Abortion

Question 1

When are the following terms used?

• abortion
• termination of pregnancy
• post coital interception

Answer 1

Abortion = don’t say in clinic,
Termination = used in clinical practice, morally neutral, less emotional
Post-coital interruption = emergency contraception, only prevents pre-embryo implantation

Question 2

Describe the legalities surrounding abortion pre the Abortion Act 1967

Answer 2

• all abortion was a criminal act, women not usually prosecuted but those performing were
• offences against the person act 1861, section 58
• punishable by life imprisonment
• still applicable for abortions performed outside of legal provision

Question 3

What are the legal requirements of abortion now?

Answer 3

• must be carried out in accordance with provision of the Abortion Act 1967, as amended by section 37 of the HFEA 1990
• the doctor taking responsibility for the procedure is legally required to notify the CMO within 14 fausof the termination
• two doctors must agree that one of more of the following grounds apply

Question 4

What is section 1(1)(a) of the abortion act?

Answer 4

• the pregnancy has not exceeded its 24th week and that the continuance of pregnancy would involve risk, greater than if the pregnancy were terminated (<12 weeks), of injury to the physical or mental health of the pregnancy woman or any existing children of the family of the pregnant woman
• ( very liberal provision with 1(1)(a) )
• not required to quantify risk to mental or physical health
• always covered by law before 12 weeks

Question 5

What is section 1(1)(b) of the abortion act?

Answer 5

• the termination is necessary to prevent grave permanent injury to the physical or mental health of the pregnant woman
• no time limit

Question 6

What is section 1(1)(c) of the abortion act?

Answer 6

the continuance of the pregnancy would involve tis to the life of the pregnant woman greater than if the pregnancy were terminated

Question 7

What is section 1(1)(d) of the abortion act?

Answer 7

There is a substantial risk that if the child were born it would suffer from such physical or mental abnormalities as to be seriously handicapped

Question 8

What is the abortion notification form?

Answer 8

HSA4
Must be filled out with each abortion
Details of mother, reasons and procedure itself

Question 9

What proportion of pregnancies are terminated in England and Wales?

Answer 9

1 in 4 end in termination

Question 10

How are most UK abortions funded?

Answer 10

Very few privately
Some by the NHS directly
Majority by independent practitioners paid by NHS

Question 11

What are the most common conditions responsible for abortions under section 1(1)(d) of the Abortion Act?

Answer 11

37% - chromosomal abnormalities
23% - other congenital malformations
22% - congenital malformations of the nervous system
18% - other conditions

Question 12

What is feticide?

Answer 12

Killing the foetus before an abortion is performed

KCl injected into skull or heart of foetus

Question 13

What percentage of down syndrome babies are aborted?

Answer 13

92%

Question 14

What are the common decision making factors in each trimester?

Answer 14

First trimester = panic, fear over someone finding out, contraceptive failure, inability to care for child, pregnancy result from rape/incest, social factors
Second trimester = prolonged consideration of choices, relationship changes, awaiting foetal screening
Third trimester = foetal handicap

Question 15

Under what section of the Abortion Act is conscientious objection covered?
What are the exceptions to CO?
Who does this apply to?

Answer 15

Section 4 - no duty to participate in any treatment
Exceptions are 1(1)b and c - must participate to prevent grave permanent injury to the physical or mental health of the mother, or to prevent maternal death
- Only applies to doctor performing abortion and not to others involved

Question 16

What was the Janaway v Salford case?

Answer 16

GP secretary refused to type abortion referral letters

Lost the case - she was an essential cog in a wheel bu was not entitled to claim conscientious objection under section 4

Question 17

What are the RCOG worries over conscientious objection?

Answer 17

• Drs and nurses increasingly using conscientious objection

- Difficult to recruit people to O&G