Let’s do the maths.

• 1.2 million women have an abortion in the USA each year.
• 28% of 1.2 million is…. 336,000 abortion-related suicide attempts by women each year.
• Approximately 1 million people attempt suicide each year in the US; 21% are women.
• 21% of 1 million is…. 210,000 total suicide attempts by women each year.

336,000 as a percentage of 210,000… 160%

That means abortion is responsible of 160% of all suicide attempts in women in the USA.

160% is a really shocking statistic. Because obviously it’s impossible.

That means more women attempt suicide because of abortion than the total number of women who attempt suicide for any reason.

Or it means the 28% statistic is wrong.

Facts matter.

DWCA

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CDC statistics on suicide

It is necessary for me to respond to an editorial written by Professor John Crown, which summarised his views on the recent Oireachtas abortion committee hearings. His article adopts the tone of a moderate and informed critic of what he characterises as extremists on either side of the argument: the Catholic church at one end and the ‘pro-abortionistas’ at the other (it’s notable that his flippant term for the prochoice spokespeople seems sort of.. gendered?). Unfortunately I am compelled to point out that his position is neither moderate nor informed.

It is a disingenuous mischaracterisation to suggest that these two groups represent similarly extreme ends on either side of the abortion debate. Those who spoke in defence of a woman’s right to determine the moral status of a fetus which is within, and entirely dependent upon, them are in much closer accord with the majority of the Irish population, who want the law changed. Meanwhile, the Catholic church represents an almost unbelievable extreme in this argument. Their position is identical to their position centuries ago. Prof Crown further flatters this group by suggesting that there are ‘sincere opponents of abortion’ who ‘wish to ensure the safety of mothers-to-be’. Nothing could be further from the truth. If you’re concerned about the health of women you have to ensure they have access to  abortions. Only a fanatic could ignore the staggering body of evidence which shows that abortion is always – always – safer than continuing a pregnancy and giving birth, with reference to both mortality and morbidity (both physical and mental). While these facts rarely inform an individual woman’s decision about a pregnancy, they must inform a legislative debate.

But the really offensive portion of his article is in the closing, where the objective facade is rather dramatically pulled back to reveal his bias. Prof Crown joins the anti-abortion movement by stigmatising abortion providers and conjuring the classic image of their seedy practices:

“It is apparent to me that much of what goes on in abortion clinics, specifically termination of mid- and occasionally late-term foetuses, is nothing short of infanticide.” [my italics]

Prof Crown is apparently unaware that under UK law ‘late-term abortion’ (presumably referring to third trimester abortion given his preceding reference to ‘mid-term’) can only be carried out in an NHS hospital, and usually only when a fetus is affected with a significant anomaly.   To make my point completely clear, ‘late-term’ abortion never ‘goes on’ in any abortion clinic in the UK because it would be illegal. I don’t doubt that Prof Crown’s credentials as an oncologist are impeccable; however, this, and other comments (such as an editorial in which he incorrectly described the mechanism-of -action of intrauterine devices as abortifacient) demonstrate his ignorance in this field of medicine.

He continues as if he has solved the problem of the abortion debate:

“But, averring that an early embryo which has, as yet, no neurological function, no awareness, no consciousness, is a “person” in the very same sense that a week-old baby is a person, is not logically sound. It is a form of life, in the same sense that a sperm, or a cancer cell growing in a dish, is a form of life. It is not yet a person.”

Seems sensible. Yet Prof Crown sidesteps the absolutely fundamental issue: when does this transition from ‘a form of life… [like] a cancer cell growing in a dish’, to a person take place? Recently, on Twitter, Prof Crown was asked this question. “About twelve weeks,” he replied, without a single scientific argument as to why. Of course, as we all know, there is no point at which this line can be drawn; fetal development is a continuum. If Prof Crown wants to have a genuinely moderate debate about abortion, it should be about how we manage this uncertainty, about how much we trust women to manage this uncertainty for themselves. Indeed, a moderate abortion debate is about how late in pregnancy we allow abortion – not about whether we allow it at all.

