The arrival of 10-minute abortions in Marie Stopes Clinics seems to have upset just about everybody - except Beth Adams
What's the problem with lunch break abortions?
The announcement that Marie Stopes Clinics were to provide an abortion service so simple that a woman would be able to end her pregnancy during her lunch break was bound to provoke a torrent of abuse from those who oppose abortion. It was only to be expected that the spokeswoman for the anti-abortion charity Life would condemn the idea as 'sickening' and 'a trivialisation of abortion'. And Cardinal Hume's call for society to reflect on the inhumanity of such a service was equally predictable from the head of Britain's Roman Catholics.
On the other hand, you might have expected those who support legal abortion to raise a glass to Tim Black, Marie Stopes chief executive, for breaking a few taboos surrounding the issue. Yet most of them chose instead to join in the chorus of condemnation. New Labour's supposedly pro-choice minister for public health, Tessa Jowell, accused Black of trivialising both abortion and women's feelings. A spokeswoman for Britain's largest network of not-for-profit abortion clinics, the British Pregnancy Advisory Service, trilled about the need for proper counselling and stated that they 'would never want to start drop-in abortions'. The National Abortion Campaign and Abortion Law Reform Association pretty much disappeared from public view, only surfacing under pressure to emphasise how seriously women take their abortion decisions.
It's a snip
Black has a reputation for being blunt, outspoken and a man who likes to shock. He is, after all, the doctor who achieved notoriety for his clinic's vasectomy service when he agreed to perform 'the snip' on a man whose only pain-relief was self-hypnosis. But his statement on this occasion was inoffensive and utterly worthy of support. His much reported comment was that a new technique introduced in Marie Stopes clinics had 'made early abortion a minor procedure that could quite easily be completed during a working woman's lunch time break'.
Black stressed that it was his intention simply to provide a service 'without drama or moral censure'. When pressed on Radio 4's Today programme as to whether he had any difficulty presenting early abortion as something as simple as having a tooth filled, he replied: 'No, we have no problem at all. Women do not lease their bodies from the state or even from the church. They own themselves and if they meet the criteria of the 1967 Abortion Act they have the right to the best service possible.'
Black's approach to abortion hits you like a breath of fresh air. For once early abortion is being presented as the simple, straightforward procedure it actually is.
A woman seeking abortion at a Stopes day-care clinic must be less than 12 weeks pregnant and must comply with the legal requirements of the Abortion Act - that is, two doctors must agree that continuing the pregnancy will cause greater damage to her health than ending it. On arrival the woman changes into a loose-fitting t-shirt which she has brought with her and a nurse checks her medical history, pulse and blood pressure. About 20 minutes before treatment she will be offered a painkiller to help relieve the discomfort of the procedure.
Like severe period pain
When the time comes for her treatment, the woman is taken into the treatment room where she settles into a chair similar to that you would expect to find in a dentist's surgery. The pregnancy is then terminated under local anaesthetic, using a technique and instruments originally meant for use in developing countries where high-tech clinical back-up is non-existent. It is a minimally invasive procedure, in which a flexible cannula of just 5 or 6mm diameter is passed through the cervical opening into the uterine cavity. The cannula is attached to a manual vacuum pump and the 'products of conception' are sucked away. The whole procedure usually takes less than 10 minutes to perform.
Nobody, not even Tim Black, will claim that the procedure is pleasant. Usually the woman feels some cramping, like severe period pains, during and immediately after the procedure. But many women understandably find the speed and convenience preferable to the inconvenience and unpleasantness of a general anaesthetic or the hours of bleeding that occur with the abortion pill.
Day-care centres providing abortion under local anaesthetic have been operating for years in countries such as Spain, the Netherlands and the USA, where many practitioners ridicule the traditional British provision of abortion under general anaesthetic in the gynaecological wards of hospitals. There is a clinical consensus that early abortion is, in itself, so safe that a woman faces more risks from the general anaesthetic than she does from the procedures for which it has been used to anaesthetise her. Dutch doctors have for many years condemned the British preference for general anaesthetic, saying it exaggerates the procedure in women's minds and makes them worry more.
From a clinical point of view it is entirely appropriate to compare early abortion to a tooth extraction. In fact, it is probably safer. From the operating doctor's point of view there is nothing to diagnose, the issue is straightforward providing only that the gestation of the pregnancy has been accurately assessed. In the USA, where most abortions are performed outside hospital settings, a five year review of abortions performed within the first eight weeks of pregnancy showed the death rate was as low as 0.2 per 100 000 procedures - one in half a million - making it one of the safest operations known to medical science. Marie Stopes cites studies which show the risk of serious complications in early abortions as just 0.2 in a hundred.
Safe and convenient
Nobody has suggested that the Marie Stopes service is unsafe. Indeed had there been any question of its safety we can rest assured the Department of Health, never known to be cavalier on matters relating to abortion, would have refused to licence the six day-care centres.
