§ Order for Second reading read.
§ 1.41 p.m.
§ Mr. Bryant Godman Irvine (Rye)
I beg to move, That the Bill be now read a Second time.
This is the second occasion on which I have had the privilege of finding my name included in the list of successful candidates in the Ballot for Private Members' Bills. As I have had the experience once before, it may be thought that I should be prepared for what will happen today. On the last occasion, shortly after my Bill had been published, I was sent for by the Under-Secretary of State for the Home Department. My Bill related to firearms in the countryside, and I was told that it was quite unacceptable to the Government. Another ten days went by and I was sent for by the Minister of State, who told me in no uncertain terms that the first opinion which I had had from the Government had been reinforced by subsequent thought.
I went away at the Christmas Recess in a state of despondency. Before I came back, there was a little difficulty regarding some policemen who had been shot in London. The Government had had a quick change of mind. I was told that, if I were minded to withdraw my Bill, it would be incorporated in a Government Measure which would be larger and better than mine. That is what, in fact, happened.
1654 On this occasion, when I selected the present Bill as the one which I wished to introduce, I heard nothing from the Government. I hope that that means that there is as favourable a brief as may be in the hands of the hon. Gentleman the Joint Under-Secretary of State for the Department of Health and Social Security, whose versatility in the subjects with which he has to deal we all admire, and that we shall be able to proceed with the matter in that way.
When I found my name in the successful list, I was subjected to the usual bombardment by people who had Bills which they thought would be suitable for me to introduce. The reason why I selected this one was that it had the backing of the two responsible professional organisations. I thought that, if they wanted the Bill, it was something to which I should lend my support. The Bill is simple. It has a second Clause, but the material part is in Clause 1.
Just to have it on the record, perhaps I should say that the Abortion Act, 1967, Section 1(1), provides that…a person shall not be guilty of an offence under the law relating to abortion when a pregnancy is terminated by a registered medical practitioner if two registered medical practitioners are of the opinion, formed in good faith "—and then the qualifications are set out.
My Bill would substitute for the words, "by a registered medical practitioner if two registered medical practitioners", the following:by or under the supervision of a consultant gynaecologist in the National Health Service or a medical practitioner of equivalent status approved by the Secretary of State for Social Services for the purpose of this Act, if the medical practitioner carrying out or supervising the operation and another medical practitioner"—and then the words following as before—are of the opinion, formed in good faith…".That is a short, easily understood and simple amendment of the Act, and, as I have said, it is sought by the two responsible professional organisations. I have no doubt that hon. Members will have seen the letter in The Times yesterday signed by the chairman of the council of the British Medical Association and the president of the Royal College of Obstetricians and Gynaecologists, in which the purpose of the Bill was concisely set out. I shall adopt the explanation which 1655 they gave in commending the Bill to the House. At the end of their letter they said:A number of motives have been ascribed to the Bill, but we would like to make it absolutely clear that in giving effect to our views it seeks only to safeguard the interests of the health of the women concerned …That is the point to which I shall direct my observations today.
There have been suggestions that the medical profession is not behind the Bill. In two large organisations it is impossible to achieve 100 per cent. unanimity. But the principles of the Bill were set out in the annual report of the council in the British Medical Journal of 6th May, 1967. They were considered and approved by the annual representative meeting of the Association in July, 1967. They have been approved in each subsequent year, and only this week the two responsible officers of the two organisations concerned reinforced the view that that is what the profession wants.
I find it somewhat difficult, therefore, to understand why there are people who suggest that this would not be a desirable course to take. One of my hon. Friends—fortunately, I do not see him present at the moment—came to me and said that he was in favour of abortion on demand. That is an understandable view, and, if that be the view which should be taken, I can fully understand why he would not wish the amendment to be accepted. But for those who accept the more responsible approach to the matter, I commend the remarks of the hon. Gentleman the Member for Roxburgh, Selkirk and Peebles (Mr. David Steel) on 21st July 1966—reported in col. 1075 of the OFFICIAL REPORT that it was not the intention of the promoters of what became the Abortion Bill to leave a wide open door for abortion on demand. I hope, therefore, that he will take the view that this is a helpful and desirable amendment and that I shall have his support. I am not entirely convinced that I shall, but I can at least express the hope.
I have noticed that the hon. Gentleman has from time to time claimed that certain things had flowed from the passage of his Bill. I shall say a word about one of them in a moment, but I wish to tell the House at this point that when I was in Hong Kong two or three 1656 months ago I picked up the newspaper which was delivered to my bedroom in the morning, the South China Morning Post, and saw the headline there,Sydney rivalling London as Abortion Capital".Is that something for which the hon. Gentleman wishes to take credit? I have no doubt that it has been a direct result of the Act he introduced.
Shortly after that I was in Denmark—
§ Mr. W. Howie (Luton)
Is that really all the hon. Gentleman intends to say about Hong Kong? Does he consider it enough to read out the headline from a Chinese newspaper, respectable as that may be? Should not he go on to give some arguments which the newspaper in Hong Kong adduced to justify that headline, if indeed it could?
§ Mr. Irvine
On a subsequent occasion, I would be happy to discuss Hong Kong or any other matter with the hon. Gentleman, but as we have a very brief period left for the debate I hope to make my remarks as concise as possible.
Turning briefly to Denmark—
§ Mr. Irvine
I talked there to one of the senior members of the Danish Government. Denmark has very liberal laws on abortion. This very senior Minister said that there were only two countries in Europe to which Danish girls could go when they could not get an abortion in Denmark. One was Poland and the other was this country.
I want to deal with three criticisms that have been put to me as a result of my introducing the Bill. The first was made by my own general practitioner, who works under the National Health Service. I asked him for his views about the Bill, and he expressed some anxiety that it would mean that there would be less responsibility for the general practitioner and less possibility for him to arrange for an abortion in the future.
A little document has been signed by some general practitioners and sent to some hon. Members. I have received two copies. One came from three doctors in a partnership in my constituency, and one was sent by a general practitioner. But the one to which I particularly want to refer was sent to one 1657 of my hon. Friends and signed by one of his general practitioners. The original draft reads as follows:The Abortion Act, as it stands at present, is a good law and generally works effectively for my patients' welfare. I strongly oppose any amendment to the Act which would limit my choice of surgeon and the patient's chance of obtaining a legal abortion with the minimum of delay. I therefore urge you to oppose any such restrictive measure.This document was signed by a general practitioner in my hon. Friend's constituency.
§ Mr. Irvine
It is my hon. Friend the Member for Woking (Mr. Onslow), if that is any help. The general practitioner who sent it added one or two words. After the first sentenceThe Abortion Act…works effectively…he added:but more particularly for the welfare of professional abortionists.At the bottom of the document he says, having scratched out the second sentence:This is a fairly guileless bit of special pleading. The Irvine Bill is intended to limit the more blatantly commercial exploitation of the new law which is largely carried out in London.That is the view which I hope will commend itself to the House. I am sure that it is accepted by the vast majority of the medical profession.
For the benefit of the general practioner who is anxious about the position, may I refer again to the wording of the Bill, which makes it clear that the general practitioner is the person to whom a girl will originally go, and it will be he who passes her on to a consultant gynaecologist.
As regards consultants, I am advised that this is a designation which technically arises only under the National Health Service, but that in fact many National Health Service consultants hold part-time appointments, so that it is quite possible to consult them outside the Service.
The hon. Member for Roxburgh, Selkirk and Peebles (Mr. David Steel) claimed outside the House last night, I think, and did so in the House as recently as last 15th July, that: 1658The limited evidence we are able to gather —for example, from the London Emergency Bed Centre figures—shows that we are achieving the objective of reducing criminal abortions. The figures given by that centre show that in the first quarter of 1966 there were 1,363 emergency admissions for spontaneous or incomplete abortions, whereas during the first quarter of this year the figure was down to 870. This is a very satisfactory development."—[OFFICIAL REPORT. 15th July, 1969; Vol. 787, c. 414–15]There was a letter in the New, Statesman on 6th February on behalf of the Abortion Law Reform Association, answering a letter which had asked whether there was any good reason for support for the Abortion Act. The letter said:Here is one…In 1966, the Emergency Bed Service, London, handled more than 5,000 abortions, which formed more than 11 per cent. of its total cases. In 1967 the Abortion Act was passed. By 1969 the total of abortions had fallen to some 3,300 and now form only 6.7 per cent. of all emergencies. This striking result probably explains why some of the more extremist opponents of reform are so anxious to wreck the Abortion Act without giving it a fair chance.The hon. Member for Roxburgh, Sal-kirk and Peebles and the Abortion Law Reform Association have conveniently omitted figures, giving only those for the past year or two. The facts are that from April, 1964 to April, 1965 there were 5,816 admissions. The figures for the following years were as follows: 1965–66, 5,670; 1966–67, 4,932; 1967–68, 4,619; and 1968–69, 3,631. The hon. Gentleman claims for the Act the whole credit for the reduction in the years after its introduction. He omits to say that, for reasons I cannot explain, the figures have been declining rapidly over a period of five years. I quote those five years only because they happen to be the years quoted in the report to which my attention was directed.
§ Dr. David Kerr (Wandsworth, Central)
The hon. Gentleman used the phrase "declining rapidly". What is significant about the figures he read out to us is their extraordinary acceleration since the Abortion Act was passed. It is not a continuously falling graph but one which goes over the edge of a precipice.
§ Mr. Irvine
If the hon. Gentleman will contain himself for a moment, I was going to deal with that point. If he does a little arithmetic he will find that just the opposite has happened. The Act came 1659 into operation on a date which left only eight months in that calendar year, so I shall take the same eight months for the various years to match them up. In that period in 1966, there were 3,357 admissions. The figures for the following years were: 1967, 2,888; 1968, 2,482; and 1969, 2,215.
For the help of the hon. Gentleman, whose mathematics appear slower than he thinks, I will give what I take to be the result of those figures, which is that in 1967 the fall was 469; that in 1968 the fall was 406; and that in 1969 the fall was only 267. If there is any message to be derived from the figures of the emergency bed service from the abortion point of view, it is that the fall which had been going on over those years had flattened out after the Abortion Act was introduced.
