Abortion Law Review Expert Group minutes: August 2024

Attendees and apologies

Members

• Professor Anna Glasier (Chair), Women's Health Champion, The Scottish Government 
• Dr Alastair Campbell, Royal College of Obstetrics and Gynaecology
• Professor Marion Bain, Deputy Chief Medical Officer, representing Chief Medical Officer, The Scottish Government
• Professor Sharon Cameron, Scottish Abortion Care Providers (NHS Lothian)
• Dr Sarah Wallage, Scottish Abortion Care Providers (NHS Grampian)
• Dr Janet Barter, Faculty of Sexual and Reproductive Health (substituting for Dr Sinead Cook)
• Professor Sally Sheldon, University of Bristol
• Dr Lynsey Mitchell, University of Strathclyde
• Dr Carrie Purcell, The Open University
• Andrew Lothian, Law Society of Scotland, Health and Medical Law Sub-Committee
• Professor Anne-Maree Farrell, University of Edinburgh
• Rachael Clarke, British Pregnancy Advisory Service
• Jill Wood, Engender, representing Advisory Group of reproductive and women's rights groups.

Secretariat

• Sean Reid, Abortion Policy Lead on Abortion Law Review, The Scottish Government
• Harriet Rogerson, Abortion Policy Team Lead, The Scottish Government
• Sam Baker, Unit Head for Organ and Blood Donation, Infected Blood and Abortion Policy, The Scottish Government
• David McIlhinney, Abortion Policy Team, The Scottish Government

Guests

• Dr Bela Ganatra, World Health Organization
• Dr Antonella Lavelanet, World Health Organization

Apologies

• Dr Sinead Cook, Faculty of Sexual and Reproductive Health

Items and actions

Welcome and introductions

The Chair welcomed attendees to the meeting and members introduced themselves.

The Chair thanked attendees for agreeing to participate in the expert group, noting that this was a vital piece of work. The Abortion Act was now over 50 years old and there had been a lot of changes to both society and clinical practice in that time. 

The Chair noted that the Scottish Government’s aim in establishing the review was to consider reframing abortion as solely a healthcare matter.

Introduction from the Minister for Public Health and Women’s Health

The Chair introduced a video contribution from the Minister for Public Health and Women’s Health welcoming the attendees to the group and thanking them for agreeing to contribute.

Overview and purpose of group

The Chair noted that the group should consider how abortion care is provided both currently and in the future.

The Chair explained that the group’s purpose is to provide recommendations to Scottish Ministers. If the group cannot agree a recommendation, the group is free to provide several options, which the Scottish Government can explore later in the process, through the anticipated public consultation.

The Chair also noted that this review was wider in scope than the decriminalisation work being done in England, considering the law on abortion in its entirety. Therefore the Scottish Government is referring to the process as a review of abortion law, rather than using the term ‘decriminalisation’ to describe this work.

In response to a query from the group, the Chair confirmed that concealment of birth legislation will fall within the scope of the review.

Ways of working

The group was content to meet once a month for approximately 6 to 9 months and was content that information be provided to them electronically in advance of each meeting. After this, the group will produce a paper outlining their final recommendations and options. The Scottish Government then anticipated running a public consultation in summer 2025.

The group was given some background on the Advisory group. This group involves a number of women’s rights groups as well as wider equalities groups. The Advisory group will meet in parallel with the expert group so they can input into the expert group’s discussions and receive feedback.

The Chair noted that there was no formal, single representation point for pro-life groups. However, instead, the Scottish Government is in contact with pro-life groups who have expressed an interest and will present the views of these groups on specific topics to the expert group for the relevant meetings.

The Chair asked for suggestions on the list of topics and the order they will be considered in. The group suggested that the experiences of and service provision for young people would be useful to discuss. The Chair noted that there would be a lot of scope for flexibility in this order, allowing the group to return to subjects as felt necessary.

