Sir John, I am pleased to be able to respond to the debate introduced by Dr. Harris. I am going to try to get through as many questions that were asked as possible, so I shall try to avoid taking interventions. If there is something that I have not covered, I suggest to hon. Members that they seek me out and I will write to them further if they are not happy with my reply.
First, in 1967 and 1990, Parliament decided that abortions may be lawfully carried out in the circumstances specified in the Abortion Acts. We have heard a considerable number of contributions about that legislation this morning. Women are legally entitled to seek an abortion at the gestation periods that Parliament sets. It should be recognised that the proportion of abortions carried out at over 20 weeks gestation is small; just 1.6 per cent. of abortions carried out on residents of England and Wales in 2003. In fact, 87 per cent. of abortions are carried out at under 13 weeks gestation and of those, 58 per cent. were at under 10 weeks.
I am pleased to say that since 2002–03, there has been an indicator on access to abortion services in the primary care trust star ratings that have been set. That is important, because a number of hon. Members have raised during the debate the issue of access to abortion during the first trimester. The Government have put a lever on PCTs to do what they can to improve services. I am afraid to say that services are patchy in different parts of the country. We are trying to improve that with the star rating. Early indications are that it is having some effect. I hope that those who are not against abortion in principle will welcome that.
Access to abortion before nine weeks' gestation is important because it allows women a choice of surgical or medical abortion. I will address the point on medical abortion made by the hon. Member for Oxford, West and Abingdon later.
The time limit in section 1(1)(a) of the Abortion Act 1967 was reduced from 28 weeks to 24 weeks by a free vote in Parliament in 1990. There is no time limit for certain categories. Amendments were submitted by Back Benchers and were attached to the Human Fertilisation and Embryology Act 1990. The Government made parliamentary time available for the issue then because there was a consensus in the medical and scientific community that the time limit should be reduced. The debate that informed that decision considered a wide range of ethical and practical issues. Today, neither the Royal College of Obstetricians and Gynaecologists nor the BMA thinks that abortion time limits need to be reviewed, which is why the Government have no plans to do so. The circumstances were very different in 1990, when there was more of a consensus across the medical world that the situation needed to be addressed.
The Births and Deaths Registration Act 1953, as amended, provides for the registration of babies born dead after 24 weeks' gestation. That is described as the legal age of viability. Guidance from the British Association of Perinatal Medicine introduces the concept of a threshold of viability of 22 to 26 weeks' gestation. Although the possibility of survival for extremely pre-term babies has improved—of course, we are aware of that—data suggests that even with modern intensive care, the chances of survival at 22 weeks' gestation are only about 1 per cent, whereas at 24 weeks they are about 26 per cent. A recent BMA briefing paper entitled, "Abortion time limits", highlighted the fact that gestational age is not the only factor that affects whether a foetus is considered to be viable. Several Members have acknowledged that today.
One question asked today was whether the reduction of the 24-week limit would impact adversely on some women seeking abortion. If the time limit were changed, there would need to be a full assessment of the impact and outcomes of the change. Recent research gave some reasons why women seek abortions at later gestations, including their failure to recognise the pregnancy earlier, a delay in seeking abortion due to personal circumstances, and, of course, the diagnosis of foetal abnormality. In some cases, screening is available only at 18 weeks and onwards.
It is important to allow the woman, her partner and other family members who may be involved sufficient time to make that decision based on the information resulting from such a screening. The woman must be allowed enough time to assess the reality of caring for the child should it be born with a disability. It is important that there is time in the process not only for women to decide to have an abortion, but for them to decide not to have one.
We are bound by the science. I am sure that if there were an earlier opportunity to test for foetal abnormalities, most people would welcome that, but, as far as I am aware, science has not advanced to the point at which that is possible. There are clear issues about what information is given to the pregnant woman and the time that she is allowed to make a choice in difficult circumstances. Therefore, there are a number of reasons why abortions take place beyond 20 weeks, and such abortions are few compared to the overall number.
Mr. Baron and other Members asked about abortions beyond 24 weeks on the ground of foetal abnormality.