House of Commons Science and Technology Committee Scientific Developments Relating to the Abortion Act 1967 Twelfth Report of Session 2006–07 Volume I HC 1045-I House of Commons Science and Technology Committee Scientific Developments Relating to the Abortion Act 1967 Twelfth Report of Session 2006–07 Volume I Report, together with formal minutes Ordered by The House of Commons to be printed 29 October 2007 To be published by TSO on 6 November 2007 as HC 1045-I The Science and Technology Committee The Science and Technology Committee is appointed by the House of Commons to examine the expenditure, administration and policy of the Office of Science and Innovation and its associated public bodies. Current membership Mr Phil Willis MP (Liberal Democrat, Harrogate and Knaresborough) (Chairman) Adam Afriyie MP (Conservative, Windsor) Mrs Nadine Dorries MP (Conservative, Mid Bedfordshire) Mr Robert Flello MP (Labour, Stoke-on-Trent South) Linda Gilroy MP (Labour, Plymouth Sutton) Dr Evan Harris MP (Liberal Democrat, Oxford West & Abingdon) Dr Brian Iddon MP (Labour, Bolton South East) Chris Mole MP (Labour/Co-op, Ipswich) Dr Bob Spink MP (Conservative, Castle Point) Graham Stringer MP (Labour, Manchester, Blackley) Dr Desmond Turner MP (Labour, Brighton Kemptown) Powers The Committee is one of the departmental Select Committees, the powers of which are set out in House of Commons Standing Orders, principally in SO No.152. These are available on the Internet via www.parliament.uk Publications The Reports and evidence of the Committee are published by The Stationery Office by Order of the House. All publications of the Committee (including press notices) are on the Internet at www.parliament.uk/s&tcom A list of Reports from the Committee in this Parliament is included at the back of this volume. Committee staff The current staff of the Committee are: Dr Lynn Gardner (Clerk); Dr Celia Blacklock (Second Clerk); Mr Edward Waller (Assistant Clerk); Dr Christopher Tyler (Committee Specialist); Dr Joanna Dally (Committee Specialist); Ana Ferreira (Committee Assistant); Christine McGrane (Committee Secretary); and Jonathan Olivier Wright (Senior Office Clerk). Contacts All correspondence should be addressed to the Clerk of the Science and Technology Committee, Committee Office, 7 Millbank, London SW1P 3JA. The telephone number for general inquiries is: 020 7219 2793; the Committee’s e- mail address is: [email protected] Scientific Developments Relating to the Abortion Act 1967 1 Contents Report Page Summary 3 1 Introduction 5 Background to the inquiry 5 The inquiry 5 Terms of reference 5 Witnesses 6 The aim of the inquiry 7 Specialist Advisers 7 Informal seminar 8 History of UK abortion law 8 Abortion in the UK 9 2 Upper gestational limit 13 Neonate survival rates 13 Defining viability 13 Evidence of medical advances 15 Consciousness 22 Foetal pain 22 The chemical depression of awareness 24 Developmental psychology 25 Relevance to the upper gestational limit 25 4-D images and foetal consciousness 26 Reasons for late presentations 26 3 Abortion for foetal abnormality 29 Arguments for tightening the definition 29 Arguments against further clarification 30 Our conclusions 31 4 Access and procedure 32 Requirement for two doctors’ signatures 32 Arguments in favour of removing the requirement 33 Arguments in favour of retaining the requirement 35 Our conclusions 35 Other causes of delay 36 Involvement of nurses 36 Arguments in favour of increasing nurses’ responsibilities 37 Arguments against increasing nurses’ responsibilities 38 Our conclusions 38 Places where abortions can be carried out 39 Arguments to allow the second pill to be taken at home 40 Arguments against allowing the second pill to be taken at home 41 Our conclusion 41 2 Scientific Developments Relating to the Abortion Act 1967 5 Impact of abortion on women’s health 43 Mental health risks 44 Physical health risks 47 Future reproductive outcomes 47 Breast cancer 49 Post abortion infection 49 Restriction of access to abortion 50 Informed consent 50 Conclusion 52 Conclusions and recommendations 53 Glossary 58 Annex A: Declarations of interest 60 Additional declarations of interest by witnesses providing oral evidence 65 Annex B: Requests for Declarations of Interest 68 General request 68 Request to witnesses providing oral evidence 68 Appendix: RCOG guidelines on ‘Information for women’ 69 Formal minutes 71 Witnesses 86 List of written evidence 87 List of unprinted evidence 88 List of Reports from the Committee during the current Parliament 89 Scientific Developments Relating to the Abortion Act 1967 3 Summary Abortion is a complex issue. Legislative decisions are informed by ethical and moral positions, philosophical, religious and political views, case law, clinical practice, and scientific and medical evidence. As a science and technology committee, we have focused only on the scientific, medical and other research evidence. As well as informing the way courts interpret the law, scientific and medical developments can alter the balance of opinion on ethical and moral issues and they often inform legislative decisions. This happened in relation to abortion law in 1990, when evidence of improved outcomes for very premature neonates led to a reappraisal of the threshold of foetal viability and this in turn to the reduction of the then 28 week limit on most abortions to the current 24 week limit. In our inquiry, we have attempted to sift the evidence on scientific and medical developments since the last amendment of the law and since the 1967 Act. In this Report, we set out the key issues that have emerged and the key questions MPs must ask themselves as they consider options for changes in the law. Where we have felt it appropriate and justified, we have drawn conclusions about what the science and medical evidence currently before us tells us. We urge all MPs to study the evidence we have taken and the conclusions we have reached. Because we recognise that what the science and medical evidence can tell us is only one of many factors that are taken into account when legislating on this issue, we have not made any recommendations as to how MPs should vote on abortion law.