Thursday, 28 October 2010

Choose Life

A look at the latest round of anti-abortion campaigns

For some reason, Christian anti-abortion groups have chosen the 43rd anniversary of the Abortion Act to launch their latest campaign.

Christian Concern's Choose Life campaign includes adverts on London buses that feature a foetus, a vigil outside Parliament, a national Service of Lament led by former Bishop of Rochester Nazir-Ali and screening an American documentary about what they call the 'abortion industry', showing 'the devestating effects abortion has on women'. Presumably, the people who chose the slogan have never seen Trainspotting.

Christian Concern (CC) said that 'For too long abortion has been a taboo subject, a situation that only compounds the problems that abortion brings. It is time for society to face up to the hidden scale and consequences of abortion'.

It's ironic then, that Christian groups objected to a recent TV advert by Marie Stopes attempting to make the subject less taboo.

Catholic groups are supporting CC even though polls have shown that the majority of UK Catholics support a woman's right to abortion and contraception.

Not given to subtle tactics, CC likes big numbers: 'MPs and Lords who voted in the 1967 Act never imagined that within four decades seven million babies would have been aborted, or that the reasons for abortion would have been so relaxed over the years'. They like emotive language too. A tiny ball of cells is a long way off being a baby.

They have also commissioned a poll by ComRes.

The poll asks:
1. How many abortions do you estimate take place in Britain each year?

Only 3% of the 1000 respondents were roughly in the right area. It's not clear whether they were told how their responses would be used.

2. In fact, according to Government figures just over 200,000 abortions took place in Britain last year. Which if these statements best sums up your view on this statistic?
It is too high and ways should be found to reduce it
It is a reasonable number and no action needs to be taken to reduce it
Don't know

Two thirds (66%) of respondents thought it was too high.

They're right, it is too high. There is no supplementary question to find out whether people thought this for moral, religious or other reasons, which allows CC to interpret the results any way they like. Pro-choice supporters would say that the solution lies in education, contraception and unbiased open discussion. The Government is currently reviewing SRE (sex education); a government poll has found that 90% of parents are in favour of children being taught about contraception although 80% of teachers don't feel equipped to teach SRE well. So one way to reduce the abortion rate would seem to be to train teachers better to equip young women to avoid unwanted pregnancy.

Religious group Family and Youth Concern are objecting to the poll because it was backed by Durex, claiming that Durex has a vested interest. It's entirely possible that they do but FYC have interests of their own: 'young people do not need to be presented with a menu of sexual options from which they can make ‘informed choices’. Rather, the whole issue needs to be approached with honesty, modesty and within a clear moral framework that shows a proper respect for parents and for marriage.' Their interest is to promote sex only within marriage and only for 'childbearing'. Condoms reduce unwanted pregnancies, not abstinence and preaching.

Back to the poll. Education is not one of the options it offers. It continues (Warning - the dice are loaded):

3.Would you support or oppose each of these possible changes to the law on abortion?
A compulsory cooling off period between diagnosis of pregnancy and abortion, to ensure a mother is sure of her decision
78% of respondents supported this proposal.

A cooling off period would mean prolonging the suffering of many women and their partners, increasing health risks (if it's compulsory) and it also assumes that women have abortions on a whim. A cooling off period would also give pro-life advocates longer to work on the women. The use of the word 'mothers' is emotive and makes their intentions clear - a woman is a 'mother' from the moment of conception. However, around one in four pregnancies miscarry naturally, many in the first few weeks when the woman doesn't even know she is pregnant.

A woman's right, enshrined in law, to be informed of all the physical, psychological and emotional risks associated with abortion
89% of respondents supported this.

A legal duty on doctors to provide access to advice and information about alternatives to abortion, such as adoption.
82% supported this.

Of course women should be given all the options, presented in an even-handed, unbiased way, as well as being told about any consequences but only the real consequences, not the made-up, morally loaded, manipulative ones (I'll get to those in a moment).

4. Would you support or oppose each of these possible changes to the law on abortion?
A reduction in the number of weeks' pregnancy at which an abortion can be conducted, which currently is 24 weeks or just under six months, to a limit of 20 weeks or less.
61% agreed with the reduction.

This is what the questionnaire has been leading up to. CC want to reduce the number of abortions not by helping women (and their partners) to avoid becoming pregnant in the first place but by making it much harder for them to have an abortion when they do. The questionnaire does not inform the respondents how many abortions currently happen after 20 weeks so that they could make an informed choice about their response. In 2007, 89% of terminations happened before 13 weeks. In 2005, only 1.3% happened between 20 and 24 weeks. So CC's campaign to reduce the limit would have very little effect on the figures, which makes their poll little more than emotive propaganda.

