2013-05-18T22:55:05-04:00 Clare Murphy http://www.huffingtonpost.co.uk/author/index.php?author=clare-murphy Copyright 2008, HuffingtonPost.com, Inc. HuffingtonPost Blogger Feed for Clare Murphy Good old fashioned elbow grease. tag:www.huffingtonpost.com,2012:/theblog//3.2285634 2012-12-13T19:00:00-05:00 2013-02-12T05:12:01-05:00

Clare Murphy http://www.huffingtonpost.com/clare-murphy/
The idea that it's "irresponsibility" which drives unplanned pregnancy - whatever the season - is misplaced. A recently conducted audit of all women contacting bpas for advice in 2011 found nearly two thirds were using contraception, including condoms, pills, patches and coils, when they became pregnant. Were the remainder - those who either admitted to using none or didn't give an answer - their more reckless contemporaries? Well maybe, and most people have taken chances at some point in the heat of the moment which they regret the next day.

Yet when you drill down into the reasons why women don't use contraception the picture is often more complex. In an age where infertility and IVF dominate the headlines, some women - both younger and older - significantly underestimate their ability to get pregnant, or believe they are infertile because of a diagnosis of polycystic ovary syndrome (PCOS) or an episode of Chlamydia, for example. We see women who have become pregnant not long after giving birth, not realising how quickly fertility returned, or after misinformation about the protection breastfeeding provides against pregnancy. Sadly we also see women who simply haven't been able to negotiate contraceptive use with a reluctant partner, as well as women for whom a much wanted pregnancy is no longer possible after a dramatic change in personal circumstances.

As it happens, we would never distinguish between the woman who has become pregnant when all thought of contraception has gone out of the window in the heat of the moment, and the woman whose LARC has let her down. Moreover, we do not distinguish between the woman who is visiting us for the first time, and she who is returning. Figures on "repeat abortion" are often pointed to as evidence that women are using terminations as a form of contraception, without any analysis or definition or what that means. No unwanted pregnancy is a carbon copy of the last but the term "repeat abortion" (with it's almost criminal connotations - think repeat offender) very much implies that these are back-to-back, identical events. "Repeat abortion" can be used to cover the most dissimilar of experiences: the woman who has an unplanned pregnancy when she forgets her pill at 21 and a "repeat" procedure at 40 after a serious problem is picked up with a much wanted pregnancy. "Repeat" is very unlikely to have much resonance for her.

But we also need to bear in mind how women's lives and expectations of motherhood have changed, and the impact that may have on the number of women undergoing more than one abortion. At 30, the UK now has the oldest average age of first time motherhood in the developed world. Many women strive to have achieved a certain level of security - in their job, finances and partnership - before taking on the significant responsibility of parenthood. But this does mean that many women are spending their 20s - the time when they are most fertile - not wanting to be pregnant. This combination of delaying motherhood, high fertility, and what we know about contraceptive failure rates (and our failure to always use it effectively) means it really isn't that surprising that the proportion of women having an abortion in their twenties who have already had one has increased.

It's estimated that about half of pregnancies in this country are unplanned - many of which will be greeted with joy and carried to term, while others will end in abortion. For one woman experiencing an unplanned pregnancy, an unstable job market and poor career prospects may make it the right moment to start a family - for another the same uncertain environment will make her certain that now is not the time for a baby. Unplanned pregnancy is not a marker of irresponsibility - it's a fact of life. The responsible thing for the rest of us to do is to ensure women have the space and support to make the decision about that pregnancy that is right for her.]]> tag:www.huffingtonpost.com,2012:/theblog//3.2017485 2012-10-28T19:00:00-04:00 2012-12-28T05:12:01-05:00

Clare Murphy http://www.huffingtonpost.com/clare-murphy/ recent report on breastfeeding suggested the NHS could save millions of pounds by encouraging more women to feed their babies naturally. An eye-watering array of figures arranged over more than 100 pages showed the cost-savings that would be made by reduced incidences of hospital admissions for both mother and baby through an increase in rates of breastfeeding.

Researchers have often found it hard to divorce the health benefits of breastfeeding for mother and baby from broader socio-economic factors that may make these families more likely to thrive in the first place. But even if we take the reported benefits and cost savings at face value, what is really lacking in the research around how women feed their babies is the reality of women's lives - and why women make the choices they do.

Some women may abandon breastfeeding because they have been given insufficient support - and if so that certainly needs to change. But many other women may choose to stop or reduce breastfeeds because of the physical burden and sleep deprivation, the desire to share care with their partner, or because they need to be able to time feeds to fit in with the needs of their other children. They do not discontinue breastfeeding because they do not want the best for their baby, but because this is their way of being the best mother that they can.

Feelings run high in the debate around breastfeeding, just as they do in other areas of women's reproductive decision-making. Ultimately, the scientific risks and benefits of one choice over another will only ever be one part of women's decision-making process as she weighs up what is best for her in the specific circumstances of her life.

