Amendment 183

Health and Care Bill - Report (4th Day) (Continued) – in the House of Lords at 11:30 pm on 16th March 2022.

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Baroness Sugg:

Moved by Baroness Sugg

183: After Clause 164, insert the following new Clause—“Permitted locations for abortion treatment(1) The Abortion Act 1967 is amended as follows.(2) In subsection 1(3) after the first “section” insert “, or section 1A of this Act”.(3) After section 1 insert—“1A Approved places(1) The home of a registered medical practitioner is approved as a class of place for treatment for the termination of pregnancy for the purposes only of prescribing the medicines known as Mifepristone and Misoprostol to be used in treatment carried out in the manner specified in subsection (3).(2) The home of a pregnant woman who is undergoing treatment for the purposes of termination of her pregnancy is approved as a class of place where the treatment for termination of pregnancy may be carried out where that treatment is carried out in the manner specified in subsection (3).(3) The treatment must be carried out in the following manner—(a) the pregnant woman has—(i) attended an approved place,(ii) had a consultation with an approved place via video link, telephone conference or other electronic means, or(iii) had a consultation with a registered medical practitioner, nurse or midwife via video link, telephone conference or other electronic means; and(b) the pregnant woman is prescribed Mifepristone and Misoprostol to be taken for the purposes of the termination of her pregnancy and the gestation of the pregnancy has not exceeded nine weeks and six days at the time the Mifepristone is taken.(4) Nothing in this section should be taken to affect any approval otherwise made by the Secretary of State under subsections 1(3) or 1(3A) of this Act. (5) For the purposes of this section—“approved place” means a hospital in England or Wales, as authorised under section 1(3) of this Act, or a place in England or Wales approved under that section;“home” means, in the case of a pregnant woman, the place in England or Wales where a pregnant woman has her permanent address or usually resides or, in the case of a registered medical practitioner, where a registered medical practitioner has their permanent address or usually resides.””

Photo of Baroness Sugg Baroness Sugg Conservative

My Lords, Amendment 183 in my name, if accepted, would maintain the existing provision of at-home early medical abortion following a telephone or video consultation with a clinician. It is very late in the evening, but this is an important issue which will impact hundreds of thousands of women. The existing provisions, which the amendment simply transcribes into the Bill, were adopted in March 2020. It is a straightforward and narrow amendment with the sole purpose of retaining a service that has been in place for the last two years.

Early medical abortion, which can take place up to 10 weeks into a pregnancy, involves two medications. Previous government policy in England was that only the second pill could be taken at home, with women having to attend an abortion provider in person to take the first pill. The approval that was put in place simply enables women to take both pills at home. This was a pandemic-led shift to telemedicine, but the clinical benefits of telemedical service were known even before Covid-19, with NICE recommending it in September 2019. Sadly, following a government announcement a few weeks ago, this approval is currently set to be removed in August this year.

At this point, we should briefly be clear on what removing the existing provision would affect. It would have no impact on the requirement for face-to-face consultation, for face-to-face safeguarding, for ultrasound scans or to be seen in person by both doctors. Any of those changes would require amending existing regulations and that is not what we are debating tonight. The only thing impacted by this amendment is the requirement for women to visit a clinic and then leave again. I hope noble Lords agree that we can focus on just that.

There is no medical reason why telemedicine, alongside interpersonal appointments, should not remain a permanent option. There is overwhelming evidence that allowing women the option to access early medical abortion at home, where clinically appropriate, has created a safer and more effective service. During the pandemic, the largest ever study of UK abortion care, published by the British Journal of Obstetrics and Gynaecology, found that this service shortened waiting times and enabled women to receive care much earlier in their pregnancy. Some 150,000 women have received telemedical abortions since March 2020 and the data on the number of women presenting to NHS services with complications has shown a decrease. Renowned medical bodies support its use, including the Royal College of Obstetricians and Gynaecologists, the Royal College of General Practitioners, the Royal College of Midwives, the British Medical Association, the Academy of Medical Royal Colleges and many more. Just last week, the World Health Organization made it a key part of its global guidance on abortion care.

It is not just the medical experts who want to see this service made permanent—women do too. A recent study in the British Medical Journal found that 89% of women who have used a remote abortion consultation would choose to have treatment at home. It helps women who may struggle to find the time and travel the distance to an abortion provider. This includes those who have childcare or caring responsibilities, who struggle to take time off work, who live in remote or rural areas with little transport and many other logistical, social and economic reasons. Importantly, it can also be a lifeline for women in vulnerable situations. Maintaining the service is fully supported by women’s groups, including Women’s Aid, the End Violence Against Women Coalition and Rape Crisis, which say that it enables women in controlling and abusive relationships to access essential medical care. Removal of telemedical abortion provisions would almost certainly lead to a resurgence in women seeking to access unregulated pills bought online. Without telemedicine, waiting times will rise and current staffing levels would be insufficient.

There is a serious risk that some women would, as a result, be unable to access legal abortion care, either because the providers do not have the capacity or because increased waiting times push some women over the legal limit. Of course, face-to-face services must still be provided for all women who require or request it. However, to take away from women a service that has proven safe, accessible and compassionate, and which enables women to deal with a difficult situation in the comfort and privacy of their own homes, is not the right way forward.

This amendment follows the guidance of medical professionals and would deliver on the Government’s aim to listen to women and put them at the heart of the women’s health strategy. I believe the case is clear and hope that the Government will accept this amendment. I beg to move.

Photo of Baroness Fox of Buckley Baroness Fox of Buckley Non-affiliated

My Lords, in speaking to this amendment, I apologise for not having spoken in Committee. I want to do so because I have received hundreds of emails urging me to vote against this amendment. I want to explain why I will vote for it—if there is a vote—and why the people who emailed me are worrying about the wrong thing. I emphasise that this is not about changing the law.

I will not make a long speech because the noble Baroness, Lady Sugg, explained the amendment brilliantly and thoroughly. I will make just a couple of points. Over the past two years, the Department of Health, the Government and SAGE—everyone—have told us to follow the evidence. The truth is that this telemedicine, pills-by-post approach to termination pre 10 weeks’ gestation is simply a medical practice innovation that is safe, effective and follows the best clinical practice. So I want to follow the evidence.