Foetal viability was examined by the House of Commons Select Committee on Science and Technology in 2007. Foetal viability means survival of foetuses who are alive at variable times during the pregnancy or the capability of surviving the neonatal period and growing up into an adult. The Committee concluded that:

'While survival rates at 24 weeks and over have improved they have not done so below that gestational point. Put another way, we have seen no good evidence to suggest that foetal viability has improved significantly since the abortion time limit was last set, and seen some good evidence to suggest that it has not.'

This conclusion is shared by the British Medical Association and the Royal College of Obstetricians and Gynaecologists.

A spokesperson from Marie Stopes International told me: "Having an unplanned pregnancy is often a very difficult experience for a woman and her partner. At Marie Stopes International we provide couples with non-judgemental information about all their options to ensure women can make the right decision for them."

It's not like Marie Stopes and similar clinics are forcing abortions on women or that doctors are pushing them as the easy option. They are pro-choice, which means that any choice a woman makes is supported, not just the forced so-called choice that CC are promoting.

The spokesperson added: “Fortunately, in Britain, women have access to safe abortion care unlike in many developing countries where abortion remains illegal and complications from backyard abortions claim the lives of tens of thousands of women each year and leave more than two million women with lasting health problems.

“Encouragingly public support remains exceptionally high for the right to access safe abortion care with a recent YouGov survey finding that less than 9 per cent of people opposed the right to an abortion.

“We are working hard to reduce the number of unintended pregnancies by educating women about more reliable contraception methods such as the implant and IUD and provide them with access to contraception.”

With less than 9% opposing abortion, Christian Concern are not representing the moral majority or protecting millions of morally feeble women from themselves. They are yet another vocal religious minority group.

It's not just Christian Concern who are ramping up their campaigning. American-style protests are also becoming more common in the UK. A Texas-based group called 40 Days For Life has been holding protests outside Marie Stopes clinics in London. The campaigners are planning to hold 40 days of protest in the US, Australia, Denmark, Canada and Northern Ireland as well as the UK.

Some of the leaflets they are handing out to women outside the clinics warn about an increased risk of breast cancer following abortion. This is an old favourite of pro-lifers. As I wrote in July last year for example, the Christian Medical Fellowship (CMF) have long spread this lie.

There has also been increased activity in Europe by pro-life lobbyists, for example in scuppering the McCafferty report recommending that doctors' conscientious objection to abortion (among other things) should not be upheld at the price of women's health and well-being.

Tory MP Therese Coffey has tabled an early day motion that would force women who want an abortion on mental health grounds to get counselling and be warned of risks to their mental health. The psychological toll of abortion is another favourite of the pro-life campaigners. The CMF are also keen on the fact that abortion makes you mentally ill - even though the 'evidence' they cite says the complete opposite of what they claim.

CC and others like this two-pronged attack: abortion kills babies and threatens women's sanity and health. They're not much bothered about the effect of unwanted children on women's health.

In Northern Ireland, pro-choice campaigners at the first all-Ireland conference on abortion and clinical practice have called for the laws to be modernised. NI is the only part of the UK where abortion is still illegal. Protesters were of course out in force, led by a group called Precious Life.

One consequence of abortion being illegal in the Republic is that abortifacients are increasingly being illegally imported, despite the health risks of self-administering.

UPDATE: A Vatican official has said that voting for a pro-choice political candidate can never be morally justified.

Religious pressure is not going to stop women having abortions. Yes, there are too many at the moment. Abortion should be safe, legal and rare. The solution will be found in education, not indoctrination.

One bit of good news is that Education For Choice has launched the A Word Campaign to help educate young people so they can make an informed choice about abortion and contraception. They say: 'EFC believes that young people should not be lied to. School should be a place where they can learn to recognise the difference between values and evidence and to avoid conflating opinion and fact, sermons and science.'

Finally, in America, one couple going to an abortion clinic fought back against protesters and filmed the encounter.

Wednesday, 20 October 2010

HRT Cancer Scare - here we go again

Scare stories about HRT come round every few years. This time, according to the Daily Mail, HRT can now treble the chance of dying of breast cancer. Other shock headlines include 'Study shows HRT even riskier than thought'. The Washington Post goes with 'Hormones also raise death risk of cancer' and talks about 'powerful evidence'.

Menopause is still a taboo subject that a lot of women don't feel comfortable talking about, which makes it easier for myths and misunderstandings to spread.

