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    Twenty one years of legal abortion.

    Munday D; Francome C; Savage W

    BMJ. British Medical Journal. 1989 May 6; 298(6682):1231-4.

    The effects of the 1967 Abortion Act, legislation which extends to women living in England, Wales, and Scotland, are reviewed. The Act was not backed by any specific allocation of money for facilities or staff within the National Health Service and the service provided has varied from district to district. Yet, the number of abortions increased rapidly in the late 1960s and early 1970s. This process had slowed down by 1974, when the number of abortions dropped for the 1st time. The introduction of free contraception seems to have had an important effect; the number of abortions declined by nearly 9000 from 1973-76, and the abortion rate fell from 11.4 to 10.5/1000 women aged 15-44. The number increased in 1977 and 1978, possibly because of adverse publicity about the side effects of oral contraception (OC). The rate of abortion in Scotland, although lower than the rate in England and Wales, has risen steadily since 1969. An important effect of the 1967 Act has been to reduce the number of deaths due to illegal abortions. In the 1st decade of legal abortion, the proportion of all maternal deaths that were due to abortion dropped from 25% to 7%. The number of recorded deaths due to abortion declined from 160 during 1961-63 to 9 during 1982-84. There were 7 deaths after legal abortions during 1982-84 and 4 during 1985-87. 21 years after the passage of the Act half of all women having legal abortions pay for them. The regional differences in the provision of abortion services have persisted since 1968. The proportion of abortions performed in the 1st trimester increased from 66% in 1969 to 86% in 1987, yet the proportions of early abortions in Britain still compare poorly with other countries. In the US, women have been able to request abortion in the 1st trimester since 1974; by 1977 this led to 91% of abortions being performed in this period. Regional differences in the surgical methods persist, and there may be considerable delays between a woman asking for an abortion and the procedure being performed. A Marplan poll conducted in 1988 reported that 80% of those surveyed thought that women should have the right to choose an abortion in the 1st few months of pregnancy; 15% disagreed, and 5% did not know or did not respond. The number of women coming to Britain for abortions peaked in 1973, when 56,000 came. The rate of abortion per 1000 women in England and Wales is 14.8, a moderate figure when compared to other nations -- rates range from 5.6 in the Netherlands to 181 in the USSR.
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