Complications from Abortions (Annual Report) Bill [HL]

Second Reading

Moved by

That the Bill be now read a second time.

My Lords, abortion is a generally safe procedure for women. It is not my purpose in bringing this Bill forward to dispute that. Rather, the question this Bill raises is: how safe is it? To know that, we need statistics that reflect real experience.

I start by drawing attention to the excellent brief that the Library has produced. This is a debate about statistics and statistical methodology, and I do not think the complexities involved could have been set out with greater clarity than they are in this brief.

The Library brief also includes at the end certain objections to the Bill expressed by the British Pregnancy Advisory Service—although it has not in fact contacted me. The first is that the Bill exceptionalises abortion. Strangely, I think that objection gives us a way into this debate. Abortion is indeed exceptional in that it is the only common procedure that is made available by the NHS but in the great majority of cases—about 80%—is provided by independent clinics, such as the charities BPAS and Marie Stopes, although there are other smaller providers as well. That is where the statistical issues start.

Independent abortion providers provide information on terminations, including on complications arising, to the Chief Medical Officer. This is known as the abortion notification system, or ANS. It covers not only the independent sector but also the 20% of terminations carried out in an NHS setting. In the case of independent providers, the complications it captures are principally those that arise within the clinic, since many women who experience a complication after discharge from the clinic—this is a key point—will present to their GP, to NHS 111 or to A&E at a hospital. These complications are not captured by the abortion notification system.

I should add that there is a legal obligation on the Department of Health and Social Care to monitor and publish statistics on abortion, and it uses the abortion notification system for this purpose. There is an annual report published. The published rate of complications is low, generally about 1.2 to 1.4 per 1,000 in recent years, for which I have the numbers. But until recently nobody has collated figures on the level of complications not captured by the ANS data, because the complications were not reported to the abortion provider but dealt with through the NHS directly.

Last year, the Office for Health Improvement and Disparities, which is a branch or an arm of the NHS, turned its hand to this task. In November 2023—very recently—it produced its report. I have a copy here and it is a fairly chunky report. The task was more challenging than one might have thought There were, of course, many of the usual statistical conundra of what to count and what not to count, whether the definitions in different datasets were the same and matched, and so forth. In fact, the first half of the report is a careful and thorough essay on the methodology used, which is an indispensable thing to provide since it was doing it for the first time. The report focused entirely on incidents arising in a hospital setting using hospital episode statistics—I am going to use the expression HES from now on—as distinct from ANS; these are the two sets of data that we are dealing with. The report used the hospital episode statistic statistics and, importantly, did not include incomplete abortions that were not accompanied by a further complication.

My Lords, I am going to take the opportunity to explain the context of the Bill and say what it is really about. In doing so, I thank the noble Lord, Lord Moylan, for yet again giving me the opportunity to draw your Lordships’ attention to the right-wing, nationalist, countergender campaign which this Bill and his previous foetal sentience Bill are a part of. We have known for some time that there is an international campaign which has an overriding strategic objective of getting rid of human rights legislation and the organisations responsible for upholding it.

On a tactical level, it has a number of objectives: anti-LGBT campaigning—with a particular emphasis in this country on anti-trans work; anti-sex and relationships education, because the state should have no part in teaching people’s children about sex and relationships; anti-surrogacy, and particularly anti-abortion. People may have read or seen, most notably, the campaigns in places such as Hungary and Poland. It is all about a campaign to restore the natural order—a selective reading and interpretation of biblical order.

When I have said that in this Chamber before, Members of your Lordships’ House have thrown the jibe, “Well, that sounds like a conspiracy theory”. Well, it is not actually, and we have some growing evidence to that effect. I encourage all noble Lords to read Project 2025—it is a very easy and clear read. It says what the organisations behind it, such as the Heritage Foundation, the Alliance Defending Freedom and big supporters of the Conservative Party in this country have as their agenda for the Trump Administration. It is all backed up by billions of dollars going to Africa and billions of dollars coming to Europe including to the UK. It is a campaign which has evolved, just as the anti-abortion campaign has evolved from rather crude demonstrations outside abortion clinics; it has now gone into a slightly different phase. It is now setting up independent universities and colleges; it is producing research evidence; it talks using the language of rights, but all the conclusions go back to that same overall objective. It is very clever, very well organised and brilliantly messaged, but it is what it is: it is a very cynical anti-gender campaign about destroying human rights.