§ Mr. Edwin Brooks (Bebington)
Has the hon. Gentleman's attention been drawn to the fact that in the period to which he referred, in 1966 and again in 1967, there was a rapid and quite dramatic increase in the number of therapeutic abortions, that this was apparently a prelude to the full implementation of the Abortion Act and that there has been no dramatic increase since the introduction of that Act, certainly not an increase of the fashion he has described?
§ Mr. Irvine
Even if one accepted all of that, one would still have to explain why this decline occurred prior to the Abortion Act coming into operation.
It is wrong for the hon. Member for Roxburgh, Selkirk and Peebles to say that the decline has been entirely due to his Act because the decline was going on before his Measure had even been thought of, though the decline is not as rapid now as it was then. I hope, therefore, that both he and his society will not continue with that line of argument.
§ Dr. David Kerr
I have no wish to turn this into a mathematical seminar, but as the hon. Gentleman challenged me on the question of the fall, I must ask him if he is aware that on the figures he has given—I confess that I have had difficulty in noting them all—the fall shows an acceleration? The hon. Gentleman omitted to point out that the numbers must be regarded as a percentage of the 1660 number of cases. Because the number of cases has been falling, the same number represents a higher percentage of that number of cases. Thus, the figures which he gave and which range about the 400 mark arise because the number of cases has been falling, and 400 represents a constantly larger percentage each year.
§ Mr. Irvine
Perhaps some conclusion can be drawn from all these figures. Nevertheless, the hon. Member for Roxburgh, Selkirk and Peebles was using figures not for the eight months to which I referred but for whole years. My argument in this context is that it would be wrong to try to draw the sort of conclusions which the hon. Member for Roxburgh, Selkirk and Peebles sought to draw from the figures that are available.
It should not be forgotten that from 1961 to 1969 there was no decline in the number of septic abortions. If the claim of the hon. Member for Wandsworth, Central (Dr. David Kerr) were correct, would not one expect to find some indication of it in the number of septic abortions?
It has been suggested by some who do not like my Bill that it would be restrictive. Here again one must look at the figures. We are told that there are 555 consultant gynaecologists. If one divides 54,000 by that number—54,000 is the latest figure I have available for the number of abortions carried out in a year —one does not need great mathematical ability to see that there must have been two abortions per week per consultant. With his knowledge of the profession, the hon. Member for Wandsworth, Central will agree that that cannot be regarded as overworking consultants.
§ Mr. Maxwell-Hyslop
Can my hon. Friend say how many of the total number of consultant gynaecologists are not prepared, on conscientious grounds, to carry out abortions? Is he aware that that number should be excluded from this arithmetical calculation—
§ Dame Joan Vickers
Would my hon. Friend say where these gynaecologists are in practice? Is he aware that they are not scattered neatly over the country?
§ Mr. Irvine
My hon. Friend the Member for Tiverton (Mr. Maxwell-Hyslop) wants to know if there are any consultant gynaecologists who, on conscientious grounds, are not prepared to carry out abortions.
§ Mr. Irvine
I do not know. [Interruption.] I hope that hon. Members will allow me to proceed.
Let us assume that one-half of the 555 consultant gynaecologists are not prepared to do abortions on conscientious grounds. That would mean that the available consultants would have to do four abortions per week, and the hon. Member for Wandsworth Central will still, I am sure, agree that that is well within their competence.
My hon. Friend the Member for Plymouth, Devonport (Dame Joan Vickers) wants to know where these gynaecologists are. I am afraid that I cannot tell her, though I can tell her that if my Bill is accepted there will be an arrangement to enable any deserts of consultants to be dealt with. [HON. MEMBERS: "How?"] The facts are set out in the Bill and if hon. Members will allow me to proceed I will explain everything to them.
§ Mr. Peter Mahon (Preston, South)
Would the hon. Gentleman not esteem the fact that these consultants are congregating as this is turning out to be a lucrative business?
§ Mr. Irvine
I entirely agree.
On the question of consultants having conscientious objections to performing abortions, the information I have—I have gone to some trouble to find out the facts—is that in cases where consultants have objections, they are most meticulous in seeing that those cases are handed over to people who hold a different view. I am told, in particular—I am not a member of the Roman Catholic Church —that consultants who are Roman Catholics are meticulous in the way they do this.
§ Mr. Peter M. Jackson (The High Peak)
Would the hon. Gentleman give the evidence on which he bases that assertion? I, too, have talked to consultants about this matter. My impres- 1662 sion—I agree that it is a personal one—is that what the hon. Gentleman has described is not the case. I believe that those with a conscientious opposition put considerable resistance and blockage in the way of general practitioners and others who take a more liberal view than themselves. I gather that they do not assist in the way the hon. Gentleman has described.
§ Mr. Irvine
If the hon. Gentleman will read the letter which I quoted and which appeared in The Times yesterday, he will see that consultants and doctors in this country subscribe to the international principle that religion must not come between them and the welfare of their patients.
§ Mr. Irvine
I regret that I do not keep my eye on the Luton and Dunstable area as closely as the hon. Gentleman obviously does. If he will bear with me I will come to the fact that there may be places where there are either no consultants or some who take the view to which he referred.
§ Mr. James Dempsey (Coatbridge and Airdrie)
Would the hon. Gentleman bear in mind that these conscientious objectors realise that their views are respected and that they, in turn, respect the consciences of their colleagues? This was made plain to me two weeks ago at a large conference in Scotland.
§ Mr. Irvine
I am obliged to the hon. Gentleman. That was the point that I tried to make as best I could.
I have so far been working on the basis of 555 consultants and 54,000 abortions. If one takes the figures of those who have completed specialised training in this country, the picture is different. The latest figures, for September, 1968, show that in England and Wales 1,618 people 1663 had completed specialised gynaecological training in this country and were practising in a specialised way. In Scotland the figure was 269. I think that with very little difficulty the Minister would be able to select some or all of those people who would be in a position to give specialised attention to girls who required it. The fact is that 1,877 people with specialised training are available, which means a total of four operations a week. Even allowing for conscientious objections, if one divides the number of operations by the number of people available to do them, I think that one comes to a very satisfactory figure.
There are, however, other people whom I suggest the Secretary of State should consider. There are professors and their deputies at various universities who are specialising in gynaecology. I am told that there are 50 or more such people. In addition there are people who have retired from service overseas, people who, at 65, after a lifetime of service as gynaecologists, would be capable of going on sessional fees to look at some of the cases. If the Minister has a brief which says that this is something which the Ministry would not wish to undertake, I ask him to look at the Mental Health Act, 1959, where a similar arrangement was made, and at the cremation Acts, where the same thing happens.
There is a suggestion that because of the shortage of consultants there is a long waiting list, My inquiries show that there is no evidence whatever of a waiting list for women requiring abortions. I suggest to the Minister that he should have no difficulty in getting over the problem of finding an adequate number of people to deal with this problem.
I commend to the Minister the remarks of the hon. Member for Lichfield and Tamworth (Mr. Snow) who then occupied the exalted position now occupied by the Minister. When discussing an Amendment, not precisely in the terms of the amendment to the law which I am suggesting, but the same sort of arguments were being used, the hon. Gentleman said:But I am advised that the procedure is not without risk, and that the requirements of this Amendment would reduce the risk to the lowest possible level. I am sure that this is something we would all wish. The safest circumstances for the termination of a pregnancy are those in which the staff are experienced in 1664 operative gynaecological procedures and the facilities are suitable for carrying out those procedures. I believe that responsible medical opinion would expect such precautions to be taken.That is what I am asking the Minister to say. That is what the amendment asks him to say, and that is what I hope he will say.
The hon. Member for Lichfield and Tamworth went on to say:Equally, it would not be possible under these particular powers regarding approved places for the Minister to stop racketeering. It would not be proper for him to seek to control the fees charged by the nursing home itself, nor could he in any way control the fees charged by doctors coming in to conduct operations. The hon. Member the sponsor of the Bill said that he believed that the twin provisions of control over the place and notification give precisely the kind of control which we require…" —[OFFICIAL REPORT. Standing Committee F, 8th March, 1967; c. 398–9.]That was rejected by the then Parliamentary Secretary, and I hope that the Minister will today feel that my Bill will enable him to exercise the control which he otherwise might find it difficult to do.
A little later in the Committee proceedings the then Minister said:It seems to me that it is for the Committee to decide whether or not the average patient would prefer to put up with some inconvenience in return for the knowledge that the operation would be in the hands of someone about whose competence there could be no doubt."—[OFFICIAL REPORT, Standing Committee F, 8th March. 1967; c. 403.]That is what I am asking the Minister to do.
Since I announced that I was going to adopt this Bill as my own, I have had a number of cases reported to me. Some of them have been reported in the Press and some have not. One girl came to see me last week. After three hours in a clinic she was sent home, and two days later she had to go into a National Health Service hospital, where she was desperately ill for six weeks. Another girl, about whom I heard yesterday, was in a clinic for one hour, and subsequently had to spend 13 days in a National Health Service hospital because of the problems which had arisen. Another girl said that the conditions in the place to which she went were rather like Piccadilly Circus. Only this morning a consultant telephoned me to say that during the last six weeks three cases of severe septicaemia had come to him for care after visiting one of these clinics.
1665 Those are conditions which we do not want to perpetuate. I think that the whole House should do something to deal with them. A girl who goes into a clinic of that sort needs to be cared for after she has left. She requires something more than one hour there, and then to be sent out and left to her own devices. She needs to be under observation for three days. She needs to be in a place where proper antiseptic precautions are taken, and not in a Piccadilly Circus type of organisation. I want to see that humanity is offered to girls in this condition, and that they get proper medical care, and I therefore commend the Bill to the House.
§ 2.18 p.m.
§ Mrs. Renée Short (Wolverhampton, North-East)
The hon. Member for Rye (Mr. Bryant Godman Irvine) has quoted various opinion polls, and various headlines from the Press. I think that perhaps I might get my headlines out of the way as well. Did the hon. Gentleman see the very good leader in last night's Evening Standard under the headline, "Abortion Reform?"? I think that that is really the crux of the whole thing.
The hon. Member is not seeking to reform the Abortion Act, which was put on the Statute Book after a great deal of discussion inside this House and outside —reform meaning, presumably, to improve, or to make progress. What he really wants to do is to repeal the Act, to make it ineffective, but he does not have the courage to come out and do that.