If you read through to the end of some of the articles they do mention the stats but the headlines are what will stick in people's minds and may be the only part of the story they see - they are what's known as the take-away. A lot of people aren't that good at interpreting stats even if they get that far.

The headlines are based on research published in the Journal of the American Medical Association (JAMA). A study of 12,788 women for 11 years looked at women taking a combination of oestrogen and progesterone in a randomized placebo controlled trial.

Rowan Chlebowski of the Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center who led the analysis commented in the Washington Post that 'the risk in the study was low and barely met the threshold for being considered statistically significant' but he was 'confident that the risk was real'.

Barely Statistically Significant Cancer Risk! is not a headline you're likely to see. Even if such a headline existed, it's the C word that readers would remember. For cancer, there is no such thing as bad publicity.

The figures are these: in the placebo group there were 0.01% deaths and in the HRT group there were 0.03% deaths a year. That's 12 and 25 women in 12,000. The research also found that combination HRT was associated with more invasive breast cancers (0.42% of cases per year in the group as opposed to 0.34% in the placebo group).

With any apparently alarming statistics, it's the explanation of absolute and relative risk that rarely gets a look-in. If a disease kills two people in ten thousand one year and four people the next then the mortality rate has increased 100%. The chance of dying is still only four in ten thousand but that doesn't make for a good headline.

During the 2008 HRT breast cancer scare, also based on research by Rowan Chlebowski, Behind The Headlines pointed out something news stories glossed over: "In addition, the authors of the study point out that the differences seen should be interpreted with caution, as they may have resulted from differences in health seeking behaviours in the two groups of women after the trial. Women who had been told that they had been taking combined HRT at the end of the trial and knew of the cancer risk may have been more likely to seek medical attention for any suspicious symptoms than women who knew they had only received placebo.

BTH also pointed out that, despite predictable scare headlines: 'the study was not directly investigating any link between breast cancer and HRT. Instead it looked at whether HRT increased the chances of detecting an abnormality on a mammogram that then required a biopsy for further investigation; this would not necessarily involve a diagnosis of breast cancer.

'The main finding of the study was that the diagnostic accuracy of mammography was decreased in women who had taken combination HRT.

'This study only investigated one type and one dosage of combination HRT'.

There are many different types and levels of dosage. For example, the combination of estradiol and dydrogesterone (oestrogen/progesterone) sold as Femoston in the UK increases the risk for women in their 50s of having a stroke from 3 in 1000 to 4 in 1000. The risk of blood clots goes up from 3 in 1000 to 7 in 1000. And the risk of breast cancer goes up from 32 in 1000 by the age of 65 to 38 in 1000 if they take it for 5 years.

The risks of HRT are real in the sense that they do exist and the latest research seems to indicate that they are higher than previously believed. Risks also have to be offset against benefits - any good GP will explain this. Some of the risks can be considerably lessened by lifestyle changes and regular check-ups. There is a good basic introduction to HRT here.

Here's another risk: in 2004, the lifetime risk of dying in a motor vehicle accident was 1 in 82 in the US and 1 in 240 in the UK. Killer Cars!

Sunday, 10 October 2010

Always let your conscience be your guide? Part 2

On October 7 the Parliamentary Assembly of the Council of Europe debated 'Women's access to lawful medical care'. The main concern was doctors' conscientious objection affecting women's access to abortion and family planning (including contraception and fertility treatment).

While recognising the right of individuals to follow their (usually religious) conscience, the debate and planned resolution happened because of a growing concern about the increasing and largely unregulated practice of refusing abortions. The intention was to get members states to introduce clear and comprehensive regulations. It did not go to plan.

In the majority of member states, there is little or no effective regulation in this area. The draft resolution proposed that only individuals should be allowed to opt out, not public or state institutions - hospitals and clinics. It also proposed that objecting doctors must give women full and unbiased information about all the options and refer them to a practitioner who would give them the procedure with the absolute minimum of delay. In emergencies or where there was no other doctor/clinic to refer women to, then the doctors should set aside their beliefs, put the patient's welfare first and carry out the procedure.

Under international human rights law, member states have a duty to ensure that healthcare providers' exercise of conscientious objection does not harm the health and rights of their patients.

Before the debate, Rapporteur Christine McCafferty prepared a report on the current situation in Europe. The report called for all medical personnel to state in advance any objections and a register of objectors to be established (as is currently the case in Norway).

Then the pro-life religious lobby weighed in. The resolution as adopted was so watered down that the religious lobby hailed it as a victory. The provisional Resolution 1763, re-titled 'The right to conscientious objection in lawful medical care' now begins: No person, hospital or institution shall be coerced, held liable or discriminated against in any manner because of a refusal to perform, accommodate, assist or submit to an abortion, the performance of a human miscarriage, or euthanasia or any act which could cause the death of a human foetus or embryo, for any reason.

