Abortion Games’

The 1967 Abortion Act placed the responsibility for determining the appropriate grounds for a termination with two medical practitioners. This assessment, to be made ‘in good faith’, hinged on the doctor's interpretation of the wording of the Act and how widely they defined the potential ‘risks’ of continued pregnancy.1 This responsibility could be troubling for doctors, who were being asked to use their medical expertise to determine what many considered to be a non-medical matter. Doctors varied, both between and within localities, not only in their interpretation of the terms of the Act but also in their ethical and personal attitudes to abortion and to women who might find themselves in this situation. While some doctors adopted a more liberal policy, based on the woman's wishes, others felt a firm conviction to interrogate the patient's reasons and perhaps persuade her to take a different course of action. This article focuses on the relationship between doctors and women seeking abortions following the passage of this Act, which placed doctors in a position of having to determine which cases were appropriate and deserving, creating a situation which some have argued facilitated performance and ‘game playing’.2 The individuals involved in these decision-making processes may have had differing perspectives or objectives, and while these were sometimes overt it was often mooted by both doctors and reproductive rights campaigners that elements of concealed strategizing or performance might be present in these negotiations. Instead of adopting outright persuasion, doctors could distance themselves from the decision-making process; for instance, general practitioners could refer their patient without including a recommendation either way, or make the referral to a gynaecologist who was known to be either particularly liberal or particularly stringent, making the decision a somewhat foregone conclusion. They could delay appointments, or approve the procedure only if sterilization was also agreed to, in order to put the woman off or encourage her to look elsewhere.3 Women seeking terminations, on the other hand, were often aware that certain circumstances or scenarios were more likely to gain sympathy than others, and might tailor their stated reasons for seeking termination accordingly. A mother struggling with multiple children already, or a ‘nice girl’ in unfortunate circumstances who exhibited remorse, were often looked upon with more understanding than someone who had apparently failed to demonstrate responsibility by using contraception effectively, and particularly someone who required more than one termination.4 This knowledge might encourage the presentation of particular narratives, and in turn cause doctors to be wary of being told something that fitted too closely to what they expected or needed to hear. Contemporary studies of abortion practice showed clearly that this process of negotiation and assessment varied significantly, contributing to divergent abortion figures and experiences of women seeking terminations both within and between regions across Britain. The way the medical interview functioned in practice will be explored through an analysis of medical and sociological studies of abortion practice in the first two decades the Act was in operation, and through the testimonies of healthcare professionals involved in decision-making and of women seeking terminations. Despite sustained and increasing criticism, and numerous attempts to change the law over the past five decades, the need for two doctors to certify appropriate grounds has remained in place for fifty years. Though the legal situation has not changed, medical and lay perceptions of the purpose and function of the medical interview have developed considerably across this time, and the degree to which doctor–patient interactions and the making of termination decisions has changed in practice as a result will be considered. Under the terms of the Act, in order to certify grounds for termination two medical practitioners have to agree in good faith that continuing the pregnancy would involve greater risk of ‘injury to the physical or mental health of the pregnant women or any existing children of her family’, or that there is ‘substantial risk’ of serious foetal anomaly. In making this judgement they can take into account ‘the pregnant woman's actual or reasonably foreseeable environment’.5 In most cases the two doctors would be the patient's general practitioner and the consultant gynaecologist who would undertake the termination, but women might also be referred to and assessed by other hospital doctors, psychiatrists, family planning doctors, medical social workers, and pregnancy advisory service doctors and counsellors, in an extended ‘interviewing process’. The Act was commended by many doctors at the time it was passed for being ‘permissive’ and yet ‘in no way obligatory’, due to its provision of a conscientious objection clause which ensured that no doctors would be forced to undertake the operation, except to save a pregnant woman's life.6 While the terms of the Act were ‘deliberately vague’, leaving considerable scope for interpretation and discretion, it stopped of abortion in the responsibility for the decision with the medical and not the pregnant The Act was passed for health to abortions and doctors with legal from certain and the provision of abortion by women of the and into with their In one or of the Act was to of terminations through and between women pregnancy and a and the on that ‘in many the of its would be being to the family could and to a patient who would a and her to with the pregnancy In the of the Act, some the decision to place the responsibility with two doctors with in other as the which in and women from seeking legal by some was that being a termination by two doctors might their reasons as and ‘the and that a women in consultant felt that women find in that it is a considered by two medical practitioners in of the and that it is not being they or their a could that a decision by a pregnant woman would not be a or and this the in the In the decision in the of doctors, the Act a situation doctors were as and while pregnant women were