Deborah Orr and the Abortion Debate

I could, I suspect, be forgiven for being more than just a little bit irritated with Deborah Orr’s comments on the seemingly never-ending abortion debate, which she kicks off with the following observations…

Oh, Lord, the right to choose. There’s no more powerful and predictable way to invite the left to start looking like a bunch of intransigent extremists than to whistle up yet another round of “debate” about abortion. But the left doesn’t lead the debate. In allowing the right to set terms, the left remains forever on the defensive. When Maria Miller, culture secretary, said before the Tory conference that she’d like to reduce the abortion limit from 24 weeks to 20 weeks, I thought: “There they go again.” When Jeremy Hunt, health secretary, pronounced that he’d like to see it at 12 weeks, I thought he was out of his tiny mind.

And yet, sadly, Orr has a point here in the sense that what passes for debate in the media, which largely serves to inform public opinion amongst the majority of the public for whom abortion is rather a peripheral issue at best, bears very little relation to the debate that’s been taking place out here in the blogosphere amongst those of us who are much more engaged with the issues. Sarah Ditum might find it hard to accept Orr’s characterisation of the debate, but I don’t because its entirely apparent from the rest of Orr’s commentary that the debate she’s referring to is not the one in which both Sarah and myself have been fairly heavily engaged; and the clearest possible evidence for this is to be found in Orr’s next couple of paragraphs.

But here’s a shocker. Britain is exceptional in Europe when it comes to abortion. Lots of countries offer abortion on request, unlike us, and Britain should too. But the gestational time limits are fascinating. Among EU countries, 16 out of 27 are with Hunt, on 12 weeks. In France, abortion on demand is available until week 12. In Germany, it’s also the first trimester. In Italy, it’s within the first 90 days. Ah, you say, that’ll be the Catholic influence. Perhaps. But that doesn’t entirely explain Sweden, at 18 weeks, Denmark, at 12 weeks, and Greece, at 12 weeks.

On this issue, at least, the Tories are in step with Europe, and the left in Britain is out on its own. Well, not completely. Closest to us is the Netherlands, which gives abortion on request up to 13 weeks, and allows it up to 24 weeks if the mother is in distress. Only Cyprus allows abortion notably later than the UK, at 28 weeks, but always under very strict conditions.

Orr is not only wrong but, to quote the great Wolfgang Pauli, she’s ‘not even wrong’, although this is perhaps unsurprising as a hyperlink in that section of the original article suggests that she’s taking much of her information from a dreadfully misleading BBC article that fails, miserably, to reflect the complex nature of abortion laws in different countries across Europe.

To get a much more accurate  and detailed picture of the real situation across Europe, both legally and in practical terms, one should avoid the BBC like the plague and turn, instead, to the most recent edition of ‘Abortion Legislation In Europe‘, which is published by the International Planned Parenthood Federation’s European Network – as a bit of a time-saver, I’ve also pulled much of the information on gestational limits into a one page summary table, which should help to illustrate just how off-beam Orr’s understanding of the European position is.

The IPPF’s guide covers a total of forty countries stretching from Iceland, in the North-West to three of the former-Soviet ‘stans’ in the South-East.  Thirty of the forty countries covered make legal provision for abortion on request with gestational time limits ranging from 10 weeks (Bosnia, Macedonia, Portugal and Switzerland) to 18 weeks (Sweden), although 12 weeks is the most common upper limit (16 countries). The list of countries that allow abortion on request does not, however, include either France of Germany, both of which require women show that they are in a ‘state of distress’ when requesting an early abortion. In practice this may well amount to abortion on request but the law in these countries, and in Belgium, nevertheless place includes a conditional element which means that, strictly speaking, they don’t offer abortion on request – and, to confuse matters further, the Netherlands also permits abortions to be carried out on the grounds that women are in a ‘state of distress’ up the point of ‘foetal viability’ in addition to allowing abortions to be carried out ‘on request’ up to 13 weeks gestation.