It effectively gives primacy to conscience.

However, it was not quite the whitewash they are claiming as the vote was won by 56 votes to 51.

Sophia Kuby, a pro-life advocate and head of the group European Dignity Watch that lobbied hard against the McCafferty Report, said the vote “is a victory for common sense and for freedom” and “a great victory for Europe. Europe has made clear tonight that freedom of conscience constitutes a pillar of a democratic society that needs to be defended, at times also against a radical minority that wishes to limit freedom and impose a unique pro-abortion thinking in Europe. It is a great sign of hope that a majority has clearly voted against a radical pro-abortion, anti-freedom, anti-diversity lobby that tries to establish unhealthy and suffocating legislation.”

Not freedom for women but freedom for believers. Diversity is hardly well served if only certain people or organisations benefit. And it's ironic that the word 'healthy' was used when it's women's reproductive health under threat. It's not clear in what way lobbying to protect women's legal right to abortion is 'unique'. The McCafferty report did not for one minute suggest that doctors could not object, just that the situation should be regulated to protect both conscience and health needs. There was no promotion of abortion.

Gregor Puppinck, the director of the European Centre for Law and Justice (a Christian organisation), commented: "The Council of Europe reaffirms the fundamental value of human conscience, and of liberty in the face of attempts at ideological manipulation of science and of medicine. Independence of science and of medicine is also an essential value at the heart of democracies."

It's not clear how routinely putting religious conscience before women's rights makes science and medicine independent. Puppinck fails to see that he is trying to manipulate medicine to suit his own ideology. He also cites the Nuremberg trials, implicitly comparing pro-choice groups with Nazis.

Putting a doctor's beliefs always and inevitably before a patient's needs creates a hierarchy of values and rights.

The women most likely to be affected are those in remote or rural areas where it's hard to get to another doctor or hospital, often because there is no public or cheap transport, women on low incomes who cannot afford to travel long distances or go private, young women still living at home who may not want their parents to know and other vulnerable groups like women with learning difficulties. Unwanted teenage pregnancies can ruin young women's education prospects and cause social stigma both for her and the child.

Other risks include raised maternal mortality rates, the increase of unsafe and illegal abortions and an increase in HIV/AIDS and other STIs where practitioners refuse to supply information about contraception or condoms. It's not just women who suffer; their partners and children also suffer if the woman's health is affected, a family that cannot afford a child (or another child) will be pushed further into hardship and couples can be denied fertility treatments. It's not clear how some - if not all - doctors would explain their conscientious objections to patients without expressing personal judgement. Not every patient in a vulnerable condition would feel able to complain or stand up to such a response.

The European Centre for Law and Justice developed out of the American version, founded by evangelical Christians, but they are not the only religious influence at work. The Catholic Church is also, not surprisingly, involved.

I wrote about two of the more extreme versions of Catholic influence in May - in the US a nun was excommunicated for allowing a life-saving abortion in the hospital where she worked and last year there was the case of an abortion given to a nine year old Brazilian girl pregnant with twins after being raped, allegedly by her stepfather. The doctor, the medical team and the child's mother were excommunicated by Archbishop Don Jose Cardoso Sobrinho of Recife who said that "A graver act than rape is abortion, to eliminate an innocent life". The child was not excommunicated because she was a minor.

British organisations also lobbied against the McCafferty Report. Anthony Ozimic from one of them, the Society for the Protection of Unborn Children (SPUC) said, in characteristic emotive style, “This evening witnessed an incredible victory for the right of staff in medical institutions to refuse to be complicit in the killing of unborn children and other unethical practices."

McCafferty's report includes examples of the current situation and of how conscience clauses are being abused. In Croatia, for example, it is reported that doctors refuse abortions but then offer them privately - and charge for them. In Italy, nearly 70% of gynaecologists refuse to perform abortions on moral grounds and 50% of anaesthetists refuse to assist even though abortion is legal. In Slovakia and Poland, conscience clauses are often abused by top management who have unwritten policies banning abortions or sterilisations throughout the hospital whatever the rest of the staff think. There is a detailed report on how Slovakia is falling in with Vatican policy here. Another tactic is delaying so that the pregnancy goes beyond the legal limit for abortion.

It's not just Catholic countries where religious conscience is imposed to the detriment of women. In the UK in 2003, a High Court judgement found a doctor negligent for failing to give proper advice to a woman about her raised risk of having a baby with Down's Syndrome because he was a devout Catholic. Also in the UK, religious groups lobbied against a TV advert for the private Marie Stopes clinics as I reported in May.

