Questions related to abortion services in Scotland: FOI release

Information requested

1. What does the Scottish Government mean by the term "clinically safe" for the procedure of abortion? Please define the words "clinically" and "safe" separately and as used in the letter received by me that the procedure of abortion should be "clinically safe" 

2. How is early medical abortion under the current temporary pills sent in the post system due to Covid-19 "clinically safe"?

3. For any post-pandemic (Covid-19) future arrangements what is the correct advice regarding adult supervision for taking the second pill(s) at home since the letter by Dr. Calderwood on the 26th October 2017 in Annex B, Available at: https://www.sehd.scot.nhs.uk/cmo/CMO(2017)14.pdf advises for inclusion criteria that "Adult to be at home with them following the self-administration of misoprostol" and on Day of Mifepristone administration in bold & underline it states "If there is no adult available to be at home with the patient then treatment as EMAH should not proceed" yet the Scottish Government’s present Early Medical Abortion at Home Consultation supporting document on page 19, point 2, Available at: https://www.gov.scot/publications/consultationfuture-
arrangements-early-medical-abortion-home/pages/2/ advises that "the patient may wish to consider having an adult at home with them for support after they self-administer misoprostol" and if it is as described in the Consultation why would that advice have changed?

4. What mental health services are directly available from the Scottish Government or National Health Service for women who have had an abortion in Scotland and what is the average waiting time to access these services for recent statistics (in the last 5 years for example)?

5. What quantitative data has been collected of any physical/sexual/mental harm to women in Scotland, commonly known as gender-based violence, since March 2020 to September 2020 inclusive and how does it compare to any corresponding data from the same period March 2019 to September 2019 inclusive or a similar reporting duration e.g. March to May inclusive?

6. The Consultation previously mentioned on page 10, paragraph 25 describes domestic abuse could be a concern for future arrangements. What quantitative and/or qualitative evidence has the Scottish Government collected, or knows, of women undergoing abortion in any setting being subject to domestic abuse by their current partner and please provide that evidence in the response?

7. Given modern contraceptive failure accounts for around half of abortions in England & Wales and likely a high proportion in Scotland too,1 consistently married women are four times less likely to undergo abortion than unmarried women in England & Wales, 2 the UK’s Academy of Medical Royal Colleges concluded in its 2011 multi-study analysis that "it is important to consider the need for support and care for all women who have an unwanted pregnancy because the risk of mental health problems increases whatever the pregnancy outcome", 3 it is estimated that 40-50% of women’s relationships end following abortion, 4 I provided clear and incontrovertible evidence of a possible link between violence against women and abortion strongly correlated with the EU countries with stricter gestational laws and limits having the lowest prevalence of physical and/or sexual violence which was the reason for your correspondence in 2019, and the rate of abortion in Scotland in 2019 was the highest on record at 13.2 per 1,000 women with the number of abortions the second highest on record at 13,583 meaning Scottish women face a multitude of problems due to abortion what is the Scottish Government’s strategy to prevent it because the latest rate and figures and the trend overall (see chart below) indicate either there is no strategy or it is not working with many European countries having much lower nominal abortion rates than Scotland such as Austria and Poland (previously shown to Minister Freeman)?

8. Why is there no information on the ethnicity of women undergoing abortion in Scotland in 2019 in the NHS National Health Services "Termination of Pregnancy" (Year ending December 2019) report, Available at: https://beta.isdscotland.org/find-publications-and-data/population-health/sexual-health/termination-of-pregnancy-statistics/ and what plans are there to include this information in any future reporting given that in England & Wales black women disproportionately undergo abortion (8% of abortions are of black unborn babies yet only 3.4% of women are black in the population in England & Wales) which should not happen in Scotland (or England & Wales)? Do you have figures for the percentage of ethnic minority women undergoing abortion in Scotland compared to their percentage in the population and what are those figures?

9. The Consultation previously mentioned on pages 4 & 12 questions the impacts of abortion on ethnic minority women yet quantitative data is not included in official statistics. How can the Scottish Government understand any impacts of abortion on ethnic minority women in relation to the Equality Act 2010 and on their communities if it does not have quantitative data (such as might be the case if they are disproportionately impacted by abortion)?