by and or to make reproductive While some doctors a woman's to and her making their assessment, others felt that was in need of an to and what was in her particular situation. that a woman in a would was in her and considered that a woman's might be different from her that making abortion too but the patient's for a time and her no from the of the Act some doctors at the responsibility that had placed on their that the Act as as and for doctors and for the doctor–patient and have argued that had responsibility on to the medical many of the of abortion at at who had to the termination and take legal responsibility for might find or not to a and that had to be in an the of to make an considerable in terms of time, and yet at the time the patient the that the is and felt that their medical had not for making decisions of this that the Act the medical to but only to that doctors were into an with their of to In the consultant a for The in which ‘game to the interactions and decision-making processes involved in determining to a with being to on considered and felt that the of the Act both doctors and to of decision-making and to In the concealed these interactions and potential to practitioners could distance themselves from decision-making by the woman in to without for one or or they could to but the decision to a gynaecologist who had a particular for either or termination they could their judgement and a with the might delay the pregnancy was too to or might agree to undertake the procedure only if the patient also agreed to a In having to these the process of an abortion from the woman's to an In a of the of it as an the women had to were first the and the consultant were between doctors and women seeking abortions if their of the situation not The potential for this could to a of the and a situation it might in be to and put on a in order to the to that might encourage a woman to that may not be woman who her situation and and that termination is that no is likely to than her more who to and the that the to the Act and the interactions it could a as women might in be to present as and in order to be an While doctors not agree with some that the in a analysis of the way by which the to making decisions abortion numerous other of doctors to the medical interview as a or the pregnant woman is required to a in order to the legal grounds for The gynaecologist of it in these terms in that it was and for a woman to have to her in order to demonstrate grounds for with a an abortion have to how is a for The or scenarios by and others can be and in the studies of abortion practice which in the decades following the no due to its and the of interactions with their doctors and how the had over the the and the They also of the doctors in an of which of patient were as or While certain can be clearly the scope for interpretation by doctors in a degree of not the need to their or by adopting as has others were from being of their Doctors had a on the and experiences of seeking terminations, they not in that a and might over the pregnant woman by her course of than her at her and that the of legal by the Act her ‘in a particularly position to the of of and pregnant women in how clearly the attitudes and of doctors could the of the medical and the to pregnant the women without their it that legal termination was an which is only two of the that they the including This placed the on women to the The on the of the Abortion Act that the of termination was not by and also that in particular women were to their in the first or perhaps that they might their of outright were not of the doctors by that was to persuade the of known they were to than that have can be of studies also that a relationship with a the that the patient could be and that in doctors who had a position either for or termination, a doctor–patient would to the of the patient to and will that were particularly to being and by doctors, and more sometimes felt they had to be firm in their in order to the they what doctors felt had the to for and not be by of the women what they felt were attempts to and one that to make a with no to have and in was had made a and to the was using who have children to at of the medical professionals that that they would to a woman from with most likely to the were likely to that they would make a referral without the and that were circumstances in which they women from as in the attitudes of doctors studies particular in terms of which of patient were more likely to be for termination, and which would the most doctors stated that or of it often the decision that was While doctors referred to in to their their assessment of these was to their personal and in some cases including one in in that might refer to the to a the they made as to the of these more of an of and as the circumstances of and the pregnant woman's relationship with her by doctors in order to make their decision the of to abortion with the pregnant woman's her or her relationship with the and her and Women seeking terminations might be and by doctors to their and In a article on to a the had in at in the to a termination for women in their with but for this the of the at the hospital stated that abortions and that is to a pregnancy without good not to the on a woman it would be for her to have the The of the woman is in numerous other studies from the and of sympathy on the of the that and and women with were more likely to find their women to be more the most sympathy was for who were and had and of abortion decisions that for termination to be and to have the reasons doctors in their not agree with or approve terminations, they that ‘the of is the girl’ and that the most from the their with two studies of termination practice in and they that the degree of the of is by women pregnant for the first and that this was the that was and most often In order to these particularly women seeking terminations had to be particularly in doctors that they an of the most to was that of ‘nice who made a and in order to be as doctors looked for that they had to use the account that had place only or of of and a of or in the In a woman might be as a good who had or made a would be considered the more appropriate if the relationship