At the end of a parliamentary Session which has seen the pro-life movement inside and outside Parliament at its most active, it is appropriate that we should debate the administration of the Abortion Act 1967, although some of us would have preferred the debate to take place at a more civilised time.
I am grateful to the Minister for being with us at this late hour and I welcome the support of my hon. Friends the Members for Basildon (Mr. Amess) and for Maidstone (Miss Widdecombe), who applied for similar debates.
During the passage of the Abortion Act in 1967, the then hon. Member for Maidstone was reprimanded by Mr. Deputy Speaker for reading a newspaper in the Chamber. He defended himself by saying that he was briefing himself for taking part in the debate. I have a feeling that the present hon. Member for Maidstone will need no such aid tonight, and I look forward to hearing her contribution.
When the Abortion Act was passed in 1967 it was claimed that it would be the answer to many problems, and few could be found to oppose it. Indeed, only 29 hon. Members voted against it on Second Reading. It was said at that time that the Act would reduce the rate of illegitimacy. Now, over 21 years later, it is running at 15 per cent. and rising. We were assured in 1967 that the Act would mean that every child would be a wanted child. Today, every time we pick up a newspaper we read of yet more cases of sexual or physical child abuse. In 1967 women were assured that the Abortion Act would make them free. Today, there is a dramatic increase in requests for post-abortion counselling, so damaged are many women by the abortions that they have had.
Far from solving society's ills, easier abortion has resulted in more problems and I believe that many people are coming to accept that no problem is so big or serious that only the death of a helpless, unborn child will solve it. The right to life is the most basic of all human rights and we in the pro-life movement will continue to speak up for the small, naked, nameless and voiceless being which is the unborn child.
This morning I wish to concentrate my remarks not on the major victims of abortion—the mother and child—but on those who are victims of discrimination because they wish to have nothing to do with abortion.
Section 4 of the Abortion Act 1967 provides that except where it is necessary to save life or to prevent grave permanent injury to the physical or mental health of the pregnant woman,
no person shall be under any duty … to participate in any treatment authorised by this Act to which he has a conscientious objection.
That conscience clause protects all those who are expected to play a part in the team effort leading to an abortion once the decision to perform an abortion has been reached. It therefore protects doctors, nurses, pharmacists, ancillary staff and clerical workers who play a necessary part in carrying out an abortion.
Those with conscientious objections to abortion are protected in the following ways. Staff may not be asked to make appointments for patients to have abortions. Nurses or paramedics may not be asked to help undress a patient admitted to hospital to have an abortion; and they may not be required to prepare the patient for the operation. Operating theatre staff may not be required to prepare the theatre or sterilise instruments for abortion. If a theatre is used exclusively or almost exclusively for abortions, a conscientious objector may not be required to take part in the work of swabbing down either before or after an operating session; neither shall he or she be required to clean instruments or tubes used in abortion procedures.
Unfortunately, however, there are many different ways in which the present conscience clause of the Abortion Act does not work effectively. Management can indicate that promotion prospects will be damaged if medical personnel do not take part in abortions. Candidates for interview for medical appointments will not be successful in some cases unless they agree in advance that they will take part in abortions. Peer group pressure—the burden falling upon other overworked medical personnel—can persuade individuals to become involved in abortions about which they are unhappy. Ancillary workers, such as medical secretaries, may be dismissed if they refuse to become involved. Unless an individual has been informed of his or her rights to object to becoming involved in abortions, when confronted with a problem, that person is unlikely to know how to opt out. For all those reasons and for many more, it is clear that the conscience clause does not work in practice and that it should be reviewed.
The case of the Carlisle baby is an example of the fear under which some doctors and nurses work. I need hardly remind the House that the case involved a baby who was aborted at 21 weeks and survived for almost four hours. Through the protests of nurses, who appealed to the local Catholic chaplain, the case came to light. However, they were terrified of losing their jobs. I stress that the young doctor who was called to see the baby when it continued to struggle to breathe was opposed to the Abortion Act and had refused to become involved in performing abortions. The gynaecologist who was responsible for the abortion had gone off duty and when he was asked to return, he refused.
Thus, nurses who disliked the operation and a conscientious young man who had opted not to carry out abortions were left to cope with the results of somebody else's work. Apart from the baby's horrifying death, the Carlisle case epitomises the total ineffectiveness of the conscience clause. Nurses who were too frightened to opt out became involved in abortions on their wards. When there was an inquiry, they were too frightened to speak up for fear of losing their jobs. A young doctor was made to appear the villain of the piece and left to cope with the remains of someone else's botched-up piece of butchery.
I was recently told of a matron who said at a meeting:
The Conscience clause works in theory … but it most certainly does not work in practice. I have to run a hospital and I cater for shifts, holidays, staff illness, ensuring that patients are looked after throughout their treatment.
Obviously this is bound to create problems and it is hardly surprising that in some hospitals—although not all—nurses are made to feel that by opting out they are creating problems or being anti-social.
In others the pressures go further than that. Perhaps one of the most extreme cases about which I have been told is that involving a young African nurse who, on being appointed a staff nurse at a London hospital, made it absolutely clear that she was opposed to abortion and that she would take part in abortion operations only to save the mother's life. For a year she was left in peace. However, she began working at nights and her duties involved her with patients in the hospital who were having abortions. At night, the number of staff was limited and the technique most commonly used in this hospital, which carried out private abortions, was to insert at some time during the night, prostaglandin pessaries in the vagina to soften the cervix before surgical intervention. The nurse refused to insert such a pessary.
At first, one senior, presume taking advantage of the fact that the nurse was foreign, told her that she could be charged for refusing to obey the law. Far from cowering, I am delighted to say, this outraged the young woman, and she made it clear that she would go to prison rather than become involved in an abortion. Her senior then became rather more devious, bringing all manner of pressure to bear on her, and picking on her work. Finally, in a great attempt to be persuasive and reasonable, the senior urged the nurse that she was not asking her to do anything unreasonable, and that all she had to do was to put the prostaglandin pessary on the patient's bedside table, instructing her how to insert it. The nurse was told that that would not involve her in an abortion and was the least required of her under the law.
At that point, the nurse, who was an evangelical Christian, went to her church minister, who put her in touch with the Society for the Protection of Unborn Children, which sent her a solicitor's letter and guaranteed all her legal fees if the hospital persisted in its conduct. The girl sent the letter to the hospital authorities and was left in peace.
