means that I will not be commenting beyond matters of workability and practical effect. As a shorthand, I am going to refer to conduct that could come within Sections 58 and 59 of the Offences against the Person Act and the Infant Life (Preservation) Act as abortion offences. I do not intend to address all amendments. There are some, such as Amendment 455 in the name of the noble Baroness, Lady Meyer, where we do not consider there to be significant workability concerns, particular operational implications or unintended consequences that your Lordships may wish to consider: it is a simple policy decision to be made. If I do not refer to any particular amendment, your Lordships may safely assume that that is because the Government regard it as a policy decision for your Lordships’ House without any operational or other matters to be considered. Finally, because this is a large group of amendments, I have tried to shorten my remarks to only the parts that I regard as being essential to bring to your Lordships’ attention. If anything is unclear, I encourage any of your Lordships to write to me so that I can provide a fuller explanation.
I begin with Amendment 456 in the name of the noble Lord, Lord Verdirame. It may be helpful for your Lordships to be aware of the usual circumstances in which certain offences require that the consent of the Director of Public Prosecutions, more usually, or that of the Attorney-General, more rarely, is required before criminal proceedings can be instituted. Generally, the concern to the DPP will be appropriate where either it is very likely that a defendant will reasonably contend that a prosecution for the offence would violate their convention rights or where there is a high risk that the right to bring a private prosecution might be abused and, if so, the institution of proceedings would cause the defendant irreparable harm. In general, prohibiting private prosecutions and ensuring that only the Crown Prosecution Service can prosecute is the check and balance used to mitigate these risks. If an offence involves national security or has an international element, the consent of the Attorney-General may be more appropriate. In response to the question asked by the noble Lords, Lord Verdirame and Lord Bailey, as to the statistics being relied on, it is not clear to me whether the data requested is collected, but I will make inquiries and write to the noble Lord.
I turn to Amendment 459 in the name of the noble Baroness, Lady Eaton. I can reassure the noble Baroness that the Government are clear that the law is also clear: sex is not itself a lawful ground for termination of pregnancy under the Abortion Act 1967. I can also reassure the noble Lord, Lord Hogan-Howe, on the same point. Accordingly, any third party, including registered medical practitioners, who terminates a pregnancy on the basis of the sex of the foetus alone would also be liable to prosecution under the relevant offences relating to abortion.
Turning to Amendments 459B and 502A in the name of the noble Baroness, Lady Maclean, it is worth noting that, as currently drafted, the deadline for the Secretary of State to lay the draft regulations and the deadline for Parliament to approve those regulations is the same in this amendment. Practically, then, the effect might be that, if the Secretary of State lays the regulations on the final day permitted, Parliament would not then have sufficient time to approve them before the deadline. As a result, Clause 191 would automatically cease to have effect, even though the Minister had complied with the requirement to lay the regulations. It is unclear from the amendment as drafted whether that is the noble Baroness’s intention or whether she intends to give sufficient time for both these processes to take place.
Amendment 460 in the name of the noble Baroness, Lady Stroud, and spoken to by the noble Baroness, Lady Foster, who is no longer in her place, would mean that women would no longer be able to have a consultation over the phone or by other electronic means before being able to self-administer medicine for early medical abortion at home, as is current practice. Instead, women would be required to attend an in-person consultation first before being able to take pills at home. The Committee may wish to note that the overall effect of this new clause would be to limit access to home use of early medical abortion pills because of lack of resources for abortion providers to hold in-person consultations. It could also reduce women’s access to early medical abortion due to travel distances, if they live in remote areas, or if they have difficulties attending a clinic for different reasons—for example, vulnerable women, women from more deprived backgrounds or women subject to coercion. The Government wish your Lordships to be aware that, given that the majority of abortions take place via this method, this new clause is likely to have a significant operational impact on access to abortions. That said, this is, of course, a matter of policy for Parliament.
Amendment 461H in the name of the noble Baroness, Lady Lawlor, is similar to Amendment 460 in that it seeks to introduce a requirement for an in-person consultation before medication to terminate a pregnancy may be lawfully prescribed. In addition, Amendment 461H would also require a scan, or what is described as a “clinically equivalent” alternative, to be conducted for all women to determine gestation before being able to take pills at home, whereas the current process is that an ultrasound scan is provided only in certain conditions where there is any uncertainty about gestation or where there is clinical need.
As drafted, it is unclear what is meant by “other clinically equivalent means” when determining the pregnancy’s gestation. Your Lordships may also wish to consider the likelihood that Amendment 461H would also result in additional costs being incurred because of either additional machines having to be bought and staff trained to provide an ultrasound for every woman seeking an early medical abortion, or the alternative, which would be to remove scanning capacity from the provision for other needs. Operationally, the requirement to have a face-to-face appointment and scan may also introduce additional waiting times for abortion care. This would have a particularly negative impact on those awaiting early medical abortion, but it might also have an impact on abortions at a later stage because of loss of system capacity. This could have the effect—unintended, we presume—of more abortions taking place later on. As with Amendment 460, the overall effect of this new clause would be to limit access to home use of early medical abortion pills because of resource issues in relation to the requirement in every case to hold in-person consultations and offer scans.
Amendment 461A in the name of the noble Baroness, Lady Coffey, seeks to apply the criminal standard of proof to medical assessments and decision-making. Your Lordships may wish to note that the operational effect of this additional burden of proof is that it is likely that women would no longer have a consultation over the telephone or by other electronic means before being prescribed medicine for early medical abortion at home, as is the current practice. Instead, women would need to attend an in-person consultation and have an ultrasound. So, for similar reasons to those I have already given in relation to Amendments 460 and 461H, Amendment 461A is likely to limit access to home use of early medical abortion pills and thus result in more abortions being undertaken at later gestation.
