Abortion And Reproductive Medicine Textbook Notes

ABORTION AND REPRODUCTIVE MEDICINE

Herring Chapter 6 – Contraception, Abortion and Pregnancy

1. Introduction

• Few topics arouse greater passion than those surrounding abortion and the regulation of pregnancy

  • The reason is that, for those on either side of the debate, the stakes are extremely high

• On one hand, there are those who regard abortion as murder of the most innocent and vulnerable human beings

  • OTOH, there are those who claim that access to abortion is a crucial part of the battle towards women’s equality and is a fundamental right

  • For them, abortion and fertility decisions should be made by the woman alone, and should not be interfered with by the State

  • Even the questions you start with and the framing of the question can reflect a particular approach

• The law seeks to strike a somewhat uneasy balance between recognising that the foetus has some interests, reinforcing medical control over pregnancy and birth control, and protecting the rights of the pregnant woman

  • Cannot be forgotten that these issues affect millions of women in the UK

  • By the time they are aged 45, a third of all women in the UK will have had an abortion

2. Contraception: its use and function

• Some argue the wide availability of effective contraception has done more to emancipate women than any other social development

  • 2015 UN Report: worldwide 64% of women of reproductive age use contraception

  • 81% in UK

• Most common forms of contraception:

  • Condom

  • IUD

  • Injectable contraceptives

  • Female contraceptive pill

  • Sterilisation

  • Natural methods

• There are serious disadvantages to all these forms of contraception

  • In a survey covering seven countries, a substantial majority of women were dissatisfied with all of the available methods of contraception.

  • Two leading clinical experts working in the UK have stated: '[T]here is a real need for new methods of contraception to be developed that are more effective, easier to use, and safer than existing methods.

• <skimmed disadvantages to contraceptives>

• A major problem with all forms of contraception is reliability

  • One practical consequence of these failure rates is that, in about three -quarters of pregnancies ended by abortion, the woman was using some form of contraception at the time of conception.

  • The National Institute for Health and Clinical Excellence (NICE) has recommended that wider use be made of reversible long-acting contraception

• Despite a widespread perception of sexual promiscuity, a major government survey found that, of those aged 16-69,75 per cent of men had had only one sexual partner in the year prior to the interview and 11 per cent had had no sexual partners.

  • For women, the corresponding statistics were 78 per cent and 13 per cent. It is notable that, of those seeking advice from National Health Service (NHS) contraceptive clinics, 89 per cent were women.

  • Sadly, contraception still seems to be regarded as largely a 'woman's responsibility

3. The availability of contraception

• Lord Denning, in Bravery v Bravery, suggested that a sterilization that is done 'so as to enable a man to have the pleasure of sexual intercourse, without shouldering the public interest attaching to it' was contrary to public policy and degrading to the man.

  • But the judges gradually moved with the times and, in Gillick v West Norfolk and Wisbech Area Health Authority, Lord Scarman held that contraceptive medical treatment is 'recognized as a legitimate and beneficial treatment in cases where it is medically indicated'.

  • Most would agree with the statement by Mumby J in R (Smeaton) v The Secretary of State for Health: It is, as it seems to me, for individual men and woman, acting in what they believe to be good conscience, applying those standards which they think appropriate, and in consultation with appropriate professional (and, if they wish, spiritual) advisers, to decide whether or not to use IUDs, the pill, the mini-pill and the morning-after pill. It is no business of government, judges or the law.

• In fact, the law does regard contraception as part of the state's business.

  • Contraceptives are medical products that must be licensed by the Medicines and Healthcare products Regulatory Agency (MHRA) ofthe European Medicines Agency (EMA) before use

  • Also, the National Health Service Act 2006, Schedule 1, paragraph 8, places a duty upon the Secretary of State, who:

  • must arrange, to such extent as he considers necessary to meet all reasonable requirements, for-

    • (a) the giving of advice on contraception,

    • (b) the medical examination of persons seeking advice on contraception,

    • (c) the treatment of such persons, and

    • (d) the supply of contraceptive substances and appliances.

  • In effect, it means that anyone should be able to access contraception.

• It must not, however, be thought that there are no barriers to accessing contraceptive treatment.

• 1) First, the oral contraceptive pill is available only under prescription or from pharmacists.

  • This is because, for people with certain medical conditions, it can carry serious side effects, and it is thought that the pill should be used only under medical supervision.

  • However, condoms and, significantly, post-coital contraception is available over the counter at a pharmacy.

• 2) The second barrier is cost: although contraception provided under prescription is free, as is contraception (including condoms) provided at family planning clinics, when purchased at a supermarket, a packet of twelve condoms can cost around 10.

  • Although, to many, these barriers appear small, as we shall see they are significant to some young people

• Sterilizations are available on the NHS, although about one third are carried out privately. In 1999, there were 64,422 vasectomies and 41,300 tubal occlusions.

  • The number of sterilizations carried out by the NHS had dramatically fallen by 2010-ll to 12,700 vasectomies for men and 9,700 tubal occlusions for women.

  • This might, in part, be explained by an increase in the use of...

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