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Marge Berer: Independent abortion counselling? Whose problem?

1 Sep, 11 | by BMJ Group

Marge BererNadine Dorries MP is a very skilful politician. She decides there is a problem, for which she has absolutely no evidence. She not only manages to get her problem on to the front pages of the newspapers but also on to the agenda of the House of Commons. Having spoken to her about it, the Department of Health (DoH) agrees to take it up and resolve it without putting it before Parliament. But the DoH have no evidence of a problem either. Nadine Dorries wants to make life harder for the one in three women in this country who will have an abortion in their lifetimes. But what excuse does the DoH have? One can only presume they were trying to stop Dorries from stealing the limelight from Andrew Lansley’s NHS bill next week, which is contentious enough without her. Today, as reported by the Guardian,  Downing Street has intervened.

What was going on? Earlier this year, Dorries claimed that the British pregnancy advisory service (BPAS) and Marie Stopes, who provide a high proportion of abortions for the NHS and for non-NHS patients, do not give unbiased abortion counselling because they earn money from providing abortions. This is patently untrue. The ethos of non-directive counselling has been central to abortion provision since the 1967 Abortion Act was passed. It is in no one’s interest for abortion clinics and counsellors to do otherwise than give unbiased information and counselling: that is their job. Dorries does not cite claims by any woman that an abortion counsellor or doctor talked her into having an abortion, or encouraged her to do so when she wasn’t sure. She merely says that the process is too fast, as if women with an unplanned pregnancy don’t think about it on their own, sometimes for weeks or even months, before approaching an abortion clinic.

In June, when this hit the news, I wrote to Anne Milton, parliamentary under secretary of state at the DoH, to protest against Dorries’ claims, and to ask what the problem was as they saw it. In mid-July, I received two replies from two different civil servants. The first said that women needed to know about “the risks to health (including mental health) posed by the abortion procedure as well as any health risks posed by continuing the pregnancy, to enable [them] to make a decision that would benefit [their] overall health and wellbeing.”

The other, some days later, said: “The department is drawing up proposals to enable all women who are seeking an abortion to be offered access to independent counselling provided by appropriately qualified individuals. Independent counselling will focus on enabling a woman to make a decision that would benefit her overall health and wellbeing. Independent counselling will be for those women who choose to have it and will not be mandatory. Full proposals are still being worked up within the Department of Health and it is therefore unable to provide detailed answers while this process takes place.”

Thus, although the department decided to approach this differently from Dorries, Dorries still managed to make her problem official – BPAS and Marie Stopes, the accredited independent providers of abortion and abortion counselling, about whose counselling no one save Dorries had complained, were seen as neither appropriate, qualified, nor independent enough, and were not acting in the interests of women’s health and well-being. Therefore a second tier of counselling should be made available to women – yet it wouldn’t be mandatory! It couldn’t have been more confused.

On 25 July, I wrote to Anne Milton again to ask to see the evidence that the abortion counselling being provided by BPAS and Marie Stopes was in some way deficient, and whether she intended to make any such information public or not. I also asked:

  • How the department defined “independent counselling” for women considering or seeking abortion, and if anyone currently provides it.
  • If no one currently provided it, did she intend for the department to set up such counselling centres, and/or
  • Did she consider that groups who advertise themselves as willing to help women with unintended pregnancies, but who do not and will not refer women to an abortion provider even if they ask for such a referral, are able to give independent counselling?

I did not receive a further reply.

Health risks? The fact is that induced abortion with a trained provider is among the safest clinical procedures available. As for mental health, recent reviews of the literature by the American Association of Psychologists and by the Royal College of Psychiatrists have shown yet again that unless a woman has mental health problems prior to getting pregnant, abortion does not increase the risk of mental health problems after it. When will that be believed?

Still, what’s that got to do with the need for independent counselling? Does the DoH believe so-called crisis pregnancy centres can do the job instead? A recent study of eight such centres in England found that many of their counsellors lacked basic listening and counselling skills and also lacked practical and accurate information about abortion and other options. Some advised against having an abortion at any cost, for example by giving dramatic misinformation, such as that 100% of women who have abortions will get cancer. Two centres did provide straightforward and impartial advice, but the “added value” of any of these centres was not clear in comparison with counselling by an accredited abortion provider. [1]

But why worry about evidence?

