Sometimes you look at a news story and think: “Now why didn’t we see that coming?” Every clue was there, every trend and current flowed towards it. When the thing happens, you look back and see that it was obvious.
The latest example emerged yesterday, in a warning from the Royal College of Obstetricians and Gynaecologists about a looming “abortion crisis”. An unprecedented number of doctors are opting out of terminating pregnancies, and the NHS struggles to cope. Ann Furedi, of the British Pregnancy Advisory Service, says: “Unless we can motivate doctors to train in abortion, we may face a situation in five years’ time in which women’s access to abortion is severely restricted.” Some doctors, she said crossly, take a “naive view” that there is now no excuse for accidental pregnancies, and think it low-status work.
The increasing number of refuseniks is caused chiefly, say campaigners, by the cut in junior doctors’ hours. This means they no longer have to train in everything, but can pick and choose. And who, given a choice, would not gladly opt out of the one task in which doctors end healthy life?
Richard Warren, of the royal college, told a newspaper yesterday that in the past abortion was “an accepted part of the workload” , but that it always was “difficult and upsetting work”, so more and more doctors now opt out. Another consultant said: “You get no thanks for it . . . who admits to friends at a dinner party that they are an abortionist?” She, and others, want it put in a core curriculum.
Well, OK. Probably the change in doctors’ training routines is indeed part of the cause of this looming “crisis”. I daresay the dinner-party factor also has some tiny effect. Young doctors are, ideally, idealists. Few of us would want them otherwise. They have plenty of time to be worn down by pragmatic cynicism, and to compromise with human folly, misery and selfishness. By the time they’re 40, some of them will have discarded sufficient of their idealism to make fortunes out of breast implants and foot surgery to fit pointy stiletto shoes. And there is a good case for telling wavering medical students, with harrowing examples, that abortion is not always a selfish choice or an evil deed.
However, there is another, even stronger, current that led us to this shortage. These young doctors have a point: if they agree to do abortions they agree to do all of them, not just those undertaken for deep, serious, heartbreaking reasons. They must serve not only the rape victims, the abused, the desperate, the weak-minded, the sick and women who might be so damaged by birth that the welfare of their existing children would be torpedoed. No: once they’re signed up for it they must also serve the silly, the selfish, the careless and thoughtless.
These young refusenik doctors are not stupid: they know as well as anyone that despite vast improvements in contraception, abortions have rocketed: doubling since the early 1970s to 190,000 a year. They know the horrifying statistic that one in three British women has an abortion at some point. They are in tune with their generation: they know that for too many women it has become a back-up form of contraception, taken for granted and never likely to be denied them.
They know that the old mantra of abortion campaigners — “No woman does this without deep thought and heartbreaking need” — is way out of date. Plenty do it irritably, without a pang, after a drunken fumble with a stranger. Plenty do it because the time isn’t “right” for them, even by a factor of half a year. Even some mothers do it, as Caitlin Moran startlingly wrote last week, after less agonising than they put into choosing new kitchen worktops (read Caitlin's article here).
The reluctant young doctors also know what a joke, what a legal fig leaf, is the system whereby two doctors have to certify that there is more risk to the physical or mental health of the mother from continuing the pregnancy than from termination (which, itself, is shown to increase the risk of serious depression). They know that the spirit of the 1967 Act is light years away from the 2007 practice: they know that without ever having debated or voted on it, we effectively have abortion on demand. And they know that this is the dodgy result of four decades of nods, winks, strident campaigning and secular consensus. And as the abortions increase and the stigma apparently fades, at the same time those emotive pictures from the womb get better and better, and passionate legal cases are fought over minute frozen foetuses . . .
So it was going to happen, this doctorly reluctance. There was eventually bound to be a shortage of volunteers to cooperate in what is sometimes an act of sorrowful mercy, but sometimes one of careless selfishness or neurotic control-freakery. Easier just to say no, and work on life instead. It would have been better, perhaps, if the spirit and letter of the 1967 Act (which I supported) had been more robustly followed, and couples given more reason to be very, very careful.
But there is one awful irony. If there is to be a shortage of abortionists there will be ever longer waiting lists, thus ever more late abortions, even for the most deserving cases. And if there is one thing that all sides tend to agree on, it is that the later the abortion the worse for everybody, born or unborn.
But we should admit honestly that the change in medical education is only the final straw. We did this to ourselves with our worship of sexual impetuosity, our cowardly right-on attitudes to anything involving women, and our dubious backdoor introduction of casual, lifestyle abortion. We did this to avoid one misery, and brought on another.
Libby Purves