UK’s Healthcare leadership should focus on decriminalising abortions by Anna Sri

On Sunday 24th June 2022, the USA’s Supreme Court made a monumental decision that allows politics and laws (of each state in America) to criminalise women who seek a basic healthcare service – an abortion. Since then, UK politicians and lawmakers may consider enforcing new legislations, so that women and people could be denied their right to make moral choices on their pregnancy, further undermining their humanity to exercise their innate rights to bodily autonomy. However, it is strongly argued that abortion, the medical or surgical termination of a pregnancy, should be treated like any other healthcare intervention.

I am mortified as a woman that my reproductive organs may be governed by people I don’t know, who don’t care about my personal choices and livelihood. I am outraged and I feel like I am being treated as a mere human “vessel” for birthing. As a psychiatrist, I am gravely concerned about the future detrimental impacts on mental health for women and trans men, when their human rights to bodily autonomy and choice are taken away by strangers they have never met.

Women who are denied their reproductive freedom, including abortion, are more likely to initially experience higher levels of anxiety, lower life satisfaction and lower self-esteem. Experiencing unwanted pregnancies appears to be strongly associated with poor mental health effects for women later in life.  Another imperative factor is that there is a strong relationship between unwanted pregnancy and interpersonal violence. Specifically, the inability to obtain an abortion may force women to stay in contact with violent partners, putting them and their children at serious risk, including death.

Choice is not just the “privilege of the privileged”, says Ann Furedi, former chief executive of British Pregnancy Advisory Service. The most potent manifestation of human agency may occur when a woman or person decides their personal future and rightfully acts on that decision. By taking away that choice, they are deprived of freedom. Sex should not be just as a means of reproduction but also as an expression of love, intimacy, closeness, and happiness. All human beings are entitled to this freedom, including our patients; as healthcare professionals we should protect that entitlement as part of right to sexual and reproductive health.

I cannot understand how it is morally ethical for pregnant women and LGTBQA+ individuals to be denied this choice and to have to prove, by law, that they are either physically or mentally unwell, to have a rightful healthcare service: an abortion? How did medicine become a companion of politics and the law, potentially denying a patient’s human rights to privacy and bodily autonomy?

Abortion, Medical Ethics and the Law

The General Medical Council’s Good Medical Practice states the principles and values on which good practice is founded; these principles together describe medical professionalism in action. When facing moral decisions during our work as healthcare professionals we must use the four pillars of medical ethics:

  • Autonomy – respect for the patients’ right to self-determination
  • Beneficent – the duty to do good
  • Non-Maleficence – the duty to do no harm
  • Justice – to treat all people equally and equitably.

In a doctor’s practice, we regularly face moral healthcare dilemmas, and we must ensure we maintain good medical practice based on our moral values while keeping within the laws that govern them. Yet I feel, the law and policies may force healthcare professionals to go against the four pillars of medical ethics, ultimately putting our patients who are seeking abortions, in danger.

In my opinion, women who need an abortion, should be treated safely, professionally, and confidentially, just as they would when receiving any other healthcare service. Yet the World Health Organisation stated that 4.7 – 13.2% maternal mortality is due to unsafe abortions, annually. In developed countries, 30 women die for every 100,000 unsafe abortions, in developing regions, 220 women die per 100,000 unsafe abortions.

In the UK, abortion is considered unlawful, unless it has been approved by two doctors. Both doctors must agree that the unborn baby would pose a greater risk to the physical or mental health of the pregnant woman, before approving the termination of the pregnancy.

Despite the  Abortion Act 1967 (as amended in 1990) stating that abortion is a safe, affordable procedure, it does not protect women’s right to choose. Samantha Dulieu, a freelance journalist for EachOther (UK-based charity sharing human rights-focused journalism) wrote that the Abortion Act 1967 does not protect a woman’s choice to no longer be pregnant under the Human Rights Act, nor to be free from discrimination (under Article 14) nor free from inhumane or degrading treatment. Over the past eight years, at least 17 UK women have been investigated by police for having had abortions. Furthermore, two British women are currently awaiting their criminal trials for abortion-related offences and are both facing charges that will carry a maximum sentence in life under the Offences Against the Person Act (OAPA) 1861. Prior to the enforcement of the Abortion Act 1967, all activities a woman undertakes to “procure a miscarriage” or for another person to help her do so would be a crime under the  Offences Against the Person Act (OAPA) 1861.

Abortion and National healthcare policies

NHS England, GMC (General Medical Council), HEE (Health Education England), Royal Colleges and training bodies will need to be further involved in national policies and guidelines for abortions, including more robust research and peer-review articles on the psychological impact of difficulties of accessing abortion care.

