The only incentives in life are financial

The myth that underlies The Dorries/Field amendment on abortion is that abortion providers have a financial incentive to promote abortion and therefore their employees do not and cannot provide independent, non-directive support for women trying to make a decision about whether or not to continue a pregnancy.

I’m not a psychologist, but I’m sure if I had more time I could lay my hands on copious literature which finds that people are motivated and incentivised to act by a range of different factors, only one of which is money. I would take an amateurish stab at things such as shared values within your community or amongst your peers and family, strongly held philosophical or religious belief, and more. 

In my experience, for example, those working for abortion providers in any capacity are very strongly motivated by a profound and deeply held belief in a woman’s right to choose the outcome of her own pregnancy and a horror of the known consequences of witholding safe, legal, free and accessible abortion as a real option for women. 

Surely the biggest incentive people have is their own personal belief, and that’s why it’s hard to fathom that during this whole debate on ‘independent counselling’ not a single organisation that was founded on an anti-abortion principles, and staffed by people who oppose abortion, has felt the need to explain how their deeply held belief that abortion is wrong does not provide them with an incentive to dissuade or obstruct women from accessing abortion.

Even in this materialistic world we all inhabit, I still think that strongly held beliefs trump money for most people. So, once again I ask you... all of you who have a strongly held belief – whether grounded in a faith position or otherwise – that every abortion is intrinsically wrong, sinful, damaging and tragic, how can you NOT want to dissuade women from having an abortion. 

More discussion of this is here and here

Why we're supporting the pro-choice demo 9th July

EFC is happy to promote the Pro-Choice demo happening next Saturday (9th July 2011) in London, to its friends and followers. This blog gives a bit more information on why we think this action is so relevant and important. To register your attendance visit the Facebook page and follow @ProChoice9July #prochoicedemo2011 for up to date information.


Recent months have seen a number of worrying intrusions into our reproductive rights in this country. Including:
• Nadine Dorries’ and Frank Field’s ‘Right to Know’ campaign which posits abortion providers as having a ‘vested interest’ in persuading women to end their pregnancies, and argues for ‘independent’ centres to provide pre-abortion counselling. EFC believes these amendments are based on a false premise – that women aren’t currently getting impartial, evidence-based support with their pregnancies.  Our research into crisis pregnancy centres in England also suggests that a great deal of ‘independent’ centres do not provide impartial accurate information but rather, are driven by an anti-abortion agenda. Read a thorough debunking of this campaign by Darinka from Abortion Rights here.
• Anti-abortion charity Life invited to sit on the government’s Sexual Health Forum.  LIFE is a well funded charity with a large profile and has every right to promote its anti-abortion position. However, as a lobbying group with no commitment to evidence-based clinical practice, or to promoting and providing good quality contraceptive and reproductive health care, it simply has no place on this group, which otherwise consists of sexual health experts, clinicians and service providers.
• Michael Gove commends the new SRE council of abstinence education groups. LIFE and Care (a Christian organisation which opposes abortion) join 5 other abstinence/anti-choice groups on the new SRE council which has been welcomed by the education minister. See our blog for more information on these groups and more information on why abstinence doesn’t work.
• Nadine Dorries’ abstinence education for girls. Worryingly, Tory MP Dorries’ misguided bill to teach girls abstinence passed the first stage vote in parliament. Another reason to keep on our toes and make the case for evidence-based comprehensive sex education.


EFC supports the rights of young people to accurate information and good quality, evidence-based information on abortion; and their right to impartial support with pregnancy decision-making. We believe that current developments will impact most on young people by depriving them of essential information and diverting them away from health professionals who could give them the support they need to access services quickly.


Those of us who believe women should have access to safe, legal abortion and they and their partners and families access to evidence-based information on contraception, pregnancy and abortion need to stand up for these rights before they are eroded.


Join EFC on the demo to make a stand for the pro-choice majority and for young people in this country.

Myth Busting Monday - pro-choice orgs don't care about pregnancy counselling

The Dorries/Field amendment on abortion counselling is based on the false premise that women cannot currently access impartial support with pregnancy decision-making . Whether or not they expect their amendment to be successful, it is obvious that the main intention of the amendment is to promote the view that:
• those who provide abortion are hell-bent on encouraging women to have abortions they do not really want
• those who support access to safe, legal abortion don't care about whether women make the right decision about abortion


As an organisation that believes women should have easy access to good quality abortion services, EFC has worked very hard to improve the level of support that young women and their partners get with pregnancy decision-making. 


