Neil Graham on the dangers of advertising abortion advice

In May Channel 4 broadcast a television advertisement for the sexual and reproductive health charity Marie Stopes. The charity says that its aim is to prevent unintended pregnancies and unwanted births. The advert, the first of its kind in the United Kingdom, has been criticised, largely by campaigners opposed to abortion. Indeed the Advertising Standards Authority received 501 complaints in the week after.

But the issue is not the rights or wrongs of abortion: those on both sides of the debate have serious cause for concern. Marie Stopes has shown that any charity may screen an advert on UK television and seek to advise pregnant women without declaring its interests first. The duty to safeguard patients’ best interests does not simply extend to pro choice, or anti-abortion doctors, it is incumbent on all of us to ensure that patients receive decent, transparent advice. We must ensure that the advertising rules come to reflect this view.

The advertisement was shown on Channel 4 in England, Wales, and Scotland; abortion remains illegal in Northern Ireland. It showed three pensive looking women, with the text “Are you late?” It then showed the charity’s name, telephone number, and web address. A voice explains, “Are you late? If you’re late for your period you could be pregnant. If you’re pregnant and not sure what to do, Marie Stopes International can help.”[1]

We should beware the assumption that charities have inherently benevolent intentions and provide advice of a high quality. Marie Stopes offer excellent, impartial advice, but there is no guarantee that this is true for all such charities.

Imagine that another charity produces a similar advert with different contact details. Pregnant women are encouraged to telephone a line that provides them with advice of the most extreme and partial nature, pressuring the woman to change her decision on the future of the pregnancy. The advice given at the end of the helpline is not subject to the same scrutiny as the advertisement, and there’s no reason that a relatively benign advert shouldn’t accompany an ethically dubious advice service.

A decision on the future of a pregnancy should be a choice that is genuine, fully informed, and free from improper pressure.[2] But advertisements by their nature seek to distort decisions, unbalancing this equation. Autonomy for women to decide for themselves is paramount, but where the criteria for an informed decision cannot be met, as in other areas of medicine, we grudgingly accept that paternalistic principles of beneficence must take precedence.
Advertising Standards Authority codes therefore demand that adverts be at least legal, decent, and honest. Decisions associated with a higher innate risk are subject to greater regulatory constraints—for example, mortgage adverts must provide further information, the “small print.” For decisions associated with the highest risk no quantity of small print is thought sufficient to protect consumers. That is why the advertising of prescription drugs to patients is banned in the UK.

The rules consider services that give advice after conception to be in the same category as services offering relationship advice, life-coaching and psychic readings, to name but a few. [3] And there are discrepancies among the rules for post-conception services advertised on billboard, radio, or television. Any services that offer advice on the management of pregnancy may advertise using non-broadcast media; only state approved broadcasters may advertise on radio, such as family planning centres approved by a local health authority, the Central Office of Information, or “another appropriate NHS body”; and television is open only to adverts from the state and charities.[4] [5]

The Advertising Standards Authority acknowledges that inconsistencies exist but argues that these reflect the view that some forms of communication are “more affecting” than others. Television sits at the top of this hierarchy, though notably not in this case, which the ASA suspects might be the result of cost differences between the media. They argue that previously advertisers of pregnancy advice services could only afford to use radio, and that rules to cover television were never required, and therefore never produced.

The distinction between profit making and charitable bodies is not easily explained by the ASA, who point out that the rules have been inherited through various regulators (Ofcom, the Independent Television Commission and the Broadcasting Authority). This was the rationale for a review of the codes in 2009, whose ruling on pregnancy advice services has been postponed, having aroused considerable debate. If the rule aims to protect patients from the free market, it must surely fail because the two are subject to similar influences. Both compete for market share, aim to expand and win contacts, employ and protect the interests of staff, and operate with particular ethical approaches.

How then are the inconsistencies to be resolved? The Committee of Advertising Practice could stipulate that, as for mortgages, charities have to fill their adverts with small print, detailing, for instance, the organisation’s objectives and ethical views. This would provide patients with a filter through which to interpret advice, but those charities with the greatest ability to pay would remain able to buy the greatest influence over patients.

Extending the ban on commercial services’ advertising on television to include charitable organisations is probably the least bad option, and should win reluctant favour both with those who support the law on abortion, and those who oppose it. The National Health Service would remain well placed to disseminate information in a democratic fashion, reflecting social consensus, subject to freedom of information legislation and accountable to voters rather than the market. Health professionals should make this case clearly, and soon, to be sure that the opportunity presented by the advertising code review does not go to waste. Marie Stopes’s advert might then become even more historic: both the first and last of its kind in England, Scotland, and Wales.
2 Herring JJW. The caesarean section cases and the supremacy of autonomy. In Freeman M, ed. Law and medicine. Oxford University Press, 2001.
3 Broadcast committee (BCAP). The BCAP Code Review full consultation document and Annex 1: the proposed BCAP Broadcast Advertising Standards Code. 2009.
4 Non-broadcast committee. British code of advertising, sales promotion and direct marketing. 11th ed. 2003.
5 Broadcast committee (BCAP). Broadcast codes (BCAP Codes).

Neil Graham is a medical student in his penultimate year of study at University College London. He read preclinical medicine at Sidney Sussex College, Cambridge, where he specialised in pathology.