40 years on, is a woman's hardest choice any easier?

In 1968, the Abortion Act came into force, allowing women the legal right to have an abortion for the first time in British history. Forty years later, does it need updating, asks FIONA MACGREGOR

"I was thinking I'd just nip it in the bud before it gets worse. They were talking about in health class how pregnancy… can often lead to an infant." – JUNO MACGUFF IN THE 2008 FILM JUNO

THIS year's film hit Juno provides a witty, sensitive and moving portrayal of the dilemmas faced by women dealing with an unplanned pregnancy. The teenage Juno in modern-day America chooses to have her baby, but for women in Britain before 1968, abortion was not only taboo, it was illegal and highly dangerous.

This Sunday marks the 40th anniversary of the Abortion Act becoming law – the legislation was passed in 1967 following a Private Member's Bill tabled by Scots MP David Steel and came into force in 1968. The Act allowed women in England, Scotland and Wales (but not Northern Ireland) to legally undergo an abortion, provided they obtained the written consent of two doctors.

Its enactment came at a time when an estimated 100,000 "back-street abortions" were taking place in Britain each year – involving everything from poisons to scissors and knitting needles. In the years immediately prior to the act, an estimated 50 British women died annually from illegal abortions, while an untold number suffered agonising injuries and infections. For obvious reasons, such figures are hard to verify but, to put it in context, the World Health Organisation estimates that globally today more than 68,000 women die each year due to illegal unsafe abortion and hundreds of thousands more experience serious injuries.

Yet four decades on, the Abortion Act remains controversial and often seems out of step with changes in sexual behaviour and ideas about family and fertility. With the Human Fertilisation and Embryology Bill currently being debated at Westminster, serious consideration is being given to amending the Abortion Act in the near future.

There is a vocal body of opinion (which Conservative leader David Cameron has said he backs, but which Gordon Brown opposes) which would see the current limit of 24 weeks' gestation (reduced from 28 weeks in 1990) at which abortion can take place cut to 22 or 20 weeks. Department of Health figures published this month show that, of 435 children born before the 24th week of pregnancy during 2005 in England and Wales, 52 survived for at least a year. However, UK law allows for an abortion to be carried out any time right up to the point of birth, if there are strong enough medical grounds.

Cameron has said: "I would like to see a reduction in the current limit, as it is clear that, due to medical advancement, many babies are surviving at 24 weeks. If there is an opportunity in the Human Fertilisation and Embryology Bill, I will be voting to bring this limit down from 24 weeks. This must, however, remain a conscience issue and a free vote."

Late-term abortions are without question distressing, but they are also relatively rare. In 2006 in Scotland, 99.6 per cent of abortions took place at under 20 weeks, with 93 per cent at under 14 weeks and 67.3 per cent at under ten weeks. Just 52 abortions of foetuses over 20 weeks took place that year – a figure which includes those performed for strong medical, possibly even life-saving, reasons (something even the Roman Catholic Church does not condemn).

So just why are our politicians, religious leaders and social commentators choosing to focus on the gestational age limit at which an abortion can take place and not instead concentrating their efforts on looking at why the 193,700 abortions that year (13,081 in Scotland) were carried out and the impact each of these procedures had on those involved? Professor Sheila McLean, an expert in medical ethics at Glasgow University, says: "I think there's a reluctance historically and even now to hand over more authority to women to make their own decisions in pregnancy."

It should be remembered that current UK law does not allow a woman to choose freely to end a pregnancy – she must seek the permission of two doctors. McLean would like women to be given the complete right to choose, at least in the earlier stages of pregnancy. She points to the American model, which allows a women absolute right to terminate her pregnancy in the first trimester. In the second trimester the state has a right to ensure it is done safely, but only in the third trimester can it step in and outlaw or put requirements on an abortion.

McLean says: "At least that way you're giving women some kind of rights and not presuming that they use abortion just as another form of contraception. You're also offering some protection to the foetus."