For ten years EFC has delivered a training course for school nurses, youth workers, sexual health workers, teachers, social workers (in fact anyone who works with young people). This provides tools and information to help professionals provide impartial support with pregnancy decision-making. It recognises that young people may find this process difficult – they may lack: knowledge and understanding of the different pregnancy options; the skills to assess their thoughts and feelings and weigh up the benefits and disadvantages of parenthood; or the support at home to decide what’s best for them.  Young people may not want to go to their GP and may not know how to access an abortion provider directly for information or support. It’s important that the professionals who young people trust are able to provide this support when and where they ask for it.


Education For Choice has written a toolkit to encourage and enable professionals to provide support with pregnancy  decision-making to the young women and men they work with. The toolkit makes the case for providing this support when and where it is needed and includes practical information and ideas on how to do so. It also provides a checklist for professionals and local area commissioners to assess the quality, impartiality and usefulness of local independent pregnancy services.


Education For Choice has published a workbook of practical tools and exercises to help those professionals working with young people to work through their decision-making process with them and to create a document of the process to increase young women’s confidence in their decision.


As a pro-choice organisation we’re really committed to good quality pregnancy decision-making support.

Myth Busting Monday: '7 year olds are putting condoms on bananas'

So, since this meeting is taking place in London tonight to get together some like-minded opponents of Nadine Dorries’ recent plans to introduce abstinence education in schools and ‘independent’ pre-abortion counselling we thought we’d be topical and touch on one of her oft repeated myths: That children in primary schools are being taught how to put on condoms using bananas.


Here’s Dorries on her own blog claiming that:
“Girls as young as seven are taught about intercourse, safe sex, how to apply a condom on a banana, where to get condoms, how to detect an STI and that they don’t need to tell their parents anything.”

And she’s repeated the banana thing in quite a few of her numerous media appearances. Now we know that Dorries' blog is, by her own admission, 70% fiction but this little nugget of fiction is particularly galling to those of us who actually work in sex education. Yes, thankfully there are some primary schools doing great SRE, but for children below 11 this focuses very heavily on the ‘R’ – relationships. By talking to children about appropriate relationships educators introduce awareness of boundaries and what is and isn’t safe.

Anyone who does work in schools/SRE will tell you that when condom demonstrations are done they a) generally take place from about Year 9 in secondary school when SRE starts to cover topics like contraception and STIs and they b) don’t tend to use fruits and vegetables but rather an appropriately but perhaps boringly named ‘condom demonstrator’ (which generally look something like this).

What’s worrying here is why Dorries chooses to roll out this myth again and again. This post on the Children’s Services Blog suggests an underlying rejection of comprehensive SRE altogether:
‘Dorries sounds alarmist. She sounds Puritan. Her objections to banana-condom practice hint at a disregard for lessons on safe sex altogether’.

So let’s file this one in the ‘70% fiction’ pile. Busted.

Myth-Busting Monday: All independent pregnancy advice centres offer women impartial, balanced pregnancy decision-making support

Since Lisa wrote a blog about Nadine Dorries and Frank Field’s ‘Right to Know’ campaign and their proposed amendments to the Health and Social Care Bill we’ve seen the issue discussed by a number of journalists and bloggers. In light of that, today’s Myth Busting Monday focuses on one particular aspect of this campaign which we believe could pose a real threat to women’s access to impartial support with pregnancy decision-making, and that is the presence of unregulated pregnancy advice centres.

The Right to Know site claims that:
An amendment to the Health and Social Care Bill would guarantee that all women considering abortion have access to independent advice and counselling - provided by someone with no vested financial interest in the outcome of their decision.

Our question is – just who would be providing this service? What is the alternative for a woman who doesn’t speak to her doctor or a counsellor at an abortion provider?

Crisis Pregnancy Centres (CPCs)
There are already a number of independent pregnancy advice centres across the country. Some are upfront about operating with a specifically anti-abortion agenda, some aren’t. Some are transparent about religious affiliations or funding organisations, some aren’t. Some may be providing evidence-based information and impartial support to women facing an unplanned pregnancy but we know of many more which aren’t. Our own research, coupled with the insight of the many professionals we speak to across the UK suggests that a good number of these centres are not offering women a balanced discussion of their pregnancy options but rather serving misinformation, health myths, overblown statistics and, in some cases showing women anti-abortion videos. This Channel 5 news report gives an idea of the kind of misleading information which may be given by a CPC.

