Tuesday, 1 April 2014

Intimate Partner Violence, Pregnancy and Abortion

The World Health Organisation defines Intimate Partner Violence (IPV) as “one of the most common forms of violence against women and includes physical, sexual, and emotional abuse and controlling behaviours by an intimate partner”. IPV has been shown to increase during pregnancy. Women’s Aid states that 30% of IPV starts during pregnancy and that between four and nine women out of every 100 are abused during their pregnancies and/or after having given birth. Women’s Aid identifies IPV as a prime cause of miscarriage, still-birth and of maternal deaths following childbirth.

One form of IPV is termed ‘reproductive coercion’ – where abuse relating to contraception or pregnancy decision-making is exercised by a woman’s partner. For example, the abuser may sabotage contraception, refuse to use it, or pressurise a partner into continuing or ending a pregnancy against their wishes. Perhaps unsurprisingly, a recent study found an association between IPV (naming rape and sexual assault, contraceptive sabotage and pregnancy coercion as examples) and termination of pregnancy. The study found that women in violent relationships were three times more likely to conceal an abortion from their partner as women in non-violent relationships and that “women undergoing terminations of pregnancy welcomed the opportunity to disclose their experiences of intimate partner violence and to be offered help”. What this tells us is that pregnancy support services need to be attuned to the risk factors for IPV and to be able to provide signposting and support where required. Domestic violence support services in turn, need to be equipped to provide accurate information on pregnancy choices and impartial support with pregnancy decision-making.

We were concerned to see that information about IPV and pregnancy is being misrepresented by anti-abortion organisation LIFE, in its recent ‘Finding Hope’ campaign. In a glossy animation LIFE claims that “the association between abortion and violence towards women is strong”. LIFE claims that one in four women seeking abortion are “victims of domestic violence” and “at least one in every four women seeking abortion, therefore, (is) not doing so freely but from a position of fear.” LIFE makes a causal relationship between IPV and abortion which is simply not in the data, implies that abortion itself is a form of violence, and states that “women who have abortions can become more self-destructive, and remain in or seek out abusive relationships as a form of self-punishment.” It is highly offensive to suggest that women have abortions, or remain in violent relationships as a form of ‘self-punishment’. It is also inaccurate to extrapolate this data to claim that a quarter of women seeking abortion do so out of ‘fear’.

It is not surprising that a large proportion of women who have abortions have also, at some point, experienced IPV. Both are very common within a lifetime. A third of women have an abortion. A quarter of women experience IPV. It is therefore inevitable that a significant number of those accessing abortion services will have also experienced IPV. What we know about IPV increasing during pregnancy, and about reproductive coercion as a form of IPV, means that there is of course a link between IPV, unplanned or unwanted pregnancy and therefore abortion, but this link is not one of simple causation as the LIFE Finding Hope campaign implies.

LIFE’s suggestion that “no one even asks them (pregnant women) if they are ok...let alone, why do you want an abortion...not even the health professionals tasked with caring for them” is particularly misleading. The Finding Hope campaign claims to, “draw attention to abortion providers' conveyor-belt service and their failure to adequately support women vulnerable to abuse”, the implication being that women seeking abortion are not assessed, supported or fully consenting to the procedure. In fact, bpas, a leading abortion provider and charity, takes a ‘routine enquiry’ approach to domestic abuse, which means staff routinely ask women about safety in their relationship. All staff are trained on domestic abuse issues and bpas provides information in formats which are accessible to a range of people and signposts to relevant agencies. The Royal College of Obstetricians and Gynaecologists advises medical professionals to work to identify those at risk of IPV and provide appropriate support.

LIFE’s campaign culminates in a fundraising appeal for its helpline service. LIFE, which campaigns against legal (and therefore safe) abortion does not appear to be promoting genuine advocacy on domestic violence issues, but rather conflates abortion with abuse in order to argue against abortion. We are particularly concerned that LIFE’s ‘counselling’ services have been shown to be misleading and biased, for example, one LIFE counsellor falsely claimed that abortion leads to an increased risk of breast cancer. Giving women false information in an attempt to influence their decision about a pregnancy is unethical. The narrative provided by LIFE, that women seek abortion only out of ‘fear’ or coercion, is simply not accurate, and negates women’s agency when it comes to making sometimes difficult choices about pregnancy. The connections between IPV and abortion are perhaps best looked at through the reproductive justice framework, which recognises that sometimes our 'choices' are restricted by factors such as economic status, race, class, location and so on. This useful factsheet from the National Women's Law Center, 'If You Really Care About Preventing Domestic and Sexual Violence, You Should Care About Reproductive Justice' makes clear the need to improve material conditions surrounding pregnancy and IPV and points out that restrictions on access to contraception and abortion services will only further constrain a person's ability to exercise bodily autonomy.