According to McLean, the few women who do decide to have an abortion at a later date have a particular reason for doing so, and that right should be protected. While she acknowledges this is controversial, she suggests it is not without legal precedence. She points to the fact that the law allows a woman to refuse a caesarian right up to full term, even if that means the death of her and the foetus.

"It seems to me to be somewhat paradoxical to be trying to offer additional protection to (younger] foetuses, which very well may not survive and, if they do survive, may well have profound disabilities. I think there's a tension between what the law says to women who are full-term and what it says to women who are not at full-term," says McLean.

The British Medical Association insists the 24-week limit should be retained, a view backed by family planning service FPA, which has launched a campaign against the move to change the limit. Julie Bentley, chief executive of FPA, says: "The most vulnerable women needing a late abortion are the ones who stand to lose if the time limit is cut. In line with all the current ethical, medical and scientific thinking, FPA, as proud advocates of a woman's right to choose, will be fighting hard to protect the time limit."

The man behind the original legislation also sees no need for change. Lord Steel insists: "The medical bodies have urged to keep the 24-week limit and we politicians should be guided by them." And, while he has admitted to being surprised by the number of abortions that take place, he adds: "When people say there are 'too many', I say, 'All right, you give me the right figure.' And of course nobody can."

The basic dilemma between the rights of a woman to choose to terminate her pregnancy versus the rights of the foetus remain. However, society and medicine have changed considerably in the past 40 years. A decline in marriage rates; some evidence that very premature babies can survive; changing attitudes to embryos in terms of their use in scientific research and the development of detailed scans which show an embryo or foetus in the womb have all created a very different climate in which to consider abortion. And yet by focusing principally on the issue of physical viability, doctors have in some ways failed to address the heart of the matter: the foetus's "human" viability – in other words, at what stage does the abortion involved the death of "a baby" rather than a cluster of cells.

For those in the pro-life camp, such as Cardinal Keith O'Brien, who is the head of the Roman Catholic Church in Scotland, there is no need for debate. As he controversially put it: "We are killing – in our country – the equivalent of a classroom of kids every single day. Can you imagine that? Two Dunblane massacres a day in our country going on and on. And when's it going to stop?"

Indeed, according to his faith, women who have taken the morning-after pill, or who use certain forms of contraception, have potentially destroyed a being with a human soul. That's an argument few outside the church would uphold, but it highlights the need for clearer information from the medical authorities.

In failing to provide women with clear scientific guidance on issues – including at what stage does a foetus become aware of pain and at what stage is its brain developed enough to allow it to function as an independent human being – medical authorities are leaving women susceptible to lurid propagandising by some extremist pro-lifers designed to play on a woman's feelings of guilt.

"There's not going to be consensus on these issues," says McLean. "The best we can do is adopt a position which is blame-free. There's no point in blaming women. We helped to create the world in which they're living and we don't know what their position is when they're making what will be a tough decision. I think all legislation should be underpinned by identifiable principles and either they should be that the embryo or foetus is a person or potential person and therefore should be protected all the time, or women should have some rights over their own body even if it affects an embryo or foetus.

"What we have at the moment is a halfway house. We need a debate on the principles rather than tying it up with the scientific stuff or disapproval or ideology. The ideal piece of legislation on this would be based on transparent principles that had as wide a consensus as it could get."

But while the debate over abortion rages on, it is vital we do not lose sight of the bigger picture. We live in a society where sex before and outwith marriage is the norm and where the average person in Britain has had – depending on their generation and gender – between eight and 13 sexual partners, and around half of the adult population has had a one-night stand.

And while everyone has a responsibility to ensure they have safe sex, the failure rate of contraception is far higher than most people realise. Given that, according to the British Pregnancy Advisory Service, almost 60 per cent of women requesting abortion claim to have been using (or attempting to use) contraception at the time they became pregnant, it wouldn't be unrealistic to conclude most people in this country have at some point put themselves in a position that could have led to an unwanted pregnancy.

Yet women who have unplanned pregnancies continue to face prejudice and condemnation, however they deal with it. Raise your hand if you think that women who have children by several different fathers – such as Fiona MacKeown, the much-criticised mother of murdered teenager Scarlett Keeling – are immoral and/or irresponsible and should be censured by society. Raise your hand if you think abortion raises serious moral concerns and should be avoided where possible.

