Keeping abortion decisions in context

The revelation in the UK's Sunday Times newspaper (6 June 2010) that some assisted conceptions end in abortion was bound to cause consternation.

Increasingly, abortion has become accepted as a necessary back-up to contraception, essential to help women avoid unplanned, unintended pregnancies. But the abortion of carefully planned, deliberately conceived pregnancies does not fit into this framework of understanding. Human Fertilisation and Embryology Authority (HFEA) member Professor Bill Ledger seemed to represent, as he often does, the voice of common sense and reason when he observed that women whose conception is assisted, 'can't be surprised to be pregnant', because, 'you can't have an IVF pregnancy by accident'.

When the Sunday Times contacted me for comment, it was to discuss whether these abortions were a consequence of unscrupulous infertility doctors 'rushing' women into ill-considered treatment; a lack of counselling offered to women seeking treatment; or a sign of a 'throwaway' consumerist society where pregnancy might seen as nice one day and nasty the next.

But the explanation is obviously none of the above. The truth is that women who have help to become pregnant are still exposed to all the difficult stuff of life that blows ordinarily fertile women off their planned reproductive course.

People tend to overlook the complexities of reproductive decision-making faced by each couple in their own individual world of personal circumstances. We tend to categorise pregnancy neatly as 'wanted' or 'unwanted', 'planned' or 'accidental'. In real life, things are rarely so clear. Some accidental pregnancies are welcomed. For some women, the fact that a pregnancy is intended and wanted at conception, does not mean that it will remain wanted as the weeks progress. Just as unintended pregnancies can, and do, become wanted. So planned, carefully-conceived pregnancies can become unwanted. The use of a technology to assist the conception does not protect it from this.

It is not unusual for bpas (British Pregnancy Advisory Service) clinics to see women requesting an end to a planned and wanted, naturally-conceived pregnancy that has turned into a life crisis. Sometimes the fetus is affected by a serious abnormality. But sometimes it is the woman's life that changes so that she faces a totally different kind of motherhood to that she planned. Perhaps a relationship breaks down, the family loses its income, an existing child becomes ill, a parent requires care.

Assisted conception does not come with a guarantee that those who use it will be protected from all the problems that close in on the rest of us. On the contrary, assisted conception can bring extra pressures to bear on a relationship. Some couples claim their relationship is strengthened, others find it shattered.

For some women, it is only when they find out they can conceive that they can consider whether a baby is what they want. The 'crisis of choice' is an issue that abortion providers are familiar with in a mirror-image context. Every clinic, every week, sees women who are adamant that an abortion is their only option, until the appointment is made, the theatre is prepared and they have the capacity to decide whether it is truly what they want. Then, the wanted end to the pregnancy becomes unwanted.

There is no scandal of post-IVF abortion that requires an inquiry or investigation. The Sunday Times discovered that of 22,856 successful pregnancies following assisted conception just 0.7 per cent were terminated. This compares with around a quarter of all pregnancies which were conceived without help. This does not flag up warnings about poor quality care, or flippant consumerism. It highlights that for some women, a difficult reproductive journey continues even after a successfully achieved assisted conception. It should prompt us to appreciate all the more the complex and complicated decisions couples must make for themselves and why we should not rush to judge them.