*****There is a confidential 24-hour National Domestic Violence Helpline on 0808 2000 247. This helpline is free and run in partnership by Refuge and Women's Aid who can provide information and support to those experiencing domestic violence. ******

Slide from LIFE's 'Finding Hope' animation which places abortion within a 'cycle of abuse'.

Wednesday, 26 March 2014

NICE guidance on young people and access to contraceptive services

Today, NICE released evidence-based guidance entitled ‘Contraceptive services with a focus on young people up to the age of 25’, which calls for improved access to contraception for young people. 

The guidance sets out various actions which it suggests will improve young people’s access to contraception, and thus decrease unplanned pregnancies amongst under 25s. As you may know, the teenage pregnancy rate in England and Wales is currently the lowest it’s been since 1969, but still remains one of the highest in Western Europe.

The guidance provides practical suggestions for improving young people’s access to sexual health services such as ensuring that services are:

Accessible (have flexible opening hours and accessible materials for those with learning difficulties, or for whom English is a second language)
Comprehensive (give information on the full range of contraceptive options, including the insertion of an IUD as a method of emergency contraception)
Practical (youth-focused services based in schools and colleges, where young people can access them easily)
Non-judgemental (staff should be trained and supported to offer impartial information)

We were glad to see that NICE specifically mentions the importance of access to contraception following pregnancy, encouraging professionals to "dispel the myth that there is no need for contraception after an abortion and explain that women are fertile immediately following an abortion." We have long been concerned that the myth that abortion causes infertility, often touted by anti-abortion groups which visit schools, may have an impact on a young woman’s access to contraception following an abortion.

The media reaction to the guidance has been interesting, with some outlets focusing on NICE’s suggestion that emergency hormonal contraception (EHC) be available in advance of sexual activity (rather than just obtained following unprotected intercourse).

The guidance states that "the evidence shows that advance provision of oral emergency contraception does not encourage risky sexual behaviour among young people. Evidence also shows that women who have emergency contraception in advance are more likely to use it, and to use it sooner after unprotected sex. Having emergency contraception on hand does not affect the use of other kinds of contraception."

Certainly, we have heard anecdotally of young women’s difficulty in obtaining the morning after pill. Some pharmacists refuse to give EHC to younger women, or attempt to charge them (at around £20 this can be too much for many teenagers). Some young people living in rural areas might struggle to get hold of EHC, especially in the first 24 hours after unprotected sex, when it is most effective. It makes sense to improve access to EHC for those who need it, to ensure it can be taken when needed, as quickly as possible.

However, some newspapers seem to think that there is a danger young women will ‘stockpile’ EHC. The Telegraph opens with:

“Teenage girls will be able to stock up on the morning-after pill under new NHS guidance which will allow young women to pre-order the drugs, despite Government fears the move will increase promiscuity.”

An interesting concept. These young women, who are seen as too feckless to access contraception before having sex, are organised enough to plan to ‘stockpile’ EHC in advance of having sex. Which is it to be, lazy and incompetent or cunning and prepared?! EHC is a form of contraception, which young people already have free access to. NICE is simply stating that it might be helpful for some young women (particularly those who live in rural areas, perhaps without their own transport) to be able to access EHC in advance, in case they ever need it.

We’re glad to see such sensible, evidence-based guidance being issued, we only wish the media could resist scare-mongering around young people and contraception, and that access to sexual and reproductive health could be rid of such stigma.

Thursday, 27 February 2014

It's time to slay the 'killer abortion' story

Today’s guest blogpost is from Lucy V Hay, a novelist, script editor and blogger who has just written a novel exploring one young woman’s pregnancy decision making process. She shares her insight on fictional accounts of abortion.

I’m grateful to live somewhere that allows for a woman’s right to choose, but abortion is frequently depicted in a negative light by movies and television. This Slate article sheds some light on the offenders, but does not, in my opinion, give a viable reason as to why this is so often the case.
As well as being the author of a pro-choice novel, The Decision: Lizzie's Story, I'm a script editor for movies, so hopefully I can offer an explanation – and though it may surprise some progressives, it’s not that the people creating those movies or television shows necessarily disagree with abortion!