Amendment 461, tabled by the noble Baroness, Lady O’Loan, seeks to create a new offence of intentionally encouraging or assisting a termination that is contrary to the Abortion Act 1967. We understand the noble Baroness’s amendment to be intended to work in the following way: a person would be guilty of committing such an offence whether or not a successful termination occurs and the amendment would also require the Secretary of State to issue guidance on the offence following consultation with appropriate stakeholders.
Clause 191 provides that a pregnant woman cannot commit an abortion offence in relation to her own pregnancy, meaning such terminations would no longer be considered unlawful under the Abortion Act 1967. As a result, Amendment 461 would apply only where a third party encourages or assists someone other than the pregnant woman. Your Lordships should be aware that this is already captured by existing encouraging or assisting offences under the Serious Crime Act 2015. Therefore, Amendment 461 would create an overlapping offence. Additionally, your Lordships may wish to note that, in any event, third parties can also still be prosecuted at the moment under primary offences such as Sections 58 or 59 of the Offences against the Person Act 1861 or the Infant Life (Preservation) Act 1929.
I turn now to Amendment 461B, tabled by the noble Lord, Lord Bailey of Paddington. Safeguarding is an essential aspect of abortion care and all abortion providers are already required to have effective arrangements in place to safeguard children and vulnerable adults in compliance with the department’s required standard operating procedures for the approval of independent sector places for termination of pregnancy in England. Your Lordships may wish to consider that the Royal College of Paediatrics and Child Health has published national safeguarding guidance for under-18s accessing early medical abortion services, which seeks to ensure that all abortion providers have robust safeguarding in place. We expect all providers to have due regard to this safeguarding guidance.
Baroness Falkner of Margravine (CB)
I will be very brief because I am conscious of the time. The other purposes for which this drug is prescribed do not require any face-to-face examination—am I correct in understanding that is what the noble Baroness is saying?
Baroness Levitt (Lab)
I am saying that this amendment as drafted would criminalise those who receive that drug by post if they are using it for some purpose other than abortion. It may also be helpful for your Lordships to be aware that this amendment as drafted would make it an offence for a business such as a pharmacy or an abortion clinic to receive these drugs by post.
On Amendment 461G, tabled by the noble Baroness, Lady Maclean, your Lordships may wish to note that not all the information required under this amendment may be readily available. For example, it may not exist, it might require additional collection, or it may be held across different systems. It is unclear how there could be an accurate estimate of those who have illegally acquired abortifacients or the data that this estimate would be based on. Producing this annual report would therefore require the Ministry of Justice and other public bodies to take on additional responsibilities with associated costs.
On Amendment 461F in the name of the noble Lord, Lord Jackson of Peterborough, the Government remain neutral on changing the criminal law related to abortion, but it is important to note that Clause 191 does not decriminalise other offences such as manslaughter, murder or infanticide. These offences will continue to be investigated and prosecuted by the Crown Prosecution Service where the legal test is met. In addition, the police and the Crown Prosecution Service are operationally independent of government, and it would therefore not be appropriate for a Secretary of State to issue guidance. Similarly, the College of Policing and the National Police Chiefs’ Council are also responsible for guidance on investigations for policing.
Finally, I turn to Amendment 461J, tabled by my noble friend Lady Thornton. It is important to note that a pardon does not quash a conviction or a caution; what it does is remove the legal consequences that would otherwise attach to it. As with any pardon or expungement scheme, consideration would need to be given to how such a scheme would operate in practice; for example, how those individuals would be identified. There is no single centrally held record of all cases that may fall within scope of this amendment, so it has implications for how and when the duty to direct deletion would be triggered.
In addition, given the breadth of the amendment, which extends to any record of an arrest or investigation, the scale of the records potentially in scope is uncertain. Also, because the amendment is not time-limited, it would thus apply to dead women as well. Taken together, these factors may mean that implementing such a duty as drafted would carry substantial operational and resource implications for policing, His Majesty’s Courts & Tribunals Service and those responsible for maintaining national databases. The scale of the work required cannot be reliably estimated at this stage but it could be considerable.
Baroness Meyer (Con)
My Lords, I thank all noble Lords who have spoken today. I particularly welcome and support the speeches of the noble Baronesses, Lady Monckton, Lady O’Loan and Lady Foster of Aghadrumsee, the noble Lord, Lord Alton, the right reverend Prelate the Bishop of Lincoln, and so many others who spoke so eloquently and passionately.
It has been a very useful debate, which also highlighted how little scrutiny Clause 191 has received and how significant its potential effects could be—legally, socially and morally. At times, the debate revealed that we were speaking at cross-purposes: balancing the rights of women and the rights or non-rights of viable babies; balancing the rights of vulnerable women versus those who abort for personal or blunt, selfish reasons. We have all heard of women who aborted their child because they were afraid that a pregnancy would ruin their figure.
The noble and learned Baroness, Lady Butler-Sloss, hit the nail on the head. If I may paraphrase badly, it went something like this: Clause 191 risks decriminalising abortions undertaken for personal reasons while failing to guarantee the protection of women who have been a victim of abuse or coercion. This is an issue of such importance that I feel it merits much further consideration and, as the noble Lord, Lord Cameron of Lochiel, highlighted, ultimately it should not be part of the Bill.