The absolute frustration for abortion providers is that we are constantly scrutinised, criticised, and stigmatised so casually; meanwhile we do an extremely difficult job which requires considerable skill, knowledge, and above all, empathy. Because of this stigmatisation only a handful of doctors provide abortions, so the burden of caring for huge numbers of patients is carried by a few. While Prof Crown and others enjoy the abortion debate as a philosophical or theological thought-experiment, we are faced with the stories of thousands of women who need abortions, each one compelling in its own right. Did the committee hear from any of these women, or from the doctors who provide their care? Those of us who do abortions share the ethical concerns those less-informed than us have. But real women need abortions right now. We feel we are doing the right thing and it would be sensible for Prof Crown to find out from us why. (Real women includes 4,000 real Irish women a year – who have them in England.  A fact conveniently omitted from his proud declaration about Ireland’s maternity care, supposedly without abortion, being some of the best in the world.)

Only someone very far removed from the provision of abortion care could stigmatise abortion providers in this way. And it is perhaps this massive distance that allowed Prof Crown to tweet recently:

“Would a doctor perform an abortion (knowing he would go to jail) to save mother’s life? Hope so.”

Presumably this doctor is able to provide the abortion because it is the same doctor Prof Crown accuses of performing infanticide? I confess, I’m not sure I would find the decision so simple; like most people, even abortionists rather like not being in jail.  But it really is that simple when you don’t actually get involved.

A quote from a colleague of mine summarises the problem rather well:

‘It’s one thing to talk about bulls.. It’s another thing entirely to get in the bullring.’

Perhaps next time this issue is discussed you could ensure you declare your biases, get your facts correct, and perhaps even invite those of us who spend much of our time in the bullring to contribute the debate.

Doctors for a Woman’s Choice on Abortion

For more infomation relevant to this see the Abortion Review website:

http://www.abortionreview.org/index.php/site/article/1142/

In the face of the Daily Telegraph’s attempt to entrap and discredit a number of doctors who provide abortions, we would like to express our support for all those doctors who are willing to provide abortion referrals in the UK and all health professionals who provide safe abortion services.

We represent pro-choice organisations that have been working for women’s right to safe abortion for many years. We believe that abortion should be available to every woman who requests it, and that the provision of safe, accessible abortion care is a vital element of health care provision.

The Daily Telegraph‘s interpretation of the 1967 Abortion Act is mistaken. The law does not specify that rape is one of the legal grounds for abortion, but a doctor can provide a referral for abortion if a pregnancy results from rape. Similarly, abortion on grounds of sex selection is neither legal nor illegal in itself. [1] Under the 1967 Abortion Act, it is the effect of the pregnancy on a woman’s health, mental health and life that must be taken into account to determine whether or not she has grounds for abortion. Doctors are not given a shopping list of specific grounds for which abortion is allowed or not allowed. Rather, the law gives doctors the responsibility to decide whether the risk of continuing the pregnancy to the woman’s health and mental health is greater than if the pregnancy were terminated. In making this judgement, doctors are directed by the law to take into account the woman’s personal circumstances. These include, for example, her age, her being unemployed or on low pay, or trying to complete her education, or being single, or having other small children to care for, or feeling strongly that she simply cannot cope with a baby (or another baby) at this particular time because of the negative impact it would have on her life, or because she has fears about the outcome and/or life chances of the child if it were born. The law further allows doctors to authorise an abortion if there is a risk to the woman’s existing children of continuing the pregnancy, or if there is a risk of serious abnormality in the fetus if the pregnancy were to go to term.

The 1967 Abortion Act gave doctors the responsibility for authorising abortions in the belief that women could not be trusted to take this decision for themselves. Yet today, it is clear that women who have babies and women who have abortions are the same women. Today, most doctors and most people recognise that women themselves do know what is best for their own lives and do take responsible decisions. Hence, most doctors are willing to provide an abortion referral for a woman if she requests it because they understand that continuing an unwanted pregnancy is not good for women or their children, and will almost always cause a woman greater distress than having an abortion.

We believe the 1967 Act is outdated because it puts the onus on doctors to be gatekeepers, rather than providing women with the right to decide what is best for their own lives. We think that abortion should be available on a woman’s request, and not be governed by criminal statute at all.

We are also opposed to gender discrimination, but sex selective abortion is not gender discrimination. Gender discrimination applies only to living people. A fetus does not have rights in the same way as a living person does, and therefore cannot be said to suffer from discrimination. Gender discrimination has its roots in economic, political, social and religious life; sex selective abortion may be one of the consequences of gender discrimination, but it is not a cause of gender discrimination.