When learning how to create fiction, the first thing any wannabe writer is taught is that, “drama is conflict”. In other words, a writer needs to create the worst problems for his/her characters that s/he can; it is overcoming those problems that make an audience relate to that character and invest in the character’s journey. So, if a story about abortion is to have the “most” conflict it can, obviously it will include death.

Simple, eh? But this is also where it gets complicated …

… 1 in 3 women in the UK will have an abortion at some point in their lives. What’s more, the likelihood of dying from having a legal abortion is extremely low. In fact, the risk of death from childbirth is 14 times higher than for abortion. So for starters, a story has potentially up to a third of its female audience going, “Eh? That just wouldn't happen!” Not. Good.

Secondly, though an individual movie or TV show may feature a death from an unsafe abortion (for example, if it was set in a time or place where abortion was illegal or inaccessible, like in the film Vera Drake), the sheer lack of variety in the representation of abortion in the media becomes problematic. It’s worth remembering, lots of people get their information from fiction … That’s why soap operas carry the famous: “If you have been affected by any of the storylines …” bit at the end of the show, alongside helpline numbers.

So if writers and producers shrug their shoulders and say, “It’s just a story!”, they are right. In isolation, their “killer abortion” story is just a story.

But all those “killer abortion” stories put together? A statement.

Working with writers, I am always at pains to point out we must be varied in our depictions of characters and situations and the “killer abortion” is no different. We are extremely lucky that safe abortion is a reality in Great Britain and that our friends, daughters, sisters and mothers have the right to bodily autonomy. But it’s also a sad reality that very few stories reflect this: instead, whether the writers and producers believe in the pro-choice message or not, they go for the lazy and stereotypical notion that “abortion kills” or is ‘dangerous’ in other ways (such as leading to infertility). It’s time to slay the “killer abortion” story and seek out representations that empower female characters – and the audience watching them.

Tuesday, 11 February 2014

Report released today – ‘Crisis Pregnancy Centres’ in the UK

CPCs are organisations independent of the NHS which provide pregnancy counselling – over half also provide sex and relationships education in schools. They are often run by charities which are outwardly anti-abortion or which have ties to anti-abortion organisations. The tactics of CPCs in the U.S have been documented by groups like NARAL, but this is the first full-scale investigation of CPCs operating in the UK.

EFC has identified 135 CPCs in the UK. Just under a quarter of these centres (33) were visited by volunteer mystery shoppers and background research into the remaining CPCs and their affiliations was also carried out.

Unfortunately the majority of CPCs visited were found to be giving misinformation about abortion and/or biased, unethical and unprofessional counselling methods. We are particularly concerned that many of these centres specifically market their services to young women. To give you an example, here are some quotes from the centres visited:

“The only other thing that has been reported with quite strong evidence is the increase in the possibility of breast cancer following termination of pregnancy” Oxford Care Centre (LIFE)

“There’s more risk of infertility from termination that there is from giving birth...some reports will say as low as 1% chance of infertility from termination and some will say as high as 25%” Central London Women’s Centre (Good Counsel Network)

“I do believe that God gives the gift of a baby” Reading Lifeline (Care Confidential)

“The other thing with abortion is the psychological effect of post abortion trauma.. of... the grieving that you lost, ‘cause you know at the moment for some girls it seems like a very quick option, you know and it’s a half day you go in, you’re out but you are left with the emotional turmoil of what you’ve done” Stillwaters Pregnancy Crisis Centre (Care Confidential)

Regular readers of our blog will know that abortion does not increase the risk of breast cancer, infertility or mental health problems. These ‘risks’ have all been discounted by medical professionals and to propose them as serious factors to consider in the decision making process inhibits someone’s ability to make an informed choice about their pregnancy. It is part of the anti-abortion agenda that seeks to limit choice under the guise of offering women support. 

Centres run by Care Confidential and Life do so under the name of the British Association for Counselling and Psychotherapy (BACP) which has a strict code of ethical guidelines for counsellors to follow. The directive, biased counselling offered in some CPCs cannot be considered good practice. Prominent psychotherapist Phillip Hodson states:

"Counselling is the opposite of conversion.  According to the ethical frameworks of our profession, no counsellor behaves properly by trying to sell to a client their personal religious or political outlook. Such an offence should trigger a formal complaint and - if this is proved - the offenders should be struck off by the regulating body. It goes without saying that supplying misleading medical information would be grounds for further sanction. It is my understanding that the regulator in such cases has always welcomed properly-founded complaints and their website explains how concerned individuals may proceed. I would hope for a swift response before it is suggested that counselling is not competent or motivated to regulate itself". 