I personally remain concerned that Clause 191 could have tragic unintended consequences both for women and for babies able to survive outside the womb. I do not see this as a right to abort, but rather how we as legislators can better protect the vulnerable—vulnerable women and the unborn child. This is why I continue to support the noble Baroness, Lady Monckton, in proposing that this clause should not stand part of the Bill. But, for now, I beg leave to withdraw my amendment.
“(2) The Secretary of State must, no later than 12 months after the day on which this section comes into force, and at least once every 12 months thereafter, conduct a review of its operation and impact.(3) The review under subsection (2) must, in particular, consider—(a) the incidence of medical complications for women acting in relation to their own pregnancy under the terms of this section, including incidence of maternal death;(b) the impact on the health and safety of women undergoing abortions;(c) the prevalence of self-induced abortions outside a clinical setting beyond 24 weeks’ gestation;(d) any reported cases of coercion or abuse related to abortions;(e) the application of criminal law to third parties involved in abortions;(f) any other topics the Secretary of State may consider appropriate.(4) Following the completion of a review under subsection (2), the Secretary of State must lay a report of the findings before Parliament.(5) The Secretary of State may by regulations repeal this section if he or she considers that a report under subsection (4) reveals it is having a detrimental effect.”
Lord Jackson of Peterborough (Con)
My Lords, I know the hour is late, and it might be as well to record for posterity that a number of us were prevailed upon to regroup our degrouped amendments to keep the number of groups at three instead of four. The quid pro quo, as far as I understood from the usual channels, was that we would be allowed a decent amount of time to transact the business. The noble Baroness the Government Whip looks at me innocently—with an innocent visage—but the reason that the hour is late is that, obviously, we have had tributes to the former Lord Speaker, dinner break business and a UQ. I am sorry that your Lordships’ Committee is having to sit later than I would otherwise have liked.
I will not labour again the points I made at Second Reading about Clause 191, but I believe it will exacerbate the dangers inherently present in the pills by post regime. Suffice it to say that the new clause will make it easier to get abortion pills, it will make it easier for abusive partners to coerce women into having an abortion and it will lead to more abortions, including more late-term abortions, thereby putting more women at risk of dangerous complications. My Amendment 457 would introduce a statutory review of Clause 191 to provide a mechanism that is, in my opinion, the bare minimum gesture of seriousness this Parliament ought to make when undertaking such a profound change to the criminal law relating to the protection of human life.
Amendment 457 has three core elements. First, within 12 months of the clause coming into force, the Secretary of State must conduct a review of its operation and impact, followed by annual reviews thereafter. Secondly, there is a requirement that the reviews examine maternal complications, including maternal deaths, the health and safety of women having abortions, late self-induced abortion, connected coercion or abuse and the application of the criminal law to third parties involved in abortions. Thirdly, there is a power for the Secretary of State to repeal Clause 191 if the review shows it to be causing harm. The areas specified for review are not arbitrary but the categories where risk concentrates. They are the precise pressure points where this legislation is most likely to go wrong.
Let me outline a couple of these areas. It is vital we look at maternal complications. There is a serious discrepancy in the Department of Health’s reporting on this. The DHSC’s latest figures published just last month claim a complication rate of just 0.3 per 1,000 early medical abortions, equating to 71 abortions out of 236,000 in total. That sounds very good. It allows the noble Baroness, Lady Merron, the Minister, to repeatedly claim that abortion pills are safe. That is incredibly misleading. The official DHSC figures do not include complications reported after being discharged from a clinic. In other words, they do not include cases where a woman has taken one or more abortion pills at home, then has to go to hospital with infections, haemorrhaging or what is euphemistically called retained products of conception.
Those kinds of early medical abortions make up 82% of all abortions for residents of England and Wales in 2023. When you take into account hospital episode statistics publicly available for the NHS, you find that an estimated 12,000 women were admitted to hospital in 2023 with complications after taking abortion pills. There is a world of difference between 71 and 12,000, but the Government consistently refuse to report on the real picture. I have asked a number of Written Parliamentary Questions about upgrading the HSA4 form but to no avail. The Minister confirmed to me in writing in November:
“The Department has no plans to publish a separate annual report on abortion complications”.
I fear that, with Clause 191, the disparity between the official statistics and what is happening on the ground will only get worse. Modes of abortion provision have changed rapidly. Home-use pills, telemedical arrangements and so on all raise new questions. If Clause 191 increases the risk that women undertake dangerous procedures without clinical oversight or at later gestations, we must know.
Then there is coercion and abuse. Coercive partners, traffickers and other abusers sometimes pressure women into ending pregnancies. We must know whether decriminalisation for the woman inadvertently empowers abusers. Amendment 457 would require that to be examined.
That brings me to the third feature of this amendment: the power to repeal Clause 191 if the evidence demonstrates harm. Without this mechanism, the review would be merely an academic exercise. The repeal mechanism is a safety valve; it would not mandate repeal but make it possible where the evidence demands it. This is entirely normal, especially in sensitive areas of law. We have sunset clauses, review clauses and renewal clauses, all designed to ensure that legislation remains under scrutiny.
Baroness Thornton (Lab)
My Lords, the noble Lord, Lord Jackson, has been around this circuit before, I think on a Private Member’s Bill proposed by one of his noble friends, about collecting the statistics. It shows that he does not actually seem to have checked what statistics are already collected before deciding that these things need to be done. I thought that it might be useful for the Committee to know that the annual abortion statistics already include the ethnicity of the woman and medical complications as part of the treatment. The noble Lord will also be aware that it is incredibly rare that the sex of the foetus is known, because the vast majority of abortions are carried out or happen before 10 or 12 weeks—so that is simply not known or collectable.