How many other young women have similar experiences but are not put in touch with people who can counsel them? The case involving Trent regional health authority came to light as a result of the work of CARE and the SPUC, but I wonder what would have happened if they had not learnt what was going on.
The Lane report referred to complaints that chances of promotion in the disciplines of obstetrics and gynaecology may be lost by those with a conscientious objection to the termination of pregnancy, but believed that it was probable that that affected only those departments where there were few staff or where the workload was heavy. Complaints and allegations of discrimination have been received, especially about fully qualified doctors who are debarred from appointments. Nurses are also affected, and their general position is difficult.
The Lane report said that, in the National Health Service, the Abortion Act 1967 has brought unhappiness to hospital nurses. The Royal College of Nursing has said that some nurses are reluctant to exercise their right to contract out under section 4 because to do so would create problems for their colleagues.
I shall let some of those who have suffered speak for themselves by reading out their letters. The first says:
I shall be most grateful if you will give me some advice re: abortion for I am having problems at work.
The position is that I am a midwife working on the labour ward at a large London hospital. We do a lot of scans, for we have an excellent scan department, so patients are referred from all over the country. Also they do fetoscopies on patients not only referred from around the country but from abroad. Many of our patients are found to have abnormal foetuses more so than from a normal catchment area, so this causes problems, for although many of the referrals go back to their home area for abortions, lots are aborted here (for they want the foetus for research purposes).
Three years ago when I applied for the post in London I made my position regarding abortions clear—that is that I would not wish to be involved in abortions at all. The then senior midwife assured me that this was not a problem for they rarely did abortions. However, while this was true three years ago, it certainly is not the case now.
The senior midwife has changed three times since then and at present we have no direct person in charge on labour ward so all the sisters have a share of power. As far as I can see they all agree with abortions, and while some don't like them being done on labour ward, none can accept my objections to caring for these patients.
So at least once a week there is trouble and I find myself having to argue my point. This has happened before, the pattern seems to recur every few months. I have up to this been reluctant to go to the chief nursing officer for I know what will happen: I will simply be moved off labour ward. Also I know it will not go well in my records, and seeking references in the future is a consideration.
I do feel very unhappy about this, apart from religious views, on an emotional level I find it difficult to cope and would find it absolutely impossible to give advice and support to a woman having an abortion while I feel so strongly that it is wrong. Just before Christmas they aborted an abnormal foetus, but at delivery it was perfect, it nearly broke my heart. The Abortion Act 1967 does have a conscience clause, but no one pays attention to it. I asked the student nurses about the position on the 'gynaecology' ward where all the social abortions are done. They said they are not allowed to opt out. If they were Catholics then they could object and would not be sent to the gynaecology ward at all, so missing this experience, but also making themselves unpopular.
A doctor whom I asked about this issue … said they fare even worse than midwives, for they are all but told if you don't want to do abortions don't bother coming into obs and gynaecology.
I should be interested to hear your view and would appreciate any advice you can offer.
A second letter said:
I work in an operating theatre in a London hospital as a trainee O.D.A. We work as scrubbed assistants to assist the surgeon and also as anaesthetic assistants.
We have operations for women when they have had a miscarriage and they are called E.R.P.C. (evacuation of retained products at conception). However, it has come to my attention that some of these are actually 'clean-ups' after hormonally induced abortions. There is no way they indicate these women have been having a miscarriage as the result of a dose of hormones.
I feel extremely compassionate for women who have had a genuine miscarriage, but I am worried and upset about those miscarriages that aren't really miscarriages. At work I was told that any miscarriage is a miscarriage, and that since it isn't an abortion they have not got to tell us that it is a hormonally induced miscarriage and that I have no right to refuse them. I want your point of view on this.
A third letter sent to the SPUC said:
I am employed as a staff nurse at my local hospital to work in the general operating department. Occasionally I am put down on the duty rota to assist in the day care theatre during the gynaecological lists which often include as many as ten abortions. I have stated my objection to assisting in abortions to the senior sister who will only assure me that I would not have to be the instrument (or scrub) nurse. However she does expect me to be present in the theatre to assist setting up the theatre, tying gowns, opening packs and clearing away, believing that this role cannot be described as 'being involved'. On Wednesday 16th September I attended a meeting at Bideford parish church where a speaker from S.P.U.C. showed us your video on abortion. Since then I feel very strongly that I must make a committed stand against the abortions taking place in my hospital and … have absolutely nothing to do with them.
Before I go and see the senior sister again I would appreciate your advice on how far I can take the clause in the 1967 abortion act in making a conscientious objection to assisting in abortion. Can I refuse to be present in the theatre during an abortion?
The letters that I have read out give some indication of the problems faced by many members of the medical profession since the 1967 Act came into force. Clearly we are putting an unfair burden on the consciences of many people. Some can be helped—as they have been—by pro-life organisations like the SPUC and its conscience code, but many others are unaware of their rights and afraid to exercise them.
Others—as in the case of Mrs. Barbara Janaway—do not appear to have rights under the Act. Mrs. Janaway, a medical receptionist, was dismissed after refusing to type abortion documents, and it was held that she was not entitled to the protection of the "conscientious objection" clause because she was not participating in a termination of pregnancy in the meaning of the Act.
Earlier this year, my hon. Friend the Member for Basildon introduced the Abortion (Right of Conscience) (Amendment) Bill, while I introduced a similar Bill to cover ancillary workers. The Bills were based on a simple principle: doctors, nurses and ancillary workers should not be expected or required to be involved in any way in the performing of abortions unless they had first made it clear that they had no conscientious objections to being so involved.
This reverses the current impractical position in which doctors and nurses are required to take part in abortions unless they declare that they have conscientious objections to such involvement. The Bill took the sensible approach of requiring those involved to opt in rather than to opt out of abortion. The Bill's purpose was to prevent medical and ancillary personnel from being cajoled or pressurised into taking part in abortions when they did not wish to do so. That suggestion has merit and would help to resolve what is undoubtedly worrying many medical staff. I hope that if a similar Bill is introduced next year the Government will look favourably on it.
Despite the late hour, I welcome the opportunity that my hon. Friend the Member for Hyndburn (Mr. Hargreaves) has given the House to debate the administration of the Abortion Act 1967. I pay a warm tribute to my hon. Friends the Members for Hyndburn and for Maidstone (Miss Widdecombe) for the magnificent job that they have done in the past year to make sure that the fundamental issue of abortion is raised in the House on every conceivable opportunity so that it does not move far from the minds of hon. Members.
