I was interested to see this week a briefing paper on abortion provided by the British Medical Association in advance of a debate at the BMA annual representative meeting (ARM) next Tuesday.
The BMA’s Worcestershire division has proposed a motion (304) that the BMA support a reduction in upper time limits for abortion. It reads as follows:
‘That this Meeting believes that the legal limit for termination of pregnancy, in the absence of foetal abnormality, should be reduced from 24 to 20 weeks gestation.’
This motion is very limited in focus. Abortion is currently legal on social grounds up to 24 weeks and legal up to birth when the baby is disabled. This motion would restrict abortions on social grounds to 20 weeks or less but have no effect on limits for disabled babies. Currently 16 countries in Europe, including most western European countries, have upper limits of 12 weeks or less so it would be a very small step towards wider Europe.
The 7 page unauthored ‘briefing pack’ from the BMA claims to ‘provide factual information in order to facilitate informed debate’. The briefing has been sent as hard copy to delegates and is not available on the BMA website. This intrigued me even more.
Why is it I wondered that the BMA has devoted so much time and energy to influencing opinion on this particular issue when there are so many other important matters to debate for which delegates are provided with absolutely no briefing material at all?
I was fascinated to see what the briefing told us and what it didn’t. I was not surprised at what I found.
The briefing begins with a whole page outlining the law and giving what it calls ‘key statistics’ relevant to the motion. But I couldn’t find anywhere the one key fact I wanted to know. Ie. How many able-bodied babies between 20 and 24 weeks, as opposed to babies with fetal abnormality, are aborted per year? The number, according to the latest annual statistics, is actually about 2,000 – or more precisely 1,936 in England and Wales in 2010. This motion in other words is concerned with only 1% of the 189,000 abortions per year in England and Wales but you will not learn that from the BMA briefing.
There are then two whole pages on neonatal viability attempting to show that babies less than 24 weeks gestation are not viable. But these pages consist almost entirely of an evaluation of a multicentred study called EPICure which was carried out in 1995 – 16 years ago. Nowhere in the BMA paper are we told that the EPICure study incorporated data from all 276 maternity units throughout UK and Ireland, many of which had no specialised facilities for caring for extremely premature babies. EPICure therefore represents a lowest common denominator figure even for 1995. In no way can it be thought of as a best-practice figure for 2011!
Published studies from specialized units around the world have shown much higher survival rates than EPICure for babies born at 23 weeks of gestation ranging from 40-66% for babies born at 23 weeks. And even in EPICure10% of babies born at 23 weeks survived to discharge.
We then get eight lines on fetal sentience which regurgitates the historic RCOG position that fetuses cannot feel pain earlier than 24 weeks gestation. We get no evidence here, only unsupported conclusions. And we are not informed of the fact that the RCOG position is highly controversial amongst neurologists and neonatologists.
We are not told, for example, of the editorial in a leading paediatrics journal (Arch Dis Child Fetal Neonatal Ed ) in February this year by Martin Ward Platt, of the Newcastle Neonatal Service, who calls the RCOG report ‘an emperor with no clothes’. Ward Platt asks:
‘So, what is the evidence that the human fetus lacks ‘awareness’? In a word, there is none… I have looked at the references in the report, and the references in the references, and when I finally got back to the primary literature I found no evidence for the contention that human lack awareness, or exist in some different conscious state, beyond the unwarranted extrapolation from sheep. In contradiction to the notion of the ‘unaware’ fetus, the everyday experience of pregnancy – the felt behaviours and responses of the unborn baby, especially to sound – as well as much primary research literature on the human fetus, contains strong evidence for an opposite view.’
Finally we get 17 lines on a Southampton study authored by the well-known pro-choice activist Ellie Lee who backs abortion ‘as late as necessary’. This paper, which has not even been published in a peer-reviewed medical journal, seeks to justify carrying out abortions on 13-24 week abortions (nothing to do with this motion) on largely social grounds. Again it is dished up by the BMA as evidence-based research.
This BMA briefing paper on abortion cherry picks outdated medical literature on neonatal viability, presents controversial conjecture on fetal sentience as medical fact, recycles quasi-scientific surveys from the pro-choice lobby and tells us nothing about fetal ultrasound, medical or public opinion, numbers of babies born alive after abortion or the legal position adopted by other European countries.
At very best it is a profoundly unbalanced piece of pernicious propaganda aimed at misleading and misinforming the ARM in order to preserve the institutional bias of the BMA hierarchy on this issue. I’m not surprised that its authors haven’t named themselves.