About the only positive outcome of the pandemic I can see is that an enforced pilot scheme has given us evidence of the efficacy of this. We also know, as has been mentioned, that many women appreciate this option because there is no clinical need for them to attend a clinic for this procedure. I really cannot see why the Government cannot see that women who do not need hospital care or in-clinic services to access a procedure should not be forced to take up valuable appointment slots and staff time and unnecessarily squander resources that would be better used to intervene in genuine medical emergencies.

Despite all this, I understand that, for many people, the issue of abortion cannot be reduced to evidence or medical practice because they have moral concerns. I assure them that nothing in this amendment, which is literally about the location where a woman swallows a pill, touches on moral values. This is not a law change. Who can and cannot have an abortion remains exactly the same. The grounds on which abortion is legal remain exactly the same. It is common sense and pragmatic as a matter for women but, if you are morally opposed to abortion, you will still be morally opposed to abortion because nothing in this amendment will change your moral objection. Be reassured: you must have a different fight but not on this amendment, which is total common sense. The Government should accept it.

Photo of The Bishop of Durham The Bishop of Durham Bishop

My Lords, I begin by paying tribute to the noble Baroness, Lady Sugg, for her tireless work on gender equality and areas of international development. We have often been collaborators on such matters. I also apologise to the noble Baroness if she has personally received any hurtful comments on this; some of the things I have seen were shameful. She should not have been abused in this way. Nevertheless, I will oppose her amendment; I hope she understands that this in no way lessens the way in which I honour her for her work.

I declare at the outset that the Church of England’s position on abortion is principled opposition, with a recognition that there are strictly limited conditions under which it may be preferable to any available alternative. My opposition to the amendment is based on that in part but also because I believe that the amendment is functionally inadequate in providing the necessary protections. This was a temporary measure introduced during the pandemic to allow continued access to abortion services, simply to meet a need in extraordinary circumstances. I support the Government’s decision to return to the pre-pandemic system for early medical abortions from August, which was supported by many in the public consultation response.

I also share the concerns of respondents to that consultation around the potential for coercion, the greater possibility of inaccurate assessment, further complications and lack of support. It is of utmost importance that women are safeguarded from coercion and abuse, that they receive accurate and effective medical care through proper assessment, that complications are minimised, and that support is provided to those who need it.

The concerns that I and others have about this kind of at-home early medical abortion are not sufficiently mitigated by the amendment, and in-person visits to a clinic or medical centre continue to be vital. Supporting the vulnerable and creating thorough and effective legislation to do so must be our priority, hence my opposition to the amendment. I conclude by repeating my honouring of the noble Baroness, Lady Sugg.

Photo of Baroness Watkins of Tavistock Baroness Watkins of Tavistock Deputy Chairman of Committees 11:45 pm, 16th March 2022

My Lords, I support this amendment, to which I have added my name. Evidence-based practice that utilises modern technology for the assessment and delivery of treatment for people who choose to take the first pill at home is cost-effective. I think we forget that the majority of healthcare workers, be they medics, midwives or nurses, try to provide person-centred care. Person-centred care means that some women will still be asked to come into the clinic to take that tablet because it is the best solution for that woman.

However, some women live in rural environments where there are very poor bus services. When I went to the women’s meeting at the UN three years ago with other Members of this House, young women representing the four country youth parliaments told harrowing tales of women who had been given the tablet in a clinic but had not got home before the spontaneous abortion commenced. We heard very good examples, particularly from some other countries in Europe, where taking the tablets at home was already normal practice.

The largest study on telemedical abortion in the world was conducted in the UK, covering 52,000 women both before and after the change—in other words, using the natural experiment that occurred as a result of lockdown. There was no change in adverse incidents, no change in successful completion rates, a reduction in waiting times, a reduction in gestation at treatment and it was preferred by women. This evidence was used by the US Food and Drug Administration to make the first tablet at home a permanent option at the end of last year. As the noble Baroness, Lady Sugg, has just said, the World Health Organization issued its international Abortion Care Guideline last week. Telemedicine and self-management of abortion outside a healthcare facility are both in there.

This amendment would enable better person-centred care for the majority of women, as well as for their families and often their partner who will be with them at the time—particularly for people who are perhaps having a third or fourth child which for clinical reasons is not advised. I therefore hope that the fact the majority of people here have a free vote means that they really consider what I have just said.

Photo of Baroness Eaton Baroness Eaton Conservative

My Lords, health and safety have arguably never been more front and centre in our nation’s thinking and approach to healthcare. The Government prioritising healthcare in one of their flagship Bills is therefore expected. I am proud of our Government.

As proud as I am, I feel equally perplexed as to why the amendment tabled by the noble Baroness, Lady Sugg, seeking to override the Government’s decision to end the temporary policy on at-home abortion would garner any serious consideration, given that it would contradict the aims of the Health and Care Bill by placing the health and safety of women and girls at risk. It also distracts from important matters in the Bill, for which the Bill was intended.

The provision allowing at-home abortion made alongside a host of other Covid regulations during an unprecedented global crisis was only ever meant to be temporary alongside almost all other temporary provisions of the Coronavirus Act that the Government are expiring or have already expired. The Prime Minister said that the Covid restrictions

“take a heavy toll on our economy, our society, our mental wellbeing and the life chances of our children”.—[Official Report, Commons, 21/2/22; col. 45.]

The health toll could not, in the specific case of the temporary provision allowing at-home abortion, be more apparent; it is a toll being taken on vulnerable women and girls. As highlighted by a submission to the government consultation on this matter, the lack of in-person consultation increases risks of potentially life-threatening conditions being missed, pills being prescribed beyond the 10-week limit, more women being coerced into a home abortion against their wishes and pills being obtained fraudulently.

These are not unwarranted concerns. Soon after the temporary policy was implemented, story after story emerged of the tragically painful experiences women underwent as a result of this policy. For example, a Telegraph article reported on a nurse whose at-home abortion led to extreme complications needing surgery. Indeed, there have been several cases of women taking these abortion pills outside the legal and safe time limit. For example, in May 2020 police investigated the death of an unborn baby after a woman took pills received by post at 28 weeks pregnant. Such cases are unsurprising given that abortion providers cannot ensure that at-home abortion pills are taken by the intended person in the intended circumstances and time. According to the American College of Obstetricians and Gynecologists, only half of women accurately recall their last menstrual period, again reaffirming that medical confirmation of gestational period is critical.