10. What plans are there to include marital status in any future "Termination of Pregnancy" reporting that could assist stakeholders and partners to understand how to prevent abortion? I have been informed by Public Health Scotland Maternity Statistics that this information is included on recording forms.

Response

1. While our aim is to provide information whenever possible, in this instance the Scottish Government does not have the information you have requested. The Scottish Government does not hold recorded information on a specific definition of clinically safe in the context of abortion services. We would rely on the definitions available in a dictionary, which set out fairly clearly what is meant by these words.

This is a formal notice under section 17(1) of FOISA that we do not hold the information you requested.

2. While our aim is to provide information whenever possible, in this instance the Scottish Government does not have the information you have requested. The Scottish Government does not advise that pills should be sent in the post, so does not have the specific information you have requested.  This is a formal notice under section 17(1) of FOISA that we do not hold the information you requested.

However, the Royal College of Obstetricians and Gynaecologists https://www.rcog.org.uk/globalassets/documents/guidelines/2020-07-31-coronavirus-covid-19-infection-and-abortion-care.pdf and Scottish Abortion Care providers guidelines https://www.gov.scot/publications/consultation-future-arrangements-early-medical-abortion-home/pages/5/ set out the circumstances where it is considered safe and appropriate for women to take both mifepristone and misoprostol at home.

3. The Scottish Abortion Care Providers guidelines determine what is appropriate and it is suggested in their current guidelines that the patient may want to have someone at home, but it’s not necessary. The original guidelines suggested there should be an adult with the patient, but this was for emotional support, rather than for safety reasons.

4.While our aim is to provide information whenever possible, in this instance the Scottish Government does not have the information you have requested. NHS Boards provide counselling services for abortion patients so the Scottish Government does not hold this information.

This is a formal notice under section 17(1) of FOISA that we do not hold the information you requested. You may wish to contact NHS Boards directly if you wish to gather this information. Information on how to submit an FOI request is available on each NHS Board's website.

5. While our aim is to provide information whenever possible, in this instance the Scottish Government does not have the information you have requested. The following data available on domestic abuse (which would cover both women and men suffering domestic abuse) https://www.gov.scot/publications/coronavirus-covid-19-justice-analytical-services-data-report-september-2020/ and the following qualitative research may be of interest https://www.gov.scot/publications/coronavirus-covid-19-domestic-abuse-forms-violence-against-women-girls-during-phase-3-scotlands-route-map-11-august-11-october/.

This is a formal notice under section 17(1) of FOISA that we do not hold the information you requested

6. While our aim is to provide information whenever possible, in this instance the Scottish Government does not have the information you have requested. Part of the purpose of the consultation you mentioned is to collect any evidence which stakeholders have that is relevant. This is a formal notice under section 17(1) of FOISA that we do not hold the information you requested.

7. NHS Boards always speak to patients having a termination about contraception options. The Scottish Government is also continuing to work with Boards to encourage increased use of Long-Acting Reversible Contraception. We will continue to work closely with NHS Boards to help improve access to services for those who wish to have a termination, as well as to reduce numbers of unintended pregnancies.

8. While our aim is to provide information whenever possible, in this instance the Scottish Government does not have the information you have requested and this information is not collected in abortion notification forms. However, you may wish to refer to the email from the Scottish Government to you of 23 October 2020 on this subject, which provides further details. This is a formal notice under section 17(1) of FOISA that we do not hold the information you requested.

9. While our aim is to provide information whenever possible, in this instance the Scottish Government does not have the information you have requested. Part of the purpose of the consultation you mentioned is to collect any evidence which stakeholders have that is relevant. Data on numbers of women from ethnic minorities would not on its own help identify whether allowing women to take mifepristone at home would be likely to have positive or negative impacts on women from ethnic minority communities.

10. While our aim is to provide information whenever possible, in this instance the Scottish Government does not have the information you have requested. This is a matter for Public Health Scotland as they are responsible for the abortion statistics. However, the Scottish Government does not feel that marital status is relevant in determining how best to provide abortion or other health services which meet the needs of patients. This is a formal notice under section 17(1) of FOISA that we do not hold the information you requested.

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