was the other hand, if women were to have only with or they were as who not an and present in numerous with one of and the consultant the who and that particular often with the were women with for termination often the most in that cases were to but that were in the the and the numerous in her of doctors women who in for abortions that they would not be a that the of to the of women who have had abortions is often based on the of and Doctors wary of to the use of abortion as which was how they to The of a with in an a recommendation from her was a termination from a hospital consultant due to her having had a termination the was in the The hospital consultant had that not be as a of and while her agreed felt that this and was in these particular the needed was and The consultant had made a judgement that had a of and not an and of this was the of her situation. and often in determining the of a woman an with the being likely ‘the their social and the their two reasons that this was likely to be the in between and patient more with the situation of who might be their and also women to be the to put their across and more in they had need to the medical they were also more likely to be to if studies of abortion this instance, the that women were likely to be for termination and more likely to that this could not be by their of to The of women in were often to be more than of their in and put this particularly woman of in an or may an pregnancy than her in a the being in the social has to The of could also be in as a for any of the studies showed that doctors might agree to for a greater of reasons on in the the procedure was more instance, a between and not to termination for and a of gynaecologist attitudes in showed a in the to on than medical grounds This that women were more likely to an abortion if they and also how by could be in the of termination The in that have adopted in the that pregnancy would be or that it would be too to an could be of course to determine were due to on or but women who often felt that this was studies clearly demonstrate for that the medical interview by the Act to encourage ‘game and performance from both doctors and women seeking terminations. might the and their and be of the and of the and that the women in their had both overt and reasons for seeking the overt reasons were the put to doctors ‘in order to the and were by their of what would be the most reasons to the medical and at their to that by the was a particularly and a that they had by the in order to the abortion it was not A way in which women could tailor their to of was through of testimonies sometimes how they might turn an situation in which pregnancy might result of and at it was to a in which they felt they might be as more to doctors was different as that this of is the that doctors be by They to of This of course not that would be Doctors were aware that of most likely to sympathy from a were in the lay and were wary of or that they felt might be to that in her were of or these might be an to and to the pregnancy on than based their assessment on from the woman's and they they the patient and they as doctors to patient on as likely to be one that the on be with for it is to that were and failed than to they were not and that was a than many of the women would have the and felt that there was by both patient and to gain the in these and that a patient in would to in of her and or use any which will her In some circumstances doctors that women might by as The from these was widely A that it was not to a on termination decisions ‘the in their Women seeking abortions were also aware that was for some than for others upon their circumstances and the of the doctors and to that an abortion was a of While some doctors might on the pregnant woman to their doctors might to women by their to the terms of the Act, their reasons on to the legal The interview with the in the for a of Despite over being asked in the extended medical the and to the they to the of the Act as a and as that abortion on was being by some doctors, at in the and being by a of service that their would not be in the if they would not in the doctors might be particularly in making their assessment of appropriate for termination due to on The Abortion Act placed on which had not to the and it was from the that this could and to decisions for of in the that on might from as as they might with one that personal is on have a that it and forced to be The was an for some and abortion which terminations at a also in regions across and were studies women who were to take this While was to the delay and that often in making this were not on the of the in her that in some cases were to put on the woman to if could and some of doctors their and of to the as a who told a patient who had by her that could the but not an and for it if a made a to for in many no what doctors were and no how the pregnant woman might be to use and performance to to the the of the medical interview was a foregone if the was one who had a firm ethical in either the woman's to or the pregnancy at and explored the by which a who is for or an would the by any account the pregnant woman might as a of their of in a They this situation they that as many of the women with what of they were could by that they what they This was the way in which women might be to the of doctors who to persuade to with an but it on having knowledge of the of doctors and service to they had The potential of this situation had by doctors from the of the as some doctors were to that woman will of being at her first and using this to is and to her doctor's to the is it for to would not her health be by leaving the decision to other studies that most who were an abortion and also to from studies that while from terminations of pregnancy were of and social in the This to the that in of the attempts at decision on the of doctors who ‘the of women seeking an abortion their In this way, time and from studies of termination many and in turn was as as that a of to termination of pregnancy on grounds if not with at as being in many practitioners to the that abortion on was ‘in the of the doctors by in the of the way their practice had changed over A who themselves as