close
CMF on Facebook CMF on Twitter CMF on YouTube RSS Get in Touch with CMF
menu advocacy

Informed Consent

<< back to abortion

Executive summary

Abortion legislation in many countries already includes mandatory counselling for women, along with a cooling off period in which they can consider their decision. This is perhaps the single amendment to the law in this country which would have the biggest effect on abortion numbers.

Examples of informed consent

The following are different countries' approaches to mandatory counselling:

In addition many countries offer women a cooling off period of reflection after making her request before the procedure is carried out:

Arguments against informed consent legislation

It upsets women:

Seeing a scan of the child you are about to abort can be traumatic, and many women opting for termination may understandably wish to be spared the details of what the procedure will involve.

It may slow access to abortion:

Cooling off periods, to allow women to think through the abortion decision, may slightly increase the time between request and procedure. However, whilst earlier abortions are preferable to late ones, a slight delay in abortions is preferable to rushing women into decisions they have not fully decided upon.

It is patronising

Some women requesting abortions have thought the decision through fully and have no ambivalence about ending their pregnancies. However there are others who agonise over the decision, for whom counselling it is invaluable in helping them to weigh up alternatives. Counselling must of course be thoughtful and sensitive.

Reasons for having law to guarantee properly informed consent

Giving information

For medical consent to be meaningful, patients must understand the nature of the procedure, the risks and benefits it entails and the alternatives available. In Britain there is currently no consent legislation specifically for abortion, but legislation on general consent does apply. Particular areas of concern include:

Where information is incomplete, women should be told of the potential for a risk and the strength of evidence.[4] A nationally agreed set of guidelines could help doctors to impart fair and impartial advice.

Detecting coercion

Abortion is a procedure particularly prone to coercion because of the secrecy which surrounds it and the social consequences of pregnancy. Research carried out in May 2008 showed that over 50% of British women felt they had 'no choice' in deciding to have an abortion and that a similar proportion said that the views of the child's father were very important in making their decision.[5]

Making abortion counselling mandatory would reduce the chances that women are forced into an abortion that they do not want.

Screening for 'high risk' patients

Some studies suggest that certain patients are at higher risk of developing subsequent psychiatric problems than others. Particular risk factors include ambivalence about the decision, feeling coerced into aborting, previous mental health problems and feeling rushed into the decision.[6]

The Royal College of Psychiatrists has said the following in its March 2008 position statement on abortion and mental health: 'Healthcare professionals who assess or refer women who are requesting an abortion should assess for mental disorder and for risk factors that may be associated with its subsequent development. If a mental disorder or risk factors are identified, there should be a clearly identified care pathway whereby the mental health needs of the woman and her significant others may be met.'[7]

A charter of informed consent would help identify women with risk factors for developing subsequent mental health problems, so that they can be advised of their increased risk.

To ensure vested interests do not lead to biased information being given

A comparison of information given to women by different groups involved in abortion counselling reveals great variation in content. BPAS, a pro-choice organisation in the UK , states that many women feel relieved after their abortion, and the small percentage (3%) of women who experience long-term feelings of guilt usually have other emotional problems in their lives other than the abortion, which could account for such feelings.[8] The Care Net Pregnancy Center, by comparison, cites that 50% of women who have had abortions reported experiencing emotional problems lasting many years, including eating disorders, increased alcohol and drug abuse, and suicide.[9]

In 2007, of the 198,500 abortions that took place in England and Wales , 89% were NHS funded, of which 57% were carried out in the private sector.[10] Private sector institutions have costs to minimise and income to maximise; interests which compete with the provision of impartial information. Likewise, an accusation aimed at pro-life groups and individuals is that they may use positions of power in abortion counselling to impose their views on pregnant women.

The introduction of compulsory counselling for women requesting abortion, which accurately represents risks, would provide clear guidance to counselling providers of all backgrounds on what information needs to be conveyed.

Does informed consent legislation reduce abortion numbers?

After excluding EU nations with very conservative abortion laws ( Spain , Portugal , Republic of Ireland, Poland , Malta and Cyprus ), the other nations were grouped into those with either requirements for abortion counselling or a cooling off period, or those with neither (appendix). An overall abortion rate was calculated for both groups based largely on 2003 figures (see appendix).

The group with providing counselling and/or a cooling-off period had an average abortion rate of 11.9 per 1,000 women of childbearing age, compared to 18.1 per 1,000 women in the group with neither requirement. The UK which currently has no informed consent legislation had an age-standardised abortion rate of 18.6 last year.[11]

Countries with good informed consent legislation had significantly lower average abortion rates than those lacking such legislation. Though a causal link is impossible to prove, these figures suggest that informed consent legislation may prove a good way of reducing Britain 's abortion figures.

Conclusions

Informed consent should be explicitly supported by pro-life and pro-choice campaigners. For decisions of such magnitude it is vital that women receive accurate information in order to make fully informed decisions without coercion.


Appendix

Abortion rates in EU countries with informed consent legislation :

Country

Counselling offered

Cooling- off period

Number of abortions

Number of women aged 15-44

Abortion Rate

Belgium

Counselling by doctor

6 days

16,200

2,025,000

8

Finland

Information on significance and effects

-

10,700

972,727

11

France

Counselling on alternatives

7 days

208,800

12,282,353

17

Germany

Counselling against abortion

3 days

129,300

1,6162,500

8

Hungary

Counselling

-

53,800

2,069,231

26

Italy

-

7 days

132,800

12,072,727

11

Luxembourg

Information booklet on alternatives

7 days

-

-

-

Netherlands

-

7 days

28,800

3,200,000

9

Slovakia

Counselling

-

16,200

1,246,154

13

Total:

596,600

50,030,692

Abortion Rate: 11.9 per 1,000 women aged 15-44

Abortion rates in countries without informed consent legislation:

Country

Counselling offered

Cooling-off period

Number of abortions

Number of women aged 15-44

Abortion Rate

Austria

-

-

2,380

1,830,769

1.3

Bulgaria

-

-

34,700

1,577,273

22

Czech Republic

-

-

27,100

2,084,615

13

Denmark

-

-

15,600

1,040,000

15

Estonia

-

-

10,600

294444

36

Greece

-

-

15,782

3,156,400

5

Latvia

-

-

19,000

655,172

29

Lithuania

-

-

11,500

766,667

15

Romania

-

-

166,700

4,762,857

35

Slovenia

-

-

6,900

431,250

16

Sweden

-

-

34,400

1,720,000

20

United Kingdom

-

-

181,600

10,682,353

17

Total:

526262

29001801

Abortion Rate: 18.1 per 1,000 women aged 15-44

The figures below include for each EU nation, the absolute number of abortions, the number of women aged 15-44 and the abortion rate.[12] Figures are taken from a 2007 paper published in International Family Planning Perspectives by researchers at the Guttmacher Institute in New York, reviewing 2003 international abortion data[13].

Note: This article did not include abortion data for five EU countries[14], and so data was derived in four of these cases from data published by the UN statistics division,[15] and the Council of Europe.[16] This data was from the years 1999-2006. Neither source included data for Luxembourg where no abortion data is published.

[1] The large scale French EPIPAGE study found that previous abortion was associated with subsequent pre-term birth: Moreau C, Kaminski M, Ancel PY, Bouyer J, Escande B, Thiriez G, et al. Previous induced abortions and the risk of very preterm delivery: results of the EPIPAGE study. BJOG. 2005 Apr;112(4):430-7.

[2] Fergusson and colleagues found that women who had previously had abortions were at an increased risk of a range of mental health disorders including depression, suicidal behaviour, anxiety and substance abuse. Proving causation is extremely difficult without a randomised controlled trial but this paper, along with others, significantly raises the chances that abortion leads to subsequent mental health problems. See: Fergusson DM, Horwood LJ, Ridder EM. Abortion in young women and subsequent

mental health. Journal of Child Psychology & Psychiatry, 2006; 47(1): 16-24.

[3] Brind found a strong link between abortion and beast cancer, explained by the high oestrogen levels caused by induced abortion. Other studies have denied this link. Aside from this, term pregnancy is known to protect against breast cancer. Brind J, Chinchilli VM. Abortion and breast cancer. Journal of Epidemiology and Community Health 2002;56:237-238

[4] Thorp and colleagues reviewed evidence for all the claimed long-term consequences of abortion and their review presents a balanced picture of the strength of evidence for the various potential risks: Thorp JM Jr, Hartmann KE, Shadigian E. Long-term physical and psychological health consequences of induced abortion: review of the evidence. Obstet Gynecol Surv. 2003 Jan;58(1):67-79.

[5] Survey 2008. Communicate Research, commissioned by Real Choice. Available from http://www.realchoiceuk.net/survey_2008.htm

[6] Reardon, D. Identifying high risk abortion patients. The Post-Abortion Review 1(3),Fall 1993

[7] Position Statement on Women's Mental Health in Relation to Induced Abortion. Royal College of Psychiatrists. 2008. Available from http://www.rcpsych.ac.uk/members/currentissues/mentalhealthandabortion.aspx

[8] BPAS Abortion Care, http://www.bpas.org/abortions/affect.html

[9] Care Net Pregnancy Center Lakes Region of New Hampshire – Abortion Risks, http://www.carenetlaconia.org/AbortionRisks.asp, citing Abortion: Your Risks, Stafford, VA.: American Life League

[10] Abortion statistics, England and Wales : 2007. Department of Health, 2008. Available from http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsStatistics/DH_085508

[11] Abortion statistics, England and Wales : 2007. Department of Health, 2008. Available from http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsStatistics/DH_085508

[12] Abortions per 1,000 women of childbearing age, aged 15-44

[13] Sedgh G, Henshaw SK, Singh S, Bankole A,Drescher J. Legal Abortion Worldwide: Incidence and Recent Trends. International Family Planning Perspectives, 2007, 33(3):106–116

[14] Austria , Greece , Poland and Portugal

[15] Available online at http://data.un.org/Data.aspx?d=GenderStat&f=inID%3A12

[16] Council of Europe, 2004, in Recent Demographic Developments in Europe: Demographic Yearbook 2003, on line at COE: http://www.coe.int/t/e/social_cohesion/population/

Christian Medical Fellowship:
uniting & equipping Christian doctors & nurses
© 2016 Christian Medical Fellowship. A company limited by guarantee.
Registered in England no. 6949436. Registered Charity no. 1131658.
Design: S2 Design & Advertising Ltd, Technical: ctrlcube