I dealt with the absurd proposition that the findings of the RCPsych/NCCMH review of abortion and mental health demonstrates that 98% of abortions carried out in the UK are, in fact, illegal within the provision of the Abortion Act 1967 in my last monster post on the subject of this review but as Peter Saunders insists on peddling this fallacy, and even got the chance to advance his ridiculous claims on the Today programme I think it only fair that I revisit this issue and spell out, in detail, why Saunders’ argument is not just wrong, its not even wrong.

Why 98% of abortions in Britain are now illegal and what it means for doctors

In this blog I explain why I believe 98% of abortions in Britain are now illegal and why doctors who authorise or perform them are committing a criminal offence. This is a long post so if you would like to read my conclusions first then skip to the summary at the end.

Before getting into the detail, its worth pointing out that Saunders is neither a lawyer, nor a psychiatrist or psychologist, nor even a medical statistician. Saunders is a former general surgeon and even without taking into account his personal/religious biases, he is operating far outside his field of expertise here.

His opinion cannot, therefore, be taken to be at all authoritative and must be judged solely on the strength and validity of his arguments.

Yesterday I took part in a debate on Radio Four’s ‘Today programme’ with Professor Tim Kendall, one of the authors of a new report on induced abortion and mental health, which was published this week by the Academy of Medical Royal Colleges (AMRC).

The rather grandiose full title of the report is ‘INDUCED ABORTION AND MENTAL HEALTH: A systematic review of the mental health outcomes of induced abortion, including their prevalence and associated factors’.

Grandiose, eh?

Hardly – the review’s title is very much a matter of ‘it does what it says on the tin’.

It’s a systematic review, its looks at the best available evidence for mental health outcomes in women who have had an abortion and, based on that evidence, it attempts to provide prevalence estimates and identify any risk factors associated with adverse mental health outcomes in women who have had an abortion.

If its grandiose you’re after then look no further that Saunders’ own claim that 98% of abortions carried out in the UK are illegal – that’s grandiose.

I have reviewed the report both on this blog and in more detail on the CMF website. The overall conclusion (that abortion poses no greater risk to mental health than childbirth for those with unwanted pregnancies) we feel was more strongly stated than the relatively weak evidence base justified.

As I noted the other day, context matters and one of key pieces of contextual information that needs to be taken into consideration here is the fact that, for the last fourteen years, a small, closely connected, coterie of anti-abortion ‘researchers’ have been busily engaged in a concerted effort to build a body of research literature which demonstrates that abortion has an adverse impact on women’s mental health outcomes.

The best of these papers – and this isn’t saying much – were included in this review and yet the evidence base remains rather weak and, in many cases, raddled with obvious confounding factors that haven’t been adequately controlled for.

In science, there are occasions in which a failure to generate compelling evidence in support of a particular hypothesis can be just as illuminating as a slew of positive results, and this is one of those occasions as the NCCMH review fails to provide any real support for any of the many overblown claims that have been made by this group of researchers and their supporters, of which Saunders is one.

But my concern here is to unpack my claim on the programme, also reported on the BBC website, that 98% of all abortions in Britain are now technically illegal and what that means for doctors.

Professor Kendall confirmed on the programme, in answer to a question from presenter John Humphrys, that childbirth does not constitute a greater risk to mental health than abortion, and that therefore abortion does not improve mental health outcomes for women with unplanned pregnancies.

I then pointed out that 98% of the 200,000 abortions carried out each year in Britain are being carried out specifically on grounds of protecting women’s mental health. This brought a gasp from Humphrys and an initial denial from Professor Kendall. He then, after being pressed by Humphrys, claimed falsely that the figure was only 95% (it is actually 98% – see below).

Well I looked below, and there was nothing to see but, to be scrupulously fair I do have a copy of the most recent published abortion statistics for England and Wales and the actual figure for abortions carried out under ground C is currently 98%.

That said, we can’t actually state, with absolute certainty, that this means that 98% of abortions are carried out on mental health grounds, as ground C also covers abortions carried out due to a risk to a woman’s physical health and the official statistics don’t give a breakdown below this level. I suspect that it would be fair to say that the vast majority of ground C abortions are signed off on mental health grounds but I can’t rule out the possibility that both figures given above might be correct and that the discrepancy is simple down to Saunders and Kendall talking about slightly different things.

I insisted that the figure was 98% and then argued that doctors who authorise abortions in order to protect a woman’s mental health are doing it on the basis of a false belief not supported by the medical evidence.