To suggest that anyone, least of all the Tories, is somehow ‘in step with Europe’ is all of bit of a nonsense as this implies the existence of common or broadly uniform European position on both gestational limits and the grounds on which abortion is allowed when, as should be obvious from the summary table, that no such common position exists. In addition to the UK, a further thirteen countries included in the IPPF guide, allow abortions to carried out on mental health grounds that are broadly similar to those specified in UK law, i.e. the law requires there to be a risk but does not qualify that risk in terms of it being ‘serious’ or ‘grave’. In six of these thirteen countries, provision for abortions on the grounds of a risk to women’s mental health operates in addition to provisions for abortion on request with gestational limits ranging from 12 weeks (Czech Republic) to what is effectively 27 weeks in both Austria and Denmark, where the upper limit is specified as ‘second trimester’. These thirteen countries, plus two others (Bosnia and Bulgaria) also permit abortions to be carried out where there is risk to women’s physical health on similar terms to those enshrined in UK law and, again, there is a considerable degree of variation in the gestational limits applied to these provisions.

Moving to the far end of scale, i.e. where the law specifies that there should be a serious or grave risk to women’s health or, at least, a high risk of foetal abnormality. thirty-three countries make explicit provision in law for serious or life-threatening risks to women’s health of which eighteen explicitly allow abortions to carried out at any point up to birth. Seven countries have an explicitly stated gestational limit either in weeks, ranging from 22 to 28 weeks, or by including a reference in law to foetal viability as the upper limit. The remaining countries either have no stated gestational limit in law or have laws which state only that abortions are permitted on these grounds after a certain limit, which is often the limit applied to abortions on request. The position on foetal abnormality is broadly similar, although fewer countries (ten) allow abortions right up to birth compared to the number of countries (fourteen) that set an explicit upper limit in weeks, which can range anywhere from 20 to 28 weeks, or by reference to foetal viability. Finally, it should be noted that of the seven countries that don’t make explicit provisions in law for serious risks to women’s health – and the eleven that don’t make explicit reference to foetal abnormality – almost all have general provisions in law for abortions on ‘medical grounds’ or similar that would cover these situations. The major exception to this is the Republic of Ireland, where the law is framed in such a way as to exclude abortions on the grounds of even serious foetal abnormality, leaving women no alternative to seek help elsewhere – mostly from clinics in either the UK or the Netherlands.

So far we’ve long only at provision for abortion on request and abortion laws that are framed in a manner that’s broadly comparable to our own, i.e. in purely clinical terms, but that’s not, by any means, the whole picture.

There are seven countries listed in the IPPF guide where merely being a minor is sufficient to enable a woman to have an abortion, in several cases at a gestational stage above the ‘on request’ limit, and there’s also no particular consensus on what, exactly,  constitutes a minor – Austria says its ‘under 14′, Finland has decided that its 16 year olds are minors while Danish law leave age out of the equation entire and just makes provision for women to second trimester abortions where their whose youth and immaturity would preclude them from affording proper care to a child. At the other end of the scale (and not listed in the summary table) Estonia allows women over 45 to have abortions at up to 21 weeks gestation by virtue of their age, while Iceland.

Fourteen countries, almost all of them either in Scandinavia or Eastern Europe, make specific legal provision for abortions on social grounds or for socio-economic reason, some solely in general terms, others in quite some considerable detail. Iceland, for example, specifies that having had several children in a short space of time is reasonable for an abortion. Kazakhstan allows women to use abortion to limit heir family size to four children. In Eastern Europe, the financial burden of raising a family is commonly acknowledged in law as providing grounds for an abortion as, in some countries. is domestic violence. In Israel, women can have an abortion on the grounds that they are currently serving in the military. Kazakhstan and Tajikistan both permit ‘forced migrants’ (i.e. refugees) to have late-term abortions at up to 22 weeks gestation, a policy that might make some in this country feel rather queasy but equally one that could catch-on pretty quickly in the comments section of the Daily Mail.

And, of course, Orr makes specific reference to Cyprus, which she incorrectly describes as the only country that “allows abortion notably later than the UK, at 28 weeks, but always under very strict conditions”. She is, in fact, wrong on several counts:

- there is no legal upper limit on abortion in Cypriot law, although 28 weeks does serve, in practice, as a de facto limit.

- Cyprus is no the only country to permit abortions notably later than the UK. Austria, Denmark and Uzbekistan all have second trimester limits (27 week) limits for abortions on clinical grounds similar, at least in law, to those in the UK, while Moldova has a 28 week limit for abortions carried out for socio-economic reasons.

- One of the ‘very strict conditions’ that Cyprus applies to abortions is that of whether a pregnancy will adversely affect the ‘social status’ of a woman and/or her family – clearly, preserving the family honour is serious business out there.