§ Mr. Godman Irvine
Responsible gentlemen who hold high office in the two professional bodies concerned take the same view as I do, and they do not want to destroy the Act.
§ Mrs. Short
If we look at public opinion polls, that is the second thing on which I was going to give the hon. Gentleman an analysis.
§ Mr. Peter Mahon
On a point of order, Mr. Deputy Speaker. Is it in order for an hon. Member to question the courage of another hon. Member because he feels that he holds a valid opinion?
§ Mrs. Short
Recent public opinion polls show that the majority of the general public are either satisfied with the Act or want to see it improved so that it is easier for women to get terminations. A similar public opinion poll carried out among doctors showed that 66 per cent. of general practitioners in the United Kingdom thought that the Act should be left as it is or should be changed to make it easier to obtain legal abortions, and only 28 per cent. thought that it should be changed to make it more difficult. It therefore appears that the majority of doctors who are in the closest contact with their patients, namely, the general practitioners, are satisfied with the Bill or want to see it improved, to the extent that women can obtain legal abortions more easily. That is an effective counter to the letter printed in The Tunes which the hon. Member quoted.
In my view it is rather early to make any sort of definitive proposal to change the Act. It has been in operation for only 18 months. I agree with what Sir George Godber said at a lecture in London last June, namely—I hope that the hon. Member for Rye is listening; I can waste the time of the House if he wants me to. I am going to quote what Sir George Godber said. I take it that the hon. Member knows who he is. At a public lecture in London last June—when the Act had been in operation for about 15 months—he said:The most important effect of the Act—the saving in human misery—cannot be expressed in statistical terms.That is a very important comment on the Act, coming from that quarter.
The hon. Member told us the number of legal terminations which are now being carried out, but I do not think that he distinguished between the number of terminations being carried out in National Health Service hospitals and in the private sector, respectively. What has been most encouraging since the Act 1667 was passed is the fact that the percentage of terminations carried out under excellent conditions in National Health Service hospitals is steadily increasing. Over 65 per cent. are now carried out in National Health Service hospitals under the supervision of gynaecologists and senior people with constant practice in this kind of work.
The number of patients being treated by private clinics, which now have to be licensed by my right hon. Friend before they can obtain permission to carry out terminations, is increasing at a much slower rate. We have no reason to believe that as gynaecological opinion becomes more educated and progressive the proportion of patients treated in National Health Service hospitals will not continue to increase, possibly at an even more rapid rate. There will probably be a decline in the number of patients ultimately going to private clinics.
The hon. Member for Rye quoted some hair-raising and terrible case histories, but he did not give the names of the clinics responsible. He could have done this, protected by the privilege of the House, so that all of us would have known where those clinics were. He must know that my right hon. Friend has recently inspected again all the clinics licensed when the Act was introduced, and has introduced rather more stringent regulations and is now insisting that patients should stay in at least one night after the operation has been performed. I suggest that in the interests of women who are concerned about the operation of the Abortion Act he should give this information to my right hon. Friend so that he can investigate the clinics concerned and see whether their licences should be revoked. No one wants to see women treated in this way.
§ Mr. Simon Mahon (Bootle)
What is the equivalent time in National Health Service hospitals? Patients stay for one night in private clinics; how long do they stay in National Health Service hospitals?
§ Mrs. Short
Some private hospitals keep their patients in for two nights and some for one night. In National Health Service hospitals the average is roughly three days. Patients do not have to pay 1668 in National Health Service hospitals, but in private clinics they do.
§ Dr. David Kerr
I regret that my hon. Friend is misinformed. It is not uncommon for patients in National Health Service hospitals, after having had the necessary operation for a termination, to be discharged in 24 hours if everything is all right. There is nothing wrong about that, just as there is nothing wrong about discharging patients who have had appendectomies if their condition is all right.
§ Mrs. Short
I am obliged to my hon. Friend. It therefore appears that there is no difference between the best practice in a National Health Service hospital and the best practice in a licensed nursing home or clinic.
The hon. Member for Rye tried to confuse us with his figures concerning the numbers of terminations carried out before the Act, the number of criminal abortions, and the number of admittances to hospital. It is important to realise, now that the Act has been passed and we can see how it is operating in different parts of the country, that fewer terminations are being carried out than there were before the Act was introduced. In 1967 the total number of admissions for abortions of any kind, including therapeutic abortions, criminal cases and spontaneous abortions, was 79,600—nearly 80,000. This year the figure is running at about 54,000 altogether. We know that this figure is accurate because the abortions are all registered with my right hon. Friend. The number includes private clinics and National Health Services cases.
In 1967 in National Health Service hospitals only 9,700 therapeutic abortions were carried out. This shows the change in the climate of opinion, and the effect that this has had since the Act was introduced. It was estimated that in 1967 about 17,000 therapeutic abortions were carried out by private doctors. I would also remind the House of a change in practice that has occurred since the Act was introduced. Before the Act it was common practice for general practitioners to carry out abortions in their private surgeries and to send the patient home immediately afterwards. Nothing was said about keeping them in bed overnight. That is now illegal. 1669 Terminations can be carried out now only in licensed premises which have been inspected by my right hon. Friend's Department. That risk, in the private sector, has been removed as a result of the passing of the Act. All hon. Members—certainly women hon. Members—should be grateful for that.
The hon. Member for Rye also told us the number of gynaecologists and other doctors who had had training in gynaecology—which is a different thing. Many people have training in different specialities, but abortion is not a matter where the bungler and the fumbler can work successfully.
§ Mr. Godman Irvine
It is obvious that I did not make myself clear. My figures were for those actively in practice in this speciality.
§ Mrs. Short
The figure given by the hon. Member in respect of the number of consultant gynaecologists was over 500, and that would include part-time as well as full-time consultants. If we reduce all those to full-time equivalents we find that there were 436 full-time gynaecologists in the National Health Service. Even if we were to say that all gynaecologists were carrying out their job conscientiously, and carrying out the wishes of the doctors who referred patients to them, this would work out at about three terminations per fortnight per gynaecologist—not a difficult burden. But the difficulty is that, in certain parts of the country, the gynaecologists employed in National Health Service hospitals are not willing, for various reasons, to carry out terminations. This therefore reduces the effective number of consultants who are able and available to carry out these operations. I therefore ask the hon. Gentleman—what happens in those areas where the consultants are unwilling, for whatever reason, religious or otherwise, to carry out terminations referred to them by two doctors?
§ Mr. Godman Irvine
If the present Act continues as it is, nothing happens, but, if my Bill is accepted, the Minister will be able to appoint a list out of the 2,000 who might be able to deal with the problems in places such as Devonport and wherever else the hon. Lady has in mind.
§ Mrs. Short
But in those figures which the hon. Gentleman gave, he included doctors who have retired and those who have come back from overseas. This is the Indian Army doctor syndrome—
§ Mrs. Short
I have not given way to the hon. Gentleman.
That is the Indian Army doctor syndrome which we debated thoroughly in Committee on the original Bill. I repeat what I said then, that this is not an operation which one would give to someone who had not had recent experience in the field. I am sure that my hon. Friend will be able to give us accurate figures of how many doctors suitably qualified, and with suitable experience, which is the important thing, are available to do these operations. My case is that, at the moment, there are 436 equivalent full-time consultant gynaecologists—
§ Mr. Christopher Price (Birmingham, Perry Barr)
Would my hon. Friend not agree that what makes this more serious is that in those areas where the consultants are unwilling to carry out terminations, they have a natural tendency to appoint juniors of a like mind, and that that is very much the situation in Birmingham?
§ Mrs. Short
That is absolutely right, and I am grateful to my hon. Friend for helping with my next point.
I do not know whether the general public or even the House appreciate the power of a consultant gynaecologist, particularly in a teaching hospital. He has great powers of patronage, of appointing doctors who are working with him in his Department. He is called in to help in appointing doctors by the regional hospital board and in appointing consultants and senior men in other hospitals, and of course his influence can spread not only in his own Department in his own hospital but throughout his hospital region. He could have considerable influence, as my hon. Friend said, in the appointment of doctors with a similar point of view to his own.
This will be denied, but we have seen this in several areas. The worst regions for percentage of abortions since the Act 1671 came in are Sheffield, Liverpool and Birmingham. That is in the first year. In these areas, it was known that the consultant gynaecologists in the teaching hospitals had campaigned actively against the passage of the Act. What is even more interesting—we can gain encouragement from this—is that, in the first half of the second year, which is as far as we can go, the percentage has almost doubled in all those areas. In Sheffield, Liverpool and Birmingham there are now almost twice as many legal terminations in National Health Service hospitals. This seems to prove what I said earlier about the education and the evolvement of a more progressive attitude among gynaecologists.
The areas in which the consultants are unwilling or unable to carry out abortions which are now legal under the Act have of course seen the growth of self-help organisations. Pregnancy advisory organisations have been set up in London, and there is one in Birmingham. The reason is that a large percentage of women dealt with by this service in Birmingham are working-class women who should be going to National Health Service hospitals, the kind of women who find it very difficult to pay to go to Harley Street and to private nursing homes. This shows the growing need in these areas for the Act's help. Where it has been possible for advisory services and nursing homes to be started, which, again, are registered by my right hon. Friend and inspected by his inspectors, they are fulfilling a useful service.
The hon. Member for Rye should not feel too despondent about the development of the Act in due course, because doctors are proving more willing to operate the Act, it appears. One of the interesting features of the public opinion poll among general practitioners was that doctors in the West Midlands, the area with which I am much concerned, think that the facilities for legal abortion in the whole area are inadequate, and they want more. If I were to make any criticism of my right hon. Friend—I have made this frequently in the House—it is that he has not seen fit, so far, to make additional provision in those regions where the N.H.S. facilities are not proving adequate because of the attitude of the consultant gynaecologists. Any development must be along these lines.
1672 The hon. Member mentioned what happens in other countries where there are terminations and quoted the headline in some obscure paper in the Far East, saying that London was now the "abortion capital of the world". That stupid and irresponsible statement, the kind of statement to encourage foreign women to come here if anything could, gained currency from a statement made by the hon. Gentleman's hon. Friend the Member for Birmingham, Edgbaston (Mrs. Knight) who, I believe, said this in America. My right hon. Friend commented on this in the House on an earlier occasion.
