London School of Hygiene & Tropical Medicine

Proposals to modernise UK abortion law are expected to be discussed in parliament soon and our extensive research says this would improve the lives of both women and healthcare professionals. 

What is the current law on abortion for the UK?

Differences in abortion law across the UK are still not widely understood, even by healthcare professionals, as revealed in our extensive research through the SACHA (Shaping Abortion for CHAnge) study, the largest research project on abortion to be carried out in Britain. 

Abortions across England, Wales and Scotland continue to be regulated by the 1967 Abortion Act. This means that, currently, abortions can only be carried out legally up to 24 weeks, must be approved by two independent doctors and performed only in an NHS hospital or a place approved by the Secretary of State. Abortions not meeting these strict conditions may be treated as a criminal offence.

What about other countries?

England, Scotland and Wales are falling behind a range of countries that have modernised their abortion laws. In 2019, Northern Ireland and the Isle of Man removed abortion offences from criminal law, a process known as decriminalisation. This led to speculation that other parts of the UK may follow. The Republic of Ireland, New Zealand, Australia, Canada and Sweden are all examples of countries which have already removed abortion offences from their criminal law.

How do current abortion laws affect patients and healthcare professionals?

All the evidence we've collected in the SACHA study points in the same direction. The current law on abortion in Britain is outdated and no longer serves any useful purpose. It increases the stress of an unintended pregnancy and sets up hurdles along the abortion pathway causing delay. The earlier in pregnancy abortion takes place, the safer it is. 

Healthcare professionals, who are already stretched to capacity, are also being prevented from providing best practice and compassionate care to the women who urgently need it, through fear and risk of prosecution.

When we asked 771 health professionals across England, Scotland and Wales, one in five were not aware that the legal requirement still requires two doctors to sign off every abortion. 

How would a change to law improve women’s health and support healthcare professionals?

Decriminalisation would mean that those who undergo or perform abortions, either where a pregnancy is intentionally ended by the woman herself or by a qualified health professional acting with her consent, would no longer be at risk of legal repercussions. 

This would allow women to rightly put their health and wellbeing at the forefront of decision-making around when and where to seek professional help, without the added fear of prosecution. 

The COVID-19 pandemic was a clear example of how impactful a legal change would be, where governments in England, Wales and Scotland approved home administration of early abortion through medication, with remote consultations and telemedical support. Patients told us that they valued the comfort, privacy and confidentiality of abortion at home while still also wanting a choice of options, including surgical abortion.

When we spoke to healthcare professionals, we found a consensus with more than nine out of 10 supporting abortion being a woman’s choice and a clear majority favouring abortion being treated as a health rather than as a legal issue. 

They also said that nurses and midwives should be able to authorise an abortion, rather than doctors, as they are already trained in relevant procedures and care-giving for women who experience miscarriage, and are the ones in most frequent contact with the patient.

Would a change to law affect abortions and patient safety?

Decriminalisation does not mean deregulation. The safety of abortion services would continue to be ensured through the same regulations that govern other medical procedures. Non-consensual abortions and abortions offered by unqualified providers would remain punishable through other existing laws such as malpractice.

There is also no evidence to show that decriminalisation of abortion increases the number of abortions requested or performed. Rather, data show that abortion rates are lowest in countries with available and effective information, education and services.

There is also no evidence to show that the rate of abortions performed after 20 weeks increases when the procedure is decriminalised. In countries with lawful abortion and reliable data, 90% or more of abortions are performed at less than 13 weeks and two-thirds at less than nine weeks of gestation. For the small number of women who need abortions further into a pregnancy, the priority must be support, not prosecution.

Can abortions put women’s lives or health at risk?

Abortion is one of the most common health procedures and is likely to be experienced by one in three women in their lifetime. Globally, virtually all legal abortions are safe and research shows that a legal abortion is considerably safer than carrying a pregnancy to term. 

Abortion does not cause infertility, ectopic pregnancy, placental abruption or breast cancer, as is sometimes claimed. 

While we all hold personal views regarding the morality of abortion, what our research shows is the clear benefits to women’s rights, health and the livelihoods of healthcare professionals of removing abortion offences from criminal law. 

Like other medical procedures, abortions should be a decision made between patients and trained healthcare professionals, not a legal issue.

Further reading

Sally Sheldon and Kaye Wellings (eds), Decriminalising Abortion in the UK: What Would It Mean?, Policy Press, 2020, 176 pp., Open Access, ISBN 9781447354024.