In all, one can reasonably say that the UK is out of step with most of the rest of Europe in terms of not permitting early abortions to be carried out on requesting, at least in law, but when you look at wide variation of conditional provisions and gestational that operate beyond the ‘on request’ systems in different European countries then its difficult, if not impossible, to say that there is a common European view on abortion for the UK to be either in or out of step with and, certainly, nothing much that actually resembles the position espoused by the likes of Jeremy Hunt.

So, on gestational limits, Orr is way off the mark in her understanding of what’s actually going on across Europe, and he next stab at an argument offers little by way of improve:

Now, I don’t point out these facts because I have a hidden agenda as a pro-lifer. I’m as pro-choice as the next progressive type. I understand why some people find all abortion abhorrent – and I think those people are dangerously sentimental, impractical and proscriptive.

I’m certain pro-lifers will never get their way in this country. But it does upset me that they succeed in having such a deadening influence over pro-choice debate. So much so that there is none. It’s all about “holding the line” and fearing “the thin end of the wedge”.

As with the disproportionate-force issue in burglary, pro-choice supporters will argue that only a very small number of abortions are carried out after week 20 anyway (about 2%). Is it completely mad of me to wonder if perhaps these abortions could be done earlier, if the imperative was there to make a decision sooner? At nearly six months, a woman is pretty seriously pregnant. And we all know that the earlier a termination is carried out, the better. Might an earlier limit actually be of benefit to women? Isn’t it even worth discussing? Apparently not.

Actually, to a degree I can understand what Orr is driving at here. A little over four years ago I wrote  piece for Liberal Conspiracy which looked, in some depth, at an American study which explored in detail the reasons why women, over there, choose to have an abortion and, after publishing the article, got a very tetchy response from a feminist blogger (who I won’t name) telling me, in no certain terms, that women don’t need to be told why they have abortions.

Well, as Orr very clearly demonstrates, some women do need to be told such things and being female does not magically imbue women, generally, with the innate ability to understand the decision-making processes that some women go through when deciding whether or not to terminate a pregnancy. In that sense, Orr is asking a fair question and, luckily enough, its  a question that we can at begin to answer thanks to a piece of research carried out at the University of Southampton, which is summarised in this paper.

Lets’ cut to the chase and head straight to the main data table, which you can click to embiggen:

Okay, so there’s nothing particularly surprising on that list of the thirteen most common reasons that women gave for delaying the decision to seek a termination until the second trimester. Indecision, not realising that you’re pregnant, discovering that your partner is complete and utter shit and, for younger women, being scared to bejeebus of how your parents will react to the news that you’re pregnant are all perfectly good explanations for such delays and, of course, running into problems with the bureaucracy is something that no one can reasonably legislate for in advance – so what’s the problem?

In a nutshell, hypocrisy.

Perhaps the most common of all the popular myths about abortion is that it must always be an absolutely terrible and agonising decision for any woman to have to make, even if, when you talk to women who’ve been in just that situation you’ll quickly find that it’s often nothing as tough a decision as popular myth likes to make out. For some women, it is a really tough decision to make, for others its actually relatively straightforward decision and so one really shouldn’t generalise about such things – but people, and especially people who write opinion columns in newspapers very often do, and almost always in terms of stressing just exactly how difficult the decision to terminate must be.

When you think about it properly, the idea that you should reduce the current upper time limit just to jolly some of these women along is a piece of pure doublethink – “Yes, yes I know its an absolutely horrible decision to have to make and I sympathise fully with your predicament, now pull yourself together, stop prevaricating and make your bloody mind up.”

Sorry, but public hypocrisy and an obvious lack of empathy is just not argument that worth considering as a basis for setting gestational limits on access to abortion and nor, indeed, is Orr’s next stab at an argument:

It’s even more heretical to suggest that it might seem odd to ask medical staff to let one foetus die, and move heaven and earth to persuade another at the same stage of development to live. To suggest anything of the sort is to mark yourself out as either some sort of hideous traitor to the cause, or an attention-seeking iconoclast who is playing with fire.

