Review of Abortion Law in Scotland Expert Group: report

3. Introduction

The Abortion Act 1967 stands as a landmark moment in the history of reproductive rights in the UK and around the world. That Act, passed by the UK parliament and spearheaded by David Steel, the MP for Roxburgh, Selkirk, and Peebles, gave women a pathway to access abortion care legally and safely.

The law surrounding abortion profoundly shapes the lives of women. It determines the extent to which individuals can make autonomous, private decisions about what happens to their bodies and their future lives. It sets the terms of who needs to be involved in that decision and why. As such, the law reflects society’s attitudes toward women and reproductive rights.

Moreover, the lack of legal abortion provision before the 1967 Act was passed certainly did not prevent abortions from taking place. Estimates of the number of abortions in the UK before 1967 ranged from around 10,000 to 250,000 illegal abortions taking place per year^[2],[3],[4] with women at risk of death or permanent injury when those procedures went wrong. Indeed, by 1966, illegal abortion was the leading cause of avoidable maternal mortality.^[5]

One of the most prominent campaigners for abortion law reform prior to 1967 refers to participants at a meeting she attended as part of the campaign for that Act:

One after another of them…came up to me in the interval and said something like ‘you know dear, I had an abortion, it was back in the 30s…Everybody you spoke to, if they hadn’t had one themselves, or a daughter, they knew somebody who had. And many of them said, I looked after a friend, or my sister or somebody, when it went wrong.^[6]

In Scotland, meanwhile, the common law which underpinned abortion provision saw significant differences in access to legal abortion care. Parliamentary debate at the time revealed that 1 in 50 pregnancies at that time were being legally terminated in Aberdeen, whereas in Glasgow that number was 1 in 3,750. In the 1960s, Sir Dugald Baird, Professor of Obstetrics and Gynaecology in Aberdeen, felt that the provision of legal abortion care in Aberdeen contributed to the low infant mortality and lower maternal mortality compared with other parts of Scotland. Aberdeen had an infant mortality rate comparable to the affluent south of England and a much-reduced incidence of women presenting as a result of septic abortion.^[7],5

The Abortion Act came into effect on 27 April 1968. Despite decades of ongoing debate between those against and in favour of legal abortion both in and outside parliamentary settings, today in Scotland, abortion is a common and safe procedure. Common, in that 18,710 women had an abortion in Scotland in 2024, and national statistics show that around one in three women in Britain will have an abortion during their lifetime.^[8] This is in line with international estimates, which generally range between one in three women and one in four women.^[9],[10] And safe; national and international evidence shows that abortion performed in line with best practice is safe, and markedly safer than carrying a pregnancy to term. A study in the Obstetrics and Gynaecology journal found that pregnancy and childbirth was associated with a 14 times greater risk of death than abortion,^[11] as well as higher overall morbidity linked to complications. Indeed, pregnancy and childbirth carries its own risks, both direct and indirect. In the UK and Ireland, the latest MBRRACE report for 2020-22 found a maternal mortality rate of 13.56 per 100,000 maternities.^[12]

Clinical medicine has evolved significantly since 1967 and so has the social and political context in which abortion is sought. This has changed the way abortion is viewed and, importantly, the way it is provided in practice. In 1967, safe medical abortion did not exist, and abortion was a major surgical procedure, typically accompanied by up to a week’s stay in hospital, with a significant risk of complications and, indeed, death.^[13] In Scotland in 2024, 96.8% of all abortions were medical abortions (done using medicines rather than surgery), and 79.3% were early medical abortions at home (EMAH), in the first trimester.^[14]

A growing emphasis on patient autonomy in healthcare provision has called into question many areas of legal involvement in abortion provision including, for example, the requirement that only doctors can provide abortion care, and that two doctors must certify an abortion at all gestations before it proceeds. These provisions were shaped by the medical, legal, social and political context of the Abortion Act 1967. For example, the requirement that two doctors must certify an abortion was created in a context in which doctors required legal protection from the potentially illegal act of providing an abortion outwith the provisions of the Act. It was also put in place in a context where one of the doctors who certified an abortion was often a psychiatrist, pointing to attitudes towards abortion at that time in which women were not deