Abortion

Summary

The requester asked for documents provided to the Minister regarding the feasibility of amending the Isle of Man's Abortion legislation. The Department of Health and Social Care disclosed a feasibility report titled 'Termination of Pregnancy (Medical Defences) Act 1995: Feasibility of an Amendment Bill during the 2017/18 legislative session'.

Key Facts

• The current abortion legislation in the Isle of Man was enacted in 1995.
• A previous review attempt by a DHSC sub-committee in 2005 did not result in comprehensive proposals.
• The disclosed document compares Isle of Man laws with other jurisdictions in the British Isles and Gibraltar.
• The report analyzes clinical evidence regarding the physical and mental health impacts of termination.
• The Department was asked to recommend whether to progress an Amendment Bill or conduct further public engagement.

Data Disclosed

• 1995
• 2005
• 2017/18
• 2017-01-26
• 2017-02-06
• 12 pages
• 1 document
• 355131
• IM75662I

Data Tables (1)

Full Response Text

Department of Health and Social Care

Rheynn Slaynt as Kiarail y Theay

REQUEST UNDER THE FREEDOM OF INFORMATION ACT 2015 (“the Act”) Thank you for your request dated 26th January 2017. You asked for: I would like an answer to the following question please:

“With reference to the Minister's recent declaration that the department had enquired but had found no evidence that any changes were required to existing Abortion legislation”

Question 1 - I would be most grateful if I could receive a copy of the information that the department provided to the Minister along with any background documents or references.

We are pleased to be able to provide a response to your request with an answer to your question:

Question 1 - I would be most grateful if I could receive a copy of the information that the department provided to the Minister along with any background documents or references.

The following document ‘Termination of Pregnancy (Medical Defences) Act 1995: Feasibility of an Amendment Bill during the 2017/18 legislative session’ is enclosed in response to your question.

Alternatively the aforementioned document may be accessed from the following link provided: https://www.gov.im/media/1354907/termination-of-pregnancy-medical-defences-act- 1995-feasibility-of-an-amendment-bill-during-the-2017-18-legislative-session.pdf

Chief Executive Malcolm Couch

Department of Health & Social Care Chief Executive’s Office Crookall House Demesne Road Douglas Isle of Man, IM1 3QA

Direct Dial No:

(01624) 656071 Email:

FOI.DHSC@gov.im
Website:

www.gov.im/dhss Date:

06th February 2017

FOI Reference:
IM75662I

Page 1 of 2 FOIA/DHSC/13

Your right to request a review
If you are unhappy with this response to your Freedom of Information request, you may ask us to carry out an internal review of the response, by completing a complaint form and submitting it electronically or by delivery/post to the FOI Co-ordinator, Department of Health & Social Care, Chief Executive’s Officer, Crookall House, Demesne Road, Douglas, Isle of Man, IM1 3QA.
An electronic version and paper version of our complaint form can be found by going to our website https://www.gov.im/about-the-government/freedom-of-information/how-to-make-a- freedom-of-information-request/ Your review request should explain why you are dissatisfied with this response, and should be made as soon as practicable. We will respond as soon as the review has been concluded.
If you are not satisfied with the result of the review, you then have the right to appeal to the Information Commissioner for a decision on;
01. Whether we have responded to your request for information in accordance with Part 2 of the Freedom of Information Act; or
02. Whether we are justified in refusing to give you the information requested.
In response to an application for review, the Information Commissioner may, at any time, attempt to resolve a matter by negotiation, conciliation, mediation or another form of alternative dispute resolution and will have regard to any outcome of this in making any subsequent decision.
Further information about Freedom of Information requests can be found on the Information Commissioner’s website at: https://www.inforights.im/information-centre/freedom-of- information. Should you have any queries concerning this letter, please do not hesitate to contact us. Yours Sincerely

Freedom of Information Team Department of Health and Social Care

Page 2 of 2
FOIA/DHSC/13 1  

Termination of Pregnancy (Medical Defences) Act 1995: Feasibility of an Amendment Bill during the 2017/18 legislative session 1. Introduction The current legislation on termination of pregnancy was enacted in 1995. There was an attempt at review (undertaken by a DHSC Termination of Pregnancy Policy Sub- committee) in 2005 but this was far from comprehensive, did not deliver any choate proposals and did not progress, as far as can be judged from the available documentation.1 The Isle of Man legislation is now over 20 years old. Considering the legal position elsewhere in the British Isles, the Isle of Man legislation is more restrictive than some jurisdictions but less restrictive than others. Termination of pregnancy is an emotive issue which elicits strong responses both for and against. Views of the public (and, indeed professionals) fall along a spectrum from (to simplify) ‘a woman’s right to choose’ through to ‘the right to life of the unborn’. There is no ‘right’ or ‘wrong’ position that can be determined solely on objective evidence of, for example, physical or mental harms resulting from termination versus continuation of pregnancy. This paper summarises: the current position and that of other jurisdictions in the British Isles and Gibraltar; the evidence for clinical impact of termination of pregnancy on physical and mental health; the position of groups with a particular interest in abortion on the Isle of Man; the current review of the legal position in Ireland and the legal challenge to that in Northern Ireland; and indicators of demand for termination of pregnancy from Isle of Man women. The Department is asked to take a view on whether, in the light of this paper, it feels able to make a policy recommendation to the Council of Ministers with a view to progressing an Amendment Bill or whether it considers that further work is required, including, for example, some form of public engagement/consultation.
2. Overview of Isle of Man Legislation and Legislation elsewhere in the British Isles and Gibraltar 2.1. Termination of Pregnancy (Medical Defences) Act 1995, Isle of Man The 1995 legislation provides a defence against prosecution under the Criminal Code 1872 for medical practitioners who terminate pregnancies in the circumstances set out in the Act. In effect, the 1995 Act, makes termination of pregnancy legal where the                                                             1 Minutes of the meeting of the Termination of Pregnancy Policy Sub-Committee, 23 May, 2005. Department of Health and Social Care Rheynn Slaynt as Kiarail y Theay 2   surgeon who will terminate the pregnancy and an independent medical practitioner (who must be a consultant psychiatrist where there is a risk to mental health) agree that:  Continuance of the pregnancy involves substantial risk to the woman’s life (greater than would termination);  The termination is necessary to prevent grave permanent injury to the physical or mental health of the woman;  The termination is necessary to preserve the life of the woman; Terminations under these grounds can be carried out without time limit. However, if the pregnancy has exceeded 24 weeks, the surgeon is required to undertake the procedure in the manner most likely to preserve the life of the child. Termination is also legal where the medical practitioners consider there is substantial risk that the child will either not survive birth, will die shortly afterwards or will be seriously handicapped. There is no legal definition of substantial risk or serious handicap and this has not been tested in court (here or elsewhere). Termination on these grounds must be undertaken before 24 completed weeks of pregnancy. Pregnancies resulting from rape, incest or sexual assault may also be terminated within the first 12 weeks. In addition to assessment by two medical practitioners, the woman must also provide an affidavit attesting to the cause of the pregnancy and must have made a complaint to the police. The Isle of Man is unique (among those jurisdictions in the British Isles and Gibraltar where termination is legal) in making pregnancy resulting from sexual crime a separate category requiring additional action on the part of the woman to substantiate. Terminations on social grounds are not allowable under the 1995 Act. However, it is not illegal for women to travel abroad for terminations in jurisdictions where it would be legal, or for information about the availability of terminations abroad to be provided to women on the Isle of Man. 2.2. Comparison of the 1995 Act with legislation elsewhere in the British Isles and Gibraltar Across the British Isles and Gibraltar: Ireland; Northern Ireland; England, Scotland and Wales; Guernsey; Jersey; and Gibraltar have their own legislation for termination of pregnancy.
Induced abortion is currently illegal in Ireland and Gibraltar (unless necessary to preserve the life of the mother). In Ireland, the right to life of the unborn, with due regard to the right to life of the mother, is enshrined in the Constitution (8th Amendment, 1983). In Gibraltar, termination of pregnancy is illegal under the Crimes Act 2011.
