Review of Abortion Law in Scotland Expert Group: report

1. Executive Summary

Abortion in Scotland is regulated by the 1967 Abortion Act. Before 1967, although abortion was illegal and could lead to a prison sentence for both the woman and the abortionist, thousands of women in the UK had an abortion each year and some of them died.

Clinical medicine has evolved significantly since 1967, as has the social and political context in which abortion is sought. This has changed the way that abortion is regarded and, most importantly, the way it is provided. In 1967, all legal abortions were done using a surgical procedure. In Scotland in 2024, 96.8% of abortions were medical abortions (using medicines), and 79.3% were early medical abortions carried out at home. Recognising the need for the law to be modernised and made fit for purpose, the Scottish Government’s Programme for Government 2023-2024 committed to undertake a review of abortion law by the end of the parliamentary term (May 2026). The overall aim was to identify potential proposals for reforms to ensure that abortion services are first and foremost a healthcare matter.

An Expert Group was established comprising clinical, legal, academic and reproductive rights experts. The Group was tasked with reviewing the current law; considering whether any aspects of the existing law should be changed; if so, assessing the various options for reform; and providing recommendations on what a reformed legal framework could look like. The Scottish Government established the Group with the remit:

“to provide recommendations to ensure that abortion services are first and foremost a healthcare matter and Scottish Ministers made clear their wish to ensure that patients in Scotland can continue to access abortions.”^[1]

The Group has carefully considered where it is appropriate to shift the regulation from abortion-specific criminal law to other, general provisions of healthcare law and clinical guidance. An overarching recommendation stemming from this review process is that a new Scottish Abortion Care guideline should be produced to ensure that best practice and patient safety remains at the core of service provision, following any changes to the legal framework.

The Expert Group structured its review around three key areas of Scotland’s current abortion law: gestational limits and grounds; pathways to abortion care (including patient and provider pathways, data and reporting, and conscientious objection); and offences (including patient and provider offences and third-party offences).

For each topic, the Group began by reviewing the current law in Scotland. examining how the law operates in practice and the extent to which it aligns with the Group’s agreed overarching principles, set out on page 26-27 of this report. The Group assessed the strengths and limitations of the current legal framework in relation to these principles and determined for each topic whether the existing law should remain in place or whether consideration of proposals for reform should be recommended.

The Group then considered stakeholder input. The Group recognises that abortion can be a polarising topic that attracts strongly held, sincere, and often competing views, which should be respected. The views of many organisations which campaign for restrictions to abortion in the UK were sought. In advance of each meeting around 50 organisations were contacted and invited to submit written evidence pertinent to the specific topic being discussed. The Group reviewed the perspectives put forward, and the quality and relevance of the supporting evidence presented. Alongside this stakeholder consultation, the Advisory Group of reproductive rights, women's and equalities organisations was convened to ensure that a concern for universal reproductive rights and gender equality was central to all stages of the Group's work, together with ensuring that the lived experience of pregnancy and abortion were represented throughout the process.

The Group also undertook a comparative review of international approaches to abortion law in order to identify instances of best practice focusing particularly on jurisdictions that had recently reformed or reviewed their abortion laws to treat abortion as a healthcare issue. These international examples were assessed both in terms of how they function in practice and how well they reflect the principles adopted by the Group.

Importantly, the Group sought and considered relevant evidence from peer-reviewed academic publications and other respected sources. Taking into account all the information and opinions gathered, the Group finally discussed potential models for legal reform. The manner of working and the justification for each of the recommendations made by the Group – and in some cases, alternative proposals offered – is presented in detail in the report.

The recommendations listed below reflect the Expert Group’s position throughout this process. The Group argues for a reformed abortion law that removes any oversight that has no medical justification and reflects the reality of current clinical practice where abortions are safely provided in the best interests of women. To this end, this report sets out 36 recommendations, among which the most significant are to remove the requirement for any grounds to be met and for two doctors to agree to an abortion before 24 weeks gestation, to enable any appropriately trained healthcare professional to provide an abortion, to amend the Grounds for an abortion over a 24 week gestational limit (while still requiring two doctors to agree), and to remove women from any criminal law relating to abortion. The evidence used to arrive at all the recommendations and the thinking behind them is laid out in detail in the appropriate section of the report.

The full list of recommendations are as follows:

Gestational Limits

1. The existing 24 week limit for most abortions should be retained.

2. Abortions after this gestational limit should be permitted under certain Grounds.

Grounds

3. No specified Grounds should be required to access abortion care up to 24 weeks gestation.

4. Decisions regarding abortions over 24 weeks gestation should be made in good faith by two healthcare professionals, who must agree that the abortion is appropriate, except in cases where an abortion is immediately necessary to save the life of the pregnant woman, in which case one healthcare professional may make a decision.

5. That Grounds for an abortion after 24 weeks’ gestation are amended in an updated abortion Act to the following:

• 1. An appropriately trained registered healthcare professional is authorised to provide an abortion for a person who is more than 24 weeks pregnant if –
• (a) the healthcare professional decides in good faith that performing the abortion is appropriate; and
• (b) the healthcare professional has agreed with one other registered healthcare professional that performing the abortion is appropriate
• 2. In considering whether an abortion is appropriate, a registered healthcare professional should have regard to –
• (a) the gestational age of the fetus;
• (b) all relevant current and reasonably foreseeable medical circumstances of the patient and the fetus;
• (c) the patient’s current and reasonably foreseeable physical, psychological and social circumstances.
• 3. One appropriately trained registered healthcare professional may terminate a pregnancy without agreement from a second healthcare professional where they believe in good faith that an abortion is immediately necessary to save the life of the pregnant person.
• 4. In the case of multiple pregnancy, anything done to terminate the pregnancy as regards one particular fetus is authorised only if that ground applies in relation to that particular fetus.