having considerable that in the of the they had often and and to and at first had with the decision not to and time circumstances that who with the were the with what they in the first this to the woman's in to a termination medical professionals involved in that their had that following terminations were and children could to and for over the had more to a woman's for In across this many doctors were in as Doctors for a on Abortion in in to legal change to women the to or not to a that the doctor's be to In general medical to be A of gynaecologist attitudes that agreed with the of a woman's to in with her or not to have an This that a of doctors might be their decisions on the woman's wishes, with many more to on this than was in the of the doctors have for a change to the Act to a woman's to at in the first with in the in for a change in the law to into with other studies have that the and decision-making of women is considered with one that doctors sometimes to their legal decision-making from women in order to the that they need to be this general the of the legal situation considerable medical and has ensured that the practice and of termination decisions have remained While a of medical felt that is the woman's decision and it is that be to it without a a of doctors to the position they were in and use it to make a of it be a the grounds there have to be legal grounds between the legal and and is but doctors a that pregnant women could not be to take that the that a woman has to pregnancy is that is to and of which make a as to her and and felt that this the need for the to take the responsibility for the no how or the In the can of particular of women or the and of termination some liberal doctors not a woman's to in a who had and in of a woman's to the in the in of a situation in which could not to the to approve termination a mother who a termination that her pregnancy would not with a this by not for a her to what with to her could not to the by her to that not a a and and with the and ethical decisions the also have a to The of a woman's to but only certain in of the was of to place by law of it was also that this situation with the Act and its for doctors to take responsibility for the it was that a law women termination on to would doctors Under a the termination decision would the woman's wishes, and not the and their and including the of at women seeking terminations, the personal testimonies of women who and and and studies of the to certain The that and to women seeking terminations clearly that there might need to be a process of negotiation with doctors, and some of the by decades in the and the of and and the need for women to be to for and appointments, and perhaps change in order to a A Abortion of the on this to women who might be put off by doctors or to the The women to their attitudes at their hospital and for referral appointments, that some not that they not approve of abortion they to a gynaecologist they will and that the of woman was to to a or The potential for particularly on the due to the sometimes or of medical professionals was in in a from the a women to be if they their might be to abortion or using women too to the for was not to or in the of will an abortion if testimonies also the of and they from medical of abortion experiences across the decades an abortion in considered her was but felt that the gynaecologist was referred to her her that had by the Though to was felt this was and with a of In a in numerous and interactions with medical having to change her due to five in to a termination hospital and being with a to of two women across decades of to perceptions of both the termination decision they but judgement from some doctors, which their of This that the for doctors to as a on or not for an abortion an abortion as a without not a termination on the that the doctors not with her for an abortion they not her as a particularly the gynaecologist was over was that it was and for an abortion and having a with the from of the that while there also A of abortion that the of terminations in was to the of consultant to it and also of doctors to the in a process of of women seeking abortions were as if these from of and of pregnancy is a in making decisions to with terminations as a by healthcare professionals except in cases of foetal In with the by and has than the the and perhaps woman seeking abortion might be looked upon with the of sympathy and the most Under the situation by the 1967 Abortion Act, women on the of the to to a The of and scope for interpretation this to doctors has to of experiences to and Doctors have to their decision-making in overt and to persuade the women of the or of This has that interactions with healthcare professionals might be by pregnant women as to between women and doctors, and and Though many women interactions with medical in the process of having a termination, the need to be by and gain from two doctors the of women and medical This it to and over it is that the in place fifty a has between law and with doctors liberal in their attitudes to abortion and to to The of abortions in and by from the with While the of doctors may it is that in the to the of the Act, medical as the the of and the of and have stated their for the of In the interactions between doctors and women seeking terminations have to be in a more way over of abortion practice have from women as as medical with women ‘the that they were off the in their as through which they had to has a from an of an understanding of the need to and patient This that and performance may have over time, and that the medical interview has of an and for testimonies of abortion experiences across the and an of experiences is clearly is more for some women to an abortion than if of have changed over time they have not is to for women in terminations through their which studies have made This an of the and that women in might the of a

Abortion · Law and economics · Negotiation · Political science · Pregnancy · Sociology · Historical Psychiatry and Medical Practices · Historical Studies on Reproduction, Gender, Health, and Societal Changes · Law · Reproductive Health and Contraception

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