Abortion: A Painful Lesson for Britain

IN any Western country with a heritage of Judaeo-Christian ethics, the regulation of abortion is an immensely complex problem in which the basic medical factors are obscured by religious, moral and emotional considerations. Great Britain is now learning the lesson of history in a most unfortunate way. A new law permitting abortion under certain circumstances was passed less than a year ago as a humane effort to treat the matter as an essentially medical issue between patient and doctor. Although the new law has proved helpful to British women, it has swamped physicians and produced some socially divisive results. It has also turned London into the abortion capital of the Western world.

Great Britain's historical opposition to abortion comes from both common and canon law. In 1803 Lord Ellenborough pushed through a bill to make abortion a crime punishable by death if performed after the fetus had "quickened." In 1837 Parliament revised the law, eliminating the death penalty, but in the process lost the distinction between abortion before and after quickening and consequently outlawed all abortion. A 1929 change made abortion illegal except to save the life of the pregnant woman.

Legal Challenge. To Obstetrician Aleck William Bourne (now retired but a hale 82), this strict regulation seemed outrageous. In 1938 he performed an abortion on a 14-year-old girl,who had been gang-raped by horse guardsmen, then invited the Attorney General of England to prosecute him. After 40 minutes' deliberation, the jury acquitted Bourne--and the "Bourne rule" stood for 30 years. Its effect was to make abortion available to any Englishwoman who was articulate and well-off enough to persuade doctors to certify, by a liberal interpretation of the law, that continuation of her pregnancy would endanger her life. Inevitably, there were uncounted and uncountable illegal, back-street abortions for the less privileged, with the danger of serious illness or death from infection or plain butchery.

Agitation in Britain for liberalization resulted in bitter debates in both houses of Parliament in 1966 and 1967. The debate culminated last year in the passage of an act that permitted a registered physician to perform an abortion, provided that at least one other physician concurred in his judgment, on any one of three conditions:

1) that continuation of the pregnancy would involve greater risk to the life of the woman than if pregnancy ended;

2) that its continuation would involve greater risk of injury to the physical or mental health of the woman or of any existing children of her family;

3) that there would be "substantial risk" that the child would suffer from such physical or mental disabilities as to be seriously handicapped.

Import Trade. The permissiveness of the law was intended to be its virtue, but it has proved to be a fault. Because the law imposes no residence requirement, the "miscarriage trade" that used to flow from Britain to Poland and Yugoslavia has been reversed. Now wealthy Americans, Canadians and Europeans, as well as women even from countries with such liberal abortion laws as Denmark's, are homing in on London. There, they can get abortions quickly and safely in private hospitals or nursing homes at fees that range from $100 to $1,500.

The fly-by-night patients are not eligible for care under Britain's tax-supported National Health Service.

The trouble, it develops, is that too few Britons are getting legal abortions under the National Health Service, which has too few gynecological surgeons and hospitals with enough ob-stetrics-gynecology beds to satisfy the rising demand. Previously, each year produced about 10,000 legal or Bourne rule abortions. In the first eight months under the new law there were 22,256, and it is expected that the total for the first twelve months will go to at least 35,000, possibly to 50,000. Even though as many as 15,000 of these operations this year may be performed in private hospitals and nursing homes, the rest are imposing a heavy burden on NHS gynecologists. They find themselves spending half their office hours passing judgment on patients seeking abortions and half their operating-room time performing them. This, say some gynecologists, is not the type of practice that they chose or for which they were trained.

Change in Attitude. Many doctors are protesting, some have become highly emotional about the matter, and a few are trying to sabotage the law. In Birmingham, England's second-largest city (pop. 1,200,000), Professor Hugh McLaren, a strong-willed Scottish Presbyterian, simply refuses to perform abortions except in case of "dire peril" to the woman's life. Since he is head of the NHS's Maternity Hospital there, he can decree what subordinates may or may not do--and they may not perform abortions. The effect of the McLaren ukase is to send most Birmingham women seeking abortions to London if they can afford that or, if they cannot, to the local back-street abortionist. Much the same thing is happening in Liverpool, England's third-largest city, which has a 40% Roman Catholic population and many anti-abortion doctors.

At bottom, what is most distressing to the protesting doctors is the fact that some of their colleagues are making a lot of money out of abortions in London's private Harley Street hospitals and suburban nursing homes. For that, no effective remedy is in sight. One opponent of the present law wants to amend it by imposing a six-month residence requirement to quash the jet-set trade, but no amendment can take effect for three years.

Even with its obvious defects, the law has had an enormous effect on the attitude of the woman seeking abortion. While she used to appear in her doctor's office weeping, cringing and remorseful, she now walks in self-possessed, knowing that she has certain rights and confident of talking out her problem sensibly with her doctor. In a growing number of cases, she succeeds.

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