John Moss: Abortions should be bought

John Moss, the candidate in Hackney South & Shoreditch in 2005, argues that the best way to reduce abortions is to stop providing them for free on the NHS.

The last week has seen a significant escalation of the debate over abortion. This debate has centred on the limit that should apply to the age of the foetus before abortion is no longer allowed, with many claiming medical advances have made the survival of the foetus much more likely at earlier gestation times. Much has also been made of the increase in the numbers of women having abortions and the comments by Lord Steel - architect of the original 1967 legislation which legalised abortion – suggesting medical abortion had now simply become another form of contraception.

It is this last comment which prompted me to write, because for a long time, I have thought that the debate focuses on the wrong thing, namely the right of a woman to choose to abort and the limits which are placed on that. The former really is a done deal and the latter is far too subjective an assessment to be anything other than a proxy for the former.

Rather, I believe we should be looking at this issue from the perspective of what policy will achieve the result all people might reasonably want to see. Namely, fewer abortions, brought about by a reduction in unplanned pregnancy, whether by a reduction in conceptions because of more widespread and successful use of other methods of contraception, or a simple reduction in sexual activity.

The question I want to pose, which is one which rarely arises, is this. If medical abortion has simply become another form of contraception, should it still be provided free by the state, paid for by other taxpayers?

Given that more than 75% of the 200,000 plus abortions carried out last year were done by the NHS at taxpayer’s expense, this is a legitimate question. At a cost of around £500 a time, the cost to taxpayers of free abortion on the NHS is over £75 million. Not a huge sum in the context of overall NHS spending, but enough to train 1,500 more junior doctors or of making cancer fighting drugs available more widely.

What would the consequences be of ending the policy of offering free abortion on the NHS to all those who can secure a GP recommendation? As Lord Steel has pointed out, the intent of the original act has faded and the test of real risk to the foetus or the mother from continuing the pregnancy is no longer applied and the majority of abortions do now seem to be a simple choice of late contraception. 

If we accept this and frame it as an extension of a woman’s right to choose, free of stigma, is this not progress? The corollary of course is that women would be expected to pay. Many will no doubt claim this is another way of driving women back to the back-street abortionists of old. But that begs the question, did they not charge for their services, however crude, and what happens at the non-NHS clinics? They are not free.

The point here is that public health policy ought to be about changing people’s behaviour from something which is harmful to them or society, pace smoking, to something better. 

Would it not help a vulnerable teenage girl to make sure her partner used a condom, or to help her back up a straight, “No”, if it was followed up with, “If you get me pregnant, you’ll have to pay”? I expect there would be a rapid decrease in abortion numbers, though probably with a short-term increase in births as some women continue with pregnancies they might otherwise have ended. I doubt this trend would last and I firmly believe the long-term effect would be to reduce both abortion and unplanned pregnancies generally, with the positive side-effect of a reduction in sexually transmitted diseases. 

I have no medical background and don’t profess any knowledge of obstetrics or gynaecology. Like most people in my position though, I have a view and I do think there remains a need for an upper limit on when a foetus can be aborted and I do think that probably needs to be lower than now, but I do not base that on the viability of the foetus. I believe the decision to end a pregnancy ought to be made as soon as possible on the basis that it was unplanned and is unwanted. That decision ought to be able to be made within 12, or possibly at most 18 weeks. I would allow abortion beyond these limits, but only against much stricter and more strictly applied criteria of real potential harm to the mother’s health or of life-threatening disability to the child, if born. 

This is another example of the and theory in practice. We can more liberal in support of a woman’s right to choose to end an unplanned or unwanted pregnancy, and we can be stricter about terminating later term pregnancies. With this, there is also a third and. We can change the way people behave in a way which is better for them and for society. 

There is an important point of principle here and that is that people need to be made to face the consequences of their choices and actions. If you insulate them from those consequences, they will make bad choices and do bad things, but they will never learn the error of their ways and will continue to behave badly. Margaret Thatcher displayed an instinctive understanding of this when she faced down the unions by making ordinary members see the folly of unsustainable industrial action, so they stopped supporting it. 

Applying similar principles to welfare policies might have similar effects. One thing is clear, efforts by the Labour Government of the last ten years have achieved nothing except an increase in pregnancies outside stable families, abortions and a massive explosion of sexually transmitted diseases, especially amongst the young at whom their condom-fixated message has been targeted. It is time to try a different approach.