Q&A: The abortion time limit and why it should remain at 24 weeks – the O&G perspective
Q1: What is the current abortion time limit?
A1: At the moment, it is legal to have an abortion in Great Britain up to the 24th week of gestation.
Q2: Why are there calls for the abortion time to be lowered?
A2: Those that want the abortion time limit to be lowered argue that the survival rate of premature babies has improved since 1990, the last time when the law was changed. According to them, medical science and technology have made it easier for premature babies born at 22 – 24 weeks to survive.
Q3: Do premature babies survive earlier now?
A3: No, a large scale study, EPICure, was undertaken in 19951 to examine the survival rates of premature babies born in the UK and Ireland at 26 weeks gestation and below. It tracked the progress and health of babies who survived into their tenth month.
The results were published in 2000 and showed that the survival rates of babies were better if they are born above 25 weeks. At 24 weeks, the hospital discharge rate was 33.6%. At 23 weeks, this was 19.9% and at 22 weeks, it fell to 9.1%.
It has been widely reported that the EPICure 2 study (currently waiting to be published) will show that the survival rate of premature babies has increased at 24 weeks and above but there are insignificant improvements at 23 weeks or below.
Based on the available and anticipated evidence on the neonatal survival rates of premature babies, at the moment, 24 weeks appears to be the threshold at which premature babies have a better survival rate.
Q4: Why do babies born below 24 weeks have lower chances of survival?
A4: If born before 26 weeks, many premature babies require very intensive and invasive care, including help with breathing and the removal of waste fluids from their bodies. This is because their lungs and metabolism are not fully developed yet (if they were still in their mother's womb they would be breathing and eating through their mothers). Their skin is also not fully formed and neither are many of the normal bodily functions you would find in a full-term baby. These babies therefore require round-the-clock attention and care in the first few months of their lives.
Q5: Recent reports claim that the neonatal survival rates of premature babies in selected hospitals show very promising results and further the case for the time limit being lowered.
A5: The RCOG is delighted whenever good results are recorded. However, with regard to looking at data from one or two neonatal units, and in exclusion to national results, a ‘wider' and more accurate picture cannot be derived.
Furthermore, the findings from these studies, though impressive, note that the majority of these premature babies have been transferred to neonatal intensive care units. It is well known that babies that are transferred tend to have a better chance of survival, especially after they have made it through the very precarious first 48 hours of life. If these babies find themselves in an environment where the prevailing ethos is to resuscitate at whatever costs, then these babies will have a better chance of survival. Likewise, neonatal survival would be better in units that have ready access to a range of specialist care and equipment.
These figures do not represent a true and unbiased picture of the survival rate of premature babies. For this to happen, it is important to look at figures of neonatal survival across the country, from all units.
Q6: Do premature babies born at these gestational ranges go on to have healthy lives?
A6: The EPIPAGE study in France2, which recently published its results, has shown that a large number of premature babies born below 26 weeks who survive go on to develop physical and learning difficulties with some requiring long-term support and care. This is true of babies in the UK too from the EPICure study of children born in 1995, these publications are widely available. In both countries, the rates of disabling conditions are much higher in babies of 23 weeks and below than at 24 or 25 weeks.
Q7: So why are some people still asking for the time limit to be lowered?
A7: Some individuals and groups associate the lowering of the time limit with a lowering in the number of abortions carried out each year. Currently, only 2% of all abortions carried out in the UK each year occur between 20 weeks and 23 weeks and 6 days, and these are carried out in instances where the women's or baby's health are at risk. The vast majority of abortions occur within the first trimester of pregnancy.
Lowering the time limit will not result in a lower abortion rate. Women who are desperate to have an abortion will look for the means to have one, and this includes having an illegal and unsafe abortion in their own countries or travelling to a country where late abortions are carried out.
Q8: So what is the link between viability and abortion?
A8: There is no link between viability with the calls for a lowering of the time limit, other than a very tenuous association. The issue of viability looks at the ability of babies to survive outside of the maternal womb. It examines the survival rate of premature babies. Medically, the longer the baby stays inside its mother (usually up to 40 weeks before birth), the better will be its outcomes. If a baby is born premature, doctors will do what they can to ensure its survival provided it is deemed to have a good chance.
The time limit on the other hand, is the cut-off point for abortions to take place. These are pregnancies which are unplanned and/or unwanted.
Q9: Apart from the argument about viability, why should the current time limit not be lowered?
A: There are many reasons why some women decide on a late abortion. The main ones are: an unplanned pregnancy, early pregnancy denial, late recognition of a pregnancy, a change in personal/financial circumstances, late referral to the abortion services, a late scan showing fetal abnormality. Keeping the abortion time limit at 24 weeks allows women who find themselves in the above circumstances with recourse to act on an unwanted pregnancy.
Q10: What is the RCOG's position on the time limit of 24 weeks?
A9: The RCOG believes that medical advancements have improved neonatal survival rates. However, there is currently a limit to successful interventions for premature babies which improve their survival rates. The abortion time limit should therefore stay at 24 weeks.
End notes and references
- Costeloe K, Gibson AT, Marlow N, Wilkinson AR. The EPICure Study: Outcome to discharge from hospital for babies born at the threshold of viability. Pediatrics 2000 Oct; 106(4):659-71
- Béatrice Larroque, Pierre-Yves Ancel, Stéphane Marret, Laetitia Marchand, Monique André, Catherine Arnaud, Véronique Pierrat, Jean-Christophe Rozé, Jean Messer, Gerard Thiriez, Antoine Burguet, Jean-Charles Picaud, Gérard Bréart, Monique Kaminski. Neurodevelopmental disabilities and special care of 5-year-old-children born before 33 weeks of gestation (the EPIPAGE study): a longitudinal cohort study; The Lancet 2008; 371: 813-820
This briefing was produced in May 2008