EFC has sent an official complaint to the BACP and is awaiting a response.

More worrying still, Care Confidential is the primary service linked to on the front page of the NHS choices website about abortion. The organisation also claims to provide pregnancy counselling in five women's prisons. When the support Care Confidential offer is as sporadic and unreliable as our investigation has found it to be, it is far from acceptable for the NHS to offer their services to people looking for support.

Have a read of the report and watch this space for further developments.

Wednesday, 15 January 2014

Sex-selective abortion in the news. Again.

Back in September, we wrote a blog in response to the Telegraph’s ‘exposé’ of sex-selective abortion in the UK. Today, the Independent has launched its own campaign to raise awareness of "the illegal abortion of female foetuses" with a series of articles headed ‘The Lost Girls’.

Firstly, as before, we take issue with the claim that sex-selective abortion is ‘illegal’. Under the 1967 Abortion Act an abortion is legal if two doctors agree, in good faith, that the continuation of the pregnancy would involve more risk to the woman’s mental or physical health than having an abortion. Therefore, if a doctor considers a woman’s individual circumstances and believes that ending the pregnancy would be better for her health and well-being he or she can permit the abortion to take place. One of the Independent's articles recognises some of the potential risks for a woman in this predicament:

“Karma Nirvana, based in Leeds, said it had dealt with a woman brought from Pakistan after marrying her British husband, who then underwent fertility treatment to become pregnant with a boy after she gave birth to two daughters. She had been physically and emotionally abused by her spouse and inlaws over her failure to produce a son”.

The law permits a woman who has become pregnant as a result of rape to have an abortion if she feels it would negatively affect her to have the child, even though ‘rape’ is not a direct ground for abortion in the UK. Sex-selection falls under the same criteria – is the woman’s mental or physical health at risk if she is forced to continue with the pregnancy? (It's also worth noting that legal abortion is statistically safer than childbirth, some doctors would therefore always authorise a requested abortion on health grounds).

We haven’t seen the original data from which the Independent draws its evidence, so won’t comment on the claim that;

“The practice of sex-selective abortion is now so commonplace that it has affected the natural 50:50 balance of boys to girls within some immigrant groups and has led to the “disappearance” of between 1,400 and 4,700 females from the national census records of England and Wales”

The question is, if there is evidence of sex-selective abortion happening in the UK (albeit on an extremely small scale) what is to be done about this?

Anti-choice groups use the ‘evidence’ (from a newspaper, not a medical body) in an attempt to shore up their belief that ALL abortions should be banned. SPUC claims that sex-selective abortion "demonstrates how legalising abortion for ‘hard cases’ is so easily abused" and Life states:“We object to all direct abortion on principle, but to end a child's life because they are the 'wrong' sex seems particularly unjust.”

The ‘hook’ of sex-selective abortion is being used by these groups to argue that there should be no legal access to abortion. It feeds into anti-choice myths that women cannot be trusted to make decisions about their own bodies. 

We reject the co-option of feminist rhetoric by these groups, feigning concern about women’s rights when in fact they seek to curtail them. It’s crucial that all those dedicated to protecting human rights, and improving reproductive health and gender equality pay attention to the underlying thrust of these arguments about sex-selective abortion. In countries where sex-selective abortion is a reality, the answer is not to restrict abortion access. Unfortunately gender discrimination is ingrained in all societies and we have a lot of work to do to improve the status of women the world over. Refusing them ultrasounds or reproductive care is not the way to do this. Reproductive rights groups, alongside women's rights organisations, will continue to campaign for improved education and material conditions for women, to tackle male violence and discrimination in all forms.

Friday, 27 December 2013

Tim Montgomerie - 'moderate' on abortion? Really?

Yes, we're still officially on holiday, but we just couldn't resist commenting on the recent 'OpEd' from Tim Montgomerie in the Times. It's behind a paywall here, but we've included quotes from some of the parts which are particularly problematic.

Montgomerie positions himself as being a 'moderate' voice on abortion, arguing that the debate only allows for 'hot and cold'. For starters, this seems to be a dishonest presentation of where he actually stands. Montgomerie is a patron of SPUC Evangelicals. SPUC (Society for the Protection of Unborn Children) is against abortion in ALL circumstances, and even believes that certain forms of contraception cause abortion. Members of SPUC Evangelicals believe that "the widespread abuse and destruction of unborn children [therefore] constitutes a flagrant offence against almighty God." So, although Montgomerie talks about lowering the time limit, or changing the law around termination on grounds of fetal abnormality it would seem his greater desire would in fact be to ban abortion completely (or he should have a re-read of the SPUC manifesto he endorses).