The group agreed that discussions on gestational limits and grounds would be very challenging to keep separate so should be discussed together. The group agreed to discuss these early. The group noted that fetal anomaly terminations could be discussed as part of this.

The group agreed that possible offences would be best discussed later in the order once other matters had been fully considered. This could follow on from discussion on oversight and regulation for providers.

The Chair asked about the use of substitutes if a member cannot attend a meeting. The group agreed that there could be a substitute from the advisory group, but others could be brought up to date by the secretariat rather than sending a substitute.

The group was content for their names and organisations to be shared publicly.

World Health Organization (WHO) presentation

The WHO joined the meeting and gave a presentation on their policy recommendations on abortion, particularly the Abortion care guideline. They noted that they place their recommendations in a framework of policy and human rights. The WHO process for creating these recommendations was described as complex and rigorous. Supporting evidence had been gathered from all WHO regions. The WHO noted that they had used evidence from Scotland on both gestational age limits and conscientious objection as part of this process.

The WHO recommendations included full decriminalisation (in other words removing any criminal offences relating specifically to abortion), with a focus on regulation of services instead. The WHO did not recommend a grounds-based approach or gestational limits, favouring instead abortion on request. Further, the WHO recommendations opposed any mandatory waiting periods or requirements for third party approvals to enable someone to have an abortion.

The WHO noted a need to protect services from the impacts of conscientious objection. The failure to do so was noted to impact groups of people, such as young people and rural communities.

The WHO noted that the guidelines operated regardless of the patient’s age and they did not feel there should be requirements for parents of young people to consent to/be involved in decisions about abortion where the young person did not want that, provided the young person has capacity to consent on their own behalf. The WHO noted that minors value and need a pathway to obtain confidential abortions, for example, when they anticipate reproductive coercion, family disharmony, or interpersonal violence (including risk for physical and psychological violence directed at them or their future children) if a pregnancy is disclosed.

In discussion the group identified a number of issues where the WHO guidance would be useful. In particular, it was agreed that it was important to consider services for marginalised groups.

Overarching principles

There was a brief readout of the advisory group’s discussions. The advisory group had suggested that non-regression should be a principle for the group to adhere to. They also wanted to keep lived experiences in the forefront of the review. The advisory group wanted the law to advance gender equality and non-discrimination and to support equitable access to abortion for marginalised women and pregnant people as part of normal healthcare. International health and human rights standards were also discussed as guiding principles.

The group agreed that the principle of ‘non-regression’ was important and included that services should not get worse as a result of the review and that their recommendations should be future proofed in order not to create barriers that might need future work to remove.

The group agreed that the review should be based around human rights standards. This would allow the review to be informed by evidence-based standards.

Evidence base

The Chair asked the group if there was any additional evidence that the group would like the secretariat to provide or any person who could be invited to attend the discussion.

A number of organisations were suggested with various interests in discussions, including clinical organisations and organisations working on women’s rights and services. 

The group suggested consulting a psychiatric expert for discussion of later stage abortions.

The group also suggested inviting the WHO to return to contribute on models from around the world.

Any other business

The group considered evidence for future sessions. They considered it would be desirable to hear evidence from regulatory bodies on how their frameworks operated, particularly when discussing oversight and regulation of providers.

While being careful not to stray into service delivery, it was agreed that Health Boards may have useful input to pick up on any unintended consequences of some proposed recommendations. Hearing about issues in service delivery was also considered to be potentially impactful in considering the issues of oversight and regulation.

The group recommended input from other countries. New Zealand and South Australia were recommended as they had recently completed reforms of abortion legislation that had previously been similar to the current law in Scotland. It was also suggested that it would interest the group to hear from Sweden and Finland about their models.

The Chair noted the group will start considering grounds and gestational limits in the September meeting. This discussion was expected to take 2 or 3 meetings to complete. 

The Chair invited group members to get in touch with any further thoughts. The secretariat will get in touch with members about any suggestions for documentation etc. ahead of the next meeting.

Date of next meeting

The date of the next meeting is 17 September from 2pm.