The figures are that, of all the terminations carried out in a year's working, only between 6 and 7 per cent. were carried out on foreign women. This does not make London the abortion capital of the world. Of that six or 7 per cent., some were on foreign women domiciled here for a time—au pair girls and so on—so the number of women coming here specifically for terminations is minute.
§ Mr. Dan Jones
Is there another capital in the world in which there is the number of therapeutic abortions carried out within the law as there is in London?
§ Mrs. Short
Yes; I will give the figures.
In 1968–69, the first year's working of the Act, the figure in England and Wales was about 40,000—I hope that my hon. Friend has that figure fixed firmly in his mind. In Czechoslovakia, it was almost 80,000; in Hungary, 180,000; in Sweden, 11,000 but Sweden's population is only one-fifth of ours; in Japan, 748,000. The percentage in England and Wales in the first year worked out at 4.6. In Japan it was 38.7, in Czechoslovakia 34.4, in Hungary 135.6 and in Sweden 10 per cent. These are abortions in countries where terminations are legal.
§ Mr. Maxwell-Hyslop
In case there is any misunderstanding, would the hon. Lady make it clear that the figure of 40,000 was for the whole of the United Kingdom and not just for London?
§ Mrs. Short
No. There are therefore several capitals which can rival the statement made by the right hon. Gentleman. 1673 I hope that no one in the House will be so irresponsible and foolish as to give further currency to that stupid remark.
I think that I have demolished some of the rather irresponsible arguments which have been adduced against the Act. A great deal of the discussion on the Bill has been very ill informed, exaggerated and irresponsible. We should allow the Act to continue. The figures for the second year's working of it will not be available until towards the end of the year. Therefore, my hon. Friend the Joint Under-Secretary of State is not in a position to give any processed figures today. The Act has brought enormous benefit to the women of this country. More and more doctors are operating it. More and more people are aware of the benefits which it has brought to women.
The fall in the illegitimate birth rate is germane to this argument. Before the Act, illegitimate births were over 70,000 a year. This is a matter of great concern in a world situation, and particularly a European situation, where the expansion of the human race has been almost of epidemic proportions. Those people who are concerned with conservation and who heard upstairs a most interesting discussion organised by the Parliamentary and Scientific Committee only this week will know that the position which faces us is very serious. Therefore, we should welcome anything which reduces the number of illegitimate births. As Sir George Godber said, the great benefit which is brought to women by the removal of the fear of unwanted pregnancy cannot be quantified in statistics.
I hope that the House will throw out the Bill if it has a chance to vote on it. It will not be we on this side of the House who prevent a vote from being taken.
§ 2.44 p.m.
§ Mr. Norman St. John-Stevas (Chelmsford)
This is a controversial and emotional subject, and we should recognise that. We should be as restrained as possible in discussing it. However, I cannot pass over without a rebuke the remarks of the hon. Lady the Member for Wolverhampton, North-East (Mrs. Renee Short) who, in the opening sentence of her speech, made a totally unjustified attack on, and impugned the motives of, my hon. Friend the Member for Rye (Mr. Bryant Godman Irvine). There is a convention in the House that, 1674 however much we may disagree one with another, we respect the sincerity of those with opposing views.
§ Mr. St. John-Stevas
Just a minute, please. It was disgraceful, because it simply is not true, as the hon. Lady said to my hon. Friend, that he was trying to wreck the Act. His views on this matter are quite different from those of the hon. Lady, but he is as much entitled to those views, and to respect for them, as she is entitled to hers. I will not emulate the discourtesy and rudeness with which I was treated by the hon. Lady when I attempted to interrupt her and she made a cheap point at my expense and got a laugh; she is welcome to that. I will now give way to her.
§ Mrs. Renee Short
I am obliged to the hon. Gentleman. I did not give way to him because I had hardly completed the second sentence of what I was saying; he was a little premature. My criticism of the Bill concerned its Title. It is misnamed as well as misconceived. It should have another title. It is not an Abortion Law (Reform) Bill.
§ Mr. St. John-Stevas
The hon. Lady has made as near an apology as she is capable of, and I accept it in the spirit in which it was offered.
I turn to the hon. Ladys arguments. I wish to deal with them because it is important that the House should not be misled. She said that the majority of abortions are carried out in the National Health Service. That is not news; everyone who has studied this subject knows it. But there are well over 20,000 abortions a year being carried out in private clinics. That is a high and significant number. In view of that figure, we are naturally concerned with what is happening in the private sector. We cannot therefore dismiss the argument behind the Bill as though the private sector is of no importance. It is not as important as the National Health Service, but it is a very important sector.
The hon. Lady then passed to the question over which she got into a great muddle and was helped out by various of her hon. Friends, namely, how long was spent having an abortion in a National Health Service hospital and how long was 1675 spent in a private clinic. She was corrected in a helpful way by one of her hon. Friends. The standard of care in the private sector is not as high as it is in the National Health Service. That is why the Royal College of Obstetricians and Gynaecologists and the B.M.A. are so concerned about the situation.
On the question of the time spent in hospital having an abortion, may I quote to the hon. Lady from the evidence given by Sir John Peel, who was then President of the Royal College of Obstetricians and Gynaecologists, and which was mentioned when we last debated this matter in the House a few months ago? He pointed out that during a three-month period 52 women were treated under the National Health Service and discharged from hospital in 24 hours and that during the same period the number of women discharged after 24 hours in the private sector was over 5,000. One can see from those figures that it is not possible to have the standard of after-care which is needed with an abortion if one is running a mill in which people simply pass in and out, are seen for 24 hours and are never seen again. That is the point about which the medical profession is so concerned. I hope that that answers what the hon. Lady said.
Then we had the jargon about the medical profession and educating them into adopting progressive attitudes.
§ Mr. Dempsey
Would the hon. Gentleman bear in mind the number of foreign nationals who come here for abortions? Has he seen the formidable details about those women which I received in a reply by the Secretary of State for Social Services?
§ Mr. St. John-Stevas
I am grateful for that intervention. I will deal with that point later. I was completing my indictment of the hon. Lady, and I do not wish to be distracted from this necessary task.
When the hon. Lady talks about educating the medical profession into adopting progressive attitudes, what she means is brainwashing them into accepting her own particular theological view of the right of women to have abortions on demand. That is the truth of the matter; that is what she means. I do not mind her being rude to me—I have 1676 forgiven her now, I have got over it—but I do object to her being so offensive and patronising to the medical profession.
The hon. Lady described the number of foreign women who came over to this country for abortions as minute, and she used a percentage figure of 6 to 7 per cent. But if one looks at the absolute figure, that represents over 3,000 abortions being carried out on foreign women per year. That is not a minute figure; it is a large figure. It may be made to sound minute by putting it in percentage form, but it is in fact a large, and, I suspect, a minimum, figure. I know returns are sent in, but I doubt whether they are entirely accurate and whether the addresses which are given always indicate the place of origin of the patient. Now I have finished with the hon. Lady and will pass on to develop my own argument.
There are strong feelings and deep anxiety throughout the country about the working of the Act. My correspondence shows that the worry about the Bill is widespread amongst those with strong religious views and those with none. My correspondence is not confined to letters from Roman Catholics, and it is unfortunate that an attempt is made to dismiss the protest against the Abortion Act as a religious lobby. It is not. It is a protest from people of all religions and of none who are concerned about our public morality and state of health after the passing of the Act. Abortions have now reached 54,000 a year. One cannot be definite about figures, because one does not know the number of illegal abortions before the Act came into operation, but there has probably been a three-fold increase. It is furthermore a steadily rising graph. If the graph is projected as it is going at present, within a measurable time we shall be faced with an abortion rate of 100,000 a year.
One effect of the Bill may be to reduce the number of abortions, and one should face that. If one thinks that rackets are operating under the present law, one wants to get rid of them, and one effect will be to reduce the number of abortions. I face that, and it is something which, all things being equal, I should welcome; but that does not mean that the Bill is specifically aimed at reducing the number of abortions and nothing else. 1677 It is aimed at getting rid of these legalised rackets, which my right hon. and learned Friend the Member for St. Marylebone (Mr. Hogg) warned the House in a prescient speech would rise up if the Bill passed into law unamended. On this matter I have strong moral views, and I shall, I hope, continue to express them—
§ Mr. Peter Mahon
Before the hon. Gentleman comes to his moral views, would not he agree that those features of the Act and of the implementation of the Act which he has outlined are very important and serious, but is it not equally serious that many women who are suffering a normal illness are being kept out of hospitals because of the accent on the Abortion Act?
§ Mr. St. John-Stevas
That is a valid point. One could spend the entire budget on the National Health Service, such is the demand for healing, and still it would not be satisfied. It therefore must be a question of priorities.
§ Mr. Brooks rose—
§ Mr. St. John-Stevas
It is a very odd form of priority in social expenditure that one should make abortion easy and family planning difficult. Perhaps the hon. Gentleman who has done so much in this sphere has something to contribute. I will give way to him. It would be much better to spend the money on instruction in family planning than on abortions.
§ Mr. Brooks
I would be the last to dissent from what the hon. Gentleman has said. But would not he agree that if there is a danger that women with normal gynaecological problems are being kept out of National Health Service hospitals because of abortions, this Bill, far from improving matters, is likely to make them worse, as there will be a greater loading upon National Health Service hospitals?
§ Mr. St. John-Stevas
One is dealing with too many imponderables to make a prophetic announcement as firm as that. It all depends on the policy adopted by gynaecologists and that, as we have seen, is a matter of great dispute.
§ Dr. David Kerr rose—1678
§ Dr. Kerr
The point that worries me about his argument is what will happen to the 50,000 women wanting abortions if they do not have them? His argument is based on the assumption that they do not need treatment or hospital beds after the termination of pregnancy. But they do need more expensive health facilities if the pregnancy is allowed to continue, apart from the social consequences of unwanted pregnancies inside or outside marriage.