Complications from abortion care are extremely rare and are already reported. Abortion care providers are regulated and scrutinised through long-established accountability mechanisms, including published safe- guarding reports and Care Quality Commission inspections. These are on the public record; I am not sure why the noble Lord has decided that these things are not. Doctors are already legally required to provide information about abortions to the Chief Medical Officer, including gestation complications and grounds for an abortion.
The noble Lord is bringing forward amendments that would cause a huge amount of bureaucracy and might risk leaving medical professionals permanently unsure of the status of abortion law. I am sure that we would wish to avoid that happening. I shall be very interested to hear from my noble friend the Minister what the Government have to say about the implications of all these amendments.
Lord Weir of Ballyholme (DUP)
My Lords, I support the amendments in the name of the noble Lord, Lord Jackson. We live in what a lot of us would describe as a post-truth world, in which facts are often passed off as opinions or, worse, that terrible phrase “fake news”. Sometimes opinions are passed off as being completely truthful facts, and sometimes we have misinformation going around the globe that comes not simply from conspiracy theorists on the internet but, sadly, sometimes from world leaders.
Given that context, it is important that when this House resolves on any legislation, looking into the future, that it should be on the basis of evidence, truth and facts. That is particularly true when it comes to abortion. It is an issue, irrespective of your views on it, which is deeply sensitive, and on which raw emotions are often provoked. To some extent we saw that earlier when, at times, the atmosphere of the Committee got a little bit tense. People have genuinely conflicting views on this, so the more we can try to base this on evidence, the better.
That is particularly true for the proposed changes that are being made in Clause 191, for two main reasons. First, although there has been some mention that this has been in the ether for a number of years, the specifics of this legislation came about by way of a Back-Bench amendment to a different piece of legislation, with a limited amount of debate on it. It was not part of a government programme or manifesto commitment. Any Back-Bench Member is perfectly entitled to bring forward an amendment; that is the normal procedure. The downside of that is that there has not been a direct level of consultation on this specific proposal.
Secondly, despite what has been said, there are some concerns about the quality of the data that we have on a range of issues. I listened carefully to what the noble Baroness said, and it seemed that she was putting forward two somewhat contradictory positions. You can either make the argument that all this data is already there and already gathered, and therefore these amendments are unnecessary, or, alternatively, you can make the argument that this would involve so much gathering of data that it would be a bureaucratic nightmare. You can argue either of those propositions, but the two are somewhat mutually exclusive in that regard. It strikes me that when we take decisions on this, it is important to get the data.
It has been highlighted—I think it was mentioned in a Private Member’s Bill that the noble Lord, Lord Moylan, proposed—that there are sometimes concerns over the quality of the data. Perhaps not unsurprisingly—it is not unique to this particular debate—we have heard different people on different sides of this argument quote sometimes contradictory data as to where we are.
It strikes me that there are one or two solutions to these problems, neither of which is mutually exclusive. The noble Lord, Lord Jackson, in the next group of amendments, proposes, apart from anything else, that we pause things until there is a proper consultation period. These amendments then look towards the idea of producing data and a report, and gathering evidence so that there can be a review of the procedures and how things work out. They highlight the range of issues that formed a number of the concerns in the previous debate. These are issues around the level of coercion, the medical complications that arise as a result of changes, whether it leads to a driver on sex selection, and, as mentioned, the incidence of late abortion, which then leads to a live birth. This range of issues highlights a lot of the concerns that were raised in the last group.
I appreciate that we have had this debate today, and that the proponents of Clause 191 will say that the concerns that have been raised—although I am sure they will accept they are genuine—are, in their view, misplaced or perhaps exaggerated, and that we have nothing to fear from Clause 191. Various incidents of what has happened in other parts of the world have been quoted. It is important, therefore, that we test that out. These amendments would gather that data and allow us to assess that. If we are dealing with false fears then, for the proponents of Clause 191, this will strengthen their argument in a year or two years’ time, whenever these things are reviewed. If the fears are genuine and are realised, however, then it is important, as the noble Lord, Lord Jackson, says, that if we gather evidence, it is not some sort of desktop exercise where we simply look at figures. If we gather evidence then it should be on the basis of having the opportunity, if it shows that there are increased dangers, for instance, to women or concerns over any other categories, to take a level of corrective action. That seems a very sensible course of action. I do not think there is anything that anybody should have to fear in these amendments, so I commend them to the Committee.
Baroness Barker (LD)
My Lords, I listened to the noble Lord, Lord Weir of Ballyholme, and what he said sounds eminently sensible, but the problem is this: the noble Baroness, Lady Thornton, has set out the level of detail that is already gathered. The noble Lord, among other Members of your Lordships’ House, have gone on all day about telemedicine and coercion, yet when the royal colleges set up the evaluation of telemedicine, when it came in during Covid, they took particular care to examine issues such as that. They came up with data that showed that telemedicine was safe. Actually, it not only discovered women who were being coerced; it discovered women who were being trafficked. Yet Members of your Lordships’ House still trot out the same argument time and again. I listened to the noble Lord, Lord Weir of Ballyholme, and the arguments of the noble Lord, Lord Jackson, and I am afraid I rather think that it does not matter what data we collect: they will make the same arguments over and again.