Given the vast evidence base highlighting how this policy has placed women’s health and safety at risk, an evidence base thoroughly reviewed by the Government in an extensive three-month consultation, I urge the noble Baroness, Lady Sugg, to withdraw her amendment but if she does not, I urge noble Lords to vote against it.

Photo of Lord Alton of Liverpool Lord Alton of Liverpool Crossbench

My Lords, it is a pleasure to follow the noble Baroness, Lady Eaton, and I rather agree with the points that she has just made. But the noble Baroness, Lady Sugg, also knows that I have considerable admiration for her, especially over issues around the stand she took about cuts to our overseas aid programmes; we had the privilege of serving together on the Select Committee of your Lordships’ House that deals with international relations and defence. She will not be surprised to know that I find myself in disagreement with her and I urge your Lordships to think seriously about Amendment 183.

I will give the House two reasons for this, if I may. One is procedural and the other is more substantive. I suppose on the substantive point, I will cite, as the noble Baroness, Lady Eaton, has done, some of the contradictory evidence that we have before us. Your Lordships may not be able to work out whether you believe one side of the argument or the other, and that brings me straight to the point about procedure.

Here we are at almost midnight. This issue has never been debated at any stage in another place in the elected House. Rather like Amendment 170 that we discussed earlier, we have to consider how we resolve sensitive and controversial ethical issues of this kind. There was no consideration of this question in the elected House, and it has come to us without being considered in Committee but at the fag end of Report stage. Surely all of us can agree, wherever we come from on the more substantive point, that this is not the way to go about parliamentary business.

We should bear in mind that since 1967, when the original legislation was passed in another place and then approved here, there have been 10 million abortions, which is around 200,000 every single year. Put another way, there is one abortion every three minutes. You do not have to come from the position that I think noble Lords will be aware that I come from, of believing in the sanctity of every human life, to think that this cannot be right. Indeed, my good friend Lord Steel, who was the mover of the original legislation, has often said that he never intended abortion to be as widespread or repeated as often as it has become.

This all points to the question of procedure. Should there not be a joint committee of both Houses to consider this extraordinarily complex ethical question? Should we not at least have a Select Committee that considers these matters? Should there not be pre-legislative scrutiny before a Bill or an amendment of this kind comes before Parliament? It is passing strange that since 1967, no Select Committee of either House has looked at this legislation, the original Abortion Act 1967. I say to the noble Baroness, Lady Fox, who always makes valuable contributions to your Lordships’ House, that we are changing the law. That is why this amendment is before your Lordships’ House this evening. We would not need the amendment if we were not changing the law.

I also ask those who have rightly emphasised the importance of conscience, and particularly some of my friends and noble friends on the Lib Dem Benches, why this is not a conscience vote. Why is there a Whip on an issue of this kind?

Noble Lords:

It is!

Photo of Lord Alton of Liverpool Lord Alton of Liverpool Crossbench

I am glad to hear that, because I was sent a document earlier on saying that there would be a Whip and that people should vote “Content” for this amendment.

Noble Lords:


Photo of Lord Alton of Liverpool Lord Alton of Liverpool Crossbench

If that is so, I am glad to hear it. Noble Lords will know that, for me, this issue led to my leaving the Liberal Democrats when it became a party policy, so I would love to hear clarity on that question as the evening goes by. I passionately believe that this should be a conscience question for every Member but also at every vote. This should never be a party policy; people should be free to make up their own minds on a serious ethical issue—one of such magnitude and order that it should not be dealt with in such a perfunctory manner.

It was the noble Lord, Lord Kamall, who said that this

“was always intended to be a temporary measure.”—[Official Report, 10/2/22; col. 1820.]

In February, in announcing its end, the Government gave the results of a public consultation. Some 70% of those who responded said that it should end immediately. The consultation highlighted increasing safeguarding risks and “concerns about coercion”. Reinforcing that point, last weekend, BBC “Newsbeat” reported that 15% of women in a Savanta ComRes survey said that they had experienced pressure to terminate a pregnancy. Some women reported being given substances to cause an abortion without their consent.

I would be very happy to share with the noble Baroness, Lady Sugg, some of the contradictory evidence from GPs and doctors. She cited the RCOG and others, but I point out that, again in that ComRes poll, 86% of GPs surveyed across the UK were concerned about women having a medical abortion past the legal limit of 10 weeks gestation. Concern was highest among female doctors, at 91%. Six in seven GPs were concerned that the policy could see more women being coerced into abortion. Some 86% were concerned that women were at risk of being coerced into an abortion by a family member or partner, and 87% were concerned that women were at risk of unwanted abortion arising from domestic abuse by partners controlling or monitoring their actions. Some 94% agreed that staff at abortion providers need to ensure that they are collecting correct medical and personal information to certify a woman for a home abortion, and that it is important that checks are put in place to ensure that women being certified for abortion meet legal criteria. So, there is contradictory evidence, and surely that should be properly evaluated before we proceed in further liberalising our abortion laws.

A study released in November 2021 suggested that more than 10,000 women had to receive hospital treatment following the use of medical abortion pills in England between April 2020 and September 2021. Previous polling showed that 92% of women in Britain agreed that a woman receiving an abortion should always be seen by a qualified doctor. There are many statements from women that, again, I could provide to the noble Baroness, should she wish to see them.

The hour is late, so I will conclude. An email from a regional chief midwife described how women had to attend emergency departments for a range of incidents, including

“significant pain and bleeding related to the process through to ruptured ectopics”,


“major resuscitation for major haemorrhage”,

and incidents involving the delivery of infants who, as the noble Baroness, Lady Eaton, told us, were up to 30 weeks’ gestation.

The evidence suggests that official statistics appear to significantly underestimate the complications and risks. The Minister will have seen that 600 medical practitioners have signed a letter highlighting concerns and calling for the cessation of the temporary measure. This is worthy of proper scrutiny and consideration. It involves the safety of women, but it also involves the taking of a new life. Science teaches us that life begins at conception. Surely, we should give this proper and due consideration before passing this into law.

Photo of Lord Bethell Lord Bethell Conservative 12:00 am, 16th March 2022

My Lords, I am grateful to the noble Lord, Lord Alton. I join him and the right reverend Prelate the Bishop of Durham in paying tribute to my noble friend Lady Sugg for her work on women’s issues—work that I support in every way I possibly can. I think that this amendment is a useful amendment to this Bill. My noble friend Lady Sugg is right that the world is changing: science raced ahead during the pandemic, and many things that had not been tried before were tried. Clinical tools have become more sophisticated, practices are undoubtedly evolving and there are definitely lessons from the pandemic that are worth our consideration.

That is why I very much welcome an opportunity to stand back and reflect on what has changed since 1967, which the noble Lord, Lord Alton, referred to, when the current settlement on abortion was agreed. That was an incredibly important moment, when those with different views engaged with public opinion, clinical judgment, ethical analysis and spiritual leaders. I accept that that settlement made in 1967 will not last for ever. In fact, I agree with my noble friend Lady Sugg that the arrangements that have been in place for many years definitely need a second look. If we agree that the moment is right, I emphasise that any reconsideration of these issues should be done in a thoughtful, considered fashion and that we should engage the large number of people who have strong feelings, as well as expert opinion.

We need to do this because these issues are extremely complex and the evidence is conflicted, and they engage so many different strands of our emotional, spiritual and intellectual life. If this this debate this evening is a starting gun for that process, I would recognise its significance and ask the Minister to reflect on the moment in his comments.

However, if this amendment is a realistic attempt to bring about a significant long-term change to the clinical pathways of our health system, I would be extremely alarmed. Regarding the point made by the noble Lord, Lord Alton, on procedure, I have serious concerns. There is no value in blowing up the long-term arrangements that were agreed in 1967 in a late-night Report debate on an amendment introduced at the last minute to a Bill that is about the integration of our healthcare system. It would be a travesty if the easements that were brought in to cope with a global pandemic were used as a pretext for a long-term rewriting of our abortion laws. We were promised that that would not be the case, and it would be regrettable if this Government went back on those reassurances.

I draw to the attention of noble Lords the report by Gynuity Health Projects, published in March 2021, on its study of the efficacy of telemedicine abortion. It found that 5% of participants using the medical abortion treatment at home needed surgical intervention to complete the procedure. These are worrying numbers and are worthy of further investigation before the current situation passes into legislation.

My hope is that this amendment is regarded for what it should be: a testing amendment to stimulate debate and not a serious effort to overturn arrangements that need to be reformed, not overturned. That is why I call on the Minister to explain why this amendment should not stand, and on my noble friend Lady Sugg to confirm that she will not be moving her amendment.

Photo of Baroness Finlay of Llandaff Baroness Finlay of Llandaff Deputy Chairman of Committees, Deputy Speaker (Lords)

My Lords, I find myself conflicted over this amendment. I am probably the only person in this Chamber who has consulted women over abortions, signed forms for abortions and performed abortions and I have been with women during late abortions for foetal abnormality. It is a complex area. I have also had women say to me, in the privacy of the consulting room, just before they go, “I have never told anybody else this before”—they have then told me about the serious abuse that they have suffered.

My worry with the first part of the amendment, on remote consultation, is that you do not know who is on the other side of camera or who is standing in the room with the woman. You do not know whether the man is using fertility and sex as a form of abuse and is standing there threatening the woman to proceed in one way or another. We know that men refusing to use condoms is a common form of coercive control of women.

The abortifacient tablets, to which my noble friend Baroness Watkins referred, are a separate step. It is inhumane to expect women to take those and then travel on a bus or even go in a taxi. Knowing what has happened before, I cannot help feeling that there is another step. Yes, let the women have their tablets and take them in the privacy of their own home. It is not pleasant to undergo an abortion—nobody should think that it is—but those women also need support and contraceptive advice as part of the package. I am concerned that I do not see that in this amendment and I have been concerned that during the pandemic the ability of women to access contraception may have become more difficult.

This is a complex issue. It is about a pathway with many steps in it. I wonder whether we should return to it at Third Reading, rather than trying to take a yes or no decision tonight on something that has some merits but also some problems. We are not adequately going into them by having a short debate now.

Photo of Baroness Stowell of Beeston Baroness Stowell of Beeston Chair, Communications and Digital Committee, Chair, Communications and Digital Committee

My Lords, it gives me great pleasure to follow the noble Baroness, Lady Finlay, whose contribution reflects her extensive wisdom and knowledge in this area. I just want to say that I commend my noble friend Lady Sugg for her leadership in bringing forward the amendment. I, too, will listen to what the Minister says in reply this evening, but instinctively I support what my noble friend is seeking to achieve.

Photo of Baroness Bennett of Manor Castle Baroness Bennett of Manor Castle Green

My Lords, I rise briefly to support Amendment 183. My background in this goes back to March 2020, in those difficult, scary, early days of the pandemic, when your Lordships’ House was operating on a skeleton crew. That led to me, as very new Peer, moving the amendment to the coronavirus regulations that would have allowed for telemedicine. I thank the noble Baroness, Lady Barker, who I note has signed this amendment, for supporting me through that process, because I had little idea about what I was doing in terms of your Lordships’ House. It is worth noting that we were doing that in part in acknowledgement that women would not otherwise have access to the necessary medical service of an abortion, but also because we knew that NHS resources were going to be enormously stretched. We are still in a situation where NHS resources are enormously stretched. Earlier we were talking about the Ukrainian refugees whom we will be welcoming here and the medical services that they will need.

Of course, we want to say that, in this area of medicine, we should be putting resources into all the NHS services that women need, but the evidence is overwhelming that telemedicine abortion is giving women a better service. I pick up the point made by the right reverend Prelate that there may be safeguarding concerns. There is evidence, particularly from MSI Reproductive Choices, reporting a major uplift in safeguarding disclosures, including from survivors of domestic and sexual abuse, with telemedicine.

On the medical side of this is a simple clear fact: since telemedicine has been introduced, complication rates from abortion have fallen by 20%. You do not have to listen to just me on this; permanent provision of abortion telemedicine is supported by eight royal colleges and medical societies, including the Royal College of General Practitioners, the Royal College of Obstetricians and Gynaecologists, the Royal College of Midwives and the British Medical Association. I also point out that abortion telemedicine is going to continue in Wales and Scotland, based on the evidence. The arguments are simply overwhelming: this is the best option.

Photo of Lord Sentamu Lord Sentamu Crossbench

My Lords, I was not going to speak on this, but I listened to the noble Baroness, Lady Finlay, and that encouraged me to stand up and speak, together with other noble Lords who are a bit cautious about all of this. I was a vicar of an inner-city parish in which there were a lot of teenage pregnancies, and those who made them pregnant tried to force them to have abortions. The only person they felt they could tell was the vicar, not their parents, because their parents would hit the roof. Some of them would get corporal punishment as a result. I found myself in difficult, tricky situations, but I was fortunate, because in the congregation we had midwives and doctors. I simply said, “I listened to what you are saying to me, but I am not medically qualified to give any advice. We have experienced people who can give you that advice.” I was grateful that those midwives and doctors were able to accompany these teenage girls and help them come to a more sensible position.

I speak as somebody who is not against abortion, because the welfare of the mother and her rights need to be protected, but I am concerned about a measure that was brought in because of extreme circumstances. The Government were right, during the pandemic, to allow the kind of arrangement that was set up. But I am with the noble Lord, Lord Bethell, that we should not change overnight a tradition and circumstances that were accepted by the majority who see the right of abortion. We should not say that we will now go down this almost administrative route as the norm. Most people would be very concerned if we were going down a particular route.

I strongly believe, because of my experience of those teenage pregnancies in Tulse Hill, that the role of doctors, specialists in counselling and others is absolutely vital. You cannot do away with that because it is easier at the end of a telephone. You may not believe it, but young boys who had made girls pregnant would put pressure on them to have these abortions, for no reason other than that they wanted to move on to the next young girl. I still find that unacceptable.

I am reminded of the Mau Mau rebellion in Kenya, when most of the clergy of the Church of England were white. Congregations wanted to have communion, but they knew that if a white person turned up at a church during Mau Mau, they would be killed. So they took the decision that the lay people within the congregation should celebrate communion. That happened. Then Mau Mau ended, and the Church in Kenya said, “Oh good, we can now have lay celebration of communion, because these white people won’t be killed any more because Mau Mau has ended.” Archbishop Randall Davidson, who was Archbishop of Canterbury at the time, said, “During Mau Mau, it was a good thing that communion was celebrated by lay people, but it must not continue, because the old order was to establish who should be celebrating.”

We have been through this very difficult period. I am not so sure that measures that were appropriate during that time are appropriate now and should simply be rolled over. We need a fuller debate and it cannot come at the end of this stage. It was not there at the beginning, when there would have been a lot of debate. I would find it difficult if the Minister accepted the amendment, because the Government announced that this measure would come to an end, like all the other measures brought in because of extreme circumstances.

Photo of Lord Duncan of Springbank Lord Duncan of Springbank Deputy Chairman of Committees 12:15 pm, 16th March 2022

My Lords, I have listened to many remarks this evening. There are three things we must remember. First, this approach was brought in during a time of necessity and it has worked. Not only has it worked but it has worked well. It has worked well for vulnerable groups; it has worked well for the wider community, and we should not lose sight of that fact.

Secondly, as we consider what we must do next, we must recognise that it has worked and, on that basis, we should move towards the next step, which is recognising how we can move this forward. It is not an easy issue; it is late at night, but at the same time, we are building on what has already been done. In so doing, we must recognise what can be done further.

Finally and importantly, there is a much wider issue. Many noble Lords have touched on it this evening. That needs to be addressed in the appropriate place, but it is not tonight. Tonight, we have a very simple amendment. It is a very careful amendment and a very simple extension of what we expect to deliver. On that basis, I hope the House will support the amendment. It is simple, it is straightforward, it is right and it is timely.

Photo of Lord McCrea of Magherafelt and Cookstown Lord McCrea of Magherafelt and Cookstown DUP

My Lords, I appreciate the lateness of the hour and, therefore, I want to make just a very few comments.

Without apology, I believe in the sanctity of human life. I believe that it is important to preserve the life of a mother. It is also right to preserve the life of the unborn child. When this measure was originally presented, it was clearly stated that it was an emergency policy introduced because of the unprecedented circumstances of the coronavirus pandemic. The policy was said to be time-limited but many, like me, feared that this was another way of extending abortion on demand. However, many noble Lords accepted that the at-home abortion powers would be exercised only temporarily and be used only for the purpose for which they were granted and in a manner proportionate to the situation. I commend the Government for the actions they took to turn the coronavirus crisis around to the situation we have today. Therefore, continuing the policy is not proportionate, although I did not think it ever was.

At-home abortion endangers the health of the woman and the girl. Consultation revealed that among a number of concerns raised about safety the most common was the risk of women being coerced. I do not think that is an unimportant issue for this House to consider. Therefore, I shall oppose Amendment 183.

Photo of Baroness Smith of Newnham Baroness Smith of Newnham Liberal Democrat Spokesperson (Defence), Liberal Democrat Lords Spokesperson (Defence)

My Lords, I want to intervene briefly, partly because I believe I set a hare running which I perhaps need to explain. I want also to ask the Minister replying to the debate a few questions.

I am told that I am not whipped to vote for this amendment, even though the Liberal Democrat Whip is to support the amendment—those of us who have a conscience reason not to support the amendment do not have to do so. I take that as being not a free vote, which is why I was of the view that, nevertheless, we were being whipped. Make of that what you will. I shall be voting against the amendment, unless the Minister can clarify certain points.

We heard from the noble Baroness, Lady Sugg, in introducing her amendment, and the noble Baroness, Lady Fox, that essentially this amendment changes nothing about the law on abortion. But we have also heard that if that were the case, we would not need this amendment at all. If it changes nothing, why is this amendment here? So it must be changing something. What I am not at all clear about is what protections are actually in place. The 1967 legislation was very tightly drawn. The nature of abortion in 2022 is much more widespread. The provisions are not perhaps quite as Lord Steel would have anticipated.

This is a very detailed amendment. We have heard that it is very simple but it is also very detailed. It explains who women need to see. They are supposed to be seeing people either via video or via telephone. I do not know whether any of your Lordships experienced telemedicine during lockdown, but it is not always very effective. If virtual medicine means a telephone call not on a smartphone, your doctor cannot see you. They have no idea how you are presenting or whether you are vulnerable. There is a real question about what certainty there is. Can the Minister say what security there is about telemedicine?

We also heard that women would still have to go through normal medical tests and so on. Where is this happening? In the amendment, all we hear about is things being virtual. At what point do we know that a woman is nine weeks and six days pregnant when she takes the first tablet? How do we know that she is not actually 22 weeks pregnant and not seen by anybody? How do we know what certainty there is? If this is, for many people, a conscience vote, do noble Lords, in good conscience, believe that telemedicine actually means that women are understood and their needs really recognised? Do they get the care that they would get if they were having consultations in a surgery?

Photo of Baroness Brown of Cambridge Baroness Brown of Cambridge Chair, Science and Technology Committee (Lords), Chair, Science and Technology Committee (Lords)

My Lords, at this very late hour, I just rise to say that I hope your Lordships will not confuse individual anecdotes, however moving, with the very extensive scientific evidence base quoted by the noble Baronesses, Lady Sugg and Lady Watkins.

Photo of Baroness O'Loan Baroness O'Loan Crossbench

My Lords, what is proposed in this amendment is a fundamental change in the law. What we must look at is, I think, fundamentally for each woman, what actually happens in each situation, and what care is provided for the woman in that situation.

I believe that the Government were right to say that this provision would come to an end and that it is not necessarily safe. There are major uncertainties for many women when they conceive. They do not always know when their last period was, as noble Lords have said. But it is not just that. They do not always know the nature of their own medical health and the consequences of taking the telemedical abortion pills.

In that period after 2020 alone, 10,000 women needed hospital treatment for the complications arising from telemedical abortions. It is not an anecdote but a scientific fact that losing a baby, whether by miscarriage or by abortion, is a very bloody and, on occasion, very painful business, which gives rise to all sorts of problems and complications.

All we need to do is to ensure that we do not pass law which does not provide proper care for women. We need to ensure that they do not feel that they are taking up their GP’s time if they seek to consult them about taking these tablets. In a moment, at a time of panic or distress, when they may be subject to coercive control of many kinds, they should not be in a position in which they can be forced to seek this medication when what they need may be care, space and time. BBC polling has shown that 5% of women aged 18 to 24 reported that such substances were given to them without their consent. We cannot protect these women if we allow this amendment to pass. I therefore ask your Lordships to vote against it.

Photo of Baroness Barker Baroness Barker Liberal Democrat Lords Spokesperson (Voluntary Sector), Deputy Chairman of Committees

My Lords, I wish that many Members of your Lordships’ House who have spoken this evening could have come to the meetings that I have attended in the last two years with people from organisations such as the Royal College of GPs and the Royal College of Obstetricians and Gynaecologists. They would have heard many of the fears that have been raised this evening addressed.

It is important that noble Lords are aware that we are talking a proposal which stems from clinically led, peer-reviewed scientific research in international journals, versus anecdotes. They are not equivalent. Those professional bodies, from the start of the change in the law, were addressing all the issues which noble Lords have raised this evening. In particular, it is important to state that we are not talking about people having to ring up some kind of remote service which is very minimal. They are talking to people who are skilled interviewers, trained to look for the signs of coercion and to detect them. Indeed, the evidence has shown that having this service has enabled service providers to find women who are being trafficked and coerced. That is one additional benefit that has come out of this service.

A further benefit to have come out of it is that women—desperate women—are no longer seeking unregulated medicine, which they will do if this service stops. The evidence behind this is overwhelming and I ask the noble Lord, Lord Bethell: why should this service not go ahead? I know, and I think that he will know, of other medical services which have changed because of lockdown and are being rolled out—cancer therapies, for one. So why this one? Why is it always the women who are at the back of the queue when it comes to equity and fairness?

I do not think that there is any doubt about the safety of the procedure. I have heard people such as the noble Lord, Lord Alton, make speeches like that before and I understand that they are absolutely and totally opposed to anything that enables a woman to access an abortion service in any way. I accept his moral point, but to all other noble Lords I say: please go and look at the evidence, and look at who is telling you that this is the right thing to do for women.

Photo of Baroness Stroud Baroness Stroud Conservative

My Lords, Amendment 183 was tabled in the name of my noble friend Lady Sugg and, like many others, I want to honour her for her commitment to vulnerable women and international development. There are a number of reasons why I cannot support this amendment, but, first, it is important to be clear what it is and is not actually about. In many of the emails that have been flying around from supporters on both sides of the argument, and the various stories in the media, it would appear that Amendment 183 is about abortion and easier access to it. However, although the subject matter is one of abortion, in practice this amendment is significantly more about the health and protection of women.

First, let us take a look at why this is not an abortion amendment. Perhaps, in this instance, I may be able to address some of the recent comments from the noble Baroness, Lady Barker. In the UK, in practice if not in law, we have abortion on demand up to 24 weeks. In 2020, there were 209,000 abortions for women resident in England and Wales—the highest number since the Abortion Act was introduced. This stands in a context where, in the same year, there were 613,000 live births. So, there was roughly one abortion per three live births. We also have access to the morning-after pill without question, and in 2018-19, there were 91,000 procured from sexual and reproductive health services—and that does not include pharmacies. Also, in today’s world, pregnancy tests are as sensitive as Covid tests, so women know from a much earlier stage in their pregnancy whether they are pregnant—not like in my day. It is quite clear that over time, women have been able to take control of their body and their reproductive choices.

If this is not an amendment about abortion, what is it about? With all due respect to the noble Baroness, Lady Sugg, public policy is littered with the results of the unintended consequences of policy decisions. In the name of wanting to serve women, this amendment removes protections for women and leaves them vulnerable and isolated at a time when support, both medical and emotional, is needed. For those of us who participated in the Domestic Abuse Bill or have taken a stand against violence against women and girls, this should cause concern. So, let us take a look at why and how it removes protection for women.

This amendment, as is obvious, provides for a telemedicine service, and the consultation takes place by phone. Hence, an ultrasound is not available. These pills, though, are deemed safe only if they are taken up to nine weeks and six days into a pregnancy. But, without accurate date keeping, and without an ultrasound to confirm the development of the baby, it is impossible to check this on the phone. Taking pills in a more developed pregnancy can be high risk, and this amendment completely abolishes the necessary checks, balances and safeguards that were previously in place to protect the health of the women involved. My noble friend Lord Duncan said it has worked and worked well, but there were over 50 cases officially reported to the Department of Health and Social Care of women who were provided pills by post beyond the 10-week gestation period, including one where, as we have heard, the unborn child was at 28 weeks’ gestation, well beyond the legal limit. There is simply no way of knowing across a phone call the actual gestation period of the baby.