Finally, raise your hand if you have had more than two sexual partners of the opposite gender (now refer back to the statistics on failed contraception). Thank you for taking part in my poll on hypocrisy and mixed messages when it comes attitudes to abortion in the 21st century.

Given that most people nowadays will have several sexual partners over their lifetime – including at least one they would not wish to raise a child with – it is possible to conclude that condemnation of women such as MacKeown has perhaps less to do with the number of sexual partners they've had than their failure to control their reproduction to a level society deems acceptable.

We must therefore consider the possibility that we've reached a situation where, despite the guilt most women are expected to feel about having an abortion, it is a more acceptable way of dealing with an unplanned pregnancy. Abortion may, for some women at least, seem the only choice if they do not wish to live out the role of the sexually irresponsible mother.

McLean says: "I certainly think women's changing sexual behaviour is putting pressure on the debate, because people can point at the increasing number of pregnancies terminated but they never really go into the detail.

"We just count the crude numbers and say this shows we're in some kind of moral decline. It's about judging women. We don't really approve of women who get pregnant when they don't want to be, or have terminations. Women are meant to be nurturing and home-loving, no matter how many are doing other things. I think there is still a residual element of that in how we view the situation and the (abortion] legislation takes that into account."

Unwanted pregnancy can happen to anyone who is sexually active. It is one thing to argue over the rights of a woman to not go through an unwanted pregnancy versus the rights of the foetus inside her.

But the suggestion a woman's right to control her body is somehow diminished because of her perceived sexual morality (or lack of it) must be challenged.

What women facing unplanned pregnancy in need is proper information regarding their bodies and the foetus, clear legal guidelines and a non-judgmental environment in which to make their choice – not hypocritical moral condemnation and restricted information that leaves them to face a lifetime of guilt whatever they decide.

ABORTION: QUESTIONS AND THE ANSWERS

IS ABORTION AVAILABLE ON DEMAND IN THE UK?

NO – Women require the approval of two doctors before they can have an abortion.

• IS ABORTION READILY AVAILABLE EVERYWHERE IN THE UK?

NO – The 1967 Abortion Act only applies in England, Scotland and Wales and was not extended to Northern Ireland.

• IS A DOCTOR OBLIGED TO REFER A WOMAN FOR AN ABORTION IF IT GOES AGAINST THEIR FAITH OR BELIEFS?

NO – The 1967 Abortion Act included a clause which enables doctors with a conscientious objection to opt out of participating in an abortion. Some doctors will refuse to refer a woman for an abortion, although BMA guidelines say in such cases a doctor should refer her to another medic.

• DO THE PARENTS OF UNDER 16S WHO ARE SEEKING AN ABORTION HAVE TO BE INFORMED?

NO – Young people under the age of 16 have the right to access confidential sexual health services, including abortion, without their parents' knowledge or consent.

• CAN A NURSE OR PHARMACIST GIVE A WOMAN THE "ABORTION PILL"?

NO – Medical abortion, often referred to as the "abortion pill", has to take place in an NHS hospital or approved clinic to comply with the 1967 Abortion Act and so is not available from pharmacies.

• CAN AN ABORTION EVER BE CARRIED OUT AFTER THE 24TH WEEK OF PREGNANCY?

In exceptional cases where the mother's life is at risk, or there is a serious risk that the child would have a severe physical or mental disability, there is no legal time limit.

• HOW LONG DOES A WOMAN HAVE TO WAIT FOR AN ABORTION AFTER SHE HAS SEEN HER DOCTOR?

Waiting times vary across the country. Up to two weeks is usual, but waits of five weeks have been reported.

• HOW MUCH DOES AN ABORTION COST?

Abortion on the NHS is free, but for various reasons, including the circumvention of waiting lists, a woman may seek a termination from an abortion charity or private clinic. Costs vary from around £400 for an early medical abortion to around £1,600 for a surgical abortion at 19 to 24 weeks.