By and large for example, women do not make decisions about ending or continuing a pregnancy based on the relative risks of childbirth versus abortion. They make up their minds on the basis of whether they are able to take on the significant responsibilities of bearing a child at that moment in their lives and whether they feel it would be right to do so. More than half of women having abortions are already mothers and they consider the impact of a further pregnancy on their existing family.

Even at the less fraught level of contraception, policy makers are often exasperated by women's "failure" to choose the most effective methods, such as implants and coils. As well as providing the highest level of protection against unwanted pregnancy, they are also the most cost-effective for the tax payer when compared to daily alternatives. Are women who decide against these making the wrong choice for themselves and the taxpayer? No, while they are a fantastic option for many women, others find the associated side-effects simply incompatible with their lives.

What matters in all these discussions around women's reproductive choices - from contraception through to feeding a newborn - is that they are just that - choices. Women's decision-making should be supported - and respected, not considered fair game for public judgement. Science and cost/benefit analyses can tell us much, but they will never be able to explain the needs and realities of a woman's own individual life and how it will quite rationally shape her decision making - that's something only she can know.]]> tag:www.huffingtonpost.com,2012:/theblog//3.1973369 2012-10-17T19:00:00-04:00 2012-12-17T05:12:02-05:00

Clare Murphy http://www.huffingtonpost.com/clare-murphy/
Moreover when it comes to the small number of women who need access to services after 20 weeks, their circumstances and reasons remain as compelling as ever. There is no need to revisit this issue: but the tragedy is that the energy spent discussing it detracts time and attention from genuine problems in women's reproductive healthcare. Were the MP for mid-Bedfordshire really as 'pro-woman' as she claims, here are some of the themes she could be tackling which affect women across the spectrum of reproductive needs.

Access to contraception
Some 40% of women using BPAS' contraceptive counselling service following an unplanned pregnancy report problems accessing contraception. Clinic closures or opening times inconvenient for working women or women with childcare commitments are frequently reported by the women we see, with women over-25 often getting a particularly raw deal as services are geared towards younger women. We have seen a rise in the number of women seeking advice about unplanned pregnancy not long after giving birth: our recent post-natal contraception survey found one in four women wanted more advice and support with contraception after a baby, and overall very few were given access to their choice of contraception from the full range of options.

Miscarriage management
One in four pregnancies end in miscarriage, which can be a particularly traumatic episode in a woman's life. Many of these women will experience "missed miscarriage", in which the pregnancy has ended but the womb has not expelled it - often meaning medical intervention is necessary. A recent campaign by the parenting website Mumsnet highlighted a range of problems women experiencing miscarriage can face - from inconsistent access to counselling services to a lack of choice in the medical methods available to manage the miscarriage. An Early Day Motion supporting the campaign was signed by dozens of MPs, although not everyone joined in.

Improving access to early abortion
Early Medical Abortion - "the abortion pill" - has transformed abortion services around the world. Two forms of medication are taken about two days apart. Akin to a natural miscarriage, it means women can avoid surgical intervention and any accompanying risks, and it can be used at some of the earliest gestations, when surgical methods may not be possible - so it has contributed to an increase in the proportion of early abortions. In the developing and developed world - including in France, Sweden and the US - women who meet the legal requirements for abortion can use the medication to expel the pregnancy in the privacy of their own home.

This is in keeping with recommendations from the World Health Organisation, which believes being able to do so contributes to confidentiality and comfort. But in the UK, regulations stipulate that women having abortions can only take the medication in a clinic or hospital, before being able to travel home. This increases the risk that they will miscarry before they get home. For many women, this combined with the sheer number of separate appointments makes this method impossible for them, particularly if they are working or live long distances from the nearest clinic - or need to keep their visits very private. A small change in the regulations could make a big difference to the many thousands of women' experience of abortion every year. (Nadine is not keen).

Reductions in midwife numbers
The Royal College of Midwives says 5,000 more full-time midwives are needed to ensure women and their babies receive the care they need. The shortages affect every region of England, according to the RCM. A recent report by the Care Quality Commission found one in seven of the 141 hospital trusts that provide maternity and midwifery services in England do not have the recommended one midwife for every 28 births. A recent survey showed that nearly a fifth of women polled said they felt unsupported during labour and birth.

So there are lots of areas a pro-woman MP with an apparent interest in reproductive healthcare could be usefully focusing on. Picking on overwhelmingly vulnerable women who need access to later abortion services really isn't one of them.]]> tag:www.huffingtonpost.com,2012:/theblog//3.1962179 2012-10-14T19:00:00-04:00 2012-12-14T05:12:01-05:00

Clare Murphy http://www.huffingtonpost.com/clare-murphy/

BPAS is launching the first ever nationwide campaign in support of women's choice. Recent comments by cabinet ministers combined with an upsurge in anti-abortion activity outside clinics show we cannot take for granted that the women we know will always have access to the services they need, when they need them.