The ‘investigation’ reported by the Daily Telegraph was carried out by unidentified persons in the context of concerted attempts by anti-abortion politicians and anti-abortion activists to discredit and frighten abortion providers by characterising them as unprofessional, greedy and wicked. Yet no evidence exists to support this proposition. Hence, they have stooped to using methods that are closer to entrapment than to any semblance of legitimate investigative journalism.

These methods are highly questionable if not downright unethical. In a video taken without the doctor’s knowledge or consent, a short segment of which was screened on ITV’s Granada Regional News on 23 February, a young doctor says to the bogus patient in front of her: “If you want a termination, you want a termination. That’s my job. That’s all. I don’t ask questions,” while the patient tries to insist on divulging her bogus reasons. This is not evidence of illegal behaviour on the doctor’s part. That this doctor has since been suspended and the police asked to investigate her and others is a travesty of justice.

We would have hoped that pro-choice politicians would stand up for abortion providers, and maybe some still will. However, initial reactions have been hasty and heavy-handed, betraying underlying anti-abortion sentiments. Andrew Lansley, the Health Secretary, who otherwise claims he wants doctors to be in charge of all our health care services, said that doctors would face the “full force” of the law if they break the 1967 Abortion Act. This is hard to swallow, especially considering that many of us hadn’t even been born the last time a doctor had to face the full force of the law in relation to illegal abortion. The Health Secretary should know better than most that the 1967 Abortion Act was formulated precisely to allow doctors to exercise their professional judgement. It is shocking that he would threaten them with prosecution for doing so on such flimsy evidence.

Some politicians, Nadine Dorries, for example, would dearly love to turn the clock back. She must be delighted that the Daily Telegraph has boosted her attempts as a woman to curtail other women’s rights. In her blog on Conservative Home, she went one better than Andrew Lansley and threatened doctors not only with prosecution but with being struck off the medical register. She even mentioned life imprisonment, which is ludicrous, but intimidating nonetheless.

The vast majority of heterosexually active people of reproductive age are currently using a method of contraception to the best of their ability, but one in three women in Britain will have an abortion in her lifetime. We will stand up for doctors and other health professionals who support and are willing to provide safe abortion services. We applaud their commitment in the face of unwarranted harassment and condemnation. Even though the public are periodically showered with disinformation on abortion, every poll and every public debate show that most people in Britain are aware of and support the right to use contraception and the right of women to seek abortion when pregnancy is unwanted. We call on everyone who supports family planning, including safe abortion, to express their appreciation for the health professionals who provide them.

_______

1 As the Chief Medical Officer explained: ‘Sex selection is not one of the lawful grounds for termination. It is illegal for a practitioner to carry out an abortion for that reason alone, unless the certifying practitioners consider that an abortion was justified in relation to at least one of the section 1(1) grounds’. (CMO/CSA letter gateway ref 17305, 23 February 2012, Abortion Act 1967 (as amended): Termination of Pregnancy)

Signed by the following members of Voice for Choice:

Marge Berer, Editor, Reproductive Health Matters

Jane Fisher, Director, ARC (Antenatal Results and Choices)

Ann Furedi, Chief Executive, and Patricia A Lohr, Medical Director, Bpas

Lisa Hallgarten, consultant

Ann Henderson, Chair, Abortion Rights

Lesley Hoggart, Principal Research Fellow, University of Greenwich

Ellie Lee, Co-ordinator, Pro-Choice Forum

Wendy Savage, on behalf of Doctors for a Woman’s Choice on Abortion

Ethically, the line between ‘good’ and ‘bad’ reasons for abortion is not hard and fast. Individual patients and clinicians will differ on whether they consider a request for abortion valid. In recent discussions amongst our members, it was clear that many felt fetal sex to be an unethical reason; however, DWCA does believe that UK law should be amended to clearly allow abortion before 24 weeks gestation on the simple basis of a woman’s request, without the need for further justification. While this may challenge some of our own beliefs as abortion providers, it is ethically consistent and puts the abortion decision in the hands of the woman. However, anti-abortion activists are desperate to convince us all that the ‘good’ reasons and the ‘bad’ reasons for abortion can be clearly separated. Unfortunately for them, in reality every woman’s decision to have an abortion is a unique reflection of their circumstances, needs and values, and hard and fast rules will not be practicable.