There have been some suggestions that, by so blatantly offering women abortion on request, the service is unlawful. But these allegations have been easily brushed aside. It is widely accepted that almost all of the 140 000 or so pregnancies terminated in the first trimester are ended simply because they are unwanted. These abortions are considered legal because the referring doctors do, in good faith, believe that it would damage the mental health of these women to force them to endure pregnancy and childbirth against their will. Black has not said that the new centres would offer abortion to any woman he would not have previously provided a service for, simply that - if she wishes it - the abortion can be carried out more conveniently than before.
It is this admittance of 'convenience' that has most provoked Black's critics within the pro-choice movement, most of whom appear to feel more at home with Nuala Scarisbrick of Life's insistence that abortion 'should not be trivialised'. Even the pro-choice movement seems to believe that abortion should not be too convenient or easy. Many have got themselves caught in a state of intellectual schizophrenia, arguing simultaneously that, on the one hand, women always agonise over their abortion decision and never take it lightly, while on the other hand, the new Stopes system might rush the poor dears into decisions they will come to regret.
The defensiveness of the pro-choice movement and their irritation with Mr Black stems from their apparent belief that it is impossible to win public support for the principle of easily available abortion, so that the best you can do is to garner sympathy for the victims of unplanned pregnancy wracked by 'difficult decisions'.
Yet portraying women seeking abortion as victims in search of deliverance does women no favours at all. For some women abortion is a difficult, heart-searching decision - but not for all. For many it is entirely straightforward. Many women simply want to get back to a pre-pregnant state as quickly as possible with as little fuss as possible. They do not want sympathy or understanding. They do not want counselling or advice. They just want a safe and effective abortion procedure and they find it irritating that even those who support their right to choose are inclined to present them as emotional cripples. Some women who have abortions may indeed come to regret their decision but, in a sense, that is what life is like. Some women who have children regret their decision. We make our choices and live with the consequences. It is not for somebody else to make those choices for us in advance.
Cynics have pointed out that Tim Black is more concerned about raising his share of the abortion market than he is about raising the issue of women's rights to abortion. It has been alleged that his love of the non-clinical setting and local anaesthetic is motivated by his sense of economy: abortions can be provided more cheaply this way. But who cares about any of that? Whatever his motivation, you have to admit that his high-profile provision of a lunch time abortion service has done more to 'normalise' abortion than any other recent action.
On this occasion the pro-choice movement could take a lesson from the doctor: stop apologising for abortion and demand the service that women need.*
Free speech branded
by Jennie Bristow
On Friday 8 August, Edinburgh University sacked psychology lecturer Chris Brand. Last November, Brand had written something on his Internet site that was seen to condone child sex. Brand was suspended from his post, and eventually sacked when a university tribunal found him guilty of 'disgraceful conduct'.
Most of us would rightly find paedophilia, and attempts to condone child sex, repellent. But child sex is not the issue at stake here, and nor is the welfare of Chris Brand. What the witch-hunt against this lecturer shows is the extent to which freedom of speech in universities is now only allowed if you say the right thing: even when expressing your personal views.
The controversy over Chris Brand has not come out of the blue. In April 1996, he admitted to the national press that he saw himself as a 'scientific racist', believing that racial inequality was an innate result of low IQ in ethnic groups. Brand's publishers immediately stopped the release of his new book, The g Factor: General Intelligence and Its Implications. The Student Representative Council of the University of Edinburgh and the Student newspaper demanded he be removed from his post. The university's principal, Sir Stewart Sutherland, launched an investigation into Brand's teaching practices.
When it was discovered that Brand was not only a racist, but supposedly condoned paedophilia as well, his days were numbered. Everything he said seemed to run counter to the accepted wisdom of what is right and wrong. But so what?
It has always been the case that some university lecturers develop theories that are controversial, bigoted and above all wrong. The principle of academic freedom has, until now, given the lecturers the space to do this and students the space to disagree. As one of Chris Brand's former students Helene Guldberg argued in LM last year, she had spent her degree course in psychology arguing furiously with Brand, and generally defeating his case ('Why ban racist Brand?', June 1996).
To call for the removal of a lecturer on the basis of his political views, as the anti-racist campaigns against Brand did, is not only an attack on academic freedom and free speech. It also betrays a highly patronising attitude to university students. It assumes that students are too vulnerable and impressionable to cope with offensive ideas. The fact that students are adults, at college to test out ideas and think for themselves, is simply not considered.
But Brand was not sacked for what he taught his students. The fact that he was sacked for his views on child sex, aired on his own Internet site, shows that the view of students as children has gone even further than restrictions on teaching practice.
On 9 August, the principal of Edinburgh University told the Guardian that it had been made clear to Brand that he 'had responsibilities to act with care, whether in a departmental, teaching or wider situation'. In other words, universities today not only restrict what you can teach as an academic: they also want to dictate your private beliefs as well. Why? Because you have a moral responsibility, in your professional and personal life, to teach your students to think the 'right' things.
Once upon a time, universities may have been places where students and academics were encouraged to think, to criticise and to develop new ideas. Now it seems that you can only survive in a university if you see your role as a vicar or childminder, constantly under scrutiny. Chris Brand may be the victim of this particular case, but the real loser in such a restrictive climate will be anybody with an original thought.
Reproduced from LM issue 103, September 1997