Not really – again all this line of argument actually signifies is that you’re dealing with someone whose understanding of the issues is likely to be, well, all a bit superficial. At 23 weeks gestation, the odds of foetus surviving outside the womb, if its still alive at the point that the mother goes into labour, are about 1 in 10 and those that do beat those odds have a 1 in 2 chance of having a severe physical or neurodevelopmental disability. Setting aside the question of abortion, for a moment, those are the odds that face any woman who is unlucky enough to go into labour at that stage in their pregnancy. For some women/families, that’s more than enough for them to ask their doctor to pull out all the stop to keep their neonate alive, if it survives the delivery, For others, those same odds are just not good enough to justify the kind of invasive treatment that will have to be administered to their newborn child. They’re the women/families that you don’t get to see splashed all over the newspapers, the one’s that look at the odds and, however, reluctantly, choose to sign a ‘do not resuscitate’ order.

Does it really seem odd that some women/families make that decision?

Is it heretical to suggest that some women/families might not automatically insist that their severely premature neonate should be immediately whisked off to a neonatal ICU to be shoved in a plastic box and covered more tubes that the London Underground?

Does that not, in fact, suggest that the argument from foetal viability, when its applied to abortion, is neither as simple or as straightforward as many people seem to suppose?

But why? We should control this debate, but we ban it. We thrust it instead into the hands of the right, a group that does include extremists who wish to terminate abortion completely.

Pro-choice people are best placed to deal sensibly with the moral issues that abortion is always going to have to negotiate. It’s precisely by digging in our heels that we start looking stubborn and intransigent, rather than sensitive and self-confident. I’m not sure I do want to see the limit changed. But I am sure that I’d like to have an honest, involved and sincere debate about it, before I decide, without being told that this is “giving in” to the right. We do that anyway – by refusing to think and defending, defending, defending, without question or discussion, instead

The Lone Ranger and Tonto are rising towards town when they’re ambushed and surrounded by a large Apache war party. Taking cover behind a small rock outcrop, the only cover available for miles, the Lone Ranger turn to Tonto and says:

“Tonto, old friend. It looks like we’re really up against it this time”.

Tonto gives the Lone Ranger a curiously quizzical look and replies…

“What do you mean we, White man?”

What do you mean we, Deborah?

It’s not for lack of effort or argument out here on the Internet that the anti-abortion lobby have been allowed to dictate the terms of the wider public debate, but those of us who are fully engaged in the debate can only carry the argument so far when even the BBC cannot be relied upon to properly challenge and scrutinise the ill-informed outpourings of idiots like Jeremy Hunt.

It’s not intransigence that prompts some people to start digging in their heels, it’s sheer frustration with people in the MSM who still appear to think that the public debate on abortion begins and ends at the boundaries of their employer’s website. Orr’s call for “an honest, involved and sincere debate” tells only that she is entirely oblivious to the fact that that debate has being going on all around her, constantly, for the last five years, a debate that she is more than welcome to join if only she could be bothered to remove her head from up the MSM’s arse for five minutes and a good close look at what’s going on out here. If nothing else, what she’d quickly discover is that she should seriously start to question her own credulous reliance on the BBC as a source of information about European abortion laws and, with a little more effort, she may well discover not only the debate she’s looking for but one in which the anti-abortion lobby have been doing anything but make all the running.

With that, I’ll leave Orr’s commentary behind and pick up on a couple of comments in Sarah Ditum’s piece which illustrate a different set of issues with the manner in which the pro-choice side approaches the wider abortion debate.

Discussion about abortion rights is constant. Medical research into foetal development and viability is ongoing, and every round of results initiates brow-scrunching about whether or how this should affect legal access to abortion. The fact that anti-abortion voices attract the most controversy doesn’t reflect a failure of the left to engage: it reflects the fact that mainland UK has a pro-choice consensus and those who wish to break it are forced on the attack. The pro-choice contingency’s failure to take seriously anti-abortion claims of “new medical evidence” reflects, not leftish intransigence, but the fact that there is no new medical evidence.

The first thing I have to take issue with is Sarah’s suggestion that there is no new medical evidence. Sorry, but I am going to have to be really picky here and point out there most certainly is new medical evidence out there that is entirely relevant to the wider abortion debate – last year’s NCCMH/RCPsych review included previously unpublished data which looked at the relationship between induced abortion and women’s subsequently mental health and new evidence on foetal viability and the early development of extremely premature neonate is emerging from the Epicure 2 study. That this evidence serves, for the most part, only to confirm and refine the findings of previous studies doesn’t mean that it is not new evidence.