Dorries’ amendments would have provided an inflammatory and unwelcome distraction from the debate on the NHS Bill and the ills that Bill is set to bring us. The Speaker of the House might not have selected the amendments anyway, given that the DoH is (or was) on the case, in pursuit of a problem created out of thin air.

Now, let’s get to the real issue: calling for the withdrawal of the entire NHS Bill.

1. Education for Choice. Snapshot of Crisis Pregnancy Centres operating in England. 2011. At: <www.efc.org.uk>.

Marge Berer is the founding editor of Reproductive Health Matters, chair of the Steering Committee of the International Consortium for Medical Abortion, and a member of Voice for Choice, a coalition of pro-choice organisations in the UK. She was the first chairwoman of the Gender Advisory Panel, WHO Department of Reproductive Health and Research, from 1996 to 2001, and a member of the International Women’s Advisory Panel of the International Planned Parenthood Federation from 1993 to 1998. She edited a book in 1991-93 on women and HIV, sexual and reproductive health. She has been an advocate for abortion rights and sexual and reproductive health and rights since 1976, and has given numerous presentations and written many papers on these issues.

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  • Bhehir

    A good argument against turning the clock back on abortion rights

  • http://twitter.com/Ranmore Ranmore

    Not sure Nadine is that skilful a politician – her amendment was framed so badly even “Life” took fright because they thought it would bring their “counselling” under DoH control. It's great to see support for the amendment is evaporating. You work on this is greatly appreciated, as always!

  • http://pulse.yahoo.com/_ZWE3CJNGSPNNK3X4WJKSQ5GPTI HC

    Berer seems to suggest that there is no problem with abortion counselling in the UK. If that was the case, why has the UK among the highest abortion rates in Western Europe? Even Lord Steel admits that there are “too many abortions” and that abortion is used as a “form of contraception” (link: http://www.telegraph.co.uk/new… )Could the “ethos of non-directive” abortion counselling be part of the problem?  
    I would like to draw your attention to the legal
    situation regarding abortion counselling in Germany. Germany has an abortion rate of 
    7.1/1000 women aged 15-44, in contrast to England and Wales, where the rate is 
    17.5/1000 women aged 15-44. So the abortion rate here is more than twice the German abortion rate. The German abortion rate has come down over the past decades.

    German law regarding abortion is actually very clear regarding the nature of counselling before an abortion. The law states:

    “The counseling serves to protect unborn life. It should be guided by
    efforts to encourage the woman to continue the pregnancy and to open her
    to the prospects of a life with the child; it should help her to make a
    responsible and conscientious decision. The woman must thereby be aware,
    that the unborn child has its own right to life with respect to her at
    every stage of the pregnancy and that a termination of pregnancy can
    therefore only be considered under the legal order in exceptional
    situations, when carrying the child to term would give rise to a burden
    for the woman which is so serious and extraordinary that it exceeds the
    reasonable limits of sacrifice.   (…)”

    and:

    “The
    physician who performs the termination of pregnancy is excluded from being
    a counselor. “
    (my emphasis.  link  http://www.iuscomp.org/gla/sta… )

    German law stipulates that abortion
    counselling starts from the premise to encourage the woman to continue
    the pregnancy, including making her aware of the unborn child's own
    right to life. This seems to be in significant contrast to the UK approach.

    After counselling, there is a minimum period of 3
    days before the abortion can be carried out (unless there is a medical
    indication for the termination or in the case of rape)

    The
    Dorries amendment was obviously much more modest than what has been
    codified in German law for many years, yet seems to attract almost
    hysterical opposition from some quarters here in the UK. The world has not come to an end in Germany as a result of the abortion regulations!

    The
    abortion rate in Germany is much lower than in the UK. Obviously there are
    also other factors that come into play, and not just the type of abortion counselling, for example lower teenage
    pregnancy rate. Yet  Germany has mandatory abortion counselling  with the focus to encourage the continuation of the pregnancy, followed by a brief “cooling off” period.

    Could it be that the “non-directive counselling” as advocated by Berger has contributed to some extent to the high abortion rate in the UK?

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