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  • Title: The abortion scene: a second look.
    Author: McEwan J.
    Journal: Practitioner; 1983 May; 227(1379):759-64. PubMed ID: 6889243.
    Abstract:
    Since the Abortion Act of 1967 was passed in England, the Act has regularly been threatened, the numbers of abortions have steadily increased, and methods have changed little despite a vast volume of research. For various reasons abortions have not been successfully absorbed into the National Health Service (NHS) and questions have been raised about the relatively high British mortality rates, particularly during the earlier years. A substantial lobby opposed to induced abortion on religious or ethical grounds has developed and a series of private member's Bills have been introduced to provide more restrictive legislation. The government has made a small contribution to the anti-Abortion Act movement through the Regulations. Throughout the efforts to revise the law, general practitioners have maintained a steady groundswell of medical opinion favoring the 1967 Act. The mid 1970s provided some encouragement to the idea that the number of abortions would drop as the use of contraceptives improved, but figures up to 1980 show that the reduction was only a pause. The proportion of abortions performed on NHS premises has steadily declined from 68% in 1969 to 47% in 1980. This may be a reflection that the hospital service is not geared to respond to fluctuating demand. Resources have never been specifically increased to provide abortions in NHS hospitals, so there is some logic to this trend. Part of the reason may be rejection of the problem on the part of some hospital staff. A connection exists between numbers of abortions and the use of contraceptives which is evident every time the media display the discovery of a major health risk in using modern contraceptives. Each "pill scare" tends to be followed by a bulge in the numbers of abortions 3 months later. General practitioners must be aware of the fact that contraceptive service fails to reach young people effectively enough. Physicians also need to be confidently well informed in their care of women who are practicing contraception. Regarding techniques, it seems certain that the length of gestation will continue to be a critical factor. The feasibility of using the day care abortion services available in some NHS districts and in some private agencies depends on performing the abortion early in pregnancy. The NHS mortality rate remains unjustifiably high. The overall rate per 1000 women aged 15-44 years was 11.4 in 1974, 10.5 in 1976, 11.3 in 1978, and 12.6 in 1980. In the US from 1972-74 the overall mortality rate was 3.7/100,000 operations. A vigorously active management policy is needed to obtain an early NHS abortion. Both the hospital units and the general practitioners must provide the vigor.
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