I also pay tribute to my hon. Friend the Under-Secretary of State for Health for the courtesy that he has shown in responding to all our debates and in providing us quickly with the information that we have sought. Our hon. Friend the Member for Chipping Barnet (Mr. Chapman) has a close interest in these matters and I am pleased to see him here for the debate. It would be extremely churlish of me not to mention the hon. Member for Barking (Ms. Richardson), because, although we fundamentally disagree with her view on the subject, at least she recognises the great importance of the matter and is here to take part in the debate.
I hope that when the Minister responds he will tell us about the Government's intentions on the Warnock report. I note that only this week his Department issued a strict new code of practice governing the use of the foetus and foetal material in treatment and research. I trust that he will take this opportunity to enlarge on the issue. Perhaps he will also give some detail about how the Government intend to handle the Warnock report.
Will there be an opportunity to vote on the time at which an abortion can be obtained? I hope that every party in the House will allow a free vote on the time limit. It would be conceived nationally as an outrage if any political party imposed a Whip on that issue. There is little point in being a Member of Parliament if the House cannot meet and decide that protection is needed in respect of the time at which life begins. A recent newspaper story carried the headline:
Tiny Thomas wins brave battle for life".
The story says:
Tiny Thomas Johnson shouldn't even have been born until the end of next month.
But already he is 10 weeks old and doing very nicely, thank you.
Doctors even refused to speculate on his chances of surviving after he was born 16 weeks premature and weighing just 11b 15oz in May.
`They just said we would have to take it hour by hour, day by day,' said proud mum Christine Johnson of Wood Street, Elton, Bury.
That is what we are debating. My hon. Friend the Member for Hyndburn spoke about the Bill that I sought to introduce on the conscience clause, but I shall direct my remarks to the financial involvement of private clinics. I am proud to be a Conservative. I have no trouble dealing with the profit motive that we enjoy in this country. However, I am outraged that anyone should make a profit out of the abortion industry. When Abortion Act was being debated in 1967, a press conference was held by pro-life gynaecologists, and it attracted much abuse because one of the doctors described what was then the Abortion Bill as a
licence to print money for the shady end of the medical profession.
Doctors pleading for the law to be passed immediately protested that money was the last thing to be included on their agenda. They simply wanted to help poor women in need of support. Yet, when the law came into effect, in the words of Sir John Peel, at that time the Queen's gynaecologist as well as president of the Royal College of Obstetricians and Gynaecologists,
they all removed themselves from the back streets to the front streets".
Once there, they increased their fees and the number of patients beyond belief.
It was hardly surprising that within only a few months, London became known as the abortion capital of the world—and once the United States Supreme Court had made its famous and disastrous decision to allow abortion on demand up to birth, we saw London reduced to the abortion capital of Europe. I need hardly say that abortionists made a large amount of money as a result of the passage of the Act.
However, life was not as easy as the abortionist believed that it would be. As we know, doctors and clinics cannot advertise. Thus, in order to reach the public, they needed some way in which to promote their service. Without the ability to advertise, they were held back. Then somebody had the brilliant idea of opening an agency, called the Pregnancy Advisory Service. There was no law to stop it from advertising. In turn, it would refer the girls who responded to its posters on stations, in tubes, at bus stops and in newspapers to the abortionists and, overnight, a considerable amount of money was made.
Such is the way of the media that these agencies were presented as some kind of guardian angels, looking after the well-being of girls in need. In fact, they were abortion referral agencies that got round the existing law and touted for clients through advertising. Shortly after they first came into being, two of them succeeded in getting themselves registered as charities. I would not suggest that they have broken any charity laws, but I would add that whereas most of us think of charities as made up of people acting from love, there is little doubt that doctors and others in the service of charitable pregnancy advisory services have been provided with incomes from their labours.
In the case of the British Pregnancy Advisory Service—for example—its total income in the year 1986 was £4,383,000. Of that, £2,176,000 went on staff salaries and wages and a further £750,000 went on medical and doctors' fees—meaning that about 67 per cent. went on salaries and fees. In comparison, only £536,000–12 per cent.—was spent on medical and other supplies. Even more surprising—considering that we are talking about a charity—is the fact that the minute sum of £32,000 was given in grants to "indigent patients" and a further £51,000 was "written off" in loans to patients. In other words this charity gave only 1·9 per cent. of its income to patients in comparison with over 66 per cent. in payments to doctors, nurses and others.
Over the years many of us have had cause to become increasingly worried about the quality of the counselling that is given to girls through the so-called pregnancy advisory services. Is the advice given more to the benefit of the doctors and others than to the girls?
Bernadette Thompson, to name one girl, runs British Victims of Abortion. It is an organisation which helps women who are experiencing trauma. Bernadette had an abortion about 16 years ago through the services of a pregnancy advisory counsellor, and a charitable pregnancy advisory service at that, but she would say that she received no counselling. She was merely referred for an abortion, an operation which she has regretted ever since. There are many thousands of women suffering as Bernadette Thompson did.
About six weeks ago there was an article about Bernadette and her experience and the work of British Victims of Abortion in the women's magazine Bella. Within one week Bernadette received over 150 calls from women asking for help, and some of them had been grieving for a number of years. She is still receiving calls. This shows the sort of feeling that there must be throughout the country among women who have gone through similar experiences and have since regretted it. Many of the women had been aborted through so-called charities and they did not want to return to them for support and help during their grieving.
There are many who do not agree with me on the principle of abortion. I know that the hon. Member for Barking is one of them. I make no secret of my opposition to the killing of unborn children, which is shared by my hon. Friend the Member for Macclesfield (Mr. Winterton). Yet when he introduced the Abortion (Financial Benefit) Bill, he was amazed by the amount of support he received. The aim of the Bill was to hit directly at profiteers in the private sector. It aimed to sever the links between abortion agencies and private clinics, and called on medical practitioners referring women for abortion to make a declaration that they had no financial interest in the place where the abortions were performed and derived no benefit from it.
As most hon. Members will be aware, the Royal College of Obstetricians and Gynaecologists opposed any amendment to the Abortion Act 1967 yet even the college wrote to my hon. Friend the Member for Macclesfield:
We have seen in the press that you intend to introduce a Private Members' Bill to implement the recommendations of the 1976 Select Committee on abortion, so that there should be no financial links between doctors and agencies who refer women for abortions, and the institutions in which abortions are carried out.