Our concern is that suggestions that women need to look for independent pregnancy advice could open up the capacity of centres which offer biased information, driven by an agenda. Perhaps not the ‘financial incentive’ Dorries accuses abortion providers of, but an agenda nevertheless.

Why Field and Dorries are wrong

Nadine Dorries and Frank Field will propose an amendment to the Health and Social Care Bill to ensure that women receive pre-abortion counselling from someone who does not ‘have a financial interest’ in providing the abortion.

In an interview on LBC radio on Friday evening (no link possible as it's subscription only) Dorries laid bare the assumptions behind this amendment. An interview with Michaela Aston of LIFE showed how eager anti-abortion organisations would be, in the event it became law, to exploit it for their own ends.

Assumption 1: Women seeking abortion all need Counselling (big C)

In fact women considering abortion all need different levels of support to ensure they are making the right decision.

At one end of the spectrum you will encounter women who have always been clear that they do not want to be pregnant and that they would have an abortion in the event of pregnancy. When they experience pregnancy this certainty remains and they are able to make a quick and unambivalent decision to end the unwanted pregnancy.

At the other end of the spectrum are women who are carrying wanted pregnancies, but whose health, circumstances or other factors mean that the continuing the pregnancy now carries serious risks for them. This may present an excruciating decision for the woman and she may require a great deal of professional and family/partner support during this time.(Antenatal Results and Choices – ARC – provides excellent support for women who have been given a diagnosis of fetal anomaly)

In between these two ends of the spectrum women experience the dilemma of unintended pregnancy in a range of ways. Some have sufficient support around them to have the conversations they need to have and to do the thinking they need to do about the pregnancy before they even reach a healthcare professional. Others may present to a healthcare professional needing either more clarification of health issues or additional support with decision-making.

‘Counselling’ with a BIG C may be useful for a woman who presents with a range of complex emotional problems, when pregnancy has brought pre-existing and unresolved problems to a head, when she is particularly conflicted by the decision, or when a health care professional is anxious that they sense deep-seated ambivalence about the choice she is making. Counselling may be experienced as overkill by women in more settled situations.

Women’s circumstances are all unique, and their knowledge levels, support systems, age, confidence and other personal characteristics will all impact on the difficulty or otherwise of making the decision. Women seek help, support and advice from a range of people other than health care professionals and may well have done absolutely all their thinking before they go to their GP to ask for an abortion referral. Ideally flexibility and responsiveness from healthcare professionals and organisations should provide women with the level of support they choose and need. (see EFC Best Practice Tookit: Pregnancy Decision-Making Support for how best to support teenagers)

Assumption 2: Women who get an abortion from an independent abortion provider such as bpas and MSI do not get sufficient counselling or accurate information about risks because those organisations have a vested interest in pressurising women to have an abortion

No healthcare provider wants a woman to undergo an abortion she feels ambivalent about. Abortion services traditionally have a relatively high ‘did not attend’ (DNA) rate because women are reassured that they can change their mind at any time and some do. Moreover, BPAS calculates that 20% of women referred to them for abortion - having used their consultation appointment to reflect again on their decision - choose to continue their pregnancy.

The idea that they have a vested interest in women having abortions is linked solely to the fact that they are paid for the abortions they carry out. It is an undeniable fact that, like brain surgeons, GPs, dentists, opticians and all other health professionals, abortion providers are paid to do the work they do. They are professionals not volunteers...

Like all health providers, abortion providers are obliged to ensure informed consent by outlining risks and side effects of procedures. This is the same for people providing abortions in NHS hospitals, in independent non-profit providers such as bpas and MSI, and in Harley Street. In fact, abortion is highly regulated in non-NHS settings.

Assumption 3: The Royal College of Obstetricians and Gynaecologists which produces the guidelines for professionals providing abortions are not the appropriate body to do so because they too have a vested interest in promoting abortion.

The idea that the RCOG wants to promote abortion is, quite frankly ridiculous. The RCOG is engaged in developing and disseminating best practice across a wide range of areas relating to women's health, including: pregnancy and childbirth, maternal health, treatment for obstetric and gynaecological conditions and more. Abortion occupies a fraction of its attention.

