Imagine the outcry. A charity offering a common medical procedure – 70,000 a year, more than in the NHS itself – is found guilty of terribly poor standards of care. You’d expect some calls for the chief executive’s head; others claiming this represents the creeping privatisation of the NHS; and serious questions asked about how NHS commissioners were unaware of the issues.
This did, in fact, happen last year. The charity was Marie Stopes International and the procedure was abortion. The Care Quality Commission found serious problems. Staff responsible for getting consent from pregnant girls under 16 were not trained in recognising signs of child sexual abuse. Doctors left clinics before all patients had been discharged, leaving them with nurses untrained to deal with emergency situations. And inspectors observed a case where doctors failed to ensure a visibly distressed woman with a learning disability understood the procedure she was about to undergo when seeking consent.
The CQC’s report was rightly couched in the neutral, objective tones of a regulator. But for believers not just in a woman’s right to choose but her right to safe healthcare, it was an upsetting read. Marie Stopes voluntarily suspended some of its services straightaway as a result. (They’re now up and running again, having satisfied the CQC they have addressed their concerns.)
But its initial media response left much to be desired. A spokesperson characterised the problems as ones of governance and protocol and said they did not endanger the safety of women. Its chief executive declared its intention to regain full assurance from the CQC within a few days, hardly the sign of an organisation on top of serious failings. Yet with one or two exceptions , this was met by women’s rights campaigners with overwhelming silence. No pro-choice voices expressed outrage or demanding accountability for these failings in women’s care.
I have friends who found it an easy decision, others agonising. The debate feels dominated by two extremes
Our abortion debate in the UK is – thankfully – nowhere near as fraught in tone and tenor as in the US. But the broader reaction to the Marie Stopes case reveals how little room it has for nuance. In saying nothing, the pro-choice lobby left the way clear for the religious right to brazenly assert that our abortion law isn’t fit for purpose. They’d have done that anyway, but it’s a sad indictment that most commentary on this case came from a few blogs on religious websites.
The case raises issues that have gone unaddressed. The CQC gives hospitals and GP surgeries, unlike abortion clinics, a clear rating that tells patients whether they are outstanding or inadequate. Surely women have the right to know this about the clinic where they are getting an abortion? The good news is that the government has signalled that this may be about to change.
It also raises lack of parity in regulation of physical and mental health services. The debate about abortion counselling has become dreadfully polarised: anti-abortion campaigners such as Nadine Dorries argue that a charity providing abortion services cannot offer truly independent counselling because they are open to accusations they’ll use that counselling to pressurise women into using their services.
I don’t believe for a minute that charities such as Marie Stopes would set out to offer biased counselling: it would be a betrayal of its charitable mission. But like all forms of counselling and psychotherapy, abortion counselling isn’t subject to independent regulation. Anti-abortion organisations such as Life can offer independent counselling with no regulation at all. And given the issues uncovered by the CQC at Marie Stopes, it’s fair enough to ask questions about the quality of its counselling service. Because it’s unregulated, we just don’t know.
This nuance risks getting lost altogether. Many pro-choice campaigners argue that the media overdramatise abortion as more psychologically difficult for the average women than it really is. It does, but there’s no one size fits all. I have friends who found it an easy decision, others agonising. The debate feels dominated by two extremes: the belief that abortion is the worst thing that can ever happen to a woman and the idea that every woman saunters out of her appointment whistling.
A woman’s right to choose is the product of a hard-won fight. In that context, I can understand how demanding a better regulatory regime for substandard providers or introducing tougher counselling standards might feel like ceding ground. But what if our morally fraught debate means we neglect the equally important question about whether women are getting the quality of care they deserve?
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The increasingly polarised debate on abortion imperils women | Sonia Sodha
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