Tuesday, 13 April 2010

Fighting red herrings on abortion

In the news recently has been Cameron's statement that the time limit for abortion should be cut to 20 or 22 weeks. This is not surprising news - he voted for 22 weeks the last time (2008) the question came up in the Commons, and many Conservative MPs (as well as some from other parties) favour larger cuts.

He claims as the reason "the way medical science and technology have developed in the past few decades". Unsurprisingly, the general response has been the same as last time, to point out that the evidence he's using for that claim is wrong.

This is not the full story.

The problem is that currently the way the debate has been framed is that the time limit on abortions1 in the UK is set with reference to the survival chances of premature babies born after an equivalent length of gestation.

Cameron and others claim that the survival rate of premature babies born in the 20-24 week period has improved significantly. Numerous doctors and scientists claim - with the support of the scientific literature - that this is not the case, although the proportion surviving who are born after 24 weeks has improved considerably.

It's a concern, definitely, if the leader of a political party is misinterpreting or unaware of the relevant research, and people are absolutely right to point this out.

The problem is that relatively few people are also pointing out that the entire basis of the argument is flawed. There is no good reason - historical inertia from the original legalisation I'd view as an "accurate" rather than "good" reason - why the survival of premature babies once born should be at all related to the time limit for abortion.

The original argument may have been to set a distinction between "alive" and "not alive" that wasn't fertilisation, conception, or birth - and if that was what was needed to get the original legalisation passed, that's fair enough. The distinction is absurd, though, and I think it's necessary to also point this out.

If medical science was to develop an incubator environment that could duplicate the uterus so well that not only did the survival rate for premature babies at any stage of development increase massively, but that babies could develop right from the embryo stage in this environment (which would be a massive boost for some branches of fertility treatment) this would hardly mean that abortion for non-medical reasons should be banned. Almost all the reasons why someone might want an abortion would still apply despite this technology existing.

Conversely, assuming that Parliament and scientific research could move rapidly enough, what about the case where a war or natural disaster significantly reduced the UK's medical and scientific resources and capabilities, to the point where survival of premature babies in the 24-30 week range became highly improbable. I doubt those now calling for a lower limit would support it being raised anyway, but it would be slightly absurd to do so even if they did.

Basing the abortion time limits on - effectively - how good the local health service is seems logically indefensible. It may have been a necessary thing to do politically at the time, and it's fortunate that the limit it provided then was a high one, but continuing to accept it as a correct way of deciding the limit will eventually be a very bad strategy. (While the reduction from 28 to 24 weeks in 1990 probably could not have been avoided in practice due to the size of the Conservative majority, it was done under exactly these grounds)

It's quite clear from the votes on 12-week and 16-week limits that some MPs would rather it was reduced significantly below any plausible limit this argument could provide, and would probably have voted for 0-week if the option had been there. If they don't accept it as a dividing line, I don't see why I should either when opposing them. The time limits at which abortion is available should be related to when it is necessary for the woman involved, not to what another woman's premature baby's chances of survival are.

So Cameron is wrong on the science, but he's even more wrong that the science is relevant in the first place.

1 Excluding Northern Ireland, where abortion remains illegal and the government refuses to do anything about it, and excluding those medically necessary to save the mother's life or prevent serious (but not less serious) injury to her which can occur at any time.
Technically those within the 24 week period must be justified by the prevention of harm to the mother or her existing child(ren)'s health (physical or mental) but the majority of doctors correctly interpret this broadly.


Other things that are infuriating about the way that the political debate over abortion is conducted in the UK:

  • Northern Ireland. The UK Parliament has the authority to legalise abortion there (which in practice means legalising abortion for poor women there, rich women being able to afford the ferry/plane trip to one of the other UK countries) but not the courage to do so.
  • "Free votes". All three major political parties give their MPs a "free vote" on abortion. I don't object to free votes as such, but this means that none of the three will ever include anything explicitly pro-choice in their manifesto, because this custom would stop them being able to require their MPs to follow it. They don't have to follow the custom, but for now they'll continue to do so. On other so-called "moral issues" the parties have quite happily set an official line. This seems to be a case where they're secretly happy to be bound by a pointless Westminster tradition.
  • Parliamentary timing. The amendments to the HFE Act that would have reduced the time limit to 12, 16, 20 or 22 weeks all got debated and voted on. Two pro-choice amendments (one to remove the requirement for two doctors to agree, which is not required for any other medical procedure; one to bring Northern Ireland into line with the rest of the UK) were scheduled later and didn't make it to a vote. That hardly seems balanced, and if that pattern - with a Labour government mostly in control of the timing - continues, any erosions are going to be very hard to reverse.