So who is to decide, case-by-case, which abortions will be done and which will not? Currently doctors decide, based on interpretation of the language in the abortion act and relevant law. The options for changing this legislation are to: a) remove the legal requirement for a woman to justify her abortion decision to anyone at all, or b) remove this power from doctors and give it to someone else. DWCA advocates for the first option.

But if we choose the latter, to whom will this power be shifted? Hopefully not to Abhijit Pandya from the Daily Mail, who recently wrote an editorial suggesting that women who use contraception or abortion are shirking their obligation to maintain the UK’s workforce and continue our cultural heritage. If that sends a shiver down your spine it might be because it’s the same rhetoric used by Nicolae Ceausescu to justify his 1966 ban on abortion in Romania.

“The fetus is the property of the entire society,” Ceausescu proclaimed. “Anyone who avoids having children is a deserter who abandons the laws of national continuity.”

If you find this hard to believe – and you have the stomach for it – you can read Pandya’s article here:

http://pandyablog.dailymail.co.uk/2012/02/the-pill-the-sexual-revolution-and-abortions-all-may-share-some-blame-for-our-dependency-on-immigrat.html

Following up the Telegraph sting operation, Nadine Dorries, on the blog ConservativeHome, wrote:

‘there is a compelling need for a much tighter regulatory framework and monitoring and inspection process to be put in place.’

In writing such statements, anti-abortionists want us to think they are reasonable people: they understand some women may need an abortion in certain circumstances, but they also believe that women need to be policed properly to prevent frivolous use of the service. This seemingly moderate stance may have a wide appeal. But Mr Pandya’s editorial indicates the frightening logic of anti-abortion rhetoric. There is a great deal at stake, and an urgent need for us to stand united and defend women’s right to an abortion: doctors, nurses, women who have had abortions, women who may need abortions. We are not dealing with reasonable people.

Louise M Howard, Professor in Women’s Mental Health

Hind Khalifeh, , Melissa Rowe, Kylee Trevillion, Trine Munk-Olsen

Section of Women’s Mental Health, Institute of Psychiatry, King’s College London and National Center

Louise M Howard*, Hind Khalifeh*, Melissa Rowe*, Kylee Trevillion*, Trine Munk-Olsen†,

* Section of Women’s Mental Health, PO31, Institute of Psychiatry, King’s College London †National Center for Register-Based Research, Aarhus University, Aarhus, Denmark

We have serious concerns about the methodology of the quantitative synthesis published in the September 2011 issue of this journal (The British Journal of Psychiatry (2011) 199: 180-186 P. K. Coleman, ‘Abortion and mental health: quantitative synthesis and analysis of research published 1995-2009’) and want to highlight these to prevent readers and policy makers drawing erroneous conclusions, in particular the incorrect statement that “nearly 10% of the incidence of mental health problems was shown to be attributable to abortion”.

This quantitative synthesis and meta-analysis did not follow the robust methodologies now generally accepted for systematic reviews[1]. There is no detail of the search strategy including search terms; the strategy is not comprehensive (only two databases included); other strategies to search the literature including citation tracking, hand searching and contacting authors and experts in the field to try to minimise publication bias were not carried out; and there was no assessment or rating of the quality of included studies, so that only those of at least reasonable quality are included in the meta-analysis. This is particularly important here as many of the primary studies included in this review have significant methodological limitations, including non-prospective design, non-standardised measures of mental disorders, lack of adjustment for pre-existing mental illness, lack of adjustment for other key confounders (e.g. social deprivation), non-comparability of exposed and non-exposed groups, and selection bias. This is especially concerning, given that previous reviews raised serious methodological concerns about some of the included studies, and came to different conclusions when these were excluded from analyses[2-4]. Furthermore, results from several of the included studies linking abortion to mental health problems have since been re-analysed by other researchers. These studies, using the same data, have less biased sample selection techniques and control for pre-pregnancy factors known to influence poor mental health outcomes (i.e. rape history) and have found no significant links between abortion and subsequent poor mental health[5, 6].

A recent population-based cohort study conducted in Denmark published in the New England Journal of Medicine this year confirmed this. Munk-Olsen et al [7] reported no difference between the incidence of first psychiatric contact before and after abortion. Importantly, the incidence of psychiatric contact is higher among women who underwent abortion; this is the result of a selection phenomenon and not a causal association because this relationship is evident before the abortion occurred[7]. This is evidence that women having induced abortions constitute a population with higher pre-existing psychiatric morbidity.