The doctrine that religious groups attempt to impose on reproductive rights is not even supported by the majority of believers in some countries. In the UK, for example, seven out of ten Catholics support abortion and nine in ten support contraception.

The resolution has to be ratified by the Committee of Ministers, who include William Hague, before it becomes formal policy. His email address is should you want to write to him urging him not to pass this resolution as it stands. Conscientious objection can also affect other areas such as end of life choices.

The full Parliamentary Assembly document is here.

Part 1 was about conscience opt-out for pharmacists dispensing emergency contraception (morning after pill).

Wednesday, 6 October 2010

Master of all you survey

Torture numbers and they'll confess to anything
Greg Easterbrook

Since Domesday Book was compiled in 1086, large-scale data collection by survey has been part of government in this country. Can surveys based on self-reported information ever be reliable, whether it's an 11th century peasant reporting how many ducks she has to a Norman or a 21st century woman giving personal information over the phone or online? Are such surveys inherently any more reliable and honest than the 'personality' quizzes in teenage magazines? Not least among the factors influencing responses are the way questions are framed and how the respondent thinks the information will be used.

A recent survey for the Office for National Statistics (ONS) based on interviews with 450,000 people for an Integrated Household Survey (IHS) has been reported as finding that 71% of people in the UK are Christian and 20% have no religion, 1.5% are gay or bi and nearly 80% perceive themselves to be in good health. (All IHS statistics are considered experimental until assessed by the UK Statistics Authority).

The IHS asked respondents 'What is your religion, even if you are not currently practising?' with the intention of discovering 'religious affiliation - that is identification with a religion irrespective of actual practice or belief'. Not surprisingly, this has been reported as 71% are Christian.

Another survey by the ONS in 2008 found that only 22% described themselves as Christian and 45% said they had no religion.

The 2011 census will include the question 'What is your religion?'. This question was asked in the 2001 census and before that only in 1851. There has been controversy about the result of the 2001 census where 71% of people self-reported as Christian. Many of these, it is believed, identify as culturally rather than religiously Christian. Most of them rarely go anywhere near a church. According to a survey done by the Church of England, only 5% go at Christmas and 2.8% at Easter - the most important Christian festival.

Less seriously, 0.8% of people put their religion as Jedi in 2001 which offically makes them a bigger group than Sikhs, Jews or Buddhists in the UK.

The ONS deputy director said that the religion question in the next census would be 'a fabulous insight into societal changes to see how people register their religion'. Registering it is of course not the same as actively practicing it. And is 'fabulous' the best word to use for such a serious project?

Both religious and non-religious groups use these surveys in their campaigns to demand or challenge legal, financial and educational privileges, and governments use the findings to decide on funding, among other things, so they are more important than being of passing cultural interest. The widely differing findings are hardly a solid basis for policy or anything other than reflecting how variable survey findings can be.

People can and do change their minds about what they believe (although probably not so many of them in such a short space of time) but sexuality is a little less mutable.

The gay/bisexual statistic in the survey has led to headlines like 'Only one in 100 Britons is gay despite long-held myth' in the Mail.

It's inevitable that some groups will use stats to serve their own agenda and affected people will challenge them, especially if they have fought hard for equality.

One response to these findings on Facebook was '‎2,185,072 gay men and lesbians are currently registered on Gaydar in the UK - equating to 6.7 per cent of the UK population'.

More officially, in 2005, HM Treasury and the Department of Trade and Industry did a survey to help the Government analyse the financial implications of the Civil Partnerships Act (pensions, inheritance, tax benefits). They found that there were 3.6 m gay people in the UK – around 6% of the population. This figure was greeted by some gay rights activists as realistic.

If there are now only 1.5%, where have the other 4.5% gone since 2005? It should be noted that 3% of IHS respondents either said 'Don't know' or refused to answer. Again, the differences in survey results make basing any action on them a leap in the dark.

As to the 80% who 'perceived themselves to be in good health', what does this prove? Feeling well and being well are not the same thing at all for a start.

Even when stats are not used to tax the hell out of conquered Anglo Saxon peasants with very good reasons to be creative in their self-reporting, surveys are not like scientific tests. They are not reproducible in lab conditions, the methodology can be peer-reviewed but there can't be placebo questions, double blinding or a control group. At best, they can provide useful demographics, at worst they tell us nothing and can be used for propaganda. If you don't like the findings of the current survey, just hold on and there'll be another one along shortly.