My Lords, I commend the noble Lord’s Bill to the House. It offers a moderate proposal that ought not to be controversial. Whatever one’s view on the issue of abortion, it is clearly in the interests of public health and patient safety to ensure that accurate data is collated and reported concerning the scale and nature of complications from abortions, as with any medical procedure. As the noble Lord has explained, current reporting is deficient and has not caught up with the changes concerning how an increasing number of abortions now occur.

As well as supporting the comments that the noble Lord has made, I wish to make two further points in relation to the Bill in the short time available to me. First, I note that while the 2023 Department of Health publication on which the Bill is based records data more accurately than previous reporting, it acknowledges in its own annexe that it does not include complications under the code O044. That code records “incomplete” abortions, where part of the unborn baby remains inside the mother after an abortion.

That report includes hospital episode statistics relating to incomplete abortions where they have led to additional complications but not to incomplete abortions themselves. However, given that any incomplete abortion routinely requires further treatment to remove the remaining parts of the baby to avoid the risk of infection, it seems to me that those also ought to be included in any accurate recording of statistics.

The second point I want to make is in relation to Northern Ireland, as all noble Lords would expect. While I understand that the Bill relates to England in order to correspond to the November 2023 report, I would like to see an improvement in data collection and reporting in Northern Ireland. Since abortion was decriminalised in Northern Ireland, reporting on abortions has been woefully inadequate. Indeed, we appear to have even less data concerning complications than the limited data published in England.

My Lords, it is a pleasure to follow the noble Baroness, Lady Foster, who spoke, as she always does, powerfully, compellingly and rationally—it is important keep that rational focus on this important Bill. I thank my noble friend Lord Moylan, who set out the rationale for it clearly, compellingly and in some detail, and I am delighted to have this opportunity to support it.

Whatever one’s views on the substantive question of abortion, I find it hard to see why we would not want as much information as we could possibly get on this question, especially when, as my noble friend Lord Moylan noted, there is clear evidence for at least a potential anomaly that needs addressing in the statistics. It is surely in the interests of any woman considering an abortion to have the best possible information about the possible risks involved.

In the short time available, I want to make one further point to those that have been made already, on the objection from the British Pregnancy Advisory Service—which the noble Lord, Lord Moylan, has already noted—that this Bill would in some way “exceptionalise” abortion. I find that worthy of a brief comment. As the noble Lord said, abortion is already exceptional in various ways. One might note in passing that it is the only form of healthcare that has required the suspension of free speech rights—and even non-speech rights, those of free thought—to allow it to be transacted. Passing on from that, more substantively, it is exceptional because it is one of those areas of care where there really are starkly clashing worldviews. I am sure that we will hear much more about that later on this morning. That means that it always is going to be subject to debate, unless there is some fundamental change in the ethical basis of our society. Therefore, ways through have to be found, in a free society, to accommodate that.

The need for debate around abortion provision will, and I think should, always make it exceptional. It means that we need that debate to be as well-founded as we can possibly make it—well-founded in the moral judgments that we bring to it and well-founded in having the best possible information and analysis around it at a technical level. That is what this Bill would help to provide, and that is why I support it.

My Lords, in following the noble Lord, Lord Frost, I stress how important the Green Party and many other people regard protecting those receiving healthcare from harassment and abuse. That is something that the law has increasingly stepped up to do, and it is terribly important.

I oppose this Bill. I begin by commending the speech of the noble Baroness, Lady Barker, who gave us an important sense of context here. This is about a very long-term, global, but US-based, exceptionally well-funded campaign against human rights. Back in 2014, I wrote a chapter in a book entitled Women Against Fundamentalism: Stories of Dissent and Solidarity, which told the story of what happened in the 10 years leading up to where we are today.

I will focus a little on context. It is important to note that, last year, YouGov looked at attitudes towards abortion and found that 87% of Britons said that abortion should be allowed, while only 6% said that it should not. It is interesting to note that one in 10 Britons think that the law makes it too difficult to get an abortion in the UK. When you look at those for whom this is most relevant—women under the age of 40—you find that that figure rises to 19%. Those are the people who are most likely to encounter the detail of the law and to have discovered, as many are surprised to, that abortion is covered by criminal law still in the UK. It is important to highlight that.

As we talk about abortion, one issue is the rise we have seen in the investigation and prosecution of what is suggested might be illegal abortions. In the 18 months to February, there was a risk of convicting as many women as have been convicted for that offence in the previous 55 years. Six women were prosecuted over suspected abortion cases, although three of those cases were subsequently dropped—the women having been through very considerable turmoil in the meantime. The president of the Royal College of Obstetricians and Gynaecologists has noted how outdated abortion law really is creating problems. That is the context.

