Abortions (Monitoring) (Hansard, 20 March 1987)

§ Mr. D. N. Campbell-Savours (Workington)
The House may know of my concern about abortion. I made my maiden speech on abortion during proceedings on the "Corrie" Bill. I did so because my socialism is built on respect for the dignity and sanctity attached to human life. I was required to leave the Chamber by Mr. Speaker during proceedings on the Canada Bill when I objected to the new constitutional arrangements which, in my view, had implications for abortion legislation in Canada.
I am not alone in expressing such views. They are the views of many hon. Members, including the hon. Member for Ilford, South (Mr. Thorne), who is in the Chamber today. Many people in the Labour party feel as strongly as I do about these matters. There are people throughout the world who subscribe to these views.
The Government should take note of the resolution passed at Zagreb during the recent conference of the International Right to Life Federation. The resolution stated: This fourth World conference of the International Right to Life Federation held in Zagreb, Yugoslavia this year condemns the present abortion policy of the United Kingdom as one of the most barbaric in the world. Delegates representing 15 nations deplore the Abortion Act 1967 and draw the attention of the British Government to the fact that it is the only law in Europe accepting social abortion beyond the 20th week of pregnancy, in consequence of which thousands of expectant mothers from overseas are encouraged to go to Britain by abortion racketeers for late social abortions, which carry enormously increased risks to women and are in breach of laws in their own countries. The conference calls on the right honourable Mrs. Thatcher and her Government to allow Parliament the time to amend the law giving greater protection to unborn children and mothers and ending this dishonourable trade in human misery. The monitoring of the abortion law in the United Kingdom has always been of concern to me, if not the statistical basis on which the Department disseminates information, certainly the criminal negligence of the Government, in turning a blind eye to the operation of the Infant Life (Preservation) Act 1929. The Act is explicit. It states in section 1 that the killing of a child capable of being horn alive and before it has an existence independent of the mother is an act of child destruction.
The 28-week limit was born in the belief that such gestational age was prima facie proof of capability of being born alive. Nevertheless, science has moved on and we now know that a baby of 18 to 21 weeks is most certainly capable of being born alive, albeit that at this stage in medicine it is too small to survive. We also know that from 18 weeks, as any gynaecologist can confirm, babies if born or aborted by hysterotomy, shows real and discernible signs of life.
It was primarily this consideration that motivated Mr. C in the case of Mr. C v. Miss S. Acting as a third party, Mr. C sought to secure protection of a baby capable of being horn alive. Miss S's pregnancy had reached the 20th week and as far as Mr. C was concerned deserved the legal protection provided by law under the Infant Life (Preservation) Act. He called in aid article 23 of the World Health Organisation constitution which was adopted by the World Health Assembly in 1976 and which defined live birth as 1214 expulsion or extraction from its mother of a product of conception irrespective of the duration of the pregnancy which after such separation breathes or shows any other evidence of life such as beating of the heart, pulsation of the umbilical cord or definite movement of voluntary muscle, whether or not the umbilical cord had been cut or the placenta is attached. Each product of such a birth is considered liveborn. Mr. C further called in aid the Births and Deaths Registration Act 1953 which in clause 41 defines a stillborn child as a child which did not at any time after being completely expelled from its mother breathe or show any other sign of life. Thus, a foetus born showing any signs of life must under the Act be registered as a live birth.
A child may die shortly after birth, as it most certainly would at only 18 or 20 weeks gestation. Nevertheless, the law of the land states that a foetus must be registered as a live birth. Someone might ask why abortions are carried out in this country up to and beyond 28 weeks. The answer is the presumption written into the 1929 Act that evidence that a woman had at any material time been pregnant for a period of 28 weeks or more shall be prima facie proof that she was at that time pregnant of a child capable of being born alive.
As I have mentioned, medicine has moved on. Whereas in 1929 it was miraculous for a 28-week foetus to survive, according to Dr. P.M. Dunn from the department of child health in Southmead hospital, Bristol, in a paper submitted in 1985 to the Royal College of Obstetricians and Gynaecologists, in 1984, 72 per cent. of all live born infants of 22 to 27 weeks gestation born at the Bristol maternity hospital survived. Only two years earlier, in 1982, the survival rate for the same group had been 43 per cent., in 1981 29 per cent. In Bristol things are really happening.
The information gleaned from the monitoring of the figures in Bristol places a new responsibility upon the Minister to review the operations of the Infant Life (Preservation) Act. The Lane committee recommendations of 1974 seem, on reflection, enlightened and farsighted when we consider them 13 years later. The committee admitted that, despite taking a liberal position on abortion, the taking of a 28-week gestational period as prima facie proof of capability of being born alive was unreasonably late. It recommended that there should be an upper limit on abortion of 24 weeks and that thereafter every effort should be made to preserve the life of the child. If the Lane committee were to consider and recommend on these matters today, it would recommend a new limit of 20 weeks.