* * For a draft Report which was not agreed by the Committee, see Formal Minutes, page 71 onwards Scientific Developments Relating to the Abortion Act 1967 5 1 Introduction Background to the inquiry 1. It has been ruled that abortion would fall within the remit of the Human Tissues and Embryos Bill, which is likely to be presented to the House in the 2007/08 session. In 2005, the Science and Technology Committee recommended that a joint committee of both Houses be formed to consider the scientific, medical and social changes in relation to abortion that have taken place since 1967.1 Despite our best efforts,2 this has not come about, and so we decided to undertake this considerable task ourselves. The inquiry Terms of reference 2. Witnesses to this inquiry were invited to submit evidence on the following points: a) the scientific and medical evidence relating to the 24-week upper time limit on most legal abortions, including: i. developments, both in the UK and internationally since 1990, in medical interventions and examination techniques that may inform definitions of foetal viability; and ii. whether a scientific or medical definition of serious abnormality is required or desirable in respect of abortion allowed beyond 24 weeks; b) medical, scientific and social research relevant to the impact of suggested law reforms to first trimester abortions, such as: i. the relative risks of early abortion versus pregnancy and delivery; ii. the role played by the requirement for two doctors’ signatures; and iii. the practicalities and safety of allowing nurses or midwives to carry out abortions or of allowing the second stage of early medical abortions to be carried out at the patient’s home; and c) evidence of long-term or acute adverse health outcomes from abortion or from the restriction of access to abortion. 3. As a Committee that examines scientific and technological issues, we decided that the ethical and moral issues of abortion were not within our remit. Therefore, we decided to focus on scientific and medical evidence relating to abortion, and explicitly ruled out ethical or moral issues in the published terms of reference. 1 Science and Technology Committee, Fifth Report of Session 2004-05, Human Reproductive Technologies and the Law, HC7-I, para 308 2 HC Deb, 3 July 2006, cols 528-584 6 Scientific Developments Relating to the Abortion Act 1967 Witnesses 4. We selected witnesses to cover a range of scientific issues and views. The emphasis of the inquiry was on seeking scientific evidence—including medical and social science evidence—that would inform debate on abortion law. Therefore, we did not ask witnesses to state their individual moral positions in advance of the inquiry and did not seek to achieve a balance between ‘pro-life’ and ‘pro-choice’ personal opinions among our witnesses. However, to ensure that we were informed as to which aspects of the body of scientific evidence are important to the ethical and moral issues, we decided to hear from a balanced panel of campaign groups. 5. We noticed that among the written submissions there were a number3 from doctors who were furnishing references and citing studies from the published scientific literature and/or providing their judgements or opinions on the scientific evidence in areas (or some of the areas – see SDA 38) where they did not appear to carry out clinical practice, research or to publish. It subsequently emerged that all these submissions except one (SDA 31) were from individuals who were either active members of organisations who had strong views on abortion and who had themselves submitted evidence (SDA 35, 37, 40) expressing this view. Submission SDA 31 was from an individual who was a campaigner against abortion and had publicly expressed very strong moral views on the subject. 6. We welcome all written submissions to all our inquiries and do not believe anyone should be denied the opportunity to make written submissions, or to have their views properly considered on account of their views. However, in keeping with the accepted practice in the scientific community of requesting relevant declarations of interest from those submitting articles for publication or submitting views for consensus statements, we think it is appropriate and important that those individuals contributing data, references or views of a scientific nature to a science committee evaluating scientific questions should declare any competing interests and specify their expertise or experience where this is not already clearly apparent. We note that this is the only approach we can take on this matter which is consistent with the recommendations of our own report on Scientific Advice, Risk and Evidence-based Policy Making.4 7. Furthermore, we recognise that for us in producing this report, and for all those MPs and members of the public who will subsequently read and evaluate the report, in the process of weighing up the strength and reliability of scientific evidence and opinions submitted on that evidence, it is necessary to be aware of the level of expertise concerned, and – especially where the expertise is not apparent – any competing interests that are not otherwise apparent. That does not mean that such views are discounted. 8. Finally, in the interests of transparency, even where individuals contest the relevance of such interests, it is far better practice for such interests to be revealed than concealed. 9. It is for these three reasons that, subsequent to the receipt of the written evidence, we requested declarations of interests from everyone who submitted evidence. We did not ask 3 SDA 24, 27, 28, 29 and 39 4 Seventh Report of Session 2005-06, HC 900-I