It is difficult to quantify the number of complications that have arisen from these pills, such as incomplete abortion and continued bleeding, because of insufficient data collection on patients receiving the pills. This is where my noble friend Lord Bethell’s comments are appropriate and need to be heard tonight—that significantly more work needs to be done around this issue. FoI requests have revealed the aftermath from the pills by post process to include sepsis, haemorrhaging, embolisms, renal failure and trauma to pelvic organs, among other medical complications.

Secondly, the amendment leaves women to bleed on their own and opens them up to increased health risks. It is extraordinary to me that many of the arguments used against back-street abortion that drove the introduction of the Abortion Act 1967 seem to be being ignored by this amendment. It puts women back to bleeding on their own, in their rooms at home, passing the early stages of the baby into the loo, and all without medical care—the very thing the Abortion Act 1967 was passed to stop.

Finally, this amendment leaves women open to coercion, as we have heard this evening, by actors within the home who do not want a child. We need to be acutely aware that self-administration of abortifacient medication in this way removes the opportunity to check whether abuse or coercion are involved in the decision. This poses a threat to vulnerable women and girls who are at risk from an abusive partner, or from child sex abuse.

Noble Lords this evening have quoted from the Savanta ComRes poll that 77% of women believe that doctors should be legally required to verify in person—

Photo of Baroness Thornton Baroness Thornton Shadow Spokesperson (Equalities and Women's Issues), Shadow Spokesperson (Health) 12:30 pm, 16th March 2022

My Lords, I hesitate to intervene at this late hour, but the noble Baroness is making what can only be described as a Committee or Second Reading contribution. Perhaps she should think about that before she continues much longer.

Photo of Baroness Stroud Baroness Stroud Conservative

I understand the noble Baroness’s sentiment. Had there been a Second Reading or Committee opportunity—that is, had this amendment not been introduced on Report—there would have been no need to make these arguments at this stage.

Tragically, we know that such coercion has been happening. A further Savanta ComRes poll commissioned by the BBC and reported on Monday showed that 5% of women aged between 18 and 24 had been given something to cause an abortion without their consent. Noble Lords have already quoted some of the data from these polls.

This amendment sounds so nice—pills by post in the comfort of your own home—but, in reality, it leaves women medically exposed and vulnerable to both health complications and coercion. I totally understand the motivation of the noble Baroness, Lady Sugg, in bringing it forward, but I urge noble Lords not to vote for an amendment that would remove protections, expose women to health complications and increase the risk of coercion.

Photo of Baroness Walmsley Baroness Walmsley Co-Deputy Leader of the Liberal Democrat Peers

My Lords, before I make any comments about the amendment, I want to make it very clear that this Front Bench believes that it does not change the law on abortion. It is just about access to a safe and legal medicine, which is why we have encouraged our colleagues to vote for it. However, it has been made clear, both in the written Whip and verbally by me at our group meeting this afternoon, that any Liberal Democrat who feels that they have a conscience or ethical reason why they want to vote against this amendment is quite free to do so. That happens all the time on these Benches, actually; it is not unusual.

I have been keeping a little tally. Adding in the noble Baroness, Lady Thornton, who has her name on this amendment, I calculate that 10 women and one man—I thank the noble Lord, Lord Duncan—have spoken in favour of it. On the other side, there are four men and four women. I think it is pretty clear that, of those in this House who felt strongly enough about the amendment to speak at this late hour—most of them briefly, thankfully—there is a majority of women who think that the availability of this medicine, which all the royal colleges have made clear they believe is safe and effective, should continue.

Photo of Baroness Neville-Rolfe Baroness Neville-Rolfe Chair, Built Environment Committee, Chair, Built Environment Committee

Some women across the Benches may not have spoken because they are conscious that the House needs to proceed with this Bill, even though they might put themselves in the camp with the other four women.

Photo of Baroness Penn Baroness Penn Baroness in Waiting (HM Household) (Whip)

My Lords, on Report, only short questions of elucidation are allowed.

Photo of Baroness Walmsley Baroness Walmsley Co-Deputy Leader of the Liberal Democrat Peers

I accept that a lot of people have shown some self-discipline and resisted speaking, but the tally is 10 women in favour and four men and four women against—and the noble Lord, Lord Duncan, on the side I am on.

Despite what has been said, I still do not believe that this amendment changes the law on abortion. It is about access to medicine and, often, access for the most vulnerable women. I accept that it is difficult to speak at this time of night about an issue such as this but, quite honestly, if the Government had thought that this medicine was as dangerous as some noble Lords have suggested, it would have been very remiss of them to allow it to go on for the past two years. Indeed, as I have said, all the royal colleges believe that it is safe; it is also legal, of course, and very acceptable to women. I, for one, think that women should continue to have access to it; I hope that noble Lords will vote for that to happen.

The only reason why this amendment had to be brought in now is that something has changed, which is that the Government have said that they will take it away from women. That is why we have not had a previous opportunity to discuss it.

Photo of Baroness Thornton Baroness Thornton Shadow Spokesperson (Equalities and Women's Issues), Shadow Spokesperson (Health)

My Lords, following on from the comments of the noble Baroness, Lady Walmsley, the reason that we are discussing this now is because the Government made their announcement on 24 February about what they intended to do. That means that this is our first opportunity to try to suggest two things.

First, this is not an extension of abortion rights. The people who have spoken against it have been, in general, the people who always speak against women’s rights to control their fertility. I have been in this House for 23 years and involved in many such debates. That is the first important thing to say. Whatever the reasons—including the noble Baroness, Lady Stroud, talking about bleeding at home—actually, most of the women in this Chamber will have had miscarriages at home on their own and coped with that happening to them.

It is a bit rich when the noble Lord, Lord Alton, questions the suitability of this issue being discussed when he is a past master, with our support, of bringing forward the issues that he cares most about in Bill after Bill until he succeeds. We have supported him in doing that. I am not suggesting that he should support us at this point, but I should just make the point regarding the suitability of Bills lending themselves to those who are campaigning on issues.

The second reason is that the noble Lord the Minister in front of us and his predecessor talked about the importance of innovation and of using the good things that were developed in the health service as a result of the pandemic. This is one of them. The noble Baroness, Lady Barker, is quite right. Why should this one issue, that has worked, that women want, given that all the statistics that the noble Baroness, Lady Brown, quite rightly mentioned in her succinct contribution were peer-reviewed and scientific, not continue? Women want this and it is safe.

