§ Mr. Biggs-Davison
asked the Secretary of State for Social Services what study he 66W has made of the experience of Bristol Maternity Hospital, indicating the special need of prenant women with a history of first pregnancy termination for careful supervision and sometimes preventive surgery; and to what extent other hospitals are offering the same care.
§ Dr. Owen
I have read with interest the paper by John A. Richardson and Geoffrey Dixon, published in the British Medical Journal on 29th May [BMJ 1976, 1, 1,303–1,304] on the effects of legal termination in subsequent pregnancies. No doubt medical staff working within this speciality in other hospitals will also read with interest of the experience of the Southmead and Bristol Maternity Hospital. The particular procedure recommended by those conducting the study was the need to insert Shirodkar sutures in order to prevent premature delivery in a patient known to have sustained cervical damage at a previous induced abortion. I understand that this is a well recognised procedure and facilities are available for this in NHS hospitals generally should it be required.
It is noted that in the study the controls were only matched for parity, there was no information presented about the duration of gestation at termination, the method used or the intervals between the termination of spontaneous abortion and the subsequent pregnancy. I am informed therefore, that it is difficult to draw valid conclusions from the reported findings.
I understand that in recent years methods of termination of pregnancy have changed; more patients are now having a termination earlier in pregnancy and by the procedure of vacuum aspiration, and the employment of techniques which involve excessive dilation of the cervix with the resultant risk of cervical damage and consequent possibility of premature delivery in subsequent pregnancly, have decreased considerably.
The authors of the article raise two other important isesues namely the reluctance of women to inform their medical attendant of a previous abortion and the high incidence of women who become pregnant again within one year of a termination. I am advised that it is almost invariably in the interest of the patient's health for her to provide information about a termination of pregnancy to her doctor and she should be encouraged to 67W do so but it must be for her to make the final decision.
I also hope that improved pre-and post-abortion counselling, the introduction of a free comprehensive family planning service providing woman with a wider choice of advisers on this matter, and improved methods of contraception will mitigate any tendency, such as is reported in this article, for women to have an unplanned pregnancy within one year of a termination.
In an attempt to ascertain the effect of induced abortion on subsequent pregnancies over as wide a field as possible so to avoid the problem which it is recognised can arise in more limited studies, my Department is sponsoring a long term prospective study into the matter. This is being conducted by the Royal College of General Practitioners in conjunction with the Royal College of Obstetricians and Gynaecologists. An extensive pilot study has been completed and the main project is planned to start this autumn. The World Health Organisation has similarly initiated a prospective study in seven European countries to obtain reliable information about the outcome of subsequent pregnancies following a previous induced abortion. It is hoped that the result of these studies will provide objective evidence about the long term sequalae of induced abortion.