I then asked why, over 1,000 times every day, British doctors signed legal documents authorising abortions on mental health grounds when in fact there were no mental health grounds for abortion (over 500 abortions are performed each day and each requires two doctors’ signatures to authorise it).

Saunders claim that doctors are acting on a false belief and that there are no mental health grounds for abortion is wholly incorrect and based – as we’ll see very shortly – on nothing more than his own inability to adequately evaluate the findings of the report and their implications, as these relate to UK abortion law.

The opening sentence of the executive summary of the AMRC report actually misrepresents the law and perhaps explains the Professor’s apparent confusion. It says that ‘the majority of abortions carried out in the UK are done so on the grounds that continuing with the pregnancy would risk physical or psychological harm to the woman or child’.

This is not strictly true (and I wonder actually if the meaning has been deliberately distorted in the report).

Misrepresents the law?

No, not really.

The worst that can be said of that sentence is that it sets out the law in more or less layman’s terms and, in doing so, omits to mention a technical requirement in the Act which relates specifically to the question of when, and it what circumstances, the risk of physical or psychological harm is sufficient to provide legal justification for an abortion, i.e. when the risk arising from the continuation of a pregnancy exceeds the risks associated with terminating the pregnancy by way of an induced abortion.

That minor omission hardly warrants an excursion into conspiracising, which is where Saunders is clearly heading when he ‘wonders’ whether this omission might be a ‘deliberate distortion’, but it is somewhat illustrative of the general mindset from which Saunders has approaching this report right from the outset – a fair chunk of his organisation’s submission to the review consultation was taken up with dubious complaints of bias in the draft report, all of which were solidly rebuffed.

Section 1 (1) (a) of the Abortion Act 1967 actually reads as follows:

Subject to the provisions of this section, a person shall not be guilty of an offence under the law relating to abortion when a pregnancy is terminated by a registered medical practitioner if two registered medical practitioners are of the opinion, formed in good faith

(a)that the pregnancy has not exceeded its twenty-fourth week and that the continuance of the pregnancy would involve risk, greater than if the pregnancy were terminated, of injury to the physical or mental health of the pregnant woman or any existing children of her family…

To avoid confusion, there terms of section 1(1)(a) cover grounds C & D (D deals with risks to other children in the family) as these are set out in the statutory requirements for reporting abortions to the Chief Medical Officer.

The key words here are that ‘the continuance of the pregnancy would involve risk, greater than if the pregnancy were terminated, of injury to the physical or mental health of the pregnant woman….’

Yes, these are indeed the key words here – this is not at issue. What is at issue is Saunders’ interpretation of the findings of the NCCMH review and how these relate to this section of the Act.

On abortion authorisation certificates the risk of injury to the pregnant woman and the risk of injury to existing children are split into two parts called C and D as follows:

c) that the pregnancy has not exceeded its 24th week and the continuance of the pregnancy would involve risk, greater than if the pregnancy were terminated, of injury to the physical or mental health of the pregnant woman (Section 1(1)(a))

d) that the pregnancy has not exceeded its 24th week and the continuance of the pregnancy would involve risk, greater than if the pregnancy were terminated, of injury to the physical or mental health of any existing child(ren) of the family of the pregnant woman (Section 1(1)(a))

Yes, this is perfectly correct.

The physical and mental health indications in section C are also separately recorded.

And this is also the case, although a breakdown of this information is not included in the published statistics, not even in terms of distinguishing between abortions carried on mental health grounds, as opposed to a risk to physical health.

So how many abortions are done under each of these clauses? For the answer to this question we need to consult the 2010 Annual Abortion Statistics on the Department of Health website.

Section 2.8 reads as follows:

2.8 In 2010, the vast majority (98%; 185,291) of abortions were undertaken under ground C and a further 1% under ground D (1,635). A similar proportion were carried out under ground E (1%; 2,290). Grounds A and B together accounted for less than a quarter of one per cent of abortions (358). The proportion of ground C abortions has risen steadily, with a corresponding reduction in ground D cases. (See Table 3a.ii.) The vast majority (99.96%) of ground C only terminations were reported as being performed because of a risk to the woman’s mental health. Abortions are rarely performed under grounds F or G.

No problems here either, but then…

So in summary 98% of all abortions are performed on the grounds that ‘that the continuance of the pregnancy would involve risk, greater than if the pregnancy were terminated, of injury to the mental health of the pregnant woman’.

