Monday, 31 May 2010
The myth that abortion causes breast cancer is widespread in the United States, where anti-abortion groups have made an effort to publicise it. Based on questions Education For Choice gets from young people and professionals, the myth has gained some traction here in the UK. But the alleged link is just that: a myth. Leading cancer charities Cancer Research UK and Breakthrough Breast Cancer have both issued statements clarifying that there is no evidence for a link.
Thursday, 27 May 2010
This week the General Pharmaceutical Council is completing a consultation on their new draft guidance to pharmacists. It is a useful document full of clear, sensible and well laid out instructions and principles. It promotes a client/patient-centred approach to dispensing; calling on pharmacists to be respectful of patients, to put quality care before any personal considerations etc...kind of what you’d expect from professionals who are an essential part of community health care in this country.
There is one glitch. It’s quietly buried amongst the good stuff, but screamed off the page at me...Pharmacists who have a personal objection to providing a particular medication can opt out of doing so. It is not named in the guidance, but we all know it’s referring to emergency hormonal contraception – the ‘morning after pill’. Ten years ago or even five it would have been inconceivable that a pharmacist would have been given the right to ‘conscientiously object’ to providing a legally available medication or treatment. Now it seems that we might be going the way of the US where pharmacists are routinely refusing to fill women’s prescriptions for the contraceptive pill and emergency hormonal contraception, or Plan B – the US brand name.
The arguments about conscientious objection are complex. They don’t divide us simply down liberal (small L) and conservative (small C) lines like so many issues seem to. Many people may argue that the individual should have the right to live by their own beliefs and that might mean not co-operating in the provision of services that go against those beliefs. On the flip side people may think that professional commitment comes before personal preferences and you shouldn’t take on a job if you’re not willing to carry out all aspects of it.
Whatever our abstract philosophical beliefs about conscientious objection we do need to worry about the women on the end of these ideas. Maybe it’s because I’ve spent the last ten years travelling around the country training nurses and hearing their anecdotes that I find myself rooted not in the abstract, but in the prosaic, the every day, the real. When I think of a pharmacist refusing to give someone the ‘morning after pill’ I don’t imagine someone standing at the Boots counter in Oxford Street, where another three pharmacists are available to step in. I see a 16 year old on a chilly Monday morning in rural North Yorkshire. Let’s call her Rachel. She’s walking into the only chemist shop in the village 36 hours after she had sex, and she’s being refused the emergency contraceptive pill she desperately wants and needs to prevent her from getting pregnant. She hasn’t got the bus fare into town where the nearest alternative chemist is – and anyway the bus is sporadic at the best of times. School starts in ten minutes and so she shrugs her shoulders and walks out of the shop feeling sick with anxiety because she knows that by the time she can get to town at the weekend it’ll be too late. She’s also feeling a bit shabby because she must have asked for something bad – and by extension be bad – if the pharmacist has refused to sell her what she wants. Nothing for it now but to cross her fingers and hope she gets her period...
There is nothing in the guidance to pharmacists that deals with this situation. No protocol for medication that is time-sensitive and urgent such as emergency hormonal contraception. No acknowledgement that all the good client-centred principles are wiped out at one stroke when a pharmacist can say ‘I know better than you what you can put in your body. I am willing to refuse you this prescription and take the risk that YOU will become pregnant against your will.’
When the right to conscientiously object was written into the 1967 Abortion Act, it recognised that someone who didn’t agree with abortion in principle shouldn’t have to physically get involved in the very practical and visceral experience of carrying out abortion. As time has gone on a small, but significant proportion of GPs have taken this to mean they don’t have to refer women for abortion if they object to it. Now it seems that pharmacists need not even help a woman to prevent a pregnancy if they don’t believe in hormonal contraception. I’ve never liked that expression “thin edge of the wedge”, but you have to wonder...condoms next?