The RCOG guidelines are evidence-based. They draw upon methodologically sound studies from around the world and UK experience to inform their conclusions and recommendations.

Abortion providers are included in the committee that creates the guidelines for professionals because it is normal practice to include medical experts on panels providing guidelines on a specialist area of medicine.

Assumption 4: Anyone who is not an abortion provider will give better support and information for women because they do not have a vested interest in ‘making’ a woman have an abortion

Some GPs will be able to provide good quality information and support with decision-making. In fact many women already go via their GP for an abortion referral and some will be getting information about abortion at that point. However, a significant number of GPs (at least one in 20% of GP practices) actively opposes abortion and may use their right to conscientiously object as licence to refuse to give accurate information and impartial support to a woman seeking abortion. This fact cannot have passed by the supporters of the amendment.

This amendment is part of a wider bill which is about giving GPs the power to decide on how much of the NHS budget will be used, it seems unlikely they will consider spending proper time counselling women about abortion the best use of their resources.

The anti-abortion charity LIFE's response to this amendment (via Aston on LBC) was little less than a licking of lips. Anti-abortion charities may well see this as an opportunity to 'help' GPs out by offering with their own particular brand of counselling via Crisis Pregnancy Centres.

Most independent pregnancy advice organisations or Crisis Pregnancy Centres (CPCs) originate from organisations that are very anti-abortion. While many different organisations run these centres and their practice varies enormously, the bottom line is that most people working for these organisations believe that abortion is at worst a moral abomination and at best harmful. Some are guilty of deliberately misinforming women about the risks of abortion, others of convincing women to continue unwanted pregnancies. There may be examples of CPCs that provide impartial, evidence-based advice and guidance, but as they are totally unregulated it is hard to know which of them do and which of them don’t.

No comprehensive study of Crisis Pregnancy Centres has been carried out in the UK, but this Channel Five news feature shows examples of particularly poor practice:

This report on CPCs from Ireland suggests they are not a reliable source of information

This report from United States outlines the many ways in which CPCs deceive women

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This is an extremely ideologically driven amendment. Dorries admits its purpose is to reduce the number of abortions. It is probably just the first of a planned programme of legislative attacks on women's right to choose and access safe, legal abortion.

This is why we oppose these amendments.

Hoping that GPs will step up to provide good quality counselling around abortion is either extremely naive or extremely cynical. Encouraging women to attend (or even insisting they attend) counselling at a separate provider, and bypassing central booking systems, will increase the time it takes to access an abortion. Creating unnecessary delays for women is unethical as abortions are safer the earlier in pregnancy they are carried out.

GPs are likely to mitigate the additional costs of providing this counselling by relying on voluntary organisations like CPCs (see above) who may have the funding to provide this free of charge.

It is unlikely that full funding for professional counselling will be mandated in the bill or that Field and Dorries will call for proper regulation of those providing abortion counselling in Crisis Pregnancy Centres.

It is unlikely any provision will be made to protect women from 'conscientiously objecting doctors'

This amendment is not about improving health outcomes for women, but is an attempt to dissuade women from accessing abortion, and obstructing those who do want to have one.

By casting doubt on the integrity of the Royal College of Obstetricians and Gynaecologists this amendment aims deliberately to undermine a really important source of evidence-based information - information they would rather the public didn't access, as it does not support the anti-abortion case.

There are more effective and more ethical ways to try to reduce the abortion rate than making access more diffcult and time-consuming, or giving women misinformation about the consequences.

If Nadine Dorries and Frank Field’s main aim is to stop women having abortions wouldn’t they be better off putting in an amendment to the health and social care bill that guarantees funding for all women to have easy access to the full range of contraceptive methods, including the three methods of emergency contraception, free of charge, seven days a week and at a range of outlets?

Wouldn’t they be better supporting calls for statutory, comprehensive Sex and Relationships - teaching young people about fertility, contraception, emergency contraception, pregnancy decision-making and encouraging them to think about the risks, benefits and consequences of sexual relationships?

Only today news came out that in the UK there are many preventable deaths of pregnant women each year from pre-eclampsia as a result of lack of investment in maternity services. If you really cared about women wouldn't this be the issue you might choose to campaign on?