§ Mr. St. John-Stevas
I am afraid there is a basic difference between us. I do not regard the birth of a child as being a disaster. I regard it as being a good thing. I do not regard the birth of a child as being equivalent to an abortion. It is a moral question not a question of which one prefers. The hon. Gentleman's approach is not a frame of argument that is mine.
I must pass on to my argument. In deference to the House I will leave out my moral views; I assume that they are well known. I will pass to the question of the law. The law should be based on the general moral consensus in the community. As far as can be judged from polls and other evidence, the consensus is that the country wants—and this is what Parliament wants—abortion for serious reasons but not abortion on demand. Secondly, the country and the medical profession want it to be carried out under the best possible medical conditions. Both those conditions are violated by the present situation. Under the Act abortion may be had on demand, provided a person can pay enough. I have no criticism of the National Health Service, I am purely concerned with the private sector and with the legalised rackets which are operating there.
We must face the fact that we have crooks in every profession. We have crooks in the legal profession and we have them in journalism—we may even have them in Parliament. We have crooked people in the medical profession, and the Act has given them a licence to run their racket free of any threat from the law. Here are people who are in it only to exploit suffering and not to relieve it, and, in exploiting it, to make as much money as possible.
§ Mr. Christopher Price
Can the hon. Gentleman give the House any evidence at all that the crooks in the medical profession, to which he has just referred, are any less plentiful among consultant gynaecologists than among the generality of the medical profession?
§ Mr. St. John-Stevas
I do not want to compare the impact of original sin on gynaecologists and general practitioners. I am not basing my argument on such a comparison, and I would be very foolish to do so. The point of bringing in a consultant gynaecologist is that we bring in a person holding a very responsible position who, because of that responsible position, is more likely to insist that the law be enforced than is another person who does not hold that position. That is my argument.
We know of the rackets, and we read about them from time to time. They can be exaggerated in the popular Press and by individuals, but they exist. There is evidence, I have it here, for instance, of the foreign women coming here, and the touting going on at London Airport. This is not the fabrication of sensation-seeking journalists. We know of the package deals that have been arranged in the United States—the combination holiday and abortion. We know too, that there are a number of doctors who, whilst observing the strict letter of the law, are completely ignoring its spirit. So there are these rackets.
My second point is that of the medical conditions. I stress here that in many cases abortion can be a most serious operation. Here I rely not on my expertise but on that of the President of the Royal College of Obstetricians and Gynaecologists, Mr. Jeffcoate, who in a speech earlier this week said:There is evidence to show that even in experienced hands recognised rupture of the uterus occurs at least once in every 200 abortion operations. In others the accident can pass unnoticed. Rupture of the uterus not only offers a considerable threat to life and may require major surgery, it leaves the uterine walls so weakened that rupture is likely to occur spontaneously in a subsequent pregnancy and labour, again threatening the life of mother and child.We should also note the statistic of the death rate after abortion, which was 15 in the last operable year—considerably higher than the maternal mortality rate—
§ Mr. St. John-Stevas
No, I am very sorry, but I cannot. I have given way to the hon. Lady once, and there are many other hon. Members who wish to speak.
I am not quoting on my own authority but the President of the Royal College of Gynaecologists.
We had the recent case of the tape recording of the young woman who was aborted in a London clinic and left in an appalling state—bleeding and in intense pain—and had to be treated as an emergency case.
I want at this stage to make a correction to what I previously said of the case. I referred to it as having taken place at the Calthorpe abortion clinic in Birmingham, and I wish to be fair even to the Calthorpe abortion clinic in Birmingham. I mixed up the cases. The case to which I referred at the Calthorpe clinic was another case but, in a way, it was almost as bad. It took place in November, whereas the most recent case took place in December. There, again, there were medical complications and an emergency operation had to take place in Birmingham under the National Health Service. Therefore, the record of the Calthorpe clinic, although I was, I think, unfair to it, is not unblemished though I welcome this opportunity to put the record right.
These cases are occurring. How can one improve the situation? One can do it by having an effective check. One can only do that in two ways; either by having a definition or by having a responsible person intervening in the process. Definitions can always be got round, so I think that my hon. Friend is right in insisting that a responsible person—namely, a consultant gynaecologist in the National Health Service—should be involved.
The argument about numbers is very important in relation to the Bill. The figure given by the President of the Royal College, which I prefer to that given by the hon. Lady, is 555 consultant gynaecologists. It must be remembered, however, that in the majority of cases consultant gynaecologists do not themselves carry out the operation. They have working under them registrars and other people who do the operations. That means that 1681 we have nearly three times as many people, namely, about 2,000 people, competent to carry out these abortion operations. It is not a question of creating areas where a service would not be available. Even in areas like Plymouth and elsewhere where there is a shortage of gynaecologists, my hon. Friend has provided for the appointment of doctors from panels supplied by the Royal College of Gynaecologists so that nobody shall be denied their right under the law. I agree with that and I know that he is sincere in putting it forward.
My hon. Friend dealt cogently with the question of the reduction in the number of those admitted to hospital under the emergency bed service. I will not go into the statistics again, but he was challenged by the hon. Member for Wandsworth, Central (Dr. David Kerr) who said that the total number of abortions was going up and therefore this represented a higher rate of decrease than before. But he could not possibly make that statement unless he knew the number of illegal abortions. This is the great imponderable. We do not know the number of illegal abortions before the Act, nor do we know the number after the Act.
§ Dr. David Kerr
With respect, I did not make that statement, and the hon. Gentleman is quoting the reverse of what I said. The hon. Member for Rye (Mr. Bryant Godman Irvine) was saying that the number of abortions had fallen. If the number by which they have fallen remains the same, then the proportion by which they fall goes up.
§ Mr. St. John-Stevas
My hon. Friend was quoting the fall in the number of people admitted for treatment under the emergency bed service as a result of abortion. He said that had been falling previously. Let us leave these statistical points. Statistics are misleading and clearly they have misled us both. They are a contribution to the argument, but they cannot decide it.
I will quote one more statistic, which is that in the first 12 months of the Act the death rate from abortion went up rather than down.
§ Mr. St. John-Stevas
If the hon. Lady wants the figure in percentages it went 1682 up by about 20 per cent. But I would not mislead the House in the way the hon. Lady misled the House, and will give the absolute figures. Deaths from induced abortion: three before the Act, four after the Act. Therefore, the figure would be 25 per cent. If I use the hon. Lady's method of calculation—
§ Mr. St. John-Stevas
Yes, it is very significant. Even one death is important, even the death of a foetus is important, though the hon. Lady may not think it is. [An HON. MEMBER: "You are in a mess."] As I was saying—[An HON. MEMBER: "Carry on, Norman."] There seems to be a division on the other side of the House as to my status.
§ Mr. St. John-Stevas
I am totally in sympathy with that sentiment, Mr. Speaker. Interventions when made seated and when one has not given way are even less justified, because one cannot control them.
I wish to deal now with the point about conscientious objection, which is a matter of great importance. Somebody has to carry out these abortions and, of course, those who have to carry them out are the members of the medical profession. They were given a right, which was built into the Act in the conscience Clause and supported by the promoter of the Act, reinforcing their common law right, to abstain on grounds of conscience from abortion operations.
If a gynaecologist or doctor does not wish to carry out an operation, what is going to be done with him? What would the hon. Member for Wolverhampton, North-East do about doctors who wish to exercise this right? Does she think that they should be forced against their will to carry out operations to which they have strong objections? If that is the case, then it is the end of freedom in the medical profession. That is why any Bill dealing with a medical matter should only be put forward with the support of the medical profession, otherwise the situation is reached, as now, when Parliament lays down one thing and the medical profession say something else. We pointed out in Committee to the then 1683 Minister the precise dangers in the situation. The then Minister had already abandoned his duties in regard to the medical profession. He had not taken their views sufficiently into account and the fact that, whatever the rights or wrongs of abortion, it is in the end the members of the medical profession who carry out the operation.
I hope that the House will give a Second Reading to the Bill. It is not a Bill which totally accords with my views, but it strikes a more reasonable balance between the needs of women, the rights of the foetus or the unborn child and the requirements of public morality. I congratulate my hon. Friend on seeking to improve the law in a reasonable and sincere way and I hope that he will be successful in his object.
§ Several Hon. Members rose—
§ Mr. Speaker
Order. I remind the House that only 50 minutes remain for this debate and that many hon. Members still wish to speak.
§ 3.10 p.m.
§ The Joint Under-Secretary of State, for the Department of Health and Social Security (Dr. John Dunwoody)
I will try to be brief because I appreciate, Mr. Speaker, that many hon. Members still desire to speak. However, I wish to refer to a number of points that have been made.
The Abortion Act is an important piece of social legislation and discussion of it arouses strong feelings among its opponents and supporters. At the outset I wish to tell the hon. Member for Rye (Mr. Bryant Godman Irvine) that I feel a certain sympathy with him, and while I believe that his proposed amendment is misdirected. I am grateful to him for giving us this opportunity to discuss the problem again.
As the House will be well aware, a number of Amendments were tabled during the passage of the Measure which subsequently became the Abortion Act, 1967, seeking subsequently a limitation on the doctors empowered to perform terminations of pregnancy. To introduce such a limitation is, of course, the primary object of the hon. Gentleman's Bill.
In Committee, for example, Amendments were tabled, including one pro- 1684 posed by my hon. Friend the Member for Pontypool (Mr. Abse), which sought to limit operations to a consultant holding an appointment involving the practice of gynaecology or to a practitioner holding such an appointment and nominated by the consultant. However, Parliament rejected that and other Amendments mainly because of the difficulty of finding a generally acceptable formula which would not seriously limit the number of doctors available to perform abortions.
An amendment of the kind which the hon. Member for Rye proposes would have the effect of reducing the numbers of abortions carried out in approved places by doctors without specialist qualifications. A likely effect of such an amendment might be a decrease in private abortions and a consequent increased demand on gynaecological departments in National Health Service hospitals, which are already under considerable pressure.
It could, perhaps, be argued that this would lead to improved care for the women concerned, but in practice there would be a number of serious objections. For example, by limiting the number of doctors available to perform legal abortions, we could also produce an increase in illegal backstreet abortions. Again, by introducing a requirement that the Secretary of State should approve practitioners for the purpose of undertaking abortions, it would impose on him an unrealistic obligation and require him to undertake the most difficult and invidious responsibility, which he would find quite unacceptable, of making distinctions between individual doctors.