How can we secure a more vigilant application of the law in the light of scientific advance? According to monitoring by the Department, in 1985, 1,628 babies were aborted at 22 and 23 weeks, seven of which were to save the mother's life, and 494 abortions were carried out at 24 weeks plus, only five of which were carried out to save the mother's life. In the latest years for which we have figures, 1,531 unborn children of 24 weeks and over have been aborted, and in only 22 cases could the operation be justified under existing law, particularly as the most avid abortionists at the Royal College of Obstetricians and Gynaecologists admit that all of these children are capable of being born alive and surviving. What action has been taken by the Minister to initiate prosecutions in the other 1,509 cases of child destruction?
1215 In addition, babies of 22 and 23 weeks are aborted, which, quite clearly from the evidence that we have from Bristol, were capable not only of being born alive but of surviving. Over three years, a total of 4,572 abortions were carried out, of which only 13 were performed to save the mother's life. They are the best figures that I have been able to glean. I am sure that the Minister will be quick to correct me if I am wrong and, certainly, to comment on them. What action has been taken in the 4,559 cases in which doctors have flagrantly broken the law, and broken it repeatedly?
In a series of written answers on 10 and 12 December, the Minister referred to the fact that the Government had circulated to all regional health authorities a copy of a report that they had encouraged the Royal College of Obstetricians and Gynaecologists to produce on the subject of foetal viability and clinical practice. The report studied the implementation of the Infant Life (Preservation) Act and pointed out that many late abortions are blatantly in breach of the law. Yet nowhere in the report is it stated that doctors should carry out such late abortions only to save mothers' lives. Nowhere in the report is it declared that criminal proceedings might be brought against doctors who break the law. The report takes a decidedly schizophrenic approach, urging that the gestational age after which a foetus is considered viable should be changed from the present limit of 28 weeks to 24 weeks gestation. The report goes on to state that: in accordance with the WHO recommendation a record should be kept of all babies born alive or dead at 22 weeks gestational age, or, if born earlier, weighing 500g or more. However, the figures that are quoted in the report to justify 24 weeks are for 1982. Science has moved on since then. The figures for Bristol in 1984 are quoted nowhere, but they show that the period of 24 weeks is already out of date.
The Government's senior medical officer, Dr. W J Modle, was a participant in the symposium on pre-term labour and its consequences, at which proceedings the Bristol paper by Professor Dunn was originally presented. Therefore, he must have known about the evidence of the survival rate of babies in that area. He was also an observer on the Royal College of Obstetricians and Gynaecologists committee that published the report on foetal viability and clinical practice, the report that the Minister so proudly told us had been circulated to all regional health authorities. How does the Minister justify the failure of Dr. Modle to ensure that this report was an accurate and comprehensive document, giving the latest data available to ensure that those in authority were fully and properly informed? Can the Minister explain why she has failed to send with such a document the instruction that late abortions are completely unlawful?
No other country in Europe allows abortions from 20 weeks, as we do for social reasons. That brings me to a further point. I am told quite categorically by nurses working in National Health Service hospitals where abortions are performed that a goodly number of the abortions are not NHS abortions, as they are listed in the Office of Population Censuses and Surveys monitors. Therefore, although they are performed on NHS premises—and listed as such quite correctly by the OPCS—many of those abortions are carried out in pay beds. Not only do I know of this from nurses who are working in the 1216 NHS, but reference has been made to it over the years by doctors working in the private sector as a response to criticism for their charges. What steps has the Minister ever taken to check on the number of abortions in the NHS that are carried out in pay beds and those performed as NHS operations? Surely that is of particular importance when a law such as the Infant Life (Preservation) Act is being broken scores of times each month quite openly.
I have always felt very strongly about this matter. I have not come here today to make an ashamedly anti-abortion speech. That has not been my objective. I shall save that for another occasion. I have come today to make a plea that the Minister should ensure that the Infant Life (Preservation) Act is implemented, taking into account the latest scientific advances. We cannot fudge these matters. Those who follow the law in detail just wonder why the Government insist on turning a blind eye to the implementation of the Act. I hope that in her reply the Minister will answer that specific question.