Whoops – all reference to risks to the physical health of the pregnant woman, from both s1(1)(a) of the Act and the abortion authorisation certificate have suddenly vanished without trace and without explanation which, if we apply Saunders’ own standards from a little earlier, would make this a ‘misrepresentation’ and afford us free rein to speculate as to whether this might not be a deliberate distortion.

But let’s not stoop to Saunders’ level – we can settle this by looking at the evidence.

And yet this week’s review tells us that there is no evidence that the continuance of a pregnancy ever involves risk to the mental health of the mother that is ‘greater than if the pregnancy were terminated’.

No, this isn’t correct at all.

What the review actually found is that, overall, for a woman who has an unwanted pregnancy, rates of mental health problems will be largely unaffected by whether she chooses to have an abortion or chooses to go on and given birth.

This is based on evidence from four studies which controlled from women’s mental health prior to the pregnancy/abortion, along with other potential confounding factor, including whether the pregnancy was wanted or not; one from from the UK, one from New Zealand and two from the United States. These are all countries in which abortions can be obtained legally although difference do exist between these countries in terms of the legal frameworks under which abortions are carried out – New Zealand’s abortion law is very similar to that of the UK, while abortion laws in the US can differ considerably from state to state within a legal framework create by the US Supreme Court’s ruling in Roe vs Wade on the unconstitutionality of laws which prohibit abortion outright.

Notionally, at least, all the women included in these studies had a free choice as to the outcome of their unwanted pregnancy.

In practice, there is some evidence to suggest that a very small minority of women who choose to have an abortion are likely to have influenced or constrained when making the decision to have an abortion by external pressures in their social environment, i.e. from a partner or from family members, close friends, etc.

So far as women who chose to carry an unwanted pregnancy to term go, we have no data on why they made this decision or even the ultimate outcome of the pregnancy, i.e. whether the baby went on to be raised by their natural mother or was put up for adoption.

We can, however, reasonably assume that this group includes women who genuinely had a change of heart at some point during the pregnancy, such that it became a wanted pregnancy, in addition to some women who’s choices were influenced/constrained by external social factors, which can include pressure from their partner, from family members, friends and perhaps even from the wider community in which they live. Because this part of the review includes data from the United States, its also possible, if not likely, that some of the women in this group carried their unwanted pregnancy for the simple reason that they were unable to meet the costs of having an abortion or because they live in a part of the United States where it is extremely difficult, if not close to impossible, to gain access to abortion services.

From this we can reasonably infer that choice as to the ultimate outcome of a pregnancy, and particularly the extent to which that choice can be freely exercised by women, may well be another potential confounding factor not least because, if we were to take Saunders’ argument at face value and act upon it this would have the effect of taking away that choice.

So, to gain a comprehensive picture of the mental health risks associated with unwanted pregnancy we have to consider not only what happens to women when they have a choice of whether to terminate the pregnancy, or not, but also what happen if women aren’t afforded that choice and her we run to some considerable difficulties as there is currently almost no available data on mental health outcomes in women who have been denied access to an abortion when this was what they wanted. The only relevant study I could find, Ludamir et al (2011), comes from Brazil and although it does find evidence of an elevated risk of postnatal depression in women after an unsuccessful attempted abortion, i.e. they asked and were turned down by their doctor, the study has too many limitations. i.e. no control groups, significant sources of confounding not not controlled for etc., to offer much by way of a useful insight. Its a useful preliminary study, inasmuch as it suggests that there are questions that are worth exploring in much greater detail, but really not much more.

What we do know for sure is that laws prohibiting abortion do not prevent abortions being carried out.

Shah and Ahman (WHO, 2009) estimate that of the 42 million abortions carried out worldwide in 2003, 20 million were carried illegally and under unsafe conditions and that unsafe abortions account for 70,000 maternal deaths each year and cause a further 5 million women to suffer temporary or permanent disability.

Moving much closer to home, in 2010 1,101 were forced to travel to the UK mainland from Northern Ireland, where abortion is still illegal unless life of the pregnant woman is at immediate risk and there is a long term or permanent risk to her physical or mental health, in order to access abortion services. In that same year, a further 4,402 women travelled to the UK mainland from the Irish Republic for the same reasons that their counterparts in the North – together women crossing the Irish Sea to access abortion services account for 84.2% of all non-resident abortions carried out in the England and Wales in 2010.