We at the Royal College would like to support the spirit in what you are trying to achieve, as we think that this, after all, is only right and proper.
Among the groups who were threatened by the Bill of my hon. Friend the Member for Macclesfield was a company. I am loth to use parliamentary privilege on this occasion and so I shall call the company Miss Y. It advertised its pregnancy advisory services. Clients—not patients—were referred to a hospital by a Mr. X, who was not a medical doctor. He was a business man who ran a private clinic.
The matter becomes much more worrying when we realise that Miss Y, who runs the agency, is none other than Mr. X's wife. Not surprisingly, they have become extremely wealthy. Their business covers abortions and cosmetic surgery, as a result of which they were exposed on the "That's Life" programme in January 1985. That programme revealed that medical services offered in connection with cosmetic surgery through certain advisory agencies had led to tragic results. The same programme also exposed other abortionists. It apparently takes a certain kind of mentality to exploit unhappiness, whether it be caused by an unplanned pregnancy or dissatisfaction with one's appearance.
Mr. X responded to that broadcast by threatening to sue the BBC—a tactic he apparently uses to silence anyone who attacks his methods. When a newspaper announced Mr. X's intention to open a hospital to perform abortions, he threatened legal action against a group that leafleted the area in an attempt to arouse public opposition to his plans. He claimed that the newspaper story was incorrect, but seemed to make no attempt to have a correction published.
Late in 1987, my hon. Friend the Member for Macclesfield was informed that eight referral agencies had financial links with clinics providing abortions. The number rose to 32 when he asked about individuals who were directors or trustees both of companies or charities providing abortions and counselling and of clinics offering abortions.
There is no doubt that immense fortunes are made from abortion clinics. The answer to a parliamentary question tabled at the end of 1987 revealed that a total of 594 beds in private clinics were licensed for abortions, and that 114,621 abortions were performed that year. That meant that each bed was used an average of 193 times a year.
At that time, the cost of a private abortion, including the referral agency's charges, was, at a conservative estimate, £200—thus producing an income of £38,592 per licensed bed. The total turnover realised from that barbaric industry reached £22,923,648 annually. As a Conservative, I am absolutely ashamed at the profit that is made from destroying lives. Returning to Mr. X, the income of the private nursing home of which he is a director, and which is provided with clients by his wife, totalled £810,600. That is not a bad income from a clinic with only 21 beds.
Earlier I spoke of a "barbaric industry." When the hon. Member for Liverpool, Mossley Hill (Mr. Alton) introduced his Bill, a video showing a D and E abortion was introduced to this country. In the earliest stages of abortion, a technique known as D and C—dilation and curettage—is used, whereby the mouth of the womb is dilated and a curette is used to scrape the inside, in the process of which the foetus is cut to pieces.
After about the 12th week of pregnancy, a curette is not sufficiently strong enough to tear apart the bone structure and limbs of the unborn baby, so the instruments used are decidedly stronger. They are rather like those used in carpentry and other forms of building work. A different title is given to that technique. It is known as dilation and extraction. That sounds harmless enough, but the video "Eclipse of Reason" proved otherwise, and showed precisely what an abortion of that type involves.
One aspect of pro-abortionists that worries me most is the way that they distort the truth, while pro-lifers are told by politicians of all shades of opinion that dilation and extraction is not a form of abortion that is performed in Britain. The pro-abortionists plant newspaper stories claiming that pro-lifers arouse public feeling in an emotive fashion, with stories of outdated abortion techniques not used in this country.
The Office of Population Censuses and Surveys monitors show that those claims are untrue. Far from D and E being used less, it is on the increase, particularly in private clinics. There are several reasons for that. It can be upsetting for nurses, to whom my hon. Friend the Member for Hyndburn referred, caring for a patient having an abortion by the use of prostaglandin to see a whole baby emerge when the abortion takes place. In contrast, D and E ensures that nothing but mangled pieces, often crushed and battered beyond recognition, emerges.
A second reason is that the D and E takes far less time than a prostaglandin abortion. When money has to be made and the whole procedure has to be completed as speedily and efficiently as possible, why not use the technique which takes the least amount of time?
I was sickened when I met a doctor who had just visited a private abortion clinic in London which specialises in late abortions. There the pieces torn from the baby were so large that huge pieces of arm and leg of spine were put through one of those large mincing machines that we see in butchers' shops to enable them to pass through the sluice.
I conclude with the latest figures. In 1987 in the private sector 12,222 abortions were carried out at 13 weeks or more and of those 3,698—nearly one third—were carried out by D and E. Those tiny humans, whom we know feel pain, are being destroyed for money. That is the kind of barbarity which I and my hon. Friends are determined to stop.
I shall never cease to be amazed at the manner in which some of those involved in the abortion industry seek to deceive themselves. The chairman of the trustees of the British Pregnancy Advisory Service wrote to doctors saying that abortion does not typically require them to diagnose and treat a morbid condition, but rather to consider the wishes, wonders and worries of normal people in normal health.
Is that really the way in which they bemuse themselves when they tear a child limb from limb, having to put the larger pieces through a mincing machine in order to get them down the sluice?
I and my hon. Friends who have spoken tonight are appalled by that, and the British nation will join us in our abhorrence.
I am grateful for the opportunity to take part in the debate and I congratulate my hon. Friend the Member for Hyndburn (Mr. Hargreaves) on securing a debate for which several hon. Members applied, because it is an issue, which has dominated the last two parliamentary years. Frequently, attempts to resolve some of the worries that have been voiced tonight have been defeated, not because a body of opinion in the House resented what was being done but because we were not allowed to have a free and fair vote.
I hope that my hon. Friend the Minister can confirm our hope that when the Warnock proposals come up For discussion next year we can have a free and fair vote on issues other than those strictly raised in the Warnock report.
The debate is on the Abortion Act 1967, which is administered far more in the breach than in the observance. In particular, there are several areas of concern where specific questions can be asked which I hope that my hon. Friend will answer.
