Looking Back, Thinking Forward
In two years’ time, the 1967 Abortion Act, which made abortion legal in England, Wales and Scotland, will celebrate its 50th anniversary. How different is the experience of young women seeking abortion today, compared to those who accessed the service before the Abortion Act—or even in the early days of legal abortion?
Today, there are about 200,000 abortions in England and Wales each year. While the age profile of women hasn’t changed all that much—the abortion rate remains highest for women in their 20s—the experience of the abortion service for young women today has undergone significant changes. Developments in the methods of abortion and the way the service is provided have combined with shifts in social attitudes to make accessing abortion in Britain, not an everyday experience or a pleasant one, but something that is much more a part of mainstream healthcare.
A More Professional Service
“The availability of abortion is much faster today, and women can access a lot more information,” explains Vee, who has worked in abortion care for four decades, previously as a clinic manager and more recently as a client care coordinator for British Pregnancy Advisory Service (BPAS). “But how women feel hasn’t changed. The women we see are all individuals, with different issues.” Some young women need to talk about their decision at length—others don’t say much at all.
Cath has cared for women requesting abortion for 20 years, and she cautions against assuming that the greater awareness of abortion has made the experience itself easier for young women. For example, as she says, “Although women can access information much more readily, this can actually make it harder for them to decide whether to have an abortion, and if so, which method will be best for them.”
When young women arrive at the clinics, says Marguerite, they are much better informed about the procedure and the different methods available, and “they expect and want a professional service.” Where previously women might have been happy just to have been seen by somebody kind and nonjudgmental, “now they want clear information with facts and figures, and their questions answered. They expect what they would from any healthcare service—local clinics, appointments to fit around work and family commitments, to be seen on time, and so on.”
For Vee and Cath, the fact that abortion remains a deeply personal, and often difficult, decision underscores the need for services to retain a commitment to a distinctive caring role. While some women benefit from the greater amount of information out there now, others struggle with the overload. Having an abortion remains very different to going to the doctor, or the dentist. As Vee says, “Nobody’s going to jump up and down with a placard because you’re visiting the dentist.”
Change, Seen from the Waiting Room
But while Millennial women’s individual feelings regarding their own abortion are as complex as ever, the normalization of abortion—both at the level of service provision and public attitudes—has impacted their expectations.
While Millennial women’s individual feelings regarding their own abortions are complex as ever, the normalization of abortion … has impacted their expectations.
Marguerite has managed abortion clinics and daycare units for 22 years. “For the majority of women coming now, there is not the same stigma attached as there was in the past,” she says. “They aren’t so worried about who they might see, or what they might think.” Younger women in particular are much more comfortable about coming to clinics and bringing their friends—sometimes a whole group of friends will come along.
Women will often be accompanied by their partners and are sometimes surprised when their husband or boyfriend is not allowed to be present at every stage of the appointment. Abortion providers need to see women on their own to establish consent to the procedure, and this is important. But for younger women and men in particular, it can seem to be at odds with the expectation that supportive partners should be present all the time. After all, Millennial men and women expecting a baby fully plan on the father coming to antenatal appointments and being there all the way through the birth: something that was rarely encouraged back in the 1970s. So they can be bemused as to why men are “excluded” from certain parts of the abortion consultation, until they understand the reasons.
To be able to go onto the Internet and research abortion, and to read other young women openly discussing their experiences, is clearly very different from the shadowy world of backstreet abortions, when the hushed word of mouth was the main channel to a secretive, potentially dangerous and highly stigmatized procedure. It is also quite different from the 1980s or 1990s, when a young woman would generally be referred for an abortion by her family physician, who may or may not have approved of her decision and often had little direct knowledge of the procedure.
This reflects, in part, great improvements in the abortion service over the past 15 years, as a result of better funding and developments in the provision of medication abortion. Women are able to have an abortion earlier in pregnancy than before, and they have access to a service that is more convenient and less stigmatized. These changes have coincided with the time in which the Millennials have been coming of age. They have grown up to see abortion less as a cause to be fought for than as an accepted fact of life.
Support for Women’s Choices
The mainstreaming of the abortion service both reflects, and shapes, changes in public attitudes. British Social Attitudes 30, a report published in 2013 by the social research company NatCen, analyzed how attitudes and values have changed over the 30 years since the BSA survey began. When people in 2013 were asked whether the law should allow an abortion “when the woman decides on her own she does not wish to have the child,” 62 percent agreed. This is a marked change from 1983, when only 37 percent agreed with the statement and 55 percent disagreed.
“In other words,” stated the report’s authors, “just over half of the public in 1983 opposed abortion being available if a woman does not want a child, while nearly two-thirds support this now.”
The BSA study found that younger generations are more supportive of a woman’s right to choose when she doesn’t want a child than are older generations. Interestingly, it also found that support for a woman’s right to choose has risen within the generations: so “among the 1960s generation, for instance, support for abortion under those particular circumstances rose from 45 percent to 69 percent.”