From this, I think we can reasonably infer that women who find themselves with an unwanted pregnancy but without access to safe, legal, abortion services do tend to be subject to a significant degree of psychological stress – why else would they be prepared to travel overseas for an abortion or take the risk of having an unsafe ‘backstreet’ abortion – but this still doesn’t address the question of whether denying women a choice about the outcome of an unwanted pregnancy is likely to have an adverse impact on their mental health.

However, if we turn back to the NCCMH review and look at the section which deals with factors associated with mental health problems associated with abortion we find that the review includes the following evidence statements:

3. The most reliable predictor of post-abortion mental health problems regardless of study type was having a history of mental health problems prior to the abortion. A history of mental health problems was associated with a range of post-abortion mental health conditions, irrespective of outcome measure or method of reporting used.

4. A range of other factors have more inconsistent results, although there was some limited evidence that life events, negative attitudes towards abortion, pressure from a partner to have an abortion and negative reactions to the abortion including grief or doubt, may have a negative impact on mental health.

Amongst women who did choose to terminate an unwanted pregnancy several studies, notably Fergusson (2009), found evidence of a small subgroup of women who do exhibit significantly higher rates of mental health problems after having an abortion, and after controlling for prior mental health problems.

What Fergusson found is that most women (85%) experience at least one negative emotional reaction to having an abortion, i.e. sorrow, sadness, guilt, regret, grief, disappointment etc,, with just over a third (34.6%) reporting five or more negative reactions. In terms of definite negative reactions, i.e. where women reported having these feeling ‘very much’, 55% reported one or more negative reactions, with 34.6% reporting three or more reactions.

These reported reactions were, however, offset to some extent by positive reactions, i.e. relief, happiness, and satisfaction, with the majority of women (86%) reporting at least one such reaction and just under a third (29.8%) reporting all three reactions. Most women understandably experience mixed feelings after having an abortion, however, when Fergusson looked at women’s long-time feelings about their decision to have an abortion he found that almost 90% felt that they had definitely made the right decision while only 2% felt that they have definitely made the wrong decision.

Fergusson then went on to look at the relationship between the number of negative reactions women experienced and their subsequent mental health outcomes and found that women who had experienced four or more negative reactions do exhibit a higher rate of mental health problems, after controlling for prior mental health, etc. – the risk is about one and half times greater for women reporting four or more negative reactions that for women with no reported negative reactions, although one does have to be cautious in approaching these findings as the number of women included in the study is relatively small (n=104) and the results are only just statistically significant – Incidence Rate Ratio (95%CI) 1.51 (1.01-2.27).

So, there is some evidence that women’s risk of mental heath problems following an abortion is mediated by the the extent and degree to which they experience negative feelings of distress after the abortion and several factors have been identified as having to play this relationship including:

– other stressful life events,

– negative attitudes to abortion, and these commonly stem from the individual’s religious beliefs,

– external social pressures, particularly from a partner, but this can also come from family members, friends and from the wider community in which the individual lives – there is, after all, still a considerably degree of social stigma attached to abortion is some communities, particularly where religiosity is a significant social factor as if often the case is many areas of the United States, and

– feelings of grief and/or doubt, the latter of which can manifest itself in terms of ambivalence or uncertainty at the time the abortion is sought or following the abortion, if a woman begins to retrospectively question whether they have, in fact, made the right decision.

The one feature common to most of these factors – the exception being that of stressful life events, which may be entirely unrelated to the pregnancy/abortion – is that they are all to some degree predicated on the existence of choice. The risk that an abortion may lead to women experiencing subsequent mental health problems is greatest where women feel that they have either made the wrong choice, in choosing to terminate the pregnancy – and that feeling may often arise only retrospectively – or where they have not been able to exercise a free choice due to external pressures from a partner or from other sources.

Choice, itself, is a mediating and potentially confounding factor albeit that, to date, the role that it plays and the extent to which exerts an influence over the relationship between abortion and mental health has not been explored in any great detail, if it can be said to have been explored at all.

This being the case, we can reasonably infer that what is true for women who make the wrong choice, i.e. they choose, or are pressured into choosing, to terminate an unwanted pregnancy only to discover afterwards that, deep down, what they actually wanted was to carry the pregnancy to term, must also be true for women either make the choice to carry a pregnancy to term, or are pressured into that making that choice, when this is, equally, not what they wanted, i.e. that the consequences of such a wrong decision – an elevated risk of subsequent mental health problems – are, at the very least, likely to be the same.

