In this article...

• Time limits
• Requirement for two doctors signatures
• Professionals with a conscientious objection
• Mental health outcomes from abortion

Time Limits

The most significant amendment to the Abortion Act 1967 in the Human Fertilisation and Embryology Act 1990 was the reduction of the upper time limit on most abortions from 28 weeks of gestation to 24 weeks, which was the point at which a foetus is deemed viable. Nadine Dorries MP has launched a bid to amend the Human Fertilisation and Embryology Bill to reduce the upper limit from 24 weeks to 20 weeks. However the Science and Technology Committee  believes that there is no good evidence to suggest that foetal viability has improved since the abortion time limit was last set. Both sides of the debate are lobbying MPs ahead of a possible vote on the issue later this month.

Requirement for two doctors signatures

The Abortion Act 1967 requires that an abortion under ground A to E is certified by two doctors. As a result of evidence from the British Medical Association ("BMA") and Royal College of Nurses, the Science and Technology Committee concluded that in the first trimester, the requirement for two doctors' signatures does not serve any useful purpose and were concerned that the requirement for two signatures may cause delays in access to abortion services. In second and third trimester abortions where the risks are more significant the BMA raises no issue about the requirement for two signatures.

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Professionals with a conscientious objection

The Abortion Act 1967 has a conscientious objection clause, which allows doctors to refuse to participate in terminations but which obliges them to provide necessary treatment in an emergency when the woman's life may be in danger. The British Medical Association guidance states that “Doctors with a conscientious objection to abortion should make their views known to the patient and enable the patient to see another doctor without delay if that is the patient's wish.” New guidance published by the General Medical Council in March 2008, entitled “Personal beliefs and medical practice” indicates that doctors should be open with patients about any treatments or procedures which they choose not to provide because of a conscientious objection, but equally they must not impose their views on patients in ways that exploit patients’ vulnerability or cause distress. Doctors should refer a patient to another doctor who does not hold the same objections. “Serious or persistent failure” to follow the guidance could result in a doctor being struck off.

Mental health outcomes from abortion

The Royal College of Psychiatrists (RCPsych) published a report in 1994 which stated that the risks to psychological health for women who have an abortion were less than those who proceed with a pregnancy which is clearly harming the mother’s mental health. However in March 2008 the RCPsych acknowledged for the first time that there may be mental health risks associated with abortion and is proposing to carry out more research. The main points in its statement were:-

		Whether or not induced abortion has harmful effects on the mental health of women remains to be fully resolved.
		Healthcare professionals who treat women requesting an abortion should assess for mental disorder and for risk factors that may be associated with subsequent development of mental disorder, and liaison between services is advisable. If necessary, a care pathway should be identified by which mental health needs of the woman can be met.
		Women with pre-existing psychiatric disorders who continue with pregnancy and those who undergo abortion need appropriate support and care.
		Informed consent requires the provision of adequate and appropriate information regarding the possible risks and benefits to physical and mental health.