6. That no specific reference is made to sex-selective abortion within any updated abortion legislation.

Provision

7. Any appropriately trained registered healthcare professional should be able to provide abortion care at all gestations.

8. Healthcare professional should be defined in regulations, rather than in primary legislation.

Certification

9. The requirement for two doctors to certify an abortion before 24 weeks gestation should be removed.

10. Two healthcare professionals should agree that an abortion is appropriate after 24 weeks gestation, before proceeding with the abortion (except in emergencies).

11. There should be no formal certification requirements at any gestation, with decisions recorded in medical records.

Place

12. Legislation should not stipulate where an abortion should take place but should state that abortions must be provided by an NHS provider or a private provider registered with Healthcare Improvement Scotland.

13. Further consideration should be made by the Scottish Government on whether existing provisions to ensure private providers are regulated are sufficient. If deemed so, no abortion specific legislation should be required.

Counselling

14. Mandatory counselling should not be included in abortion legislation.

15. Clinical guidance, rather than legislation, should state that there should be timely access to counselling available for patients who wish to access it.

Mandatory Waiting Periods

16. Mandatory waiting periods should not be included in abortion legislation.

Conscientious Objection

The Group recommends that this provision should remain similar to the current legislation, with a number of amendments:

17. With regard to wording in section 4(1) of the Abortion Act which states that ‘no person shall be under any duty, whether by contract or by any statutory or other legal requirement to participate in any treatment authorised by this Act to which he has a conscientious objection’, the Group recommend that ‘by contract’ should be removed.

18. An inclusion of a duty on those with conscientious objections to refer patients on to somewhere they should be included in an updated conscientious objection clause.

Reporting and notification

19. The requirement to notify the Chief Medical Officer of an abortion should be removed.

20. The requirement to collect data should be included in any updated abortion legislation.

21. Any requirements on what data are to be collected should be in guidelines, not primary legislation.

Adults with Incapacity, Young People and Brain Stem Dead Patients

22. There should be no specific changes to primary legislation regarding adults with incapacity (AWI) or young people.

23. The courts should not be involved in authorising abortions for AWI.

24. The Mental Welfare Commission should ensure there are clearer pathways and guidance in future for helping ensure swift processes and support for AWI where an abortion is being considered.

25. There should be no specific additional requirements for young people.

26. There should be no specific additional requirements within abortion legislation for patients who are brain stem dead.

Positive Duty to Provide

27. The Scottish Government should include a duty to provide abortion services – or a ‘right to abortion’ – with said duty being on Scottish Ministers and Health Boards.

Offences in relation to women having abortions

28. There should be no offences for anyone ending their own pregnancy and any common law offences should be repealed.

Concealment of Birth

29. The Concealment of Birth (Scotland) Act 1809 should be repealed, and the crime of concealment should be repealed.

Offences in relation to healthcare staff

30. The common law offences for registered healthcare professionals who provide an abortion(s) outwith the terms of abortion legislation should be repealed.

31. The Scottish Government should consider how compliance with the provisions of revised abortion legislation will be enforced. The Group proposes two options relating to offences for healthcare staff:

• a) The Scottish Government may consider that existing law around healthcare, including the registration and regulation of healthcare professionals, is sufficient to appropriately enforce the law, and thus no specific statutory penalty should be created; or
• b) A new specific offence should be included for any healthcare professional who provides an abortion outwith the terms of the legislation. This should reflect provisions within The Abortion (Northern Ireland) (No. 2) Regulations 2020 where the maximum penalty is a fine, and prosecution should only be brought by, or with the consent of, the Lord Advocate

32. The Scottish Government should ensure that any new offences would not prevent innovation in contraceptive and abortion care, including the use of new medications, or the development of contragestives.

Abortions provided by someone who is not a registered healthcare professional

33. Any person who is not a 'healthcare professional' (as proposed by the Group and defined in Regulations) providing abortion services should be guilty of an offence. If this is already an offence the Group does not see any need for a separate offence to be created; however, if that is not the case, then a new offence should be created.

34. Any new offence should be carefully considered so as to avoid prosecuting anyone helping someone to access an abortion in good faith, such as a mother helping her daughter.

Procurement of abortion through fear, force, or fraud

35. The Group proposes two options in relation to coercion:

• (a) The Group’s position is that existing offences would be likely to be sufficient to capture the most serious cases where coercion can be proven and that, given the complexity of coercion and the need to distinguish it from pressure or influence from others, it would realistically be difficult to prove in most cases. The Scottish Government could therefore decide that no new, specific offence is required.
• (b) However, if the Scottish Government decides that existing offences are not sufficient, a new specific criminal offence relating to reproductive coercion of all forms could be created. If this course of action is pursued, careful thought should be given as to how best to balance the offence in terms of policy goals and the experience of individual abuse survivors.

In either option, any clinical guidelines on abortion could provide recommendations to ensure all abortion providers have robust procedures in place to detect suspected coercion and support those involved.

Offences relating to ending a pregnancy without consent

36. The Scottish Government should consider if there should be an offence of a third party undertaking criminal acts against a pregnant woman which intentionally or recklessly causes the end of her pregnancy without her consent.