§ The Parliamentary Under-Secretary of State for Health and Social Security (Mrs. Edwina Currie)
As is the normal courtesy, I should like to congratulate the hon. Member for Workington (Mr. Campbell-Savours) on his success in Mr. Speaker's ballot. As he has just demonstrated, abortion is a subject about which people have very strong views that are sincerely held, and often widely differing, but Governments traditionally have adopted a neutral stance and free votes have been allowed in this House and elsewhere on these subjects.
Let me put on record some of the latest statistics. In 1985, the total number of abortions performed was 171,873, of which 65,176 were performed in the National Health Service on residents. In 1986, the equivalent figures were 129,131, and 49,433 in the first three quarters of 1986. The rates per 1,000 resident women in the quarter ended September — the most recent figures that I have — are 2.92, which suggests that the rate of abortion may be dropping in this country, as the previous full year's figure was 12.97. I hope that that may indeed be the case.
The number of terminations in the case of women under 16 has also shown something of a trend. In 1985, there were 4,002 such terminations and the rate per 1,000 among women of 14 and 15 years of age was 5.41. In the first quarter of 1986, there were 1,028 such terminations; in the June quarter there were 980; and in the September quarter there were 900. Therefore the most recent figure gives us a rate per 1,000 women aged 14 and 15 of 1.22. Again that is a drop on the previous year.
As the hon. Gentleman knows, the gestation period is also one of the statistics that is collected. In 1986—in the first three quarters only—of the 110,000 abortions performed on resident women in this country, nearly 100,000 were performed at the gestation age of 12 weeks or less. Therefore, the vast majority are done on pregnancies in the early weeks of the woman's time. The total number of terminations in the first three quarters of 1986 on babies of a gestation period of 25 weeks and over was 19. Therefore, I caution the hon. Gentleman when he talks about 24 weeks or over 24 weeks—[Interruption.] I said, "25 weeks and over". The rule that I mentioned says, "over 24 weeks", so I take it in exactly the same way. There is a difference between talking about at 24 weeks and over 24 weeks. There is a distinction. It is also worth 1217 pointing out—I am sure that the hon. Gentleman will agree—that gestation may be a matter of rather fine judgment, particularly before a termination takes place.
The hon. Gentleman mentioned the Bristol study in which a 70 per cent. survival rate was reported for babies born alive at gestations between 22 and 27 weeks. I have no doubt about that, but I suggest that those figures were heavily skewed towards the later age. In fairness, the figures should be disaggregated. There is a danger that the hon. Gentleman might give the wrong impression, with statements such as, "70 per cent. of babies born at 22 weeks will survive." The hon. Gentleman knows that such a statement is not true.

§ Mr. Campbell-Savours
The hon. Lady said that the figures were slanted towards the figure of 27—

§ Mrs. Currie
I did not say "slanted". I said "skewed".

§ Mr. Campbell-Savours
Do I presume that the hon. Lady accepts that 22-week foetuses are surviving and can survive? If the hon. Lady accepts that, does she not then accept that she has a duty to look at the statistics to ensure that in every one of the cases where there is a potential for survival, which must run into hundreds each year, every effort is made to see that the foetus survives and is not aborted?

§ Mrs. Currie
We monitor the figures all the time. The word "skewed" is a statistical term, which I am sure the hon. Gentleman will realise. I do not want to imply any bias in that.
The hon. Gentleman should be aware that if figures are to be useful and are to form part of an intelligent discussion, it is probably better if they are disaggregated appropriately. The figures that he quoted in the booklet that he mentioned clearly show that there might be a 70 per cent. survival rate of babies born alive at the later stage in that age range.

§ Mr. Campbell-Savours
Can they survive at 22 weeks?