Study selection and evaluation should be carried out by two independent raters; the Coleman review was carried out by one author only. Eleven of the twenty two papers included were authored by Coleman, the author of the review. This is a conflict of interest, and undermines the author’s ability to critically review the primary studies.

Finally, the synthesis of the data and the summary statistics are flawed. The criteria for synthesizing data meant that several effect measures were included from the same study. Eleven of the included studies contributed more than one effect measure, with two studies contributing four measures each. Despite the clustering of effect measures by study, they are analysed as independent measures. This is an important limitation, since the use of several effect measures from a flawed study can magnify the bias.

Most importantly for readers of this study to know, is the erroneous conclusions drawn by the author regarding the Population Attributable Risk (PAR). The underlying assumptions for estimating PAR include that there is a causal relationship between the risk factor (abortion) and the disease (mental health) and that there is independence of the considered risk factor from other factors that influence disease risk[8]. These assumptions are clearly not met in this review and therefore it is completely inappropriate to calculate a PAR from these data.

Abortion and mental health is a politicized issue – it is therefore essential that research in this field is methodologically robust.

Declaration of Interest: One of the authors of this letter (Trine Munk-Olsen) was the lead author of the population based cohort study cited above

References

1. Stroup, D.F., et al., Meta-analysis of observational studies in epidemiology: a proposal for reporting. Meta-analysis Of Observational Studies in Epidemiology (MOOSE) group. JAMA, 2000. 283(15): p. 2008-12.

2. American Psychological Association, T.F.o.M.H.a.A., Report of the Task Force on Mental Health and Abortion. APA, 2008.

3. Charles, V.E., et al., Abortion and long-term mental health outcomes: a systematic review of the evidence. Contraception, 2008. 78(6): p. 436-50.

4. Robinson, G.E., et al., Is there an “abortion trauma syndrome”? Critiquing the evidence. Harv Rev Psychiatry, 2009. 17(4): p. 268-90.

5. Schmiege, S. and N.F. Russo, Depression and unwanted first pregnancy: longitudinal cohort study. BMJ, 2005. 331(7528): p. 1303.

6. Steinberg, J.R. and N.F. Russo, Abortion and anxiety: what’s the relationship? Soc Sci Med, 2008. 67(2): p. 238-52.

7. Munk-Olsen, T., et al., Induced first-trimester abortion and risk of mental disorder. N Engl J Med, 2011. 364(4): p. 332-9.

8. Rockhill, B., B. Newman, and C. Weinberg, Use and misuse of population attributable fractions. Am J Public Health, 1998. 88(1): p. 15-9.

http://www.guttmacher.org/media/nr/2012/03/05/index.html

Coleman also published a more recent article in the British Journal of Psychiatry, the abstract of which you can read here:

http://bjp.rcpsych.org/content/199/3/180.abstract

This was quickly discredited by a group from King’s College London. You can read their assessment of the scientific rigor of Coleman’s analysis in a separate post above.

Coleman will be presenting her completely discredited findings at an anti-abortion meeting in London this week.

We represent pro-choice organisations that have been working for women’s right to safe abortion for many years. We believe that abortion should be available to every woman who requests it , and that the provision of safe , accessible abortion care is a vital element of health care provision.

The Daily Telegraph‘s interpretation of the 1967 Abortion Act is mistaken. The law does not specify that rape is one of the legal grounds for abortion, but a doctor can provide a referral for abortion if a pregnancy results from rape. Similarly, abortion on grounds of sex selection is neither legal or illegal in itself. Under the 1967 Abortion Act, it is the effect of the pregnancy on a woman’s health, mental health and life that must be taken into account to determine whether or not she has grounds for abortion. Doctors are not given a shopping list of specific grounds for which abortion is allowed or not allowed. Rather, the law gives doctors  the responsibility to decide whether the risk of continuing the pregnancy to the woman’s health and mental health is greater than if the pregnancy were terminated. In making this judgement call, doctors are directed by the law to take into account the woman’s personal circumstances. These include, for example, her age, her being unemployed or on low pay, or trying to complete her education, or being single, or having other small children to care for, or feeling strongly that she simply cannot cope with a baby (or another baby) at this particular time because of the negative impact it would have on her life, or because she has fears about the outcome and/or life chances of the child if it were born. The law further allows doctors to authorise an abortion if there is a risk to the woman’s existing children of continuing the pregnancy, or if there is a risk of serious abnormality in the fetus if the pregnancy were to go to term.