In the first case, I am concerned about the administration of the Act and the way in which it takes on board the Infant Life (Preservation) Act 1929. In an Adjournment debate on 8 June, my hon. Friend the Minister accepted that it was necessary to observe the Infant Life (Preservation) Act in the administration of the 1967 Act. In response to a point that I made in that debate, which was principally about the Carlisle baby, he said:
Doctors are properly mindful of the requirements of the Act and do not carry out an abortion, by any method, when they consider that a child is capable of being born alive."—[Official Report, 8 June 1989; Vol. 154, c. 465.]
My question to the Minister is this: if they do not carry out abortions when they consider that a child is capable of being born alive, what is the purpose of the injection of urea or saline, which is commonly used in the prostaglandin treatment to ensure that the child is born dead? What is the point of ensuring that a child is born dead if the doctor does not believe that it is capable of being born alive in the first place? The Act is not administered to take account of the Infant Life (Preservation) Act.
We now know that children are capable of surviving independently from the 24th week. Yet in a parliamentary answer the Minister told us that last year there were 17 cases of abortions after the 24th week, six of which were not even for handicap or to save the life of the mother; they were done under the social clauses. Will the Minister explain how he can reconcile the statement that doctors do not abort children capable of being born alive with the fact that they abort children of a gestational age in excess of that at which children do survive, and at which such survivals are fully documented?
In the light of the recent spate of survivals at 22 weeks, how can doctors abort after that age and seriously believe that the child is not capable of being born alive? In the Carlisle baby case, in which the abortion took place at 21 weeks, the child was not just capable of being born alive; she was actually born alive.
Will the Minister consider outlawing completely the D and E method? There is no good reason for dismembering alive in the womb, without anaesthetic, a child which in different circumstances would be in an incubator, loved and cherished, with everyone desperately fighting for his or her survival. Can the Minister imagine circumstances in which a child in an incubator could be dismembered alive? Can he imagine a National Health Service or a Ministry that was responsible for licensing private clinics allowing that? If it cannot be done to a child in an incubator, why should he allow it to be done to a child in the womb? It is not just a question of medical or clinical judgment—the panacea behind which so many of these issues disappear. It is not down to clinical judgment whether we dismember alive babies in the womb. It is a clear moral issue for society. There is an optional method. I do not particularly like that either, but at least it does not involve cruelty. That is the prostaglandin method.
Will the Minister bring into general conformity with the rest of operations abortions involving children under the age of 16? If a child needs its tonsils out, it must have parental consent for the general anaesthetic that will be applied. Yet in response to my hon. Friend the Member for Bury, North (Mr. Burt), the Minister said that young girls under the age of 16 do not require their parents' consent to have an abortion performed under general anaesthetic. Why is abortion singled out for exemption? Why is a child not allowed to decide to have her tonsils out when she is allowed to decide to kill an unborn child—at an age when she cannot possibly have a concept of the consequences and of all the moral issues involved, for which, surely, she requires parental guidance?
Then there is the question of the unperson, to use an Orwellian phrase. When I asked the Minister about the case of the Carlisle baby, and asked why the child was allowed to stay for three hours, breathing, with a pulse rate, fully alive—so much so that the nurses saw fit to baptise her—he replied that resuscitation equipment was not provided, and she was not registered for birth, and she was not registered for death, all for the same reason: the doctor in the case had decided that it was not a live birth.
If a living, breathing human being can survive for three hours, how can a doctor say that that is not a live birth and that none of the rights of life follows? If a small premature baby as a result of a normal premature birth is alive, then a small premature baby as a result of an abortion is alive. The Abortion Act 1967 is not administered fairly or equitably. Anything goes when it comes to an abortion. There is no way that a child born normally could be declared a non-person.
There is also the nonsense of piecemeal legislation for the foetus at all stages of development. The Warnock report proposes experiments up to 14 days. In the same breath, the Polkinghorne report states that foetal tissue may be used in the second trimester, which is from the 12th to the 24th week. Those two reports are not taken in conjunction with the Abortion Act 1967 and considered comprehensively. They are being taken piecemeal.
When it discusses Warnock the House will probably be deceived into believing that nothing will happen after the 14th day. But Polkinghorne states that experiments can occur at horrendously late stages. Will the Minister admit that we need one comprehensive Abortion Bill which reviews the working of the Abortion Act 1967, considers the Infant Life (Preservation) Act 1929 and the financial administration—a matter raised so ably by my hon. Friend the Member for Basildon (Mr. Amess)—examines the workings of the conscience clause, and considers foetal tissue and embryology research. One Bill should do all that to clarify those issues and sort them out once and for all. We do not need a long series of attempts to amend each and every working of the gross Abortion Act 1967.
Is the Minister convinced that the Abortion Act 1967, in its own terms, is adhered to? The Carlisle baby was aborted under the terms of a clause which states that if there is a substantial risk, not just some sort of risk, of serious—and not any old sort—of handicap, that is grounds for an abortion. The Carlisle baby had a 50 per cent. chance of inheriting a very rare disease of which her father had only a mild form. Where does a substantial risk of serious handicap occur there? Will the Minister admit that abortions have been carried out for club foot, hare lips and all sorts of minor handicaps? The Abortion Act 1967 is not even policed properly in its own terms and there is no will to police it. Does the Minister believe that new advice should be issued, if not a comprehensive inquiry launched, into how well the 1967 Act is implemented even in its own terms and even before we have seen the abuses that result from it?
To sum up, I put these questions to the Minister. How can he equate the use of injections to kill a child with a statement that doctors would not abort where they thought that there was a possibility of a child being born alive? Will he consider outlawing the D and E operation altogether? Will he re-examine the requirements for permission for anaesthetics for young girls under 16? In what circumstances is a child declared a non-person when it has existed? We know that the Carlisle case caused horror, but there are probably other cases where children are born and live for only a very brief time. Are they also regarded as non-live births? Will he investigate the financial regulation of private abortion clinics and consider issuing advice on the interpretation of "substantial risk"? Will he overhaul the policing of the Abortion Act 1967 and will he consider the case for comprehensive, rather than piecemeal, reform?
Hon. Members have heard, as I rather suspected that we would, three highly contentious speeches in yet another debate designed to undermine the Abortion Act 1967. As usual, the speeches have been laced with many smears and much lurid language. I remind the House that there have been 14 Commons attempts by anti-abortion people to try to change the Abortion Act 1967, and two Lords Bills on the subject. All 16 attempts were introduced over the past 20 years. I have not been involved in all of them, but I have been involved in a good many—I am not an unfeeling person, contrary to what some hon. Members might think—and I have watched carefully and I have heard the same arguments, and I am not at all convinced that there is any need to do more than improve the Abortion Act 1967 by going a little further.