This gives us a testable hypothesis – we could look for evidence of whether choice does have a mediating effect on mental health outcomes by looking at rates of post natal depression and other psychiatric problems using a prospective longitudinal study of women who do carry an unwanted pregnancy to term, comparing outcomes for women who did genuinely have a change of heart with those who didn’t, although whether we’d find enough women in the UK who meet those criteria to generate reliable results is, at this stage, anyone’s guess.

Moreover, the possibility that choice, itself, is a mediate factor in post abortion mental health outcomes in such a way that a wrong choice, or a denial of choice, is associated with an elevated risk of adverse outcomes is more than sufficient to satisfy the legal requirement that abortions can be carried out on mental health ground only where “the continuance of the pregnancy would involve risk, greater than if the pregnancy were terminated, of injury to the… mental health of the pregnant woman.”, at least until such time as sufficient evidence has been accrued to either confirm or refute the hypothesis.

So far, we’ve looked at all this in purely general terms.

The women we’ve been discussing are, in reality, nothing more than statistical abstractions derived from evidence contained in research papers, at least in terms of the manner in which the issues this evidence raises have been discussed, and this leaves us with the question of what this all means in practice, i.e. for individual women who are actually considering/seeking an abortion and for the doctors who deal with these inquiries/requests.

Where are they in all this? Well, not where Peter Saunders’ would have us believe:

This raises an interesting question. Are those doctors who authorise abortions on these mental health grounds aware of these facts or not? In other words, when they sign these forms, are they just ignorant of the facts or are they being deliberately disingenuous?

Let’s give them the benefit of the doubt and assume that up until this point every doctor in Britain signing an abortion authorisation form did so ‘in good faith’, genuinely believing that normal pregnancy and childbirth constituted a greater risk to mental health than abortion.

Now, however they will not be able to do so ‘in good faith’ because the true facts are known and have been made public in a major report endorsed by the AMRC and the Department of Health.

If they continue to authorise abortions on mental health grounds from now on they will then be knowingly making false statements on legal documents when previously (giving them the full benefit of any doubt) they were doing so unknowingly.

Again, Saunders is wrong, both because he completely disregards the possibility of choice as a mediating factor – but then he is anti-choice of course – but also because his argument runs headlong into what is, in effect, the is-ought problem.

Although the review find that, in general, the risks to women’s mental health are the same irrespective of whether women choose to terminate an unwanted pregnancy or carry the pregnancy to term, one cannot automatically apply those findings to individual woman at the point at which they speak to a doctor about having an abortion.

Why?

Because what the review is telling us about are, in effect, the average risks women face not the specific risks than any individual may be subject to, based on their own specific personal circumstances. Within each of the groups included in the study there are some women for whom the risks are higher than average and some for whom the risks are lower and although the review does identify some factors that do appear to associated with a higher risk of psychiatric injury, list list is not exhaustive and does not, therefore, provide doctors with an accurate diagnostic tool to work with when assessing individual patients.

In short, doctors cannot accurately predict, at the time they are contacted about an abortion, which women are subject to a risk of psychiatric injury from the continuance of the pregnancy greater than than which would arise from a termination, and which are not because any adverse impact that the eventual outcome of the pregnancy might have will become fully apparent until after the fact. This is true even without taking into account the evidence which suggests that choice may be a significant mediating/choice factor, although this evidence does serve to strengthen the argument that doctors should avoid interposing their own opinions unless there is clear evidence that tips the balance of risks one way or another.

If a woman presents with a prior history of mental health problems, or strongly expresses uncertainty or ambivalence as the possibility of an abortion, or reports feeling that she is being pressured into a decision that she is reluctant to make then an offer of a referral for further counselling is not only entirely appropriate but ethically mandatory.

If, however, the woman is clear as to her preferred course of action and the outcome for her pregnancy and it capable of giving informed consent to the procedure, if it an abortion she wants, then a doctor has no legal or ethical grounds for declining a request for an abortion on mental health grounds providing that the request for an abortion is made before the pregnancy has reached 24 weeks gestation, the current upper limit for elective abortions in law, other than under the Abortion Act’s conscientious objective clause – and even here, if doctors exercises their rights under this cause they are still under a positive ethical obligation to refer their patient on to a doctor who can consider their request for an abortion without placing their own personal beliefs ahead of the clearly expressed wishes of the patient.

And so Saunders claim that 98% of abortions in the UK are carried out illegally falls, as does the proposition that doctors are failing to act in good faith by signing abortion consent forms, and the findings of the NCCMH review make no difference whatsoever, either legally or ethically.