The 1967 Abortion Act gave doctors the responsibility for authorising abortions in the belief that women could not be trusted to take this decision for themselves. Yet today, it is clear that women who have babies and women who have abortions are the same women. Today, most doctors and most people recognise that women themselves do know what is best for their own lives and do take responsible decisions. Hence, most doctors are willing to provide an abortion referral for a woman if she requests it because they understand that continuing an unwanted pregnancy is not good for women or their children, and will almost always cause a woman greater distress than having an abortion.

We believe the 1967 Act is outdated because it puts the onus on doctors to be gatekeepers,  rather than providing women with the right to decide what is best for their own lives. We think that abortion should be available on a woman’s request, and not be governed by criminal statute at all.

We are also opposed to gender discrimination, but sex selective abortion is not gender discrimination.Gender discrimination applies only to living people. A fetus does not have rights in the same way as a living person does, and therefore cannot be said to suffer from discrimination. Gender discrimination has its roots in economic, political, social and religious life; sex selective abortion may be one of the consequences of gender discrimination, but it is not a cause of gender discrimination.

The ‘investigation’ reported by the Daily Telegraph was carried out by unidentified persons in the context of concerted attempts by anti-abortion politicians and anti-abortion activists to discredit and frighten abortion providers by characterising them as unprofessional, greedy and wicked. Yet no evidence exists to support this proposition. Hence, they have stooped to using methods that are closer to entrapment than to any semblance of legitimate investigative journalism.

These methods are highly questionable if not downright unethical. In a video taken without the doctor’s knowledge or consent, a short segment of which was screened on ITV’s Granada Regional News on 23 February, a young doctor says to the bogus patient in front of her: “If you want a termination, you want a termination. That’s my job. That’s all. I don’t ask questions,” while the patient tries to insist on divulging her bogus reasons. This is not evidence of illegal behaviour on the doctor’s part. That this doctor has since been suspended and the police asked to investigate her and others is a travesty of justice.

We would have hoped that pro-choice politicians would stand up for abortion providers, and maybe some still will. However, initial reactions have been hasty and heavy-handed, betraying underlying anti-abortion sentiments. Andrew Lansley, the Health Secretary, who otherwise claims he wants doctors to be in charge of all our health care services, said that doctors would face the “full force” of the law if they break the 1967 Abortion Act. This is hard to swallow, especially considering that many of us hadn’t even been born the last time a doctor had to face the full force of the law in relation to illegal abortion. The Health Secretary should know better than most that the 1967 Abortion Act was formulated precisely to allow doctors to exercise their professional judgement. It is shocking for him to threaten them with prosecution for doing so on such flimsy evidence.

Some politicians, Nadine Dorries, for example, would dearly love to turn the clock back. Shemust be delighted that the Daily Telegraph has boosted her attempts as a woman to curtail other women’s rights. In her blog on Conservative Home, she went one better than Andrew Lansley and threatened doctors not only with prosecution but with being struck off the medical register. She even mentioned life imprisonment, which is ludicrous, but intimidating nonetheless.

The vast majority of heterosexually active people of reproductive age are currently using a method of contraception to the best of their ability, but one in three women in Britain will have an abortion in her lifetime. We will stand up for doctors and other health professionals who support and are willing to provide safe abortion services. We applaud their commitment in the face of unwarranted harassment and condemnation. Even though the public are periodically showered with disinformation on abortion, every poll and every public debate show that most people in Britain are aware of and support the right to use contraception and the right of women to seek abortion when pregnancy is unwanted. We call on everyone who supports family planning, including safe abortion, to express their appreciation for the health professionals who provide them.

Signed,

Marge Berer, Editor, Reproductive Health Matters, and Honorary Chair, International Campaign for Medical Abortion

Further reading

Reproductive Health Matters‘ blog on sex selection

Education for Choice’s blog on sex selection

Observer editorial calling for moderation

Granada Television report and video clip

One of many Daily Telegraph articles, quoting Lansley

Nadine Dorries Conservative MP’s blog

Download “Late Abortion – An Emotive Topic” as a Powerpoint presentation or PDF file.