I have added up the time that has been spent over the past few years on debating abortion Bills and private Members' Bills and added on the time spent on private Members' motions about private Members' Bills on abortion, and ten-minute Bills and Adjournment debates. Parliament has spent more than 350 hours on the issue. Those 350 hours could have been more practically spent.
Attacks on the Act have been mounted from every quarter. The three hon. Members who have spoken in this debate have referred to a number of Bills that have been proposed during this Session. If my memory is correct, six Bills—they will not get anywhere now—have been put forward by Conservative Members. Over the years, particularly in the past two years, as the hon. Member for Maidstone (Miss Widdecombe) said, there has been a concentration on this issue. Not a trick or an opportunity has been missed by those who, if they were honest with the House and with the public, would like to see abortion outlawed altogether.
The hon. Lady has stood up to say that she is anti-abortion. When hon. Members read the debate, they should take note of that.
While all those attempts have been going on, I have been at pains to point out to the House that public opinion has been going in a counter direction. The 1988 Marplan poll asked a sample of 1,552 people in 103 constituents
Do you think that women should have the right to choose an abortion in the first few months of pregnancy?
Eighty per cent. of the women and men who were polled agreed that they should. Eighty one per cent. of women were in favour. When the sample was analysed, it was found that 86 per cent. of those who said that they were Church of England were in favour, and, surprisingly, 67 per cent. of Roman Catholics were also in favour. The fifth report on British social attitudes in 1988 showed that 54 per cent. of men and 54 per cent. of women supported the idea that only the woman should decide whether to have a child.
Although no one likes the idea of abortion—contrary to what has been said here this morning—the sample shows that a substantial majority of the population believes that it is the woman who is important. I have been quite taken back during the debate by the lack of reference to the women who have to make agonising decisions and who do not like having an abortion, but who have one for various reasons which are personal to them, either medical or social. When we say "social", we mean things that are connected with their personal lives and their families. The public obviously recognise that those women are the ones who are important and who should make the choice.
A relatively small group of hon. Members, who are against abortion, have been trying to convince the House that women should have no say at all, and that public opinion should be treated with contempt, in favour of their narrow and, in my opinion, cruel, moral judgment. So far, thank goodness, they have been unsuccessful.
The hon. Members for Basildon (Mr. Amess) and for Maidstone have both asked the Minister directly—I, too, will be interested in his reply—whether the forthcoming Bill on embryo research and other matters that appeared in the Warnock report will contain some opportunity for the House to make a decision on abortion. My personal view is that I hope very much that that Bill will not contain any reference to abortion. As I understand it, the Government are proposing to give the House an option of voting for or against pre-embryo research, which is probably the right way to deal with it. However, to mix the whole argument up with abortion would be wrong and would, in fact, obscure many of the other parts of Warnock that need to be fully explored and fully debated. I hope that the Minister will resist any blandishments to include a clause on abortion.
The hon. Member for Basildon really went over the top when he talked about the millions that are being made, as he alleges, out of abortion clinics. I do not know very much about the commercial sector, but I know quite a lot about the charitable sector. I am a trustee of the British Pregnancy Advisory Service, and I have seen or heard nothing of which I could be ashamed. I invite the hon. Gentleman to come along to see for himself. If he is talking about the commercial sector, which existed long before the 1967 Act came in, that is a different matter, and one which he must take up with the Minister and on which the Department of Health must decide. I am sure that the Minister will be able to confirm, however, that everything is all right in the charitable sector.
I shall give as an example some figures that I obtained only this afternoon, when I knew that I would be participating in the debate, and which I have had confirmed by the British Pregnancy Advisory Service, which is one of the biggest charitable organisations. The BPAS carries out one third of all the National Health Service abortions. Sixty eight per cent. of BPAS's total income is spent on fees and salaries, and 77 per cent. of the total NHS expenditure on abortion is spent on fees and salaries. The BPAS is not, therefore, paying out lavish money.
The average cost of a BPAS abortion, at 1989 prices, is less than £190, including overheads. The cost of a National Health Service abortion, at 1988 prices, is £190, excluding overheads. The BPAS cannot, therefore, be charging exorbitant fees. National Heath Service hospitals using BPAS services are, therefore, not wasting public money but saving it.
I wish that the hon. Member for Basildon and other Conservative Members would stop making allegations about the charitable sector. I do not deny that it pays wages, because people must be paid for their work and expertise. However, they are not millionaires and they are not trying to make profits in the dreadful way that the hon. Member for Basildon suggested. All BPAS counsellors and general practitioners are paid on a sessional basis. They therefore see however many patients turn up at a session, which includes contraception, infertility advice, pregnancy testing, and counselling on matters other than abortion, as well as abortion counselling and referral.
The consultant who performs the operation has no link with patients until they visit the clinic. There are therefore no incentives, links or profiteering. There is no Department of Health information to uphold claims of abuse of misuse. If claims of abuse or misuse had been made, the Department would have withdrawn the rights of the pregnancy advisory service or the BPAS to act.
Several references were made to the Carlisle baby. Of course everyone was shocked by what they heard, but I was shocked by the lack of concern shown throughout the saga for the mother. Much as been said of the baby, who was allegedly born alive and who breathed for a while before dying, which we regret. I also have feelings for the mother, who had her name, medical records and life history dragged through the courts, but for what? Why should she have been so castigated? Why should she have had to open up her life in that way?
Yes. Her personal life and medical records were dragged through the public domain.
I wish that Conservative Members, in their concern for premature babies—we are all concerned about premature babies—would think of the mother and the father.
If Conservative Members do, they certainly do not mention it. Time and again, Conservative Members drag up the case of the Carlisle baby, but it will not further influence the public.
I know that the Minister wants to ask all the questions asked by the hon. Member for Maidstone, so I shall make one or two final points. The anti-abortion Lobby fails to face up to the fact that the Abortion Act 1967 was woman-centred legislation. It was enacted because before that women felt forced to go to back streets for abortions.
The force of the Abortion Act 1967 was to protect and support women. There is nothing wrong with that. We should now take it a step further and introduce earlier abortions for women who want them. At present they are alowed only in exceptional circumstances. Early abortions will be possible only if we amend the legislation to provide for self-referral up to 12 or 14 weeks.
