New guidelines on abortion were last night hailed by campaigners as a turning point in a service that has had to fight for legitimacy and is still often subject to stigma.
Ann Furedi of the British Pregnancy Advisory Service said the Royal College of Obstetricians and Gynaecologists document setting new standards for the NHS and private clinics was a clear sign that the medical profession, policy makers and society at large were beginning to accept abortion as part of essential reproductive health care.
She added: "Abortion may have been legal in Britain for 30 years but it has yet to be recognised as entirely legitimate and is often the subject of controversial debate. If the RCOG succeeds in establishing these principles of care nationally it will represent the 'coming of age' of abortion services."
The anti-abortion lobby is incensed by the suggestion that abortion could become respectable, and will shortly be even further angered by a booklet for children which the Family Planning Association plans to publish and distribute in schools. The booklet is in cartoon style and aimed at those in their early to middle teens. It describes what abortion is and the reasons why a girl might seek one.
Today's royal college guidelines, compiled by a group funded by the department of health, says abortion services should "provide high quality, efficient, effective and comprehensive care that respects the dignity, individuality and rights of women to exercise personal choice over their treatment."
Abortion is far more common than most people realise. Because of the stigma and shame attached, few women will talk about it, but the college points out that at least a third of women experience an abortion before the age of 45. Studies have shown that the majority are not young girls, but women in their twenties, and that a substantial number are older women who already have children. Organisations like the pregnancy advisory service - and the FPA with its booklet for children - think it is time for the normalisation of abortion which, they insist, nobody ever embarks upon lightly.
They are delighted that the college's guidelines emphasise the safety of the procedure. It is safer, the document states, than carrying a pregnancy to term, and complications are uncommon. But there is unequal access to abortion around the country and many women have to endure lengthy and distressing delays under the NHS. This, and the disapproval of some GPs, are the main reasons why many women resort to private clinics.
The guidelines state that no woman should have to wait longer than three weeks from her initial referral by the GP. Ideally, she should be offered an appointment for assessment within five days of referral and she should have the termination within seven days of her request being approved.
The document recommends that day care services should be provided because they are cost-effective and can minimise disruption to the lives of women and their families. Some clinics have begun a lunch-hour service, which has been castigated by critics. The royal college suggests no more than 10% will need an overnight stay.
Wherever possible, women who are admitted for an abortion should be treated separately from those who are pregnant and want their baby - particularly if they are having an ultrasound scan. Putting them together can be distressing for both. Health authorities should provide more information to let women know how to obtain an abortion and what options are available to them.
The document, The Care of Women requesting Induced Abortion, suggests that psychological trauma is more common in women who have been denied an abortion than in those who have had one. "Only a small minority of women experience any long term adverse psychological sequelae after abortion," it says. "Early distress, although common, is usually a continuation of symptoms present before the abortion. Conversely, long-lasting, negative effects on both mothers and their children are reported where abortion has been denied."
