Doctors who provide abortions say current law prevents provision of best possible care for women

Abortion doctors feel they provide a vital and valued service – but that legal requirements set out in the 1967 Abortion Act are prohibiting the provision of the best possible medical care for the women they see.

That was one of the key findings of a new study published in March by researchers at the University of Kent into the values and professional identity of doctors who provide abortion services.

The research involved detailed interviews with 14 doctors who have spent at least a decade providing abortions. Most are current, or recently retired, consultants in obstetrics and gynaecology or sexual and reproductive health.

Almost all doctors interviewed strongly criticised the legal requirement for ‘two-doctor’s signatures’ to authorise each abortion as being at odds with the doctor-patient relationship and causing obstacles to access.

Doctors described the requirement as ‘completely unnecessary’ and ‘a joke’, while one doctor spoke of having to wander around a hospital to find a second signature:

‘Best practice is to allow direct access from the patients so they don’t have to go through a GP or another service…  we’d love to be able to do that but the reality is getting that second signature is difficult so we rely on the GPs signing the first part… If we allowed direct access it would mean for every occasion we’d have to go round the hospital trying to find someone to sign it… today in clinic there were three that were unsigned it probably took me about half an hour just sort of literally walking around interrupting someone and getting them to sign it.’

Doctors were also concerned that the Abortion Act, which is 50 years old this year, is restricting their ability to provide abortion procedures in the way they saw as best clinically. In particular, doctors raised concerns about the provision of medications used for Early Medical Abortions.

Current interpretation of the law prevents women from taking the abortion medication in their own home, as women experiencing a miscarriage are able to do, which means, said the doctors, that some women will begin to pass the pregnancy on their way home from the clinic:

‘It’s extraordinary that you can subject women to travelling mid-abortion [after they have taken both drugs used to induce miscarriage and leave the clinic]. I mean I find that unbelievable that the government can do that and why? I mean it’s not morally better; it’s medically more unsafe, it’s logistically more difficult for women so that’s another one of my absolutes, certainly the second part of abortion should be available at home.’

Doctors also worried that the threat of prosecution that is unique to abortion, alongside public debates about the morality of abortion care, has a negative impact on the recruitment and training of new abortion doctors:

‘It makes doctors frightened. Apart from the fact that it’s a Cinderella position anyway because it’s not seen as part of normal obs and gynae and on top of that they’re now also frightened because they say, “Well if we don’t cross this and if we don’t tick that then somebody’s going to take our registration away”, and it’s got nothing to do with good clinical care and I’m furious about it.’

Led by Dr Ellie Lee, Director of the University’s Centre for Parenting Culture Studies, the researchers sought to establish what the doctors felt about their work within a context of a debate that very often centres on issues of unethical abortion practice, a claimed lack of care for patients and scant regard for the law.

The study also found that there is a ‘strong and clear sense’ among doctors providing abortion services that what they do matters ‘and that most of all it matters to women’, but doctors expressed frustration and anger over the way their work is often perceived by the public, other medical professionals, and policy makers.

The researchers conclude that further research is now required to ‘broaden the scope of the debate about conscience when applied to abortion provision’.

The study, entitled Doctors who provide abortion: their values and professional identity, was carried out by Dr Lee and Dr Jan Macvarish, of the Centre for Parenting Culture Studies, and Professor Sally Sheldon, of Kent Law School. It is available here: https://blogs.kent.ac.uk/parentingculturestudies/

Staff Writer