We must ensure that NHS facilities are evenly spread throughout the country. Incidentally, that would deal with the arguments about the charitable sector. Women in the west midlands—an area which you, Madam Deputy Speaker, represent—have much more difficulty in getting an abortion than women in the north-east or south-west. Wealthy women always have and always will be able to get an abortion, even if the anti-abortionists succeed in repealing the Act, which I hope they do not, but ordinary women face great difficulties.
We are moving into the 1990s. Women are being exhorted to train for new technologies, to plan their lives, to enter new industries and fill the gaps in the employment market. How can they do that if restrictions on abortions make it even more difficult for them to plan their family properly? Family planning is being cut. I hope that Conservative Members do not approve of that. I certainly do not. How can women control their bodies if this male-dominated House makes it more difficult for them to plan their lives and keep their family happy?
Only this evening I was talking to a member of staff who told me that when many years ago a local friend of her mother's who had 13 children became pregnant for the 14th time and when she tried to abort the child herself, she died. I do not want those days to return. I want women to be confident that they are not being patronised and that the legislation supports and gives them as much information and as many facilities as possible, and then allows them to make choices about their life, family, partners and children. That is the way to approach this thorny subject. None of us likes abortions or wants people who do not want them to have one. We should improve the 1967 Act to give women the choice.
I congratulate my hon. Friend the Member for Hyndburn (Mr. Hargreaves) on his success in the ballot and on introducing yet another debate on this extremely important subject. I also pay tribute to the eloquent contributions by my hon. Friends the Members for Basildon (Mr. Amess) and for Maidstone (Miss Widdecombe) and to the contribution by the hon. Member for Barking (Ms. Richardson).
These are important issues and, from my point of view, any hour of the day or night is appropriate to debate them. My hon. Friend the Member for Maidstone asked a number of questions. Although I shall, in the time available to me, answer as many as I can, I hope that she will permit me to write to her in due course so that I may answer them more carefully and comprehensively.
My hon. Friend the Member for Basildon drew attention to those who were present in the Chamber at this early hour, and he was charitable in referring to me, for which I thank him, and to others, including the Whip who was on the Bench at the time. It should be noted that one of the new members of the Whips' Office is now on duty. We congratulate my hon. Friend the Member for Sheffield, Hallam (Mr. Patnick) on his appointment and hope to welcome him to many more debates at these early hours.
On the Order Paper earlier in the day was a motion to wish the Serjeant at Arms well for the future. I am sure that hon. Members who are present now and were not in their places earlier will wish to be associated with those good wishes. It must be unusual for a distinguished servant of the House to be thanked and then to have to remain in the Chamber for the succeeding 24 hours. In regard to this debate he and I perform the same duties. We are servants of the House. My job as Minister is to make sure that the Act with which we are concerned is administered properly and to provide information and statistics to the House, but not to make moral judgments or take any initiative in relation to an extension or contraction of the Act. Therefore, I see my role as being to answer questions of fact and to assist in the deliberations of the House.
This subject has featured often in our deliberations. The hon. Member for Barking said that in the present Session, for example, the House had debated on 16 December a motion on the rights of the unborn child, introduced by my hon. Friend the Member for Slough (Mr. Watts), and that six private Members' Bills on abortion-related subjects have been introduced, including the Abortion (Amendment) Bill sponsored by my hon. Friend the Member for Maidstone. There have been two Adjournment debates, one introduced by my hon. Friend who initiated tonight's debate, on the United Nations convention on the rights of the child, and the other on 8 June on the Carlisle baby case initiated by my hon. Friend the Member for Maidstone. In addition, 112 parliamentary questions on abortion topics have been addressed either to the Department of Health or to the Office of Population Censuses and Surveys, for which I have ministerial responsibility.
There has been reference tonight to the prospect of legislation on the issues dealt with in the Warnock report which the Government have said will be introduced during the lifetime of this Parliament. There has been considerable media speculation in recent weeks about its content and timing. Hon. Members will understand that I cannot go beyond restating that commitment to bring forward a Bill.
It would not be right for me to comment on the contents of the legislation and in particular on whether, as some hon. Members have suggested, it should contain provisions about abortion. I shall, as I have done in the past, draw the attention of the Leader of the House to the comments that have been made.
In 1967 Parliament was given the opportunity in a private Member's Bill to build on an existing framework of criminal law which prevented abortions except in a very restrictive set of circumstances. Parliament agreed to do so on a free vote. It is, of course, open to Parliament to alter that framework. I realise that many hon. Members feel sincerely that the law needs radical adjustment. It is against that wide divergence of views that the Government must operate. We also have the views of the Select Committee in another place, which has suggested a framework for amending the abortion law. Clearly, the Government must take account of all those factors, and of what has been said in this debate, in looking at the legislative position. That we shall carefully do.
This debate focuses mainly on the administration of the Abortion Act 1967. As the House knows, my Department takes seriously its task of monitoring the operation of the Act, which was introduced as a private Member's Bill and was passed by both Houses on the basis of a free vote. The Act allows abortion where two doctors certify in good faith the the risk to the life, or injury to the physical or mental health, of the pregnant woman or the existing children of her family would be greater if the pregnancy continued than if it were terminated.
As Parliament has decided that abortions may lawfully be carried out in the circumstances set out in the Act, the Government, like their predecessors, consider that facilities for abortion treatment should be available. The Government also have a duty to ensure that the provisions of the Act are properly applied until and unless Parliament chooses to change that law.
Within the National Health Service the level of gynaecological provision, including abortion, is, like any other provision, decided by individual health authorities. The Government believe that such decisions are best taken locally in the light of authorities' first-hand knowledge of local needs and priorities and competing claims on resources. The private sector adds to the range of options available offering flexibility to both patients and health authorities. It is for health authorities to decide the extent of any arrangements made for treating NHS patients in the private sector. In 1988 some 9,000 abortions were performed under such arrangements.
The operation of the Act is monitored closely by my Department, through its control of the private abortion sector and the investigation of specific complaints. All operating medical practitioners are required to notify the chief medical officer of each abortion that they perform. The notification form contains many details, including the grounds for abortion, the estimated gestation and the method of operation. Those forms are scrutinised by staff authorised by the chief medical officer to ensure that they do not indicate any contravention of the abortion law.