My noble friend Lady Brinton cannot be here this evening, but she particularly wanted to say this: the detail of these amendments is designed to confuse and delay the safe and effective legal rules of abortion. They would also take abortion out of the clinical sphere, trying to exceptionalise it and create an environment so hostile that it would deter women and, equally important, clinicians and medical staff, as the rules become more and more complex; and it would also be at the whim of the Secretary of State to amend details or to report at various times. It is a worrying idea to use secondary legislation to make everything more complex, because it gives Ministers the powers to change things and causes confusion and distress.
Lord Weir of Ballyholme (DUP)
I have listened to what has been said. Initially, I was not quite clear whether it was an intervention or not, but I appreciate that it is actually a speech. I think comparisons with America are somewhat facile, because if we were gathering data, it would be on an NHS-wide basis in that regard. The idea of anybody, as you would have in the United States—where an individual county will take a particular view—imposing different decisions or requiring different things is not something that could happen in this country. By all means, criticise the amendments and try to take them apart, but let us not make false comparisons based upon the very different federal system they have in the United States compared with what happens here.
Baroness Barker (LD)
I do not think that it is a false comparison. What we are saying is that, instead of having a system that is democratically decided openly and in Parliament, we will leave it to regulation and officials. I think that is wrong.
The other thing that my noble friend Lady Brinton wanted to say relates to proposed new subsection (3) in Amendment 457. Imagine a woman who is, in the words of the amendment,
“acting in relation to their own pregnancy”,
having to identify and report medical complications. What does that mean? I do not think that that is intended to make it any easier for a woman in need to access the care she needs. I think it is intended to frustrate and, therefore, I hope that these amendments will not be passed.
Lord Jackson of Peterborough (Con)
My Lords, before the noble Baroness sits down, I fail to understand the logic of both the noble Baronesses, Lady Thornton and Lady Barker, in setting their face against collecting more data. The fact is, we are not certain. We are still not certain as to the veracity and accuracy of any of this data. To give an example, the Royal College of Gynaecologists has issued “Making Abortion Safe” guidelines to providers for the safe use of medical abortion after 20 to 22 weeks. These guidelines recommend the use of feticide to avoid the foetus being born with signs of life, which can cause distress for women and their care providers. In the same guidelines, the RCOG states that there will be a
“need for further intervention to complete the procedure”
in 13% of cases. That is more than twice the highest rate reported by the—
Baroness in Waiting/Government Whip (Baroness Anderson of Stoke-on-Trent) (Lab)
Order. My Lords, I am ever so sorry, but an intervention, according to the Companion, should be short, brief and specific to the point. So, if the noble Lord could actually make his point, I would be grateful.
Lord Jackson of Peterborough (Con)
Standing Order 29 does not apply, and I am entitled to speak more than once in—
Baroness Anderson of Stoke-on-Trent (Lab)
Absolutely, but this is an intervention.
Lord Jackson of Peterborough (Con)
I have not finished yet. Standing Order 29 does not apply in respect of the ability for a Member individually—
Baroness Anderson of Stoke-on-Trent (Lab)
My Lords, the hour is late, and I appreciate that this has been a very difficult debate. What I am saying is that the rules on an intervention are clear. The noble Lord is absolutely right that he can speak repeatedly, but he said
“Before the noble Baroness sits down”,
so we believed this to be an intervention.
Lord Jackson of Peterborough (Con)
The Government Chief Whip is very flexible when it comes to that side of the Chamber segueing between speeches and interventions, and she does not intervene. It is only on this side that she intervenes, to throw off this side. The points she has made are not in line with what the Standing Orders and the Companion say, which is that a mover of an amendment and others are entitled to speak more than once.
Baroness Anderson of Stoke-on-Trent (Lab)
The noble Lord has just promoted me, and I thank him for that. However, we have a very good Government Chief Whip, who I am privileged to serve under. The noble Lord will appreciate that, through my whipping, I have been trying to manage this in such a way that everybody has been able to be heard. Regardless of position, I do not think anyone here knows my personal views. On the current topic, it is the name of the noble Baroness, Lady Barker, that is still on the annunciator, and the noble Lord indicated that he wanted clarification on a point before the noble Baroness sat down. That is what I was saying. We all believed it to be an intervention. If it is not, we can move on and revert back to the noble Lord for his second speech.
Baroness Barker (LD)
My Lords, I think my case has been made. These are a set of amendments which are designed to be unworkable. They are wrecking amendments, and I hope that we will not pass them.
Baroness Coffey (Con)
The thing about Amendment 461C, bearing in mind what the noble Baroness, Lady Thornton, has said, is that quite a lot of this data is collected. Clearly, it was late this year, and there would be no point in doing a JR on the basis of that.
I understand that not every abortion happens at the point at which the sex of the foetus is known, but that data would be worth collecting, given the concerns that exist about gender or sex-selective abortion. It might be worth the ONS adding the question to the questionnaire or HSA4 form in the future.
Last year, the collection rate on ethnicity was 92%, but it would be useful to understand what further work the ONS might be doing to try to get that up to 100%.
Lord Cameron of Lochiel (Con)
My Lords, I thank all those who have spoken in this debate, and my noble friend Lord Jackson of Peterborough for tabling these amendments. I have already set out at length the view of the official Opposition on what we see as the procedural issues with Clause 191 in my response to the previous group. I will not repeat myself, but simply refer your Lordships to my previous comments.
My noble friend’s amendments relate to the provision of information and statistics relating to abortions and complications arising from abortions. As has been highlighted by my noble friend Lord Moylan in his Private Member’s Bill on this topic, there is an issue with the collection of data for complications from abortions. To conclude, I hope the Minister will be able to set out what action the Government are taking to improve the collection of data for such complications.
