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rhm in the media

Marge Berer: Independent abortion counselling? Whose problem?

Published: 1 September 2011 by BMJ Group

Nadine Dorries MP is a very skilful politician. She decides there is a problem, for which she has absolutely no evidence. She not only manages to get her problem on to the front pages of the newspapers but also on to the agenda of the House of Commons. Having spoken to her about it, the Department of Health (DoH) agrees to take it up and resolve it without putting it before Parliament. But the DoH have no evidence of a problem either. Nadine Dorries wants to make life harder for the one in three women in this country who will have an abortion in their lifetimes. But what excuse does the DoH have? One can only presume they were trying to stop Dorries from stealing the limelight from Andrew Lansley's NHS bill next week, which is contentious enough without her. Today, as reported by the Guardian, Downing Street has intervened.

What was going on? Earlier this year, Dorries claimed that the British pregnancy advisory service (BPAS) and Marie Stopes, who provide a high proportion of abortions for the NHS and for non-NHS patients, do not give unbiased abortion counselling because they earn money from providing abortions. This is patently untrue. The ethos of non-directive counselling has been central to abortion provision since the 1967 Abortion Act was passed. It is in no one's interest for abortion clinics and counsellors to do otherwise than give unbiased information and counselling: that is their job. Dorries does not cite claims by any woman that an abortion counsellor or doctor talked her into having an abortion, or encouraged her to do so when she wasn't sure. She merely says that the process is too fast, as if women with an unplanned pregnancy don't think about it on their own, sometimes for weeks or even months, before approaching an abortion clinic.

In June, when this hit the news, I wrote to Anne Milton, parliamentary under secretary of state at the DoH, to protest against Dorries' claims, and to ask what the problem was as they saw it. In mid-July, I received two replies from two different civil servants. The first said that women needed to know about "the risks to health (including mental health) posed by the abortion procedure as well as any health risks posed by continuing the pregnancy, to enable [them] to make a decision that would benefit [their] overall health and wellbeing."

The other, some days later, said: "The department is drawing up proposals to enable all women who are seeking an abortion to be offered access to independent counselling provided by appropriately qualified individuals. Independent counselling will focus on enabling a woman to make a decision that would benefit her overall health and wellbeing. Independent counselling will be for those women who choose to have it and will not be mandatory. Full proposals are still being worked up within the Department of Health and it is therefore unable to provide detailed answers while this process takes place."

Thus, although the department decided to approach this differently from Dorries, Dorries still managed to make her problem official - BPAS and Marie Stopes, the accredited independent providers of abortion and abortion counselling, about whose counselling no one save Dorries had complained, were seen as neither appropriate, qualified, nor independent enough, and were not acting in the interests of women's health and well-being. Therefore a second tier of counselling should be made available to women - yet it wouldn't be mandatory! It couldn't have been more confused.

On 25 July, I wrote to Anne Milton again to ask to see the evidence that the abortion counselling being provided by BPAS and Marie Stopes was in some way deficient, and whether she intended to make any such information public or not. I also asked:

  • How the department defined "independent counselling" for women considering or seeking abortion, and if anyone currently provides it.
  • If no one currently provided it, did she intend for the department to set up such counselling centres, and/or
  • Did she consider that groups who advertise themselves as willing to help women with unintended pregnancies, but who do not and will not refer women to an abortion provider even if they ask for such a referral, are able to give independent counselling?

I did not receive a further reply.

Health risks? The fact is that induced abortion with a trained provider is among the safest clinical procedures available. As for mental health, recent reviews of the literature by the American Association of Psychologists and by the Royal College of Psychiatrists have shown yet again that unless a woman has mental health problems prior to getting pregnant, abortion does not increase the risk of mental health problems after it. When will that be believed?

Still, what's that got to do with the need for independent counselling? Does the DoH believe so-called crisis pregnancy centres can do the job instead? A recent study of eight such centres in England found that many of their counsellors lacked basic listening and counselling skills and also lacked practical and accurate information about abortion and other options. Some advised against having an abortion at any cost, for example by giving dramatic misinformation, such as that 100% of women who have abortions will get cancer. Two centres did provide straightforward and impartial advice, but the "added value" of any of these centres was not clear in comparison with counselling by an accredited abortion provider. [1]

But why worry about evidence?

Dorries' amendments would have provided an inflammatory and unwelcome distraction from the debate on the NHS Bill and the ills that Bill is set to bring us. The Speaker of the House might not have selected the amendments anyway, given that the DoH is (or was) on the case, in pursuit of a problem created out of thin air.

Now, let's get to the real issue: calling for the withdrawal of the entire NHS Bill.

[1] Education for Choice. Snapshot of Crisis Pregnancy Centres operating in England. 2011.