The 1967 Abortion Act fifty years on: Abortion, medical authority and the law revisited

Abstract

The recent 50th anniversary of the 1967 Abortion Act provides the opportunity to revisit what has been termed the 'remarkable authority' this Act ascribes to doctors. This paper does so using as its starting point a seminal commentary on this question by the renowned medical sociologist Sally Macintyre, published in this journal in 1973 as 'The Medical Profession and the 1967 Abortion Act in Britain'. We revisit themes from that paper through an analysis of the findings of interviews with 14 doctors who, throughout lengthy careers, have provided abortions and led the development of the abortion service in England and Wales. We contrast our findings with Macintyre's, and argue that our interviews highlight the shifting meaning of medical authority and medical professionalism. We show that those doctors most involved in providing abortions place moral value on this work; uphold the authority of women (not doctors) in abortion decision-making; view nurses and midwives as professional collaborators; and consider their professional and clinical judgement impeded by the present law. We conclude that medical sociologists have much to gain by taking abortion provision as a focus for the further exploration of the shifting meaning of medical authority.

Systematic review of early abortion services in low- and middle-income country primary care: potential for reverse innovation and application in the UK context

“…We used a PI(C)OS framework to establish search terms and selection criteria (Additional file 1: Search terms and selection criteria) [21]. The population was defined as all healthcare providers strictly in primary care settings, according to the WHO definition 3 [22]. Studies in secondary and tertiary settings were excluded.…”

“…Governments were urged to impose less punitive measures on women seeking abortion, provide safe abortion services and measures to manage complications resulting from unsafe abortions. 3 WHO defines primary care (PC) as the gate keeper to healthcare services and is where "first-contact, accessible, continued, comprehensive and coordinated care" occurs [22]. 4 According to the World Bank 5 According to World Abortion Law…”

“…Nevertheless, some suggested follow-up interventions to ensure long-term effectiveness, such as provider support networks and follow-up practice assessments [29,35]. Several studies used an ultrasound scan to confirm gestational age of the pregnancy, but later have considered it unnecessary in most cases, consistent with WHO recommendations [3,31,32,43,45,46]. Pain medication was provided to over 90% of clients in most cohort studies and RCT studies [40,43,45], but actual practice may be as low as 54%, observed by Banerjee et al in India [31].…”

“…According to the 1967 Abortion Act, all abortions must be approved by two doctors, reported to the Department of Health and Social Care (DHSC), and can only be performed by doctors within licensed premises [2]. This legal framework causes accessibility issues, especially in rural communities lacking in both medical facilities and providers, and prevents the development of other innovative models, such as nurse/midwife-led surgical services [3]. The UK is unable to implement the WHO recommendation for services to optimise health worker roles in healthcare systems such as primary care because of the legal restrictions [4].…”

‘A disastrous blow’: psychiatric risk, social indicators and medical authority in abortion reform in post-war Britain

“…152. Ellie Lee et al (2018), “The 1967 Abortion Act Fifty Years On: Abortion, Medical Authority and the Law Revisited,” Social Science and Medicine, 212 (September 2018): 26, https://doi.org/10.1016/j.socscimed.2018.07.010.…”