It might be helpful to my hon. Friends and to the House if I were to say something at this point about the way in which the operation of the Abortion Act is monitored in the private sector. Before we approve a clinic or private hospital for the termination of pregnancy under section 1(3) of the 1967 Act, the premises and facilities are inspected by the Department's medical and nursing officers, and persons connected with the application are interviewed by investigating officers. An important element in the process of approval, and subsequent monitoring, is the system of "assurances"—instituted in the early 1970s after some abuse of the original arrangements had become apparent. The assurances are specific undertakings which proprietors of "approved places" are required to give to the Secretary of State on the conduct of their premises and the facilities available. In effect, the assurances form a set of conditions on which initial approval depends and contravention of which could lead to the withdrawal of approval, thus preventing any more abortions from being carried out at that place unless approval is reinstated.
All private sector nursing homes, clinics and private hospitals approved under the Abortion Act are subject to periodic, unannounced inspections by the Department's medical, nursing and investigative officers. A thorough check of business and administrative arrangements is made and patients' notes and medical records are examined. Any irregularities are followed up and the appropriate action taken to obtain future compliance by the proprietors. In an extreme case this could involve the withdrawal of the Secretary of State's approval or, where there is evidence that a criminal offence may have been committed, a reference to the Director of Public Prosecutions. The machinery that I have described does not reveal any abuse of the Act. My hon. Friend the Member for Maidstone asked me to comment specifically on that.
The Carlisle baby case was raised by my hon. Friend the Member for Maidstone. This case was the subject of the Adjournment debate on 8 June during which I addressed as fully as possible, and as far as the requirements of confidentiality and possible legal action allowed, the issues that gave rise to the concerns expressed by hon. Members. My hon. Friend asks again why no attempt was made to resuscitate the baby. As I told the House on 8 June, the doctor concerned made a clinical judgment that this was not a live birth.
The Minister says that the doctor decided that it was not a live birth. The question that I asked in this debate was how can one accept, when a child has been breathing without the aid of artificial equipment, has a pulse rate and has survived for three hours, that that was not a live birth? Under what circumstances do we call a person an unperson?
I am about to deal with that point. The decision was properly, and entirely, for the doctor, and it would not be appropriate for me to comment on it. It was a clinical judgment. I shall deal shortly with the circumstances surrounding it. If he had decided that resuscitation should have been attempted, the appropriate action would have been taken.
How doctors decide whether a baby has been born alive is a question that should be asked of obstetricians and paediatricians. My understanding is that a doctor's main criterion of a live birth before 28 weeks of pregnancy is that, when born, the baby starts to breathe properly. In these circumstances a heartbeat will, of course, be present, but a beating heart on its own would not be regarded as sufficient to label the delivery a live birth since delivered foetuses of 16 weeks or even less may have beating hearts although they have no prospect whatever of surviving. I am making no moral or ethical judgment.
Deciding that a live birth has occurred is only one step towards reaching a decision on the appropriate subsequent management. Very few live born babies of less than 28 weeks continue to survive without a great deal of intensive care. Even if they do survive, there is a significantly increased risk of their developing substantial handicaps. The doctor responsible for the care of the mother and the baby has to weigh all the relevant considerations and use his or her knowledge and clinical judgment to decide what action is appropriate and in the best interests of the mother and baby in the circumstances of each case.
My hon. Friend the Member for Maidstone asked me how a doctor could avoid the possibility of a live birth through the application of medical techniques or injections. My hon. Friend the Member for Basildon asked how doctors can use techniques such as dilation and evacuation. I am making no moral judgment, but these are matters for clinical judgment. It is not right for the Minister or any politician to make judgments about what are essentially clinical matters. I appreciate that my hon. Friends have strong views on this subject. All of us have strong views, but these are matters for clinical judgment.
The conscience clause has been mentioned. Section 4 of the Abortion Act 1967 provides that
no person shall be under any duty, whether by contract or by any statutory or other legal requirement, to participate in any treatment authorised by this Act to which he has a conscientious objection".
Under a longstanding agreement with the medical profession, no reference to termination duties should be included in the advertisement of hospital posts, but it should be included in the job description made available personally to all applicants. This procedure ensures that all practitioners, including those who, for whatever reason, do not wish to undertake such duties, are made aware of
the requirements of the post before interview. National guidance about this was sent to regional health authorities in 1975 and 1979 by the former chief medical officer. In view of a recent error on the part of Trent regional health authority over the wording of an advertisement for a consultant post in obstetrics and gynaecology, the chief medical officer will remind regional medical officers of the existing guidance.
For non-medical staff, in a recent ruling in the House of Lords—R v. Salford health authority—Lord Keith of Kinkel stated that, in its ordinary and neutral meaning, the word "participate" in section 4 of the Abortion Act referred to taking part in treatment.
I am of course aware that my hon. Friends the Members for Hyndburn and for Basildon have introduced Bills proposing amendments to the conscience clause. They fall to be considered by the House in accordance with the procedures governing private Members' legislation.
My hon. Friend the Member for Hyndburn spoke eloquently about the difficulties experienced by hospital staff who have a religious or ethical objection to abortion. Everyone can sympathise with someone who experiences pressure to take part in a form of treatment to which he has a conscientious objection. Any such pressures could take a number of forms, but it is very difficult, if not impossible—I am sure that my hon. Friend would agree—to legislate to encourage the development of appropriate attitudes. What is clear is that the law explicitly protects those who have conscientious objections to taking part in abortion treatment. The law is crystal clear on this subject, and we expect both the letter and the spirit to he observed. I am sure that the hon. Member for Barking will join me in that.
Let me conclude by dealing with the issue of financial links. Since the passing of the Abortion Act 1967, several attempts have been made to introduce legislation relating to the links between doctors and agencies who refer women for termination of pregnancy and the institutions in which they are performed. These have led to the existing requirements that all nursing homes must notify the Secretary of State of any financial arrangements between the nursing home and any medical practitioner, pregnancy advice bureau or referral agency, and must report any changes in existing financial arrangements. Furthermore, all pregnancy advice bureaux referring women for abortion at places approved under the Act must identify financial links with other businesses, and doctors must not operate on patients whom they see at a referral agency.
Those requirements are drawn to the attention of administrators of premises when the first visit of inspection is made. Checks continue to be made on subsequent visits, and company searches are carried out as necessary. Proprietors and administrators are well aware that failure to comply with an assurance could constitute grounds for withdrawal of registration of bureaux or approval of nursing homes.
I hope that this has been a useful debate, and that it has increased understanding of a very important issue.