§ Mrs. Currie
Perhaps the hon. Gentleman will allow me to continue.
It is worth putting on record the number of deaths following legal abortion in England and Wales. In 1969 there were still 17 women who died following abortion, but in the years since 1973. the number has never been more than a single figure. In 1985 only two women died following legal abortion. Clearly, the change in the law has helped some people quite considerably.
The hon. Gentleman asked me to say how the Government have been monitoring the Abortion Act 1967 and ensuring that its provisions are properly applied. I am glad to do so. Compliance with the Abortion Act and the assurances that have been developed in the 20 years since that legislation are monitored in three broad ways—first, inspection; secondly, notification; and thirdly, investigation of complaints and allegations of abuse.
I refer first to inspection. All private sector nursing homes and clinics approved under the Abortion Act are subject to periodic unannounced inspections by the Dept's medical, nursing and investigative officers. A thorough check of business and administrative arrangements is made, and patients' notes and medical records are carefully examined. In the public sector, individual health authorities take the responsibility for the way in which abortion services are provided in their own area, just as they do for other forms of medical care.
1218 As for notification, operating practitioners are required to notify the chief medical officer, within seven days, of each abortion that they perform. Forms are scrutinised by staff authorised by the chief medical officer to ensure that they do not show any contravention of the abortion law.
The Department investigates rigorously any specific complaints or allegations of abuse, as it did on the matter raised by my hon. Friend the Member for Broxhourne (Mrs. Roe) at Question Time last Tuesday. Appropriate action is taken to deal with any irregularities that are discovered. In the extreme, that might well involve a reference to the director of Public Prosecutions or the withrawal of the Secretary of State's approval, or both.
The hon. Gentleman asked: how can we secure a more vigilant application of the law in the light of scientific advance? We feel that we have not just done that, but have gone further. The control of late abortions is a typical example of the way in which the assurances required by the Secretary of State can be varied to take account of new situations and medical developments.
Medical developments now make possible, as the hon. Member for Workington rightly stated, the survival of some infants born before 28 weeks. In 1985 the Royal College of Obstetricians and Gynaecologists, in a report requested by the Government on foetal viability and clinical practice, recommended that the age after which a foetus is considered viable should be changed from 28 weeks to 24 weeks. In the private sector the DHSS initially agreed a voluntary limit of 24 weeks. Subsequently, in February 1986, that was made a condition of approval. On inspection visits all cases over 20 weeks are now carefully monitored and we are satisfied that those arangements are working. The Royal College of Obstetricians and Gynaecologists has also sent out the document to all its members, who must comply with it.
The age has effectively been reduced in the light of medical science. It was argued in debates recently in another place that we should see how the voluntary arrangement works before proceeding further.
With regard to the comments made by the hon. Member for Workington about the leaflet that referred to breaking the law, the Royal college was extremely careful to explain that that is not what the leaflet was about. The college was so concerned that it included the following statement in italics: The Committee, recognising the complexity of the present legislation relating to fetal viability, did not address themselves in detail to the legal issue, but concentrated on clinical considerations. The college then stated: For this reason they did not attempt to define viability in terms that would be legally acceptable but have described it as it is used by clinicians, for example, when maturity is a important factor in deciding whether or not to deliver a preterm fetus from an unfavourable intrauterine environment. It is our view that in the clinical sense of the word the fetus is viable when there is good evidence that survival is a reasonable possibility, given the availability of what is currently regarded as the best of neonatal care. We do not share the hon. Gentleman's view that the law has been broken in the way that he described. As far as I am aware, there have been no successful prosecutions under the existing legislation—either public or private prosecutions — in recent years. Broadly speaking, practice has changed in the light of scientific knowledge.
The hon. Gentleman referred to a large number of late abortions and mentioned the figures for the three latest years. I must stress that the three latest years that he was 1219 able to use were 1983, 1984 and 1985. They were all years before the changes I have just described. I have therefore taken into account the points that he made.

§ Mr. Campbell-Savours
Will the Minister give way on that brief point?

§ Mrs. Currie
I want to respond to one or two of the points that the hon. Gentleman has made.
I urge the hon. Gentleman not to attack people like Dr. Modle. That was a most disgraceful attack. Dr. Modle is a member of the Royal College of Obstetricians and Gynaecologists and is a most distinguished public servant. The hon. Gentleman's remarks contradict all the conventions of the House. I am prepared to restate that the responsibility for the action of our officials rests with Ministers. I am glad to state our full confidence in Dr. Modle and his staff and we are very fortunate to have him.
The hon. Gentleman raised the point about notification and pay beds. The notification of an abortion shows the location where it was carried out. If it was carried out in a National Health Service hospital that is shown in the statistics. I am satisfied that that is a sensible approach. No doubt the hon. Gentleman will continue to disagree about that.
The hon. Gentleman knows that the Oxford students' case was taken to appeal and the Court of Appeal held that on the evidence that a foetus of 18 to 21 weeks was incapable even of breathing, it was not a child capable of being born alive within the meaning of the Infant Life (Preservation) Act 1929. The court left open the question whether the prospective putative father had locus standi to bring proceedings or whether the child could bring proceedings. The father applied to the House of Lords for leave to appeal on the question whether an unborn child of 18 to 21 weeks' gestation was capable of being born alive. That was refused.
The hon. Gentleman may call in evidence the words and arguments of the plaintiff in that case, Mr. C., and question the actions of the judges concerned. However, I understand from the transcript that the judges proceeded as they did at the request of counsel for both sides, mainly because of the urgency of the case.