My Lords, I speak in favour of my noble friend’s Bill. I am a great supporter of patient empowerment, and one sure way to give patients power is to arm them with knowledge and the medical options available to them. Recently, I had a hand procedure for Dupuytren’s disease. In the run-up to the procedure I wanted to know all the evidence available about the condition itself, the treatment, the options, the aftercare, and indeed the complications. I did so partly by talking to a GP and other doctors I knew, but partly by looking at websites.

This simple measure, proposed by my noble friend Lord Moylan, for a report that collates both sorts of data—that from the hospital episodes statistics and that from the ANS—will provide a fuller picture for people like myself. More importantly, it will strengthen the channels of information on the complications arising from abortion. While the annual published statistics may not be read by many people, and rely solely on the ANS data, note will be taken of a report issued by the NHS that collates the full information, both from the medical press and GPs. Levels of public information about possible complications and potential risks will be available. Because the role of medical practitioners in advising about any procedure is rightly deemed central, it is important that, as a result of the measures proposed in this Bill, they will be better informed.

My mother was a doctor. My abiding recollection of her is that, every night, at the end of the day when her chores were done, she would pick up her medical journals and updates on all medication available to keep herself up to date with the latest evidence and research, in an otherwise very busy day. That was what she anticipated doing each night, and she was bang up to date on treatments and everything to do with her work.

Not only that, but an annual report could be read by people themselves, especially if they want to follow up on one or other point of the medical advice. Professionals can disagree among themselves about how they interpret the evidence—we heard from my noble friend Lord Moylan one example of how gynaecologists can disagree over even a definition. It would be very helpful for people to see such a report for themselves; this is particularly so in the case of sensitive subjects.

My Lords, this is not my area of expertise. Like the noble Lord, Lord Moylan, my background is in local government and business. Unlike the noble Lord, Lord Moylan, I do not think that we should be passing legislation on which areas of health we should collect data on. Certainly, we should collect the data, and certainly our job in this House is to question inconsistencies, but it is not to legislate for them.

The noble Lord, Lord Moylan, criticised the British Pregnancy Advisory Service for talking about “exceptionalism”. In fact, at the heart of this Bill there is an illogicality. It tries to collect data just on the abortions and is not looking at the complications—for example, of women having to carry to term babies that, for a multitude of reasons, they would have chosen to abort.

On the face of it, this is a very logical Bill, but I am grateful to my noble friend Lady Barker and the noble Baroness, Lady Bennett, for laying out the context and background. When I looked at the last Bill from the noble Lord, Lord Moylan, on sentience, I got a clue as to where he is going with this whole thing. That is why I have chosen to speak briefly today.

I deeply believe in a woman’s right to choose what she does with her body. Women’s rights, as the noble Baroness, Lady Hodgson, said when she was talking about her Bill on peace, are being rolled back across the world and it is our job to make sure that we uphold them. It has taken centuries to get to a place where back-street abortions are a thing of the past in this country, and I do not wish to see us make any move that makes us arrive at a place of less safety. It took so much effort to get women to a place of greater safety and we must stop any attempt to reverse that.

My Lords, the goal of improving women’s healthcare through better access to information, particularly regarding potential complications of medical procedures, is indeed important. Access to information enables individuals to make informed choices and allows healthcare professionals to provide safer, more effective services. However, while I support the overall goal, I have concerns about legislating for an annual report in this manner.

First, as we have heard, it is important to emphasise that abortion is a safe and effective medical procedure and, in fact, can be safer than continuing a pregnancy to term. While any medical procedure carries some risks, those associated with abortion are well managed and women are fully informed of them by healthcare professionals, ensuring that they are equipped to make the best decision for their own health. I agree that improving this data collection is crucial. As highlighted by the Royal College of Obstetricians and Gynaecologists, the lack of effective data has hindered innovation and improvement in women’s healthcare and, ultimately, the improvement of patient care. However, as we have heard, BPAS and the royal college have significant concerns about the Bill’s potential to exceptionalise and stigmatise abortion care.

Unlike other medical procedures, abortion would be singled out for mandatory complication reporting. No other procedure is subject to this. Doing so for abortion could create a false impression that it is uniquely dangerous. In reality, complications from abortion are rare—