It is fair to say that the hon. Gentleman's Bill is directed at the private sector and, by implication, criticises private practice in this field. For this reason, I will at this stage say something about the actions which my right hon. Friend has taken to raise the standard of places approved for the purpose of the Act.
There are at present 56 private establishments functioning under his approval and they are all nursing homes registered with the appropriate local authority under the Public Health Act, 1936. The question of the standards to be demanded of these homes is a matter which has occupied a great deal of our attention during the last year.
1685 With one exception—and here an inspection will be carried out within the next month—every one of these approved places has now been inspected by a Departmental inspecting team of medical and nursing officers, in co-operation with the registering local authority. In the case of those approved places with a high turnover of abortions in the North West Metropolitan region, two and sometimes three inspections have now been made. All proprietors of these establishments have been told that approval and renewal of approval will be dependent on their satisfying my right hon. Friend that the standard of their premises, of their facilities, of their conduct and their staffing are all adequate.
Among the steps which he has required to be taken to ensure that deficiencies revealed by these inspections are remedied are structural alterations to premises to ensure safe post-operative management; reorganisation of booking arrangements to ensure that the number of women operated on for abortion in any one day does not exceed the number of beds available on the same night; and the installation of suitable autoclaves.
While it is not possible to lay down precise criteria for approval, because of the variety of circumstances, of these places the question of ensuring adequate standards is something which is under constant review. As an illustration, we have now considerably expanded the form of application which each home is required to complete when seeking approval or renewal of approval. I should make it clear that for the present in no circumstances is the Secretary of State prepared to grant approval for a period in excess of one year. Indeed, in some instances approval has been for a much shorter period.
The form of application is extremely detailed and lays particular emphasis on facilities required to ensure that the patients are safeguarded in emergencies. The form also sets out the Secretary of State's requirement which I mentioned earlier, that the number of patients booked for termination of pregnancy on any given day should not exceed the number of beds available for such patients on the same night. It calls for written evidence of arrangements entered into with suppliers of blood and of the agreement of doctors who will be respon- 1686 sible for providing medical cover in an emergency.
Immediately a completed application form is received within my Department the registering local authority concerned is contacted and asked to check the information given on the form and to let the Secretary of State know as soon as practicable whether there are any circumstances or, in the case of applications for renewal of approval, whether any new factors have arisen since approval was last given, which indicate that approval should be refused or withdrawn.
When sending the completed form to local authorities the Secretary of State emphasises his concern that the facilities should be such as to safeguard the life and health of the patients. To this end he asks authorities to pay particular attention in carrying out their investigation into the arrangements at the home in question for dealing with emergencies which may arise. He also asks the authorities to make full use of their statutory powers of inspection under the Public Health Act. They are further asked to bring to his notice immediately anything which, in their view or that of their medical officer of health, might make continued approval of a particular establishment undesirable. My Department maintains close contact with registering authorities and has, in fact, met representatives of the local authorities most concerned.
Whatever measures may be taken by the Secretary of State to improve standards at approved places, it must be remembered that the use which doctors operating in approved places make of the facilities provided at these establishments is a matter for their own clinical judgment. This is not something in which my right hon. Friend has any power, or wish, to intervene. He refers any cases of alleged professional misconduct to the General Medical Council which is, of course, fully alive to the need to complement the Government's efforts by ensuring that they take whatever action is proper to them.
§ Mr. Peter Mahon
In this debate there has been some discussion about the discrepancy between the time that is spent in hospital for abortion operations by National Health Service patients and private patients. Can my hon. Friend clarify this situation and say whether he 1687 is satisfied that a one-night stay for a serious operation like this is adequate?
§ Dr. Dunwoody
The decision as to the timing of the discharge of a patient is very much a question of clinical judgment, and neither I nor my colleagues in the Department would consider it appropriate for a Minister to interfere in a question of clinical judgment. If a patient has criticism to make of the medical profession, there are avenues open to that patient. It is not the role of Government to interfere in questions involving clinical judgment.
I turn now to the questions which have been raised about the adequacy of provision for abortions in National Health Service hospitals. I think it is significant that the latest figures show that over 70 per cent. of all abortions notified in respect of women with addresses in England and Wales are being carried out in National Health Service hospitals. No one denies that there are considerable variations in the numbers of abortions carried out in National Health Service hospitals from one region to another, and further that within individual regions one can find variations from town to town and unevenness in the extent to which the needs of the community are being met locally.
There are a number of factors which contribute, in varying degrees, to the unevenness of the service across the country. One is the conscientious objection which some doctors and other staff have to participation in abortion operations. The right of any person to opt out of participation in the treatment authorised under the Act, except when he has a duty to help save the life or prevent grave permanent injury to the physical or mental health of a pregnant woman, has been debated at great length in this House, and I am sure that it would be quite contrary to the wishes of the House and of the public at large if this right of conscientious objection were to be withdrawn.
Other factors bearing on regional variations within the National Health Service include the availability of facilities for examination, assessment and treatment of patients seeking abortions. Such patients in hospitals are normally seen first in the out-patient department, and generally speaking it seems that those seeking 1688 abortion take up more time than others in the gynaecology department. So there are limits on the numbers of additional abortion patients who can be fitted into clinic lists without additional staff or detriment to the treatment of other Patients en the gynaecology list. It has been suggested that one solution to this problem and also to the problem of fitting these cases into gynaecological lists in the hospitals is that we should set up special out-patient clinics specifically for patients seeking abortion. This has been done in some hospitals, and with some success, but there must be sessions available and the staff to provide the service.
Some of our hospitals are short of operating theatre space and time. Additional operations involve more theatre time and this is not always easy to find, since surgeons aim, quite rightly, to make the best possible use of the resources available. Theatre sessions tend therefore to be fully taken up some time ahead. The development of "day surgery" where patients are discharged after minor general surgery the same day is providing more operating theatre time and this will help with other surgical operations including abortion.
The other main area in which availability of resources limits the work that can be done is in the wards. The majority of patients who have abortions in National Health Service hospitals are admitted to hospital beds and occupy them for a few days. Broadly speaking the longer the pregnancy has continued the longer the period of in-patient treatment which may be necessary.
Suggestions have been made that special abortion units should be set up in the Health Service to cope with this demand. I am sure that it would be wrong to set up isolated units to undertake this work. Abortion, like any other surgical procedure in the Health Service, should take place in a general hospital with full pathological and gynaecological facilities and a blood bank for use in emergencies. Fragmentation of limited hospital resources is most undesirable. But even if it were considered appropriate to set up separate units of this kind I doubt whether sufficient hospital doctors and nurses could be found who would be willing to spend all their time doing this work. Most people like to use the full range of their skills, and repeated abortions do not offer this opportunity for 1689 surgeons, nurses, social workers and all who would be involved in the treatment of those cases. It could result in the other skills falling because of their disuse in treating abortion alone.
There may be scope for improvement in hospital services for termination of pregnancy. It is now possible to identify those hospitals where very few abortions, or none at all, are being done, and to consider what additional staff, resources and facilities might be needed to get adequate services established. Where a service is already being given it may be posible to make improvements in the arrangements for patients seeking abortions. Where an adequate service is not possible at present, I hope that hospital boards and committees will be able to make arrangements for it to be provided. I am conscious that the difficulties in some localities are severe. But I do not see the problems as insoluble if they are tackled with imagination and good-will on all sides.
Facilities for abortion in the National Health Service cannot be considered in isolation. They form an integral part of all the other health services for the community. The Health Service has developed considerably over the last 20 years and a great deal has been achieved. It remains true however that there are many fields in which improvements still have to be made to bring standards up to those which we should all like to see. Against this background one sees the difficulty of providing a uniform service throughout the country for patients needing abortion less than two years after the Abortion Act came into operation. I should like now to turn to the inquiries into the Act which are being undertaken.
§ Mr. Dempsey
What my hon. Friend has been stressing very greatly is the difficulty of finding skilled personnel, professional people and nurses for this service. Why is it that we can have the same professional consultants and surgeons and nurses for all other operations that are taking place? Why for those and not for abortion?
§ Dr. Dunwoody
We face difficulties in terms of staffing right across the board and it would be wrong to suggest that we do not have problems in other fields. One need only look at the waiting lists—fortunately they are falling slightly 1690 but they are still very long—for routine surgery of various kinds, and the difficulties experienced in finding hospital beds for mentally handicapped children, and so on. This is not a problem confined to one part of the service.
There are some grounds for dissatisfaction about the operation of the Abortion Act as far as private practice is concerned, and we are watching the situation in the private sector closely. A very small number of doctors operating in the private sector are doing things of which neither my colleagues in the medical profession nor we in the House would approve. But there is reason to believe that, in relation to provision within the National Health Service, the Act is working reasonably well. Certainly, it is not possible to arrive at a considered assessment of the overall working of the Act until current inquiries are complete. These include the inquiry being carried out by the Royal College of Obstetricians and Gynaecologists on the basis of a questionnaire sent to its members asking for detailed information about their experience of the workings of the Act. We hope that the findings of this inquiry will be available shortly and that they will provide valuable information on current practice.
Apart from the inquiry being carried out by the Royal College, we are ourselves in the Department carefully studying the detailed analyses of information deriving from the forms of notification prepared by the General Register Office in respect of 1969. They include information about many aspects of the operation of the Act, including the method of termination, the length of stay in hospital or nursing home, and complications arising from abortion. We are also continuing the confidential inquiry into maternal deaths, which include deaths arising from abortion. Until current inquiries into the working of the Act are complete, it would not be advisable, in the Government's view, to give support to any particular amendment such as proposed in this Bill.
I have mentioned the problems which, I think, we face in certain respects in the private sector. I assure the hon. Gentleman the Member for Rye that, if he has any evidence which concerns him about poor conditions, I shall be only too pleased to look into it if he will let me 1691 have it. The same offer is open to all hon. Members. We should welcome any information which they might feel to be of use.