The discussion about abortion exists at a number of levels, but rarely does it reflect the reality and diversity of the tens of thousands of women who come to us for advice about unplanned pregnancy every year. Sadly stereotypes often prevail - women are often cast as feckless and irresponsible for seeking abortion after finding themselves with an unwanted pregnancy - or career women interested only in their own personal goals. Recent comments and campaigns by politicians opposed to abortion often imply that women do not know what they are doing when they request abortion and need protecting from themselves, or that what they are doing is morally wrong - and that their pregnancies need protecting from the women themselves.

One in three women will have an abortion in her lifetime. They are not a particular 'type' of woman, they are everywoman - of all ages and all circumstances. Contraception fails, and sometimes we fail to use it properly. Amid incessant talk of infertility, many women - both young and middle-aged - underestimate how easy it is to get pregnant. BPAS sees women with unplanned pregnancies not long after giving birth, having been told that breastfeeding provides effective contraceptive protection. We also see women whose lives have been turned upside down when a problem is found with a much wanted pregnancy, or when personal circumstances change so much that a planned pregnancy can no longer be carried to term.

These women do not have abortions because they do not know what they are doing, or because they have no sense of right and wrong. They have abortions because it is the right thing for them and their families at that time in their lives. Only the woman herself can make that judgment - not the banner-bearing protester outside, the health secretary - or even the doctor providing her care.

These women will be mothers, daughters, sisters and friends. They will be women we all know, and that is what we hope to bring home with our campaign. We live in a country where the majority of us support a woman's ability to make a choice when faced with an unplanned pregnancy, but where a vocal and determined minority have the potential to undermine women's access to care - if we are not careful.

Abortion is a fundamental part of women's reproductive healthcare - for all the women in our lives, let's make sure we protect it.]]> tag:www.huffingtonpost.com,2012:/theblog//3.1936092 2012-10-03T19:00:00-04:00 2012-12-03T05:12:02-05:00

Clare Murphy http://www.huffingtonpost.com/clare-murphy/
The British Pregnancy Advisory Service (BPAS) carries out the majority of later abortions in this country. Our staff would have been more than happy to explain to the women's minister just what kind of impact restricting access to abortions after 20 weeks would have on the small numbers of women who need them.

For one, it's fairly unsettling that a minister of state appears so misinformed about science. While survival rates for babies born at 24 weeks and beyond have improved, sadly for the parents who deliver much wanted babies before that point, the prospects remain extremely poor. But the science - or lack of - is only part of the picture here. This is about real women's lives.

Around 2% of all abortions in England and Wales last year were carried out past 20 weeks. The numbers are relatively small but each one comes with their own story that always gets lost in the statistics. BPAS carries out the majority of these abortions, our doctors and nurses providing the most compassionate care possible to women who are often in the most unenviable circumstances.

These women rarely tell their stories, which provides a vacuum that gets filled with assumptions about the kind of women they must be. Who would end a pregnancy at that stage? For a period of one month, we asked staff to keep an anonymous record of the women they saw needing these later abortions.

In just a couple of lines, a story unfolds. Girls who had hidden their pregnancies so long they were on the cusp of the time limit: "15-year-old who had sex for the first time to see what it was like. Thought she might be pregnant but "buried her head in the sand hoping it would go away". She started to self-harm: punching herself in the stomach and making herself vomit. Mother took her to GP suspecting bulimia and the pregnancy was detected." But the stories stretch across women of all ages in all sorts of circumstances. "Mother is in a longstanding relationship, and has three children, one with Down's Syndrome. She has known about her pregnancy and felt that abortion was her best option for "some time", but as her child with Down's Syndrome was scheduled for major surgery, she had to "push it to the back of [her] mind" until the surgery was over"... "University student being treated for depression. She thought her weight gain and nausea were side-effects of her medication, and went to GP to request a different prescription. GP diagnosed her pregnancy"... "This mother has two young children. This pregnancy was unplanned but her current partner had persuaded her to continue. She then found out that he was abusing her children."

It's hard to know which of these women Maria Miller would deny, and why she thinks she is better placed to make a moral decision about their predicament than they themselves.

Early access to abortion services is extremely important. Thanks to tests which can detect pregnancies before a woman has even missed a period, women who know they do not want to continue with their pregnancy can now often refer themselves directly into services, with their care paid for by the NHS. The arrival of Early Medical Abortion - the 'abortion pill' - means women are able to end pregnancies at some of the earliest gestations, without surgical intervention and its accompanying risks.

Abortion is a very safe procedure - inevitably safer than ongoing pregnancy and childbirth - but the earlier it can be carried out the lower the risk to women. But no matter how early and swiftly women can access services, there will always be women who need later care. Our women's minister is absolutely entitled to her own personal convictions about abortion - but she should think hard before she sacrifices these women to assuage her own moral qualms.]]>