This negates the rest of Saunders legal arguments, which would be applicable only if he could sustain the argument that abortions are being carried out unlawfully, so you can feel free to skip this next section unless you’re at all curious about how the law does treat illegal abortions.

Is this serious? Well yes because abortions which are carried out outside the bounds of the Abortion Act 1967 are still illegal, as section 5(2) of the Act makes very clear:

‘For the purposes of the law relating to abortion, anything done with intent to procure a woman’s miscarriage (or, in the case of a woman carrying more than one foetus, her miscarriage of any foetus) is unlawfully done unless authorised by section 1 of this Act’

Section 6 of the Abortion Act states that:

‘“the law relating to abortion” means sections 58 and 59 of the Offences against the Person Act 1861, and any rule of law relating to the procurement of abortion’

Many people do not understand that abortion is still a crime in Britain if the exemptions in the Abortion Act do not apply, and as I have argued above they do not currently apply in 98% of cases.

So what do sections 58 and 59 of the Offences Against the Person Act 1861 say?

58 Administering drugs or using instruments to procure abortion.
Every woman, being with child, who, with intent to procure her own miscarriage, shall unlawfully administer to herself any poison or other noxious thing, or shall unlawfully use any instrument or other means whatsoever with the like intent, and whosoever, with intent to procure the miscarriage of any woman, whether she be or be not with child, shall unlawfully administer to her or cause to be taken by her any poison or other noxious thing, or shall unlawfully use any instrument or other means whatsoever with the like intent, shall be guilty of felony, and being convicted thereof shall be liable . . . to be kept in penal servitude for life . . ..

59 Procuring drugs, &c. to cause abortion.
Whosoever shall unlawfully supply or procure any poison or other noxious thing, or any instrument or thing whatsoever, knowing that the same is intended to be unlawfully used or employed with intent to procure the miscarriage of any woman, whether she be or be not with child, shall be guilty of a misdemeanor, and being convicted thereof shall be liable . . .to be kept in penal servitude . . ..

In other words anyone convicted of carrying out an illegal abortion could face life imprisonment.

But what about those doctors who knowingly make false statements on abortion authorisation forms? For that we need to turn to the Perjury Act 1911 Section 5 which reads as follows:

5 False statutory declarations and other false statements without oath

If any person knowingly and wilfully makes (otherwise than on oath) a statement false in a material particular, and the statement is made—
(a)in a statutory declaration; or
(b)in a… certificate, declaration… or other document which he is authorised or required to make, attest, or verify, by any public general Act of Parliament for the time being in force… he shall be guilty of a misdemeanour and shall be liable on conviction thereof on indictment to imprisonment… for any term not exceeding two years, or to a fine or to both such imprisonment and fine.

In other words, making false statements on an abortion authorisation certificate is a form of perjury.

And so, to summarise the actual position here:

Summary

So where does this leave doctors? Let me sum it up:

1.There is no evidence that continuing with an unwanted pregnancy poses any greater risk to a pregnant woman’s mental health than an abortion does and yet 98% of abortions are authorised on these grounds

Wrong.

There is actually some evidence which suggests that choice plays an important role in mediating the risks of psychiatric injury associated with unwanted pregnancies such that denying women the choice of terminating an unwanted pregnancy may well increase their risk of developing mental health problems over and above the risk associated with terminating the pregnancy.

2.The doctors who are authorising these abortions are not therefore doing so ‘in good faith’

Wrong.

Doctors cannot accurately predict, in advance, which women are subject to elevated risk of psychiatric injury and, on current evidence, the balance of risks remains in favour of permitting women a free choice as to whether or not to terminate an unwanted pregnancy, within the law, except where individual women present with specific risk factors that act to tip the balance of risks one way or another or lack the mental competence necessary to consent to the procedure, in which case it all becomes a matter for the courts to decide.

3.These abortions are therefore unlawful under the Abortion Act 1967 and Offences Against the Person Act 1861 and those doctors who are carrying them out are committing a criminal offence

Wrong.

4.Those doctors who are authorising them are knowingly and wilfully making false statements on legal documents and are thereby committing an offence under the Perjury Act 1911

Not even wrong!

5.These offences under the Abortion Act and Perjury Act both carry custodial sentences

Correct, but completely utterly irrelevant as Saunders’ entire argument amounts to nothing more than a pile of tendentious hogwash.