I assure hon. Members that we shall continue to investigate very carefully all the reports which come to us containing prima facie evidence of contravention of the Act, and we shall seek the assistance of the Home Office and police authorities wherever appropriate. There have been references to a report in the Press earlier this week about a particular clinic, in connection with which a tape recording was sent to my Department. I have read the transcript of the tape recording. This is a case which we have under urgent consideration at present.
This process of investigation—and a very time-consuming process it is—is something on which we are constantly engaged. I reiterate the view expressed several times lately by my right hon. Friend the Secretary of State that, while there may be some grounds for dissatisfaction about the operation of the Act in the private sector, we must not concentrate our attention exclusively on unfavourable features of its working. Indeed, some of the discussion about the Act is exaggerated and ill-informed.
This is a subject which arouses strong emotions and prejudices which make rational consideration difficult. But it must be our aim in the House to debate the question reasonably and sensibly and arrive at a balanced conclusion. Our task today is to survey dispassionately the workings of the Act since the House passed it 18 months ago. I believe, on the basis of our experience over these 18 months, that the Abortion Act is generally operating satisfactorily.
I believe that most people would agree that it has brought advantages. The rate of emergency admissions to hospital for abortion is falling. I have the figures here for the last three years in respect of the emergency bed service: about 4,300, about 3,700, and about 3,200. I do not put too much weight on these figures, and I do not suggest that the Act would be the only factor. I do not even go so far as to say that it would necessarily be the main factor, but there is a definite decline in the rate of emergency admissions for abortion.
§ Mrs. Jill Knight (Birmingham, Edgbaston)
Do not those figures relate to all maternity cases, not only abortion cases? The improvement may be the result of better organisation in the hospitals concerned.
§ Dr. Dunwoody
I doubt that there has been any really significant improvement in organisation over the last two or three years. I said that I do not put too much reliance on these figures. They cover quite a broad diagnostic group. That is true. The figures I quoted were for the emergency bed service in London, and do not take into account the picture over the whole country. But there is an undoubted trend of a reduction of admissions. In the same way, there has been a reduction in the mortality rate consequent on abortions. In 1968 there were 50 deaths from abortions. In the first 10 months of last year there were 28. Again, I would not put too much weight on that, but these are perhaps encouraging trends. I think that we have in them some evidence of the way in which the Act is causing a real reduction in the sum total of human misery in our society.
§ Dame Joan Vickers
Is it true to say that 47 per cent. of the abortions are for single women, therefore stopping the bringing of illegitimate children into the world?
§ Dr. Dunwoody
The hon. Lady is right. The figures show that 47 per cent. are for single women, while 44 per cent. are for married women and the remaining 9 per cent. are women who are widowed, sepaarted or divorced.
I hope that by what I have said I have convinced the House that this would not be the appropriate time to amend the Abortion Act in a significant way.
§ 3.31 p.m.
§ Mr. David Steel (Roxburgh, Selkirk and Peebles)
I would like to return in a moment to some of the Minister's points about the unsatisfactory working of the Act in the private sector in one or two clinics.
But I would like to begin by congratulating the hon. Member for Rye (Mr. Bryant Godman Irvine) on the manner in which he introduced the Bill. In the two or three years during which the subject of abortion has been sometimes a 1693 heated subject of debate in both Houses of Parliament, it has been a pleasure to listen to a moderate and well-reasoned speech such as that which the hon. Gentleman made in introducing the Bill.
The hon. Member for Chelmsford (Mr. St. John-Stevas), on the last occasion he chose to introduce a similar Bill, said that it was a pity he was not an agnostic mother of nine. At least this afternoon he appeared in the guise of a Protestant father or two, which was no doubt a step of some significance.
I have no doubt that the hon. Member for Rye introduced the Bill with the best of intentions, but its results and consequences have not been fully understood by him. And since the hon. Member for Chelmsford is a sponsor of the Bill, and was so critical of the drafting of my Act, I am surprised that he has not noticed a major drafting error in the Bill, which gives the Secretary of State for Social Services a sovereignty over health services in Scotland that exists in no other field. That would have to be put right if the Bill went beyond Second Reading.
Some of the main arguments for and against the Measure have been debated twice in full here and in another place. Constantly the point is made that because the Royal College of Obstetricians and Gynaecologists and the B.M.A. are pressing for this change, as they pressed for it during the passage of my Act, we must accept it. I cannot accept that argument. The House must take into account representations from a wide spectrum of opinion, knowledge and expertise on the subject. Of course, we must give special weight to their views, and 95 per cent. of their views, I would say, were incorporated in the main Act. But they cannot dictate to Parliament what should be the provisions of an Abortion Act.
One very serious result of the Bill's being passed would be that the tendency would grow for abortion to be delayed because of the limited number of people who, even if one appointed others and extended the phrase "under the supervision of" would be qualified to sign the certificate. Because they would have to sign it, whereas at present they do not, this limited number of people would have to be involved not just in the operation but in the diagnostic 1694 process. That is a factor which has not been brought out fully, and there would inevitably be delays.
The figures I have show that 63 per cent. of abortions have been carried out up to and including the twelfth week of pregnancy and 35 per cent. after the twelfth week. I consider that 35 per cent. to be too high. If abortions have to be carried out, they should be carried out at the earliest possible time, from both a medical and ethical point of view. Therefore, any red tape, any restriction, any queue-forming, would be very undesirable.
Second, it would have the effect of encouraging a restrictive practice on abortions in certain parts of the country. It is all very well for the hon. Member for Chelmsford—I think that it was the hon. Gentleman, but if I have attributed somebody else's remark to him I apologise—to say that in addition to consultants there are registrars and other people who can do this work. We know that if a consultant at a hospital takes the view, which he is entitled to do, that he is opposed to a liberal practice on abortions there is no question of registrars and others on his staff taking a different view. The effect of an amendment of of this kind would be to encourage a restrictive practice on abortions.
§ Mr. Dempsey rose—
§ Mr. Steel
I think that the hon. Gentleman has had a fair innings of interruptions during the debate.
It is unfair to suggest that because the leaders of the B.M.A. and the R.C.O.G. are pressing for the amendment it would be widely welcomed in the medical profession. Today's edition of the Lancet, one of the most authoritative journals says in its editorial:… Mr. Irvine's Bill is out of place. What difference can it really make? Few of the abusing doctors will be excluded from the market by legislation which requires a Government Department to pronounce that they are, or are not, of 'equivalent status'. Perhaps, under cover of this device some supporters of the Bill are now reviewing a long-rooted opposition to reform.That is the case, whatever may have been the laudable intentions of the sponsor of the Bill. The hon. Lady the Member for Wolverhampton, North East (Mrs. Renée Short) quoted a national 1695 opinion polls survey of general practitioners which showed that 66 per cent. are either satisfied with the existing law or want to see it amended so that it is easier, and not more difficult, to get a legal abortion.
Finally, in considering medical opinion, an editorial in yesterday's Medical News-Tribune strongly came out against the Act and said:The only motive which we can realistically ascribe to the perpetrators of this amendment is to wreck the Abortion Act by drastically reducing the number of abortions performed.It would be a mistake fundamentally to alter a piece of legislation when we still have comparatively little knowledge of its consequences. I have here a letter which a Professor of Obstetrics and Gynaecology in Aberdeen sent to a Member of this House asking him to be present to vote today. He says:We have in Aberdeen for the past 18 months been running an Interdepartmental Study into the way in which women react either to having a pregnancy terminated or having to carry on with the pregnancy for which they have requested termination. It will probably be another year before the final results of the study are available, but until such results are available, and aso fuller analysis of the workings of the Abortion Act throughout the country have been made it seems premature to make any alterations in the Act.We have to consider the fact that this is a very wide Bill, a point which hon. Members might consider before voting. The Long Title merely says that its purpose is to amend the Abortion Act, but all sorts of Clauses could be added in Committee.
We have to consider the effects of the present Act as it has operated in the country. The figure which I have for the first year of its operation is that the death rate for abortions was 21 per 100,000, whereas the death rate in respect of child births was 24 per 100,000 in the same year. At the time of the passage of my Bill I should never have dared to predict that the death rate from abortions would be lower than the death rate from childbirth, and that is a very satisfactory conclusion. This is not statistically significant, but there have been more deaths in National Health Service hospitals than in private practice clinics.
We can say from the provisional evidence available that there has been a 1696 reduction in criminal abortions. I do not want to go into the mathematical argument again about the London emergency bed centre figures, but they show a certain definite trend in the right direction. The death rate given by the Minister just now showed that from an average of 50 from abortions, both criminal and medical, for many years, the figure fell last year to 28 in the first ten months, and that was a very significant and welcome drop.
Nobody has quoted precise figures, but the House should notice that the illegitimacy rate had been on the increase. In 1955 it was about 4 per cent., and rose by 1968 to more than 8 per cent. For the first six months of 1969, which is the latest period for which I have figures, there was a small, but nevertheless significant down-turn in the illegitimacy rate which I think can be credited to the Act.
§ Mr. Peter Mahon
Would the hon. Gentleman accept that if there has been a reduction, it has been induced by other exigencies?
§ Mr. Steel
I am not suggesting that the Abortion Act is solely responsible for the downturn in the illegitimacy figures. However, we have seen for the first time—this in the first full calendar year since the Abortion Act came into operation—the illegitimacy figures decrease. Can it be described as only a coincidence that the first downturn should have occurred at this time?
To get the arithmetic correct, one should note the rates of abortion in this country compared with the rates in other countries. I deplore the use of headlines such as:London: the Abortion capital of the world".That is not true. The rate since the operation of the Abortion Act has been 6.8 per cent. per 100 live births. That compares with 8.3 per cent. in Denmark and 10 per cent. in Sweden. In countries which do not have adequate family planning provision the figures are horrifying, such as 38 per cent. in Japan and 34 per cent. in Czechoslovakia. I hope that those figures are never reached here.
The hon. Member for Chelmsford referred to 3,000 foreign women having had abortions in this country during the last year. Presumably that number includes a substantial number of foreign 1697 women who are, in any event, resident here. I do not know what the percentage of foreigners here is at a given time. What about the 30,000 Danes who, we were told, would be coming here for abortions? They have not appeared. What about the American package tours of which we read? Not one has arrived. These things may make good newspaper copy but they bear very little relationship to the facts of how the Abortion Act is working.
