Draft guidelines on childbirth issued this month suggest pregnant women at low risk of complications should be advised to give birth either at home or in a midwifery unit, rather than in hospital - which should be reserved for women at greater risk of problems. Many women may be thrilled at the prospect of home births becoming the preferred standard of NHS maternity care, but for other women the prospect of birth in their bedroom without ready access to effective pain relief or doctors may fill them with dread. When it comes to birth women should have access to unbiased, evidence-based information about all their options, delivered in a way that seeks to inform not persuade - with all modes of delivery on the table: from a drug-free delivery in her own home to a planned caesarean section if that is her preference. Birth is a monumental event in a woman's life, and her choices should be at the heart of the care she receives.
Women need to be the ones making their own reproductive decisions right the way through - from choosing contraception to experiencing pregnancy and childbirth. At the British Pregnancy Advisory Service we believe a woman faced with an unplanned pregnancy or a pregnancy she feels she cannot carry to term is the one best placed to make the very personal decision to end that pregnancy. We feel strongly that in the 21st Century abortion should no longer sit in the criminal law, with 2 doctors needing to legally authorise each women's request - not on the basis of what she feels is best for her and her family, but on what that doctor judges is in her best interests. As an organisation we act within the terms of the 1967 Abortion Act at all times, but would much prefer a system in which abortion was regulated like other areas of women's reproductive healthcare. Like childbirth, support and care could be provided by midwives and nurses where clinically appropriate and in keeping with a woman's wishes (indeed as it traditionally was), with doctors' involvement where requested or deemed necessary. Taking abortion out of the criminal law doesn't mean women have more abortions or end pregnancies at ever later gestations - as the example of Canada shows - but it does feel in keeping with a society which in every other way respects women's bodily autonomy and capacity to make her own decisions.
It's true, we might not always like or approve of those decisions. We may find morally challenging a woman's decision to deliver a complicated pregnancy at home, when the risks to the baby may be very high, there may be abortions for reasons we deem not quite "good enough", conversely we may find a woman's choice to have a baby at what appears to be an inopportune time not a decision we would make for ourselves - but they are not our choices to make. The only person who can make those decisions is the woman who must experience that pregnancy and bear the consequences of those choices.
There are not women who have abortions and women who are mothers. These are all the same women. One in three women will have an abortion, and more than half of women having abortions are already mothers. Women have abortions often they are not yet in the position to be the mother they want to be, or because they know that another child will stop them from being the mother that they are. We should stop compartmentalising these interconnected areas of women's lives, and let a commitment to women's choice and autonomy underpin the reproductive health services that women will need across the three decades they are fertile. Let's support her choices, and let's trust her to decide.
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