These findings indicate that public attitudes—Millennials and older generations alike—towards abortion have been shaped, in part, by improvements in abortion provision. As abortion has been more openly provided, accessible, funded and talked about, so acceptance of abortion has risen, both at a general and a personal level.
In Britain, policymakers are fond of bemoaning the proportion of “repeat” abortions and suggesting that one way to reduce these is to encourage women to make better use of Long-acting Reversible Contraceptives (LARCs), such as the IUD or implant. But both the idea that “repeat” abortions are a problem, and that LARCs provide an easy and obvious solution, do not speak to the experience of younger women who come to abortion clinics.
Overall, 37 percent of women who have an abortion will have had one or more previous abortions. This could seem like a lot until we consider the context. Women are beginning sexual relationships earlier and having children later: the average age of first intercourse for women is 16, and the average age of motherhood is now 30.
These trends are linked to the availability of legal abortion and the social expectation that parenthood should be planned. As Kaye Wellings and Anne Johnson explained in 2013, when discussing the findings of the third National Survey of Sexual Attitudes and Lifestyles, for young people today “sexual activity is not primarily, or even necessarily, about reproduction.”
In this context, it is surprising that the proportion of women having had a previous abortion is as low as it is. The phrase “repeat abortion” implies that women are having several abortions—in fact, the majority of these women have had only one previous abortion, and of women aged 20–24, seven percent have had two or more previous abortions.
Women also self-report the number of abortions they have had. That is another reason for treating statistics that seem to indicate more “repeat” abortions with caution. Cath and Vee explain that women are more forthcoming about having had a previous abortion than in the past—at least in the sense that “they’ll write it down, but they often won’t discuss it.” In this respect, young women see having had a previous abortion as something that they don’t need to lie about, and which might be relevant to their treatment—but it may also be something they may be a bit embarrassed about and don’t want to make a big deal of.
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Before it was legal
Obstetrician and gynecologist Peter Diggory (1924–2009) helped usher in the age of legal abortion in Britain. Diggory recalled in 1997 that in Kingston Hospital in Surrey during the mid-1960s, more than 400 women were admitted to the hospital suffering from complications of illegal abortion each year. A confidential survey conducted between 1964 and 1966 questioned 734 women about their illegal abortion.
Some women had taken drugs, such as quinine or ergot extracts, alone or with alcohol. For the largest group of women, “something had been introduced through the cervix into the uterus”: fluids or instruments ranging from crochet hooks to lengths of thin lead pipe to catheters. In 270 cases, women were “quite unable to give even a sketchy description of the method used,” although, Diggory suggested, “some may have used this denial as a form of protection for the abortionist.”
Diggory and other doctors helped raise awareness of the bloody consequences of criminal, “backstreet” abortions. They expressed a compelling case for abortion to be made legal and brought under the auspices of the medical profession, as it has been in England, Scotland and Wales since 1967.[/sidebar_text_center][/sidebar]
Contraception: Attitudes and Access
What about the contraception piece of reproductive healthcare? Young women today have access to much more effective methods than previous generations, although uptake of LARCs remains quite low, and many young women dislike the side effects. “Women seem to be allergic to contraception much more than they used to be,” muses Vee.
Whereas young women in the early days of the pill were prepared to suffer quite significant side effects to ward off the risk of pregnancy, young women today, for whom contraception is not a novelty and abortion is available if they need it, may feel more able to “take chances,” as US sociologist Kristen Luker put it back in 1975.
This is particularly the case given that, in contrast to the development of more professional abortion services, the experience of accessing contraceptive services in Britain can often be haphazard and frustrating. “Women will say they have been trying to get an IUD from the local family planning clinic, but they can’t get an appointment,” says Vee. The development of more effective methods is all very well, but when young women cannot access them conveniently, the benefit is not so great.
Abortion is Mainstream, but Not Yet Normal Enough
Millennials in Britain have grown up with the expectation that abortion is legal, and that it should be available if they need it. They can access information openly, and they are treated at the clinic with kindness and respect.
Yet the abortion service still has to meet a number of requirements laid down by the 1967 Abortion Act, which are increasingly out of step with Millennials’ attitudes, experiences and expectations. These include the requirement that abortions are authorized by two doctors, and that women who have a medication abortion are prohibited from taking misoprostol, the second drug, home with them, as they do in the US. Instead, they are required by law to return to the clinic to take this drug—a monumental inconvenience for women and a frustration for staff, who know that this is clinically unnecessary.
“We have streamlined things so much, but there are some things that we just can’t do anything about,” says Marguerite. “Women will say, ‘but I don’t want to do that’ and we have to say, ‘you have to, because it’s the law.’ We have made the experience better, but we still have women saying, ‘but why do I have to do that?’”
In this regard, young women seeking abortion are also made acutely aware that a 50-year-old law makes their experience more complicated, time-consuming and distressing than anyone wants it to be. There is a generational disjuncture between the reality of abortion and the requirements of Britain’s abortion law.