So let's look at some of the arguments he puts forward for 'tighter laws'. First, Montgomerie claims that 2013 "was the year when the reality of foetal “gendercide” within Britain surfaced — the deliberate, discriminatory termination of unborn baby girls". We've written about this before, but the 'reality' of 'gendercide' within Britain did not in fact surface. What surfaced was a 'sting' set up by the Telegraph where no abortions were actually performed. The Department of Health has reported a normal sex ratio for births in the UK.

Then, Montgomerie drags out an old Christopher Hitchens quote (also used by Mehdi Hasan in his anti-abortion piece last year, yawn) to argue that the public is becoming more 'concerned' about abortion:

“In order to terminate a pregnancy,” he said in 1989, “you have to still a heartbeat, switch off a developing brain, and, whatever the method, break some bones and rupture some organs.”

Well, not quite Hitcho. As we know, the majority of abortions in this country are carried out early on in pregnancy, when this simply isn't the case. We liked Edinburgh Eye's take on this:

Yes, that’s sometimes true. Of course, the earlier an abortion takes place, the less likely that it will be: the heart may not have developed, the brain may not yet exist, the bones and organs may still be so undeveloped that there is nothing there to break or rupture. But yes: terminating a pregnancy kills the foetus. 

But it’s also true that anywhere girls and women are denied the right to choose abortion, that denial of termination ensures that heartbeats are stilled, a brain is switched off, organs are ruptured: women die. As a woman I know wrote wistfully once, “Do you suppose if we pointed out that we have dear little faces and actual fingernails on our hands, that they’d care that we die?”

With regards to UK law, Montgomerie appears to support a reduction in the legal time limit for abortion:

"Others want a still earlier limit because of research that shows that even if the foetus is not viable outside the womb it can still feel pain."

In fact, the current time limit remains at 24 weeks because experts concluded that this is the limit of viability and that the best medical evidence does not support lowering this limit. The BBC reports on the Royal College of Obstetricians and Gynaecologist's findings that there is no fetal pain before 24 weeks gestation here.

Montgomerie tweeted "I don't think abortion should ever be 'easy'". In the article he suggests introducing 'fully informed consent' by showing women scans or images of fetuses: 

'A Michigan law based on this principle requires pregnant mothers to inspect “depictions, illustrations or photographs of foetal development”. Women are still in charge but are helped to fully understand what they’re choosing'.

Thanks Tim! Women (sorry, 'pregnant mothers' ) should be given picture books to fully understand what abortion is. Because, you see, they don't understand what they're choosing, but Tim does. Tim thinks some women should be allowed to have abortions (someone tell SPUC!) but only if it was made as difficult as possible for them, and it wasn't after 12 weeks, and the decision wasn't made due to a diagnosis of fetal abnormality.

He claims that the 'exception' in the UK law which allows for abortion after 24 weeks due to fetal abnormality "has produced an alliance between anti-abortion and disability rights campaigners". Perhaps we're reading the wrong blogs but we haven't seen evidence of this. In fact, many disability rights campaigners have stated their disgust with groups like SPUC co-opting disability rights campaigns to argue against a woman's right to access abortion. 

Either Tim Montgomerie should be more honest about his desire to make abortion completely illegal, or we would suggest that his reconsider his allegiance to SPUC, a group which aims to do just that.

Monday, 2 December 2013

Double your donation to EFC!

We're excited to be part of the Big Give Christmas Challenge this year. If you want to support our work with young people please read on for information on how donations you make this week can be doubled!

You can read more about the Christmas Challenge here but basically, if you make a donation to EFC on the 5th, 6th or 7th of December it has a chance of being doubled, thanks to matched funding from a generous individual donor and our 'Charity Champion' the Cabinet Office.

These matched funds are released at 10am on Thursday, Friday and Saturday this week. In order to access these funds it's important to try and make a donation as close to 10am on these mornings as possible. So please set a reminder to yourself to visit the Big Give donation page at this time to make a donation!

As always, your donations will go directly towards our work advocating for young people's right to evidence-based information about pregnancy options. If you have any questions about making a donation please email efc@brook.org.uk or call 0207 284 6056.

Thanks for your support!