Tuesday, 25 May 2010
I was really happy to see the abortion statistics published by the Department of Health today. They show reductions in the abortion rates for women of all ages. Since it is unlikely that women had less sex in 2009 than they did the year before, it probably means that men and women are using contraception more regularly and more effectively and getting offered a better choice of contraceptive methods – good news! For those women who did access abortion the statistics show that services for women are improving too. 94% of abortions were paid for by the NHS and a massive 91% were carried out before 13 weeks into pregnancy .
The figure that shows an increasing proportion of abortions taking place earlier in pregnancy definitely brings a smile to my face. The earlier abortions happen, the safer they are, and the easier to access. Young women are often the last to seek help because they’re scared, lack knowledge or are in denial about their pregnancy, so getting them into services earlier is a challenge we’ve been helping professionals to meet all over the country.
Just in case you wondered, I’m not complacent. Most abortions happen because the women didn’t intend to get pregnant at that point in her life. That’s a lot of people who still aren’t getting support from partners and professionals to use contraception successfully and of course there’s still that pot of gold at the end of the rainbow we are all searching for – the perfect contraceptive method...
No Sir, these figures don’t make me want to put my feet up and light a fat cigar. There’s so much more to do to make sure young people are given accurate information about pregnancy prevention, pregnancy choices and abortion. Education For Choice is one of dozens of organisations which rue the day the Government failed to give us statutory sex education. We still visit students in schools who have been given presentations by anti-choice organisations who quite deliberately misinform and distress them. Young women seeking abortion after 12 weeks, in all but a few large cities, are most likely to have to travel substantial distances to get an abortion – which is extremely difficult for those with no parental or partner support. In a nutshell , there’s still loads to do and these statistics are just showing slight improvements across all areas. Those improvements have been hard won with professional commitment and substantial investment. Let’s hope the money and commitment continue so we can celebrate again next year.
Monday, 24 May 2010
It is not surprising that an advert that alludes to abortion is controversial. The consensus in the UK seems to be that abortion is something that should be freely provided, but should not be talked about if at all possible. Although one in three women in the UK will have an abortion in their lifetimes, this common procedure remains shrouded in myth and mystery. This is one of the reasons why the EFC blog has launched Myth-Busting Monday today and will be posting a new myth-busting fact each week. It’s also the reason why we welcome clearer and more accessible information for women on how to access abortion if that is what they have chosen.
National helplines play a vital role in providing accurate information for people wanting to prevent pregnancy and those who face unplanned pregnancy. For many women a telephone service is the best, most convenient way for them to access information and advice, but these services must be complemented by good, accurate information about local services available from the professionals women meet face to face every day. That means that whether a woman asks her family planning clinic, her GP, her health visitor or other health practitioner locally, they should all be able to provide really good, clear information on how to get support with unplanned pregnancy. Young women especially need to know that they can ask the professional they trust – whether it is a school nurse or other health worker, a youth worker, a social worker, or a Connexions worker – to give them the support they need to consider their pregnancy options and access the services they need to continue healthily with a pregnancy or to have an abortion. Training should be available for all professionals who work with young people to ensure that they can provide accurate information about all pregnancy options and local referral pathways.
But before you open that phone book, keep in mind: Some services which offer advice and guidance for women facing unplanned pregnancy are anti-abortion and may try to deter women from having an abortion. Organisations which advertise free pregnancy helplines, pregnancy testing, abortion counselling and post-abortion counselling, may not always provide accurate information or impartial support. This video shows how some of these centres operate. For more information on how to assess a local information service EFC’s Best Practice Toolkit: Pregnancy Decision-Making Support is free to download.
Helplines you can trust:
Brook - provides a specialist sexual health helpline for young people and has a network of clinics around the country providing face-to-face support
Fpa – provides a helpline for men and women of all ages and will help you find a local clinic
Marie Stopes and bpas – provide a range of sexual health services including abortion. Most of the abortions they provide are funded by the NHS
NHS Choices – information on all aspects of health including abortion, ante-natal care and child health
Let’s start with the basics. One of the most common questions we get from young people and professionals alike is: does abortion cause infertility? There is no link between abortion and infertility. In fact, most women are fully fertile within two weeks of having an abortion, so it’s crucial to get advice to help choose and use an appropriate form of contraception right away. Some contraceptive methods can be fitted or initiated at the time of abortion and women seeking abortion should ask about this.