In some cases, abortion is a life-saving medical and surgical treatment. Stevenson et al. estimated that carrying a pregnancy to term may be up to 33 times riskier than having an abortion. The physiological and mental changes of even the early stage of pregnancy are life-changing; in some cases, it can cause illnesses and can be life-threatening. As a result, pregnant mothers and people are faced with incredibly difficult choices. When a patient comes to see a doctor for termination of a pregnancy, it is poor medical practice to have contemptuous prejudice on those who seek it. Our medical profession gives us a keyhole view of our patient’s lives, allowing us to unconsciously make assumptions of them. Through this keyhole, law and politics can pass legislations that amplify prejudicial biases, further resulting in deprivation of liberty of the patient seeking the right to enforce their bodily autonomy and have the right to be decisive on their own reproductive and sexual health.

To provide an abortion, the provider must have medical knowledge and be properly trained and regulated in healthcare settings. No human being should be forced to take desperate measures and risk their own lives of infections or unavoidable deaths because they feel suffocated and bound by invisible chains of law and politics that are currently denying their right to sexual health by criminalising abortions.

In UK maternity care, pregnancies in LGBTQA+ communities are deeply affected by stigma and discrimination, therefore they are less likely to access maternity services and prefer free birthing (giving birth without ever accessing perinatal care). Trans and non-binary pregnant people are at risk of higher mortality rates. Henceforth, LGBTQA+ communities are faced with a double-edged sword: the increased maternal mortality risk in pregnancy due to stigma and discrimination, and criminalisation for having an abortion unless two separate doctors can approve the medical/ surgical procedure to take place.

Healthcare sectors implement their policies as legislations and governmental policies, eradicating discrimination of women’s free decision making to enforce their bodily autonomy, sexual and reproductive health. Our medical legislations should remove all barriers to the abortion and 100% decriminalise abortions. At the moment, anyone seeking the right to choose an abortion is still vulnerable to criminalisation in the UK. Good healthcare leadership should ensure that every patient seeking an abortion is treated with compassion, dignity, privacy and respect regardless of their circumstances.

I want to trust that our national healthcare bodies including NHS England, General Medical Council (GMC) and British Medical Association (BMA) will advocate further for our patients’ abortion rights and legislate policies and regulations that ensure abortion is not only a healthcare service that our patients need as every healthcare service for family planning but are entitled to as a right for bodily autonomy, reproductive and sexual health. In my view, there is no ethical justification to criminalise our patients for seeking abortion. Our male patients are allowed to have discrete medical procedures and take medications (such as vasectomies and erectile dysfunction drugs) to enforce their sexual health and bodily autonomy. There are no laws to prevent them from having sterilisation, and there are no legal requirements to have a partner’s permission. They can be done under the NHS without awaiting two doctors’ opinions, and with privacy.

Unless we 100% decriminalise abortions, our healthcare services are at risk of endangering our patients’ lives. We need to also ensure that politics and legislations based on religious beliefs and patriarchal ethics don’t intervene with our good medical practice, the four pillars of medical ethics and the rights for our patients’ privacy and dignity. We need lawmakers to revisit legislation on sexual and reproductive rights for women and people, to ensure the closure of all loopholes that would risk the removal of abortion rights, as well as criminalise patients and abortion providers.

Since Roe V Wade was overturned, we have witnessed what we have feared the most: a domino effect of an abortion ban worldwide. The domino effect of refusing women and LGBTQA+ communities on their right to choose family planning, right to bodily autonomy and right to have self-determination to navigate their own livelihoods.

It is not only the duty of healthcare professionals, but it is the duty of healthcare regulatory bodies and NHS healthcare leaders to protect all patients seeking healthcare from legislations and politics that breach their human rights to healthcare and bodily autonomy.

Dr Anna Sri

Dr. Anna Sri was born in the UK, but she travelled to Hungary and  graduated from International Medical School, University of Debrecen. She returned to UK and completed her Foundation Training in King’s Lynn and Telford. She is currently a Core Trainee Psychiatrist in Cornwall. She passionately advocates for human rights and mental health. She is the leader of Geopsychiatry, an NGO (non-governmental organisation) which studies the impacts of war conflict, climate change, public health issues, globalisation and foreign policy on mental health. She the part of the executive committee for the Royal College of Psychiatrist’ Women’s Mental Health Special Interests Group. In her spare time, she enjoys her solitude whilst reading, writing articles and blogs, and taking long walks. Twitter: @DrAnnaSri @geopsychiatry

Declaration of interests

I have read and understood the BMJ Group policy on declaration of interests and declare the following interests: none.

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