The other day I read an interesting Conservative Central Office pamphlet about abortion. I confess that Conservative pamphlets are not among my normal staple reading, but this one suggested that it might be worth considering establishing abortion clinics in certain parts of the country. I have never found that an attractive idea, but I appreciate that if there is a restrictive practice operating in certain parts of the country it may be necessary for the Ministry to consider this matter.
It is true that private clinics as a whole have a good record, as the death figures show. There is no doubt, however, that one or two clinics in London—and there are only one or two such clinics—have been abusing the spirit and, perhaps, the letter of the Abortion Act.
I was interested to hear the Minister say that an inquiry was going on and I welcomed his remarks about the instructions which he had given. There is a case, in the light of our experience of the working of the Abortion Act, for changing the Ministerial regulations applying to private practice. I see no reason why the same notification forms—which are, in essence, simple—should not be used for both National Health Service and private patients. More information might also be required from private clinics about each case. For example, we might require the signature of the patient on discharge from the clinic saying that she was satisfied that she had received proper medical attention. The dates of entry and discharge should also be included on the notification form.
I would go further and say that there should be no objection to including on the notification form the amount of fee charged because there is a suggestion that no receipts are given, that cash is always demanded, and that the Inland Revenue is being defrauded.
1698 One clinic—the Minister referred to this case—has aroused considerable interest, and it is the case of the tape recording. I believe that the hon. Member for Chelmsford had this case in mind. I have made inquiries into the matter following the publicity which the case received last week. I spoke to the person in the Pregnancy Advisory Service in Birmingham who first met this applicant for an abortion.
The first thing to remember is that the girl came from Birmingham. She was referred to the Pregnancy Advisory Service by her own family doctor. I suggest that if she had lived in Newcastle, Aberdeen or many other places she would not have been in a clinic in London to start with; and that is the first lesson to be drawn from this case.
The girl was aged 18 and went to the Pregnancy Advisory Service accompanied by her father. This service is a voluntary body and not a money-making organisation. It is a charitable body, providing a social service. The woman who interviewed this girl gave her services voluntarily, as a social worker in the evenings in this centre. As for the charge of providing abortion on demand, about 30 per cent. of the women going there for abortions are refused. Those are the centre's figures. It was untrue, as suggested in the tape recording, that the first thing said was, "How much can you pay?" or "It will be £125." The normal particulars were taken and the father of the girl in question then asked how much it was likely to cost if it were carried out in a private clinic.
I should like to know why this case, which occurred in November, was not referred to the General Medical Council by the National Health Service people who took it over. I should like to know why they kept it in cold storage until a week before the Bill was introduced.
The most important fact of all was that the doctor who carried out this operation in the clinic was an F.R.C.S. and a member of the Royal College of Obstreticians and Gynaecologists who, under the Bill, could not be regarded as other than of equivalent status. Therefore, the Bill would have provided no safeguard in respect of the case that has received so much publicity during the past week.
1699 We would all welcome a reduction in the figures for abortion, but I believe that that reduction must be achieved not by denying a facility that is badly needed for women in unfortunate circumstances but, rather, by reducing the need for resort to abortion at all. A great debate is now going on about sexual responsibility and sexual education. I welcome this, and also the steps that the Secretary of State for Social Services has taken to encourage local authorities to use their powers under the Family Planning Act to set up local authority family planning clinics. It is disgraceful that the Secretary of State for Scotland should have issued instructions preventing this in Scotland.
The slogan that should go out from this House should be, "No unwanted pregnancies", which is a very much better slogan than, "No unwanted babies". I hope that the House will divide on the Bill, and will reject it.
§ 3.47 p.m.
§ Mr. Douglas Houghton (Sowerby)
It is many years since I spoke in a debate on abortion. Throughout that time, however, I have been a strong supporter of a change in the cruel Offences Against the Person Act of 1861. The hon. Member for Rye (Mr. Bryant Godman Irvine) seemed to be unaware of the full implications of what he was doing. The House knows him, and we all know that he would never have any intention of introducing a Bill which might have heartless and cruel effects, but I am sure that this Bill would have.
In introducing the Bill the hon. Member relied mainly upon the opinion of the two medical bodies that are asking for statutory limitations to be placed upon the activities of gynaecologists and others outside the National Health Service. As the Parliamentary Secretary pointed out, and as the hon. Member for Roxburgh, Selkirk and Peebles (Mr. David Steel) has just mentioned, these views were expressed in the House when the Abortion Bill was under consideration; they were fully debated in Committee upstairs, and later on the Floor of the House; they were debated in another place—and they were rejected all the time. The House will realise that medical bodies—important as they are, and having influential opinions as they 1700 do—are not the last word in what should be written into the law of the land. This House is in charge of the law and having decided—as it did less than three years ago—on the form of the law in this case, it would be unwise to make a change at this stage.
The Bill proposes to place a statutory limitation upon operations done by gynaecologists and other qualified people. It seeks to restrict the lawful conduct of these operations to consultant gynaecologists in the National Health Service, or persons acting under their supervision. A statutory limitation of this kind can be justified only if it can be shown that it is in the interests of the community. It is a surprise to me that an hon. Member opposite should seek to restrict the freedom of choice of the citizen in the matter of medical care. Neither the B.M.A. nor the Royal College would wish to see this freedom eroded in other fields of medicine and surgery. Why, then, do they want it eroded in this? Is it because there is some special risk attaching to this operation?
Certainly that is not proved by the mortality rate of abortion operations. In fact, there is, unfortunately, a higher proportionate death rate in the National Health Service than there is in the private sector, but this is no reflection on the Health Service. It usually gets the bad cases, the cases which have been too long delayed by the time that they reach it. There is no evidence from the mortality rate that it is necessary to restrict this operation to gynaecologists and others acting within the National Health Service.
What other considerations, then, can there be? Is it a matter of skills? There are skills outside the National Health Service as well as inside. Some gynaecologists in the National Health Service have done few, if any, terminations. Some, quite properly, holding the views that they do, have refused to do them. It cannot be a question of skill, because skill is not the monopoly of the National Health Service.
Is it suggested that ethical standards are higher inside the National Health Service than outside? If so, is that a view which the B.M.A. and the Royal College accept? Is it their view that it takes the National Health Service to make upright doctors? Are we to regard 1701 ethical standards as one of the great reforms of the National Health Service?
What do the two medical bodies think of the proposal implicit in the Bill that if a gynaecologist who did not hold a consultative appointment in the Health Service were to perform a termination outside the National Health Service he would be committing an offence for which the penalty is imprisonment for life? This is what we are talking about. The penalties were never interfered with when we reformed the original Act in 1967.
Is it suggested that a termination is lawful if it is done by a consultant gynaecologist in the Health Service and near murder if it is done by a gynaecologist outside it? Is that the distinction which the law should make? Is it suggested that the Health Service can now take all the terminations which would come to it under the Bill? No evidence which the hon. Gentleman produced, except the law of averages, would justify such a conclusion. Have we reached the stage, in this field and in none other, to force people into the National Health Service? Is this a new monopoly in State medicine being suggested from the benches opposite? This is the astonishing thing. Is this a new tyranny coming from the Opposition?
The hon. Member for Rye, in dealing with the average of terminations which might be spread over the available gynaecologists, had little to say about the regional variations which are the great mischief of the working of the Abortion Act. It is a strange thing that if the National Health Service can cope with the terminations which are now needed it is necessary for pregnancy advisory services to deal with so many referrals from general practitioners, hospital doctors and family planning association doctors. Fifty-four per cent. of all the referrals to the London Pregnancy Advisory Service in the first year came from general practitioners, and 42 per cent. were by hospital doctors, Family Planning Association doctors and others.
In fact, some of the cases that went to it had been refused under the National Health Service. Two girls under 14 were refused, as were five girls under 15 and 40 women over 40. Another patient, a girl of 17, pregnant by her father, was 1702 refused a termination under the National Health Service. Four married women with five or more children and 10 unmarried women with two or more illegitimate children were all refused, and all were sent to the London Pregnancy Advisory Service to see whether a termination could be made available elsewhere. So long as the National Health Service cannot meet the demand and there are these regional variations, the time is not right to change the law.
The real problem in abortion is the difficulty of getting people to consider it and discuss it rationally. It is so full of emotion and offers so much scope for headlines, drama and exaggeration. It is almost impossible to get good publicity on abortion, because the good that the Abortion Act is doing is not news, while the mischief and abuses under it are. We hear nothing of all the thousands of women who have been relieved of suffering, whose health has been improved, whose families have been safeguarded, whose children have been safeguarded against ill treatment, neglect, and even cruelty, where these considerations were taken into account when the decision on termination was reached.
§ Mr. Peter Mahon rose—
§ Mr. Mahon rose—
§ Mr. Houghton
I am sorry. I have only two minutes before four o'clock.
We get all the publicity about alleged wealthy foreigners and distressed girls arriving from other countries. We hear a lot about the touting going on and the package deals. May I utter one warning in this connection. A good deal of this is propaganda in other countries to secure a change in their own abortion laws. They are suggesting that it is a national humiliation that their women should have to come to England for abortions, and they want to change their law in their own country.
There is so much mischief surrounding the question of abortion that it is the duty of both sides of the House to apply rational and temperate opinion to the working of the Act. Are we going 1703 through this again and again? Is this part of a persistent campaign to change the 1967 Act? First there was a Ten-Minute Rule Bill. Then we had an early day Motion, and now we have this attempt. I sincerely hope that hon. Members on both sides will give the Act a chance to work under the wise directorship of my right hon. Friend the Secretary of State for Social Services.
I hope that the House will register a vote on the Bill, and that all hon. Members will keep their seats and allow a vote to be given.
§ Sir Stephen McAdden (Southend, East) rose—
§ Mr. Peter M. Jackson (The High Peak) rose in his place and claimed to move, That the Question be now put.
§ Sir S. McAdden rose—
§ Mr. Peter M. Jackson rose—
§ Mr. Speaker
I have not called the hon. Member for The High Peak (Mr. Peter M. Jackson). Sir Stephen McAdden.
§ Sir S. McAdden
I do not know why it should be considered that anybody holding a certain point of view should not be allowed to express it in this House—nor do I—
§ It being Four o'clock, the debate stood adjourned.