The problem I have with Sarah’s no new evidence argument is that it too readily serves to reinforce the common misconception that, in the sciences, novelty is somehow either synonymous with, if not more important than, quality, a misconception that some newspapers, particularly the Daily Express and Daily Mail, routinely exploit in order to peddle the most absurd health-related claims and one that supplies the epistemological foundations of the Daily Mail’s notorious Oncological Ontology project. In reality, a large proportion of the new evidence that scientific research generates every year is, at best, mildly interesting and does very little to advance the total sum of human knowledge in particular field beyond either flagging up potentially interesting questions that require further investigations or pointing out flaws and limitations in earlier research.

Novelty is no guarantee of quality and its quality of your evidence that makes or breaks your argument, a point that the wider public too often fails to understand, which is why we need to be just that bit more careful when making evidence-based arguments to place the emphasis firmly on the quality of the evidence that supports or undermines a particular argument and not on how new, or otherwise, that evidence might be.

The other point I need to pick up from Sarah’s remarks is the assertion that there is a pro-choice consensus in the UK. In broad terms this is correct, overall public support for abortion rights in general terms rarely if even dips below 60% in opinion polls, while support for prohibition or near prohibition similar to that found in Poland and the Irish Republic barely manages scrape its way above 10%. However, when we start to break things down and look specifically at late-term abortions at 20-24 weeks gestation and public attitudes towards some of the reasons that those abortions take place what we find, from polling undertaken for even avowedly pro-choice organisations, is that this ‘consensus’ is rather less solid than some people suppose.

In 2008, Marie Stopes commissioned a poll through Ipsos Mori that included the following question:

Q Abortion is currently legal within 24 weeks. That is, a woman is allowed to have an abortion at any time within the first 24 weeks of her pregnancy, when two doctors have agreed that the abortion is in the interests of her physical or mental health. A very small proportion of abortions (fewer than 2 in one hundred) take place between 20 and 24 weeks. There is currently a debate about the legal time limit. In which, if any, of the following circumstances do you think a woman should have the right to access an abortion between 20 and 24 weeks? You may select more than one option.

The results table from this question looks like this:

The foetus is diagnosed with severe abnormalities
She was raped
The pregnancy places her own health at risk
She has an abusive partner
She was delayed by her doctor
She did not realise earlier that she was pregnant
She is young and has been in denial of pregnancy signs
Her partner left her during the pregnancy
Any of the above circumstances
Any of the above circumstances (including other)
She should be able to access an abortion between 20 and 24 weeks, regardless of her circumstances
Any of the above circumstances (including other) or she should be able to access an abortion between 20 and 24 weeks, regardless of her circumstances
She should not be able to access an abortion between 20 and 24 weeks, regardless of her circumstances
Don’t know
I would prefer not to answer
Not asked this question*
Not asked this question**
She should not be able to access an abortion between 20 and 24 weeks, regardless of her circumstances or not asked this question as disagreed with abortion at Q1

* screened out as stated ‘prefer not to answer’ at all of the first three questions

** screened out as stated strongly disagree or tend to disagree with abortion in general

Okay, so the good news on the pro-choice side is that 61% of those polled found at least one thing they could support on the list of reasons why women might want a late-term abortion, and the bad news is that no individual item polled better than 40%, or 44% when you take into account the regardless of circumstances option, on a list that includes two items (serious health risk and serious foetal abnormality) where the law current allows abortions to be carried out right up to birth.

This is exactly the kind of polling data that has encouraged the anti-abortion lobby to switch tack and adopt a wedge strategy which seeks to conceal their real objective – a complete or near complete ban on abortion – behind calls for incremental changes at the edges of the current law, where the scientific and ethical issues are at typically at their most complex and, consequently, offer the most scope for bamboozling the general public with wholly false assertions of certainty and simplicity.

In that sense it doesn’t matter that foetal viability is far more complex issue than much of the public realise or that scientific evidence that underpins that argument is rather equivocal and wide open to interpretation and [deliberate] misinterpretation. It matters only that much of the general public doesn’t cotton on to the fact that that’s actually the real position and that the anti-abortion lobby is lying its back teeth when it claims that their position is underpinned by medical evidence and that a reduction in the current upper limit is only a matter of ‘common sense’, and its perhaps there that there is greatest scope for pro-choice to retake the initiative, if only some of supporting the MSM would pull their finger out and engage in our debate rather stick to their own solipsistic media ghetto.