Abortion Law Review Expert Group minutes: September 2024

Attendees and apologies

Members

• Professor Anna Glasier – Chair
• Sarah Wallage – Scottish Abortion Care Providers (NHS Grampian)
• Sinead Cook – Faculty of Sexual and Reproductive Health
• 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 rights groups

Apologies

• Professor Marion Bain – Deputy Chief Medical Officer
• Dr Alastair Campbell – Royal College of Obstetrics and Gynaecology
• Professor Sharon Cameron – Scottish Abortion Care Providers (NHS Lothian)

Secretariat

• Harriet Rogerson – Scottish Government
• David McIlhinney – Scottish Government, Note of meeting

Items and actions

Welcome and Introduction to topics 

The Chair welcomed the attendees to the meeting. The Chair outlined that this meeting and the next would discuss gestational limits and grounds for abortion.

Discussions would be split between the September and October meetings. This meeting would focus on the current law, including a look at international examples and input from stakeholder groups. The group will propose and discuss potential Scottish models in the October meeting. 

Agreement of Minutes from Meeting 1 

The minute of the meeting was agreed with some amendments.

Review of agreed overarching principles 

The expert group reviewed the overarching principles following further comments made after the previous meeting. The group suggested some amendments to the principles to keep in line with the remit provided by the Scottish Government. 

The advisory group representative provided views on gender inequality and taking a human rights approach.

The expert group discussed their remit keeping in mind the specific Scottish context. The expert group also discussed that they could provide options for the Scottish Government to consider. 

It was agreed that the overarching principles would be published as part of the final report.

Discussion of Current Law on Gestational Limits and Grounds 

The expert group discussed how the current law worked in practice in relation to gestational limits and grounds.

The expert group noted the legal requirement for a two doctor sign off and how this works in practice. The group also noted how this works in practice in rural areas. 

It was noted that the way abortions are provided has changed since the Abortion Act had come into force.

The expert group discussed whether the current law aligns with the overarching principles of the review. The group discussed access to service provision and international standards as well as stigma around having an abortion.

The expert group discussed grounds that have to be met for an abortion from the perspective of patients and providers, including the reasons that are given by patients for having an abortion.

The expert group agreed that, based on discussions so far, the current law is not fit for purpose and alternative models should be considered. 

The expert group noted that existing grounds are used by clinicians as a template to frame conversations with patients and this should be considered in any future change to the law. Additionally, it was noted that if the law changes, clinicians would need to frame conversations in a different way, but that the topic of coercion should be considered carefully and that patients have sufficient opportunity to confirm their choice. The expert group agreed they would return to the topic of coercion at a later date.

The expert group noted that women in Scotland needing an abortion at a later gestation are more likely to be vulnerable, for example those under 18 or experiencing domestic abuse. For these women, as well as those in remote and rural areas, it was noted that travel was a real issue when getting to appointments.

The expert group noted that there may be significant issues for women in certain circumstances who scan over the current legal limit, as there is currently no established pathway. It was noted that over 24 weeks, there is no established pathway at present for ground A or B abortions where continuing the pregnancy would have a significant impact on a patient’s mental or physical health.

Discussion on views provided by stakeholders 

The advisory group reported that they had a discussion on the public reception of any potential reform proposals. On access to later abortion, there was concern around barriers for marginalised groups, including domestic abuse, sexual violence, immigration status, ethnicity, age, faith, and LGBT identity. 

Later term access was noted to be rare but would have a high impact on the patients.

The expert group considered feedback from six organisations that had provided written input.

The expert group noted that there were a range of issues and concerns raised. The expert group discussed these issues and agreed that it is important that these views are taken into account. The expert group agreed that they will reach their own view on the range of evidence received and considered, including stakeholder organisation views, as well as clinical evidence. 

The expert group agreed further stakeholder engagement would be beneficial to gain further evidence on some of the topics covered by stakeholder input provided so far. 

Review of International Examples 

The expert group considered a number of models for reform that had been used internationally. The models in South and Western Australia were discussed. The expert group looked at standards used in these areas to justify medical intervention and how these were interpreted by clinicians. The expert group agreed that it would be appropriate to invite a speaker from Australia to talk about how this legislation is working in practice.

The expert group noted that the French government had written a right to abortion into their constitution. The expert group noted that this was not a limitless right, but may give women a course of action if provision was short of what was legally allowed. The expert group agreed to consider this, along with a positive duty to provide abortion services, later on in the process.

The expert group noted that New Zealand had recently changed their law along similar lines to West and South Australia. The expert group noted that any practitioner could make a decision on medical appropriateness, which would allow for entirely nurse or midwife-led services. The expert group agreed it would be helpful to understand from clinicians in New Zealand how decision making there works and if there is a difference between the decision making of nurses, midwives and doctors.

The expert group noted the change of law in Northern Ireland. The group highlighted the influence of the Abortion Act on the Northern Irish regulations and they noted that if they decide to recommend a gestational limit and grounds for abortion.

The expert group noted the Republic of Ireland abortion law allows for terminations up to 12 weeks and after that only in exceptional circumstances. Additionally, the group noted that women were still travelling to England to access abortion care. The group discussed a lack of policy/guidance,  gaps in the availability of abortion services and lack of qualified medical practitioners who were providing the service. These issues in access were noted to be particularly difficult for fetal anomaly terminations.

The expert group discussed how abortion laws can differ from the situation in practice.

The expert group requested that the secretariat provide further models in the future, particularly models that centred on abortion ‘on request’. This would include Australian Capital Territory, Canada and seven US states. The group agreed that as per feedback from stakeholders, some European countries should be considered.

AOB 

The group agreed that the overarching principles would be reviewed regularly and included in the final report. 

The next meeting will be on 28 October.