Northern Ireland still follows the Offences Against the Person Act 1861 in respect of procuring abortion. However, as a result of a subsequent legal judgement (R v. Bourne 3   [1939] KB 687, per Macnaghten J at 694) termination is legal if the doctor considers that continuation of the pregnancy will make the woman ‘a physical or mental wreck’. In England, Scotland and Wales, termination is legal, up to 24 weeks, on the grounds of risk to the physical or mental health of the woman or any existing children – effectively enabling termination on social grounds. In addition, termination is permitted to prevent grave physical or mental injury to the woman, or where there is risk to life of the mother or substantial risk of serious handicap in the child (physical or mental). There is no time limit to termination on these grounds. There is no specific provision for pregnancy resulting from sexual crime although this would be covered under the other provisions. (Abortion Act 1967) Jersey permits termination up to 12 weeks where the pregnancy is causing distress to the woman and she has been counselled as specified in the Termination of Pregnancy Law 1997. Termination is also legal to save the life of the woman (at any point in pregnancy); or to prevent grave or permanent injury to her physical or mental health or where there is risk of serious handicap in the child (up to 24 weeks of pregnancy). (Termination of Pregnancy (Jersey) Law 1997) Guernsey law (The Abortion (Guernsey) Law 1997) provides for termination up to 12 weeks where continuance of the pregnancy would involve risk to the physical or mental health of the woman or any existing children of her family. Termination is also legal without time limit to preserve the life of the mother or to prevent grave permanent injury to the physical or mental health of the woman. Termination for serious handicap is legal up to 24 weeks. Comparing the current position in the Isle of Man with the other jurisdictions, the Isle of Man has a less restrictive legal framework than Ireland, Northern Ireland or Gibraltar but is more restrictive than Jersey, Guernsey or England, Scotland and Wales (where termination on social grounds is permitted). The position of the different jurisdictions is summarised in table 1. 4   Table 1. Legal basis for termination of pregnancy across the British Isles and Gibraltar – summary table. Jurisdiction (Law) Grounds for termination Immediate need to preserve life of mother Prevention of grave permanent injury to physical or mental health of woman (Time limit) Risk to physical or mental health of the woman or existing children greater than from continuance of pregnancy(social grounds) (Time limit) Significant risk of serious handicap in child Pregnancy resulting from sexual crimes Isle of Man (Termination of Pregnancy (Medical Defences) Act 1995) Yes Yes
No Yes (24 weeks) Yes (12 weeks) England, Scotland, Wales (Abortion Act 1967) Yes Yes (no time limit) Yes (24 weeks) Yes (no time limit) Would be covered by other grounds Jersey (Termination of Pregnancy (Jersey) Law 1997 Yes Yes (no time limit) Yes (distress –12 weeks) Yes (24 weeks) “ Guernsey (The Abortion (Guernsey) Law, 1997) Yes Yes (no time limit) Yes (12 weeks) Yes (24 weeks) “ Northern Ireland (Offences Against the Person Act 1861) Yes Yes – as a result R v. Bourne [1939]
No No No Gibraltar (Crimes Act 2011) Yes No No No No Ireland (Constitution
8th Amendment, 1983) Yes No No No No *Grounds without time limit but if carried out after 24 weeks, surgeon must take appropriate actions to preserve life of child 3. Evidence of physical or mental harms resulting from termination of pregnancy There is a lack of high quality, prospective studies to enable robust conclusions about the impacts of termination of pregnancy on long term physical (including reproductive) or mental health. 5   A systematic review by the Academy of Medical Royal Colleges concluded that, subject to the limitations of the available evidence:  The rates of mental health problems for women with an unwanted pregnancy were the same whether they had an abortion or gave birth.  An unwanted pregnancy was associated with an increased risk of mental health problems.
 The most reliable predictor of post-abortion mental health problems was having a history of mental health problems before the abortion.
 The factors associated with increased rates of mental health problems for women in the general population following birth and following abortion were similar.
 There were some additional factors associated with an increased risk of mental health problems specifically related to abortion, such as pressure from a partner to have an abortion and negative attitudes towards abortions in general and towards a woman’s personal experience of the abortion.2 A retrospective cohort study of reproductive outcomes (in subsequent pregnancies) in women who had previously undergone a termination of pregnancy between 1981 and 2007 was carried out in Scotland.3 The study compared the outcomes in the subsequent pregnancy for 120,033 women who had had a termination of pregnancy; 457,477 women whose previous pregnancy resulted in a live birth; and 47,355 women who had had a miscarriage. The study found that risk of preterm birth after termination is lower than that after miscarriage but higher than after a previous live birth. This risk is not increased further in women who have had two or more terminations. Surgical but not medical termination may be associated with increased risk of spontaneous preterm birth compared to first pregnancies. A literature review did not find evidence of any effect on subsequent fertility or risk of ectopic pregnancy unless the termination was complicated by infection.4 The evidence of harm from termination of pregnancy compared to continuance of an unwanted pregnancy is, therefore, inadequate to drive clinic

[Response truncated — full text is 31,082 characters]