Baroness Levitt (Lab)
My Lords, the amendments in this group all relate to reporting requirements and monitoring abortion services. It is important to say again that the Government are neutral on this. My remarks are limited to workability, operational concerns or possible unintended consequences. I am not going to speak to all the amendments, only those where there are particular issues that should be brought to the attention of the Committee.
Amendment 457, tabled by the noble Lord, Lord Jackson of Peterborough, as currently drafted means that parts of the information that would be required are broad and the exact meaning is not always clear, raising practical workability issues. Not all the information required may be readily available, and producing an annual report would require the Department of Health and Social Care to take on additional reporting responsibilities, with associated costs.
Amendment 458, also in the name of the noble Lord, Lord Jackson of Peterborough, seeks to require the Secretary of State to produce an annual report detailing complications from abortions procured contrary to the Abortion Act. Determining whether specific cases fall within the report’s remit would require investigations to determine whether they could be considered to be contrary to the Abortion Act. This could necessitate involvement from medical professionals or other public bodies to review individual circumstances.
Further, as I have just said in relation to Amendment 457, as currently drafted parts of the information required are broad and the exact meaning is unclear, raising questions about practical workability. Not all the information required may be readily available; for example, it may not exist, it may require additional collection or it may be held across different systems, including the abortion notification system held by DHSC and patient records within the NHS.
Your Lordships may also wish to note that producing this annual report would require additional responsibilities with significant associated costs to the Department of Health and Social Care and other public bodies.
Amendment 461C would require the Secretary of State to publish an annual report disclosing data collected as required under Section 2 of the Abortion Act. I can confirm what has been said by my noble friend Lady Thornton: the Department of Health and Social Care’s abortion notification system already collects data on the self-reported ethnicity of the woman, when known, and complications that occur up until the time of discharge for all abortions. This data is published in the annual abortion statistics publication for England and Wales. However, as my noble friend Lady Thornton also commented, the abortion notification system does not currently collect information on the sex of the foetus, as most abortions are performed at an early gestation when the sex of the foetus will not usually be known.
On two further matters, the noble Lord, Lord Jackson of Peterborough, is correct: there has been a delay in the publication of the abortion statistics, but not for policy reasons. These are operational issues, which include moving to a new data processing system. We will announce dates for the publication of the 2024 data in due course.
Finally, on the question of sex ratios at birth, raised by the noble Baroness, Lady Coffey, the Department of Health and Social Care remains committed to publishing these statistics, and the publication dates for sex ratios at birth in the United Kingdom from 2018-22 and 2019-23 will be announced in due course.
Lord Jackson of Peterborough (Con)
My Lords, I thank noble Lords for their contributions to the debate, including the noble Baronesses, Lady Thornton and Lady Barker, in particular, my noble friend Lord Cameron and the Government Whip, who is always very strict in the House, perhaps for the right reason.
It has been a good, lively debate. If I may press the Minister, and if she would perhaps be so good as to write to me on this, I have never had a satisfactory answer on the point I made earlier, about the use of the HSA4 form and why complications arising from terminations when a woman has left the clinical setting are not collected. It may not be hundreds of thousands, but it is a significant cost in terms of health outcomes and trauma for that woman, and cost for the NHS and private providers. We still need to know why that is not captured, because it does not provide the whole picture.
Nevertheless, with the proviso that we will return to this issue of data collection and empirical data that informs policy decisions, I seek the leave of the Committee to withdraw my amendment.
“(2) Subsection (1) does not apply if the gestational age of the pregnancy exceeds 39 weeks.(3) For the purposes of subsection (2), the gestational age of a pregnancy is to be calculated from the first day of the woman’s last menstrual period.”
Lord Jackson of Peterborough (Con)
My Lords, I promise I did not allocate the amendments in these groups, so I am sorry if noble Lords have had enough of me. In fact, I have had enough of me today—but we are on the home stretch.
It will be obvious that Amendment 459A is a probing amendment, but it raises a very important point. It makes absolutely clear just what Clause 191 is going to permit. I believe it is beyond the bounds of what any responsible legislature should accept. As we all know, at 39 weeks’ gestation, a pregnancy has reached full term. At this stage, one is no longer speaking of premature viability, uncertain outcomes or developmental limitations; one is speaking, as clinicians will confirm, of a baby about to be delivered. Do we really believe that the criminal law should be entirely silent about the responsibility of the mother at that point? Should Parliament not insist upon a basic threshold of protection for the viable child who is quite literally on the threshold of birth?
The Deputy Chairman of Committees (Viscount Stansgate) (Lab)
The noble Lord is moving his amendment.
Lord Jackson of Peterborough (Con)
I am taking an intervention. I was more than happy to take an intervention from the newly minted noble Lord, Lord Doyle, but on the basis that wiser and better heads have prevailed, I will continue my words briefly.
The current criminal framework provides an important safeguard for women, particularly those under 16 and those who are vulnerable or at risk of coercion in what is already a highly permissive system. During the debate in the other place, the sponsor of the amendment, the honourable Member for Gower, claimed that legislative changes were needed “to protect the women”, but removing the legal deterrent to late-term abortions will only increase harm to women. It will mean a return to the days of backstreet abortions. A desperate woman will know she can end her pregnancy after 24 weeks without facing any police investigation for it, but she will be unable to obtain the abortion legally and so she will be driven towards illegal and unsafe providers.