Photo of Earl Howe Earl Howe Deputy Leader of the House of Lords

My Lords, I am grateful to my noble friend Lady Sugg for bringing forward the amendment. I know that many noble Lords on all sides of the House have strong feelings on this issue. Indeed, it is because any change to the law on abortion is traditionally a matter of conscience that the amendment will be subject to a free vote on the Government Benches if a vote is called.

Noble Lords will be aware that, as a temporary measure, in response to the Covid pandemic, an approval was issued in accordance with the Abortion Act 1967 that allowed women to take both pills for early medical abortion at home at gestations up to nine weeks and six days. We announced on 24 February that there will be a six-month extension to the approval and that the approval will end at midnight on 29 August 2022. From that point, the arrangements set out in the pre-Covid 2018 approval, which allows women to take the second pill for early medical abortion at home only, will be reinstated and face to face services will return.

The temporary measure was put in place at the start of a public health emergency to address a specific and acute medical need, reducing the risk of Covid-19 transmission and ensuring continued access to abortion services. At the time, a decision was made to time limit the approval for two years or until the pandemic was over, whichever was earliest.

The Secretary of State has decided that the provision of early medical abortion should return to pre-Covid arrangements from midnight on 29 August 2022. He has done so for three principal reasons: first, in the light of the success and impact of the national vaccination and booster programme; secondly, having carefully considered all the responses submitted to the Government’s public consultation on whether to make permanent the temporary measure; and thirdly, on the basis of wider evidence regarding the provision of the service since March 2020. Of course, we will continue to work closely with abortion providers and the Royal College of Obstetricians and Gynaecologists—alongside NHS England, NHS Improvement and the Care Quality Commission—to support a safe and reliable return in six months’ time.

The noble Baroness, Lady Smith, asked about the protection afforded to the woman by the temporary approval. The change, as introduced by the temporary approval, was to enable a woman seeking an abortion to consult a clinician via a teleconsultation. If the clinician was satisfied that the conditions laid down in law for approving the request were met, she would be prescribed both stages of the requisite medication for use at home. The responsibility rests with the clinician to ensure that all the necessary conditions are satisfied. That is, essentially, the protection.

The intention of this amendment is to halt this process and overturn the Secretary of State’s decision. In our view, this is not the appropriate way to achieve the intended policy objectives. The legal approval framework already exists in statute, and primary legislation should not be used to circumvent that. Parliament decided to give the Secretary of State a power to issue approvals under the Abortion Act 1967. It did so for good reasons. It would be inappropriate to specify such details about how, and where, healthcare services are carried out on the face of primary legislation. It would hinder the ability to account for external circumstances such as pandemics, or to account for changes in medicines used for such procedures. This is why the existing approvals power allows the Secretary of State flexibility to make decisions about how healthcare in this area is provided. This can be adapted quickly and easily to respond to changes in service provision or other external circumstances—just as was the case in 2020, when the temporary approval was made in response to concern about the risk to services caused by Covid; and, in 2018, to permit home use of the second medication. This framework works and a change to primary legislation does not need to be made.

Finally, although I do not want to labour this point, it is far from clear what my noble friend intends by wording the amendment as she has. The amendment as drafted would create legal uncertainty for both women and medical professionals, in a highly sensitive area of law, by including wording on the statute book that does not in fact change the law in the way in which it would appear. That is a real difficulty for noble Lords who might be inclined to support the amendment—but it is not the reason why I ask the House to withhold support for it. Ministers have made a decision on this issue and have done so responsibly on the basis of the powers given to them under law. I respectfully suggest to my noble friend that it is right for that decision to stand.

Photo of Baroness Sugg Baroness Sugg Conservative 12:45 pm, 16th March 2022

I am very grateful to those noble Lords who have stayed up until this hour to discuss this important amendment, and I grateful to the Minister for his answer. However, I am disappointed by it.

On the argument around these regulations being temporary, we now have the evidence of their success, as we have heard. Since they have been introduced, the World Health Organization and medical professionals have been clear that their advice is that this service should stay. The removal of this service represents a step back, when in all other areas of telemedicine we are moving forward.

On evidence, we really should be looking at the largest ever UK study into abortion, which took place just before telemedicine was introduced and just after. That showed that the rate of complications fell significantly. On complications themselves, the same procedure happens and it is going to continue to happen. Voting against this amendment is not going to remove early medical abortion; it will just allow women to maintain the choice of taking a pill at home.

I want to briefly address the issues around vulnerable women and safeguarding because that is incredibly important. Of course, safeguarding is a really essential part of all healthcare. But there is evidence, as noble Lords have cited, that telemedicine is helping to improve safeguarding, with providers reporting a major uplift in safeguarding disclosures, including from survivors of domestic and sexual violence—particularly from women in abusive relationships. It is more common to be forced to keep a pregnancy than to end one.

Those who work closely on gender-based violence, coercion and abuse will tell you that the solution to reproductive coercion is to get stronger reproductive rights. Women’s Aid confirmed to me just this evening that it is fully supportive of keeping the service, as making abortion access more difficult does not prevent coercion. In fact, it does the opposite. The very fact that vulnerable women are being used as an argument against maintaining the service which is going to benefit them, I find very difficult to take.

This is not a debate about early medical abortion. As I said, it will remain legal. It is not about broader abortion. It is about whether women can continue to choose, receive and take medicine in the comfort and safety of their own home. It does not bring in a new service; it would simply avoid removing an existing service that women are using safely.

I really do not want to keep anyone any longer, and I appreciate there is diversity of opinion in your Lordships’ House. I respect that people have deep-seated views on abortion. But I believe we should listen to the medical experts who are clear on this matter. We should listen to the women who want, need and will use this service. We should stand strongly against what would be a rollback of women’s rights. Telemedical abortion care has been repeatedly proven by peer-reviewed, clinician-led large-scale studies to be safe, effective, accessible and preferred by women. It is what the medical professionals advise, and it is what women want. I believe that is what should guide us in this vote. I would like to test the opinion of the House.

Ayes 75, Noes 35.

Division number 6 Health and Care Bill - Report (4th Day) (Continued) — Amendment 183

Aye: 75 Members of the House of Lords

No: 35 Members of the House of Lords

Ayes: A-Z by last name

Amendment 183 agreed.

Amendments 184 and 184ZB not moved.