Late abortion, that is, abortion conducted at 20 or more weeks gestation, is rare, making up just 1.6% (2,927 of 181,582) of all abortion procedures carried out for residents in England and Wales in 2003. Almost 90% of abortions were carried out at 12 weeks or less gestation.Footnote1 Late abortion has always been the subject of much discussion, yet there has been little research that addresses the important question:
Why do women present late for abortion?
Recently, late abortion has been hotly debated in both the media and the political arena in the UK. This debate has singularly failed to take account of the emotions, reasoning and experiences of women undergoing late termination of pregnancy, instead focusing on the viability of the fetus, scientific advances in neo-natal medicine and the alleged nature of late abortion methods.
This publication presents the findings of research into the circumstances surrounding the decision to undergo late abortion of women attending two Marie Stopes International (MSI) centres in the UK at 19+ weeks gestation. At MSI, women having abortions between 19 and 24 weeks undergo the same two-stage surgical procedure, and are free to go home on the same day.
The research illustrates the situations that lead to late abortion, and examines the processes women go through, from identifying the unwanted pregnancy to seeking and undergoing abortion. Women taking part were also asked to explain exactly what it would mean for them if they couldn't have accessed late abortion; the implications on their lives; and their views on moves to lower the upper gestational limit for abortion in the UK, currently set at 24 weeks.
Methodology
Women of 19-24 weeks gestation attending either of the two MSI centres in London which perform abortions up to 24 weeks gestation were invited to take part in the study. All research was carried out on the day the procedure took place. At one centre (West London), face-to-face interviews were conducted, using open questions to explore women's experience of late abortion. At the other centre (South London), women were asked to complete a questionnaire, which consisted of 13 tick boxes of reasons for having the termination later in pregnancy and four open-ended questions. Research was carried out between January and April 2005.
Key findings
For the vast majority of women taking part in this study, the signs and symptoms of pregnancy were not recognised until an advanced stage, making late abortion an inevitability rather than a conscious choice on their part.
Others put recognisable pregnancy symptoms down to other physiological factors peculiar to them, such as a history of erratic periods, a recent pregnancy, or the consequences of using particular methods of contraception.
A small minority of women taking part were aware of the pregnancy at an early stage but were either in denial, or subsequently faced a significant change in their circumstances that forced them to re-evaluate their pregnancy.
Some women reported significant delays in accessing services once a pregnancy had been detected and a decision to terminate made - these included encounters with obstructive medical practitioners and protracted waiting times for consultations, etc. This caused considerable distress and anxiety to the women affected by such delays.
Many of the women taking part found the decision to terminate particularly difficult to make, and reported taking a considerable amount of time to fully consider their options before deciding to proceed with abortion.
Most women did not act in isolation, but consulted and were supported by partners, family and friends.
Most women reported a combination of factors influencing their decision to terminate - every woman's situation was unique and most felt that they were the only person capable and qualified to make the decision.
Considerations of the impact of continuing the pregnancy on partners and existing children exercised a significant influence on most women's decision to seek abortion.
The vast majority of women felt that the current legal upper gestational limit of 24 weeks should be left intact, and that to have been unable to access services because of a change in the law would have caused emotional trauma - two respondents even reported that they might have taken their own lives.
Many women feel that the media's depiction of abortion is biased and unfair, and called for more balanced and considerate treatment for women who find themselves in this situation.
Once women decided that they wanted a termination, support was found from doctors and other health care professionals who showed understanding and referred speedily for the procedure. There were, however, many examples of women being delayed throughout the referral process, from delay in getting an appointment to confirm the pregnancy and to arrange referral, to getting results from tests for fetal abnormality. A small group of women highlighted cost as an issue, as it was difficult for them to get the money together to fund their abortion if they had not arranged referral through their GP. Women coming from overseas must also meet the additional costs of travelling to the UK. Getting the appointment for the termination itself could also take time, something that women do not have when pregnancies are discovered late.
The women felt a high level of responsibility in their decision to abort and expressed high levels of concern over bringing an unwanted child into the world. Whilst personal factors were mentioned, the impact of carrying the pregnancy to term on partners, existing children, and on the potential child resulting from the unwanted pregnancy were clearly thought through in many of the testimonies. The women were clear about their personal situations and whether they felt they were in a position to bring up a(nother) child or not. Emotionally and physically, women realised the extent to which their lives would be affected and talked about not being able to cope.
Conclusions
Women generally find the decision to have a late abortion hard to make. Women undergoing abortion late in pregnancy are acting responsibly and feel a strong sense of duty towards their existing children, their partners and any future children. It is important that women are supported in their decision making and given time to choose. Every woman presenting late for abortion has a set of individual circumstances that place them in that situation. Each woman's circumstances and each pregnancy are very different.
Note
This text is excerpted from the introduction and findings of the study with the kind permission of Marie Stopes International.
Available from:
Marie Stopes International
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Notes
1 UK Department of Health. Summary Abortion Statistics 2003. 2004.