A report in advance of the provisions coming into force might highlight all this and give us all a chance to think again, if indeed we are willing to think. There is a fanaticism around support for abortion that makes many people unwilling to consider the evidence. For example, some of the academic literature provides insight into the often-overlooked psychological impact of abortion, which was mentioned earlier. One study of 1.2 million pregnancies in Quebec hospitals followed women over a 17-year period. The results revealed that women who had an abortion were much more likely to be hospitalised for mental health conditions, such as depression and anxiety, as well as for substance abuse and suicidal ideation. This risk was higher among women who were under 25 at the time of their abortion and among those with a history of mental health difficulties. Another study found that, for many women, having an abortion is associated with lasting negative emotions such as feelings of guilt, regret, shame and self-unforgiveness. These feelings were strongest among women who reported being coerced.
I am constantly amazed at how little many feminists have to say about coerced abortion. The introduction of telemedicine abortion has undoubtedly made it much more difficult for coercion to be detected. A 2022 survey commissioned by BBC Radio 4 found that 15% of women have experienced pressure to have an abortion. This points to a significant cohort of women who are not exercising choice but are being manipulated into terminating the life of their unborn baby. I give way to the noble Baroness.
The Deputy Chairman of Committees (Viscount Stansgate) (Lab)
If it helps the Committee, I note that an intervention cannot be made when someone is moving an amendment. The noble Lord is moving his amendment.
Lord Jackson of Peterborough (Con)
I am very grateful for that guidance, and I apologise for starting to accept what I am sure would have been a sparkling intervention from the noble Baroness, Lady Bennett of Manor Castle.
There are huge gaps in our understanding, particularly in relation to complications, but I will not repeat the points I made on my previous amendments. Suffice to say, there is a pressing need for a more comprehensive and robust system of data collection. My noble friend Lord Moylan’s Bill, which is currently awaiting Report, seeks to address this deficiency by ensuring that complications are more accurately reported. It would be remiss to proceed with Clause 191 without first seeking to understand the consequences for the recording and monitoring of abortion outside a clinical setting, particularly when we know that the present framework fails to capture the true scale of complications.
Finally, it is deeply regrettable that we are being asked to approve the most far-reaching change to abortion law since 1967 without the public having first been consulted. A change of such moral, legal and societal consequence warrants proper consultation, yet the public have been afforded no such opportunity.
Whichever side of the debate one may be on, we can surely agree that this is a matter that should not be pursued without proper consultation and consideration on its likely impact. I therefore urge noble Lords to support my amendment. I beg to move.
Baroness Coffey (Con)
My Lords, I support my noble friend’s Amendment 562, particularly his proposed new subsection (13)(e). I did not hear from the Minister earlier about what they are going to do once Clause 191 goes ahead—assuming it does; we will decide on Report whether or not that will happen. I do not think that the Minister will answer that today.
Amendment 562 would require the Government to give some proper consideration to how this is going to work in practice before it is enacted. For that reason, it is a sensible way to get a bit of breathing space to open up what we are walking into and, for those where potential crimes are committed, given that one person in the arrangement has been decriminalised, what is going to happen to the people who have facilitated what could be a crime. That is why I support Amendment 562 at this stage.
Baroness Thornton (Lab)
As we have heard from the noble Lord, Lord Jackson, basically, this suite of amendments drives a coach and horses through abortion rights as a whole, as well as, of course, completely opposing the clause that is under discussion. For example, virtually zero abortions occur at 39 weeks’ gestation. Taking abortion pills at that stage of gestation would simply induce labour. To accept the amendment would mean continuing criminal offences for abortion for vulnerable women. The same applies to the other suite. There would be delays and reversals, and vulnerable women would continue to face life-changing and traumatic investigations.
Amendment 563 is a wrecking amendment linked to all the other amendments to delay the implementation of the change in law. So while the noble Lord might say that he is—
Baroness Coffey (Con)
Forgive me for interrupting the noble Baroness, it is just that the annunciator has still had my name for the last minute, when indeed it is the noble Baroness, Lady Thornton. It has just changed now.
Baroness Thornton (Lab)
I do not mind. At this stage, they are probably a bit tired too, changing the annunciator.
The noble Lord might say that he is not opposed to abortion but, frankly, these amendments suggest that he probably is.
Lord Doyle (Lab)
My Lords, I should make the point that I jumped to my feet to make earlier—on the comment that the noble Lord made about how long this issue had been debated in the other place for.
The noble Lord was a Member of the other place previously. I have not had that privilege, but we should show colleagues there a little bit more respect, in that the amount of time that they spent debating this issue should not be seen as an indication of whether or not they actually supported it. I am not sure whether the noble Lord is suggesting, if they had debated it for 46 hours or 46 days that, somehow, the 379 MPs who voted for the clause would not have done so or that they were not aware of what they were voting for in the first place.
Lord Jackson of Peterborough (Con)
As the noble Lord has specifically challenged me on that issue, the point that was raised in earlier groups was that for government Bills there is an impact assessment, an equality impact assessment and pre-legislative scrutiny. There is significant public consultation resulting from the Cabinet Office, as the noble Lord knows very well, and there are guidelines as to public consultation. None of that happened on this occasion. Therefore, let us pay due regard to the deliberations, scrutiny and oversight of the Commons if there is a proper due process in the way that a Bill evolves and is debated, tested and challenged.