Myth one, consider yourself busted.
Thursday, 20 May 2010
Education For Choice trains thousands of professionals around the country each year. Training Tales will bring you stories from the amazing frontline professionals EFC trains.
A few weeks ago on training in Hull, a professional asked about the prevalence of illegal, or “backstreet”, abortions in the UK. Many professionals we work with are already aware that unsafe abortion is a major cause of global maternal mortality. Indeed, the World Health Organisation estimates that complications from unsafe abortion kill at least 70,000 women a year in parts of the world where safe abortion is illegal or inaccessible. Because of the fear of prosecution or stigmatisation, this number is difficult to estimate, but there is no doubting that in Latin America, Africa, Asia, and everywhere abortion is illegal, illegal abortion continues to threaten women’s lives. (And research indicates that making abortion illegal doesn’t necessarily make the practice less common, but it does force abortion underground.)
The short answer to the question of illegal abortion in the UK, however, is that we don’t know. It is unlikely to be a common practice in this country, given widespread availability of free services. That said, although abortion is widely available on the NHS and from providers such as Marie Stopes and bpas, some women are ineligible for free abortions on the NHS. Others may be unaware of the services available to them. According to a BBC report, there are indications that illegal abortion in the UK is an issue.
As far as I know, no one has yet undertaken a comprehensive study of the issue of illegal abortion the UK (although please correct me if I’m wrong!). Whatever the figures, I think this interesting question should remind us of the importance of talking to all young people about pregnancy choices, including abortion, openly, honestly, and early. The BBC report also indicates that the women accessing illegal abortions in the UK may come from marginalised communities, a reminder that everyone deserves the same information. Professionals sometimes feel anxiety about addressing abortion with some young people because of their backgrounds, but young people from cultural or religious communities that disapprove of abortion need information about choices just as much, if not more, than other young people. Education about pregnancy choices keeps young people safe by equipping them with the knowledge and skills to prevent pregnancy and to make safe, informed choices when facing unintended pregnancy.
In a related note, EFC director Lisa Hallgarten recently issued a statement regarding abortion medication available on the internet. Check it out here.
Monday, 17 May 2010
In October of 2008, many professionals in the sexual health community were elated to hear the Government announce that sex and relationships education (SRE), as part of Personal Social Health Education (PSHE), was to be made a statutory part of the national curriculum. For years, SRE provision had been spotty, with proactive schools developing brilliant, comprehensive programmes of work, while other schools languished. A 2008 UK Youth Parliament survey of over 20,000 young people found that 40% rated their sex ed as poor or very poor, with a further 33% saying it was average. Many professionals and professional bodies, including the Sex Ed Forum (of which EFC is a member), have long held that making PSHE statutory will elevate the subject to the same status as other curriculum subjects, helping to lead to improved provision.
However despite widespread support among professionals and young people themselves, statutory SRE was dropped last month. As members of the Sex Ed Forum, Education For Choice will continue to push for excellent SRE for all young people. Until and after sex ed becomes a part of the mandatory national curriculum, we’ll continue training teachers, providing resources, and supporting best practice provision, particularly around the issue of abortion. You can still access our Best Practice Toolkit: Abortion Education free of charge on the EFC website.
What happened to statutory SRE? A Timeline
2007: UKYP launches “SRE: Are you getting it?” campaign
2008: Government announces a review of SRE
October 2008: The Government announces, on the day of the Sex Ed Forum’s 21st birthday, that SRE, as part of PSHE, is to be made a statutory part of the national curriculum
April 2009: Alastair MacDonald’s review of PSHE concludes; Government confirms intention to make SRE statutory
November 2009: Bill will lower parental withdrawal age to 15, so all 15-year-olds would get at least one year of sex ed
February 2010: Campaigners outraged by a Commons amendment to the Children, Schools, and Families Bill that would allow faith schools to teach sex ed from a faith perspective
April 2010: Statutory SRE ultimately dropped