New guidance was issued today by the Department of Health in relation to the provision of abortions in England and Wales. Following an independent, covert investigation by the UK newspaper The Daily Telegraph, concern was raised that abortion was being provided in the UK out with the provisions of the Abortion Act, andwhich would obviously be illegal. The reporter for the Daily Telegraph accessed two abortion providers attempting to seek abortion on the basis of fetal sex alone, which is not grounds for termination in the UK and the latest guidance has clarified that this would be an illegal act.

The guidance doesn’t change the law on termination, but is designed to clarify the interpretation of the rather vague conditions specified. Most “social” terminations in the UK are performed under Category C of the Abortion Act which states The pregnancy has not exceeded its twenty-fourth week and that the continuance of the pregnancy would involve risk, greater than if the pregnancy were terminated, of injury to the physical or mental health of the pregnant woman. The guidance clarifies that fetal sex alone does not qualify as a valid reason.

The new guidance also does not remove the condition that two doctors must consent to the termination of pregnancy, and in particular, addresses the issue of “pre-signed” forms and whether or not it’s acceptable to have a verbal history from a colleague prior to signing the form: it’s not. According to the clarified guidance, the opinions of each doctor must be formed individually, and viewing the second signature as a “rubber-stamping” exercise goes against the principles of the act.

In addition to the new guidance, the DoH also produced the results of their analysis of the UK birth sex ratios, after the requests for termination of pregnancy on the grounds of fetal sex called in question whether or not the UK is affected by the phenomenon of “missing girls”, something which is well-described in other countries where a higher social value is placed on male children, resulting in female infanticide and termination of pregnancies on the basis of fetal sex. The results suggest that the UK is not affected, even when the results are broken down to assess the ratios on the basis of the ethnicity or country of origin of the mother.

Currently, to terminate a pregnancy on the grounds of fetal sex, the fetal sex must be identified prior to making this decision. Invasive testing such as amniocentesis and chorionic villus sampling have the risk of fetal loss, and ultrasound assessment is user, and fetal position, dependent. As access to these tests become more widely available, and uptake increases, the sex ratio imbalance gets worse in affected countries. It remains to see what effect the development of commercial testing for free fetal DNA in maternal plasma has on this problem. Currently it is possible to ascertain fetal sex for a £400 test from maternal blood, available on the NHS in a limited capacity for reasons such as congenital adrenal hyperplasia. It remains to be seen, as costs for these tests drop over time, what affect this has on fetal sex ratios. Readers of speculative fiction may wish to consider Ian MacDonald’s River of Gods for an exploration of this phenomenon, and the social consequences, in a near future India.