That has not been the case on this occasion, and it is very similar to the pills by post situation. The original wording of the pills by post amendment in the Commons was disorderly and had to be rewritten by special advisers in the Department of Health before it was introduced in the House of Lords. That was tacked on to a Health and Care Bill in the same way that this has been tacked on to a mainstream Crime and Policing Bill. So, with all due respect to the noble Lord, I do not think that his analysis stands up to scrutiny.
Baroness Bennett of Manor Castle (GP)
My Lords, I will just very briefly intervene, as I was going to intervene until I was corrected. I have learned something—it is always good to learn new things in your Lordships’ House. The noble Lord cited a number of statistics suggesting that abortion was something that did emotional damage to women or that they regretted afterwards.
I will just cite one landmark study, published in Social Science & Medicine in 2020—this is in the context of America, where there is a huge amount of pressure and social discussion around abortion—which said that five years after having had an abortion more than 95% of women said it was exactly the right decision for them. That is a very different figure from those the noble Lord was citing. It is important to put that on the record for anyone who might be reading the debate and thinking about this.
Lord Cameron of Lochiel (Con)
My Lords, I thank my noble friend Lord Jackson of Peterborough for tabling these amendments. Again, I refer to comments that I made in the earlier group about procedure, during which I noted the absence of an impact assessment and consultation. My noble friend’s amendments attempt to insert those processes later on in the legislative stages, and reflect in some way what I said on that earlier group. I look forward to the Minister’s response.
Baroness Levitt (Lab)
My Lords, your Lordships have heard me say now on at least two occasions that the Government are neutral, and therefore my only observations are about workability and operational issues.
I can respond to the amendments in this group in the name of the noble Lord, Lord Jackson of Peterborough, very briefly. It is unclear whether Amendment 563 is intended as an alternative to Amendment 562. If it is not, they would create two parallel commencement powers for Clause 191, each imposing slightly different and conflicting obligations on the Secretary of State.
In any event, your Lordships may wish to consider that not all the information required to produce the report as described in the amendment may be readily available within the timeframe, and some of the areas to be considered—for example, standards of clinical oversight—are broad. Although the amendment does not specify the consequences of failing to meet the specified deadlines for consultation or reporting, its effect would be that missing these deadlines would prevent Clause 191 coming into force.
Lord Jackson of Peterborough (Con)
My Lords, that is a very brief response from the Minister. I do not think the two amendments that I put to the Committee at this late hour are mutually exclusive—they are complementary. One is about a public consultation exercise and one is about a report to be prepared by the Government using secondary legislation. I accept that there would be an element of discretion for the Government. Obviously, this would be primary legislation in the Bill, but it would be largely facilitated—as the Minister knows, being a very eminent lawyer—by secondary legislation.
I finish very briefly with one thought. To a certain extent, the situation with this clause, and how the Government have handled it, is if not quite novel then constitutionally unusual, because the Minister is not in a position to answer detailed questions. She has undertaken to write and we take her at her word.
The clause is a cuckoo in the nest, really. The Government are, in effect, saying that they do not support it and they do not oppose it but it is in the Bill. I do not always praise the leader of my own party, but I will on this occasion. She had the courage of her convictions to whip in the other place against the whole Bill, even though it is largely a very good Bill, because of the inclusion of Clause 191. The Government should resolve this constitutional novelty and the odd situation arising from the fact that they did not have the moral courage to push back against the Member for Gower, which they should have done, and say that Clause 191 is too extreme and does not have a place. The Government should have said that this clause should be put it in a Private Member’s Bill, or that the Member should lobby Government Ministers to bring it forward as government legislation. But they did not do that; they put it in the Bill. They are therefore going to need to give better answers by the time it gets to Report.
For all that, I appreciate the Minister’s efforts to answer some questions and to undertake to write. On that basis, looking forward to further discussions on Report, I beg leave to withdraw my amendment.
“Providing assistance under assisted dying legislation in Crown Dependencies: criminal liabilityIn the Suicide Act 1961, after section 2A (acts capable of encouraging or assisting suicide) insert—“2AA Assistance provided in Crown Dependencies(1) In sections 2(1) and 2A(1), a reference to an act that is capable of encouraging or assisting suicide or attempted suicide does not include—(a) participating in acts that facilitate the provision of a medically assisted death in Scotland or the Crown Dependencies (the “jurisdictions”) under or in connection with legislation in those jurisdictions (“relevant legislation”),(b) performing any other function under that relevant legislation in accordance with that relevant legislation, or(c) assisting a person seeking to end their own life in accordance with that relevant legislation to access that relevant legislation.(2) It is a defence for a person charged with an offence under section 2 to prove that they—(a) reasonably believed they were acting in accordance with relevant legislation in those jurisdictions, and(b) took all reasonable precautions and exercised all due diligence to avoid the commission of the offence.””
Baroness Finlay of Llandaff (CB)
My Lords, I am not moving this amendment, but I feel I owe it to the House to explain why I took my name off it when it had been drafted. I was contacted by the Chief Minister of the Isle of Man, who felt that it was premature: they had not been consulted, their Bill has not received Royal Assent, and they felt that a considerable number of parliamentary colleagues would be greatly concerned if this was to pass as an amendment without formal consultation. I feel I should simply place that on the record, but I do not wish to move this amendment, so I realise that this is slightly irregular.
Member’s explanatory statement
This amendment is consequential on my amendment to clause 192, page 223, line 27.
Member’s explanatory statement
This amendment removes provision that is no longer needed because of the general data protection override in section 183A of the Data Protection Act 2018, which was inserted by section 106(2) of the Data (Use and Access) Act 2025 and came into force on 20 August 2025.