§ Mr. Campbell-Savours
Not both sides.

§ Mrs. Currie
That is my information. The transcript shows that the parties proceeded on that basis with the understanding of counsel on both sides.

§ Mr. Campbell-Savours
That is wrong.

§ Mrs. Currie
We have no option but to respect the law as it stands and as it is restated in case law. As there was no further action on the locus standi, Mrs. Justice Heilbron's ruling in the High Court remains in force. She held that there was not a sufficient basis for the father's claim that the abortion of the foetus amounted to a threatened crime under the Infant Life (Preservation) Act 1929.
We can make progress by avoiding the need for late abortions in the first place. The hon. Gentleman will know that health authorities have been encouraged to improve administrative referral systems. Ministers have already announced plans for three family planning pregnancy counselling projects for young people, which might help to reduce delay. A submission has been placed before my 1220 hon. Friend the Member for Braintree (Mr. Newton), the Minister for Health, and we are expecting an announcement soon.
I am sure that the hon. Gentleman shares with me the feeling that we wish to see abortions not being necessary at all. A woman's right to choose exists before conception as well as after it.
The hon. Gentleman has said that there are many in the Labour party who feel as he does. I am sure that he will accept that this is not a party-political issue and that feelings run deep in all the main political parties. Should he need proof of that, he might do no worse than read the speeches of Lord Houghton of Sowerby in the debates on the Bishop of Birmingham's Bill in another place. It is clear that there were strong feelings against amending the law in the way that the hon. Gentleman would wish.
Abortion, fertility and its treatment, the use of embryos and embryonic material and related topics are most difficult issues and have been matters of public debate for some years. They have been aired and explored recently in the various documents including the Warnock report. The consultative document following that report, which takes up some of the other issues as well, is available for consultation and is likely to result in legislation. The Government have promised that certain alternative clauses will be prepared and that there will be a free vote. We have already declared our support for the Bishop of Birmingham's Bill, and that view still stands.

§ Mr. Campbell-Savours
May I take the Minister back to the question that I asked her earlier? Does she accept that a foetus of 22 weeks can survive? That is all that I want to know. Does she accept that?

§ Mrs. Currie
I accept that the vast majority of foetuses at that age of gestation cannot now be born alive at all and cannot survive.

§ Mr. Campbell-Savours
But some can.

§ Mrs. Currie
I have no doubt—

§ Mr. Campbell-Savours
A minority can survive.

§ Mrs. Currie
I have no doubt that, even if it is not possible today, it may be possible in the near future.

§ Mr. Campbell-Savours
The Minister referred to the "vast majority".

§ Mrs. Currie
I have no strong feelings—

§ Mr. Campbell-Savours
Come on!

§ Mrs. Currie
It would help if the hon. Gentleman were willing to listen to what I have to say.
I have no doubt that if it is not possible now it will shortly be possible. The advances that are possible in medical science are such that the age of viability is likely to continue to fall. That is the age at which a baby may be born alive and viable. That is why the wording of the Act is as it is, and that is why we shall continue to monitor the statistics as they come.
The hon. Gentleman may look pleased with himself, but age does not alter or make any easier the arguments, the discussions and the care that has to be taken to ensure the welfare of mother and baby and of all the staff concerned. It is not an argument in which we wish to score points, and I am sure that the hon. Gentleman would wish to agree with that.
Much of the hon. Gentleman's argument has been based on the notion—he used the term—of "abortion 1221 on social grounds" or for social reasons. He knows that that is not legal in this country, though I believe that it is used as a form of contraception in one or two countries. We would find that unacceptable here and the law is 1222 specific. All abortions are tragedies for all concerned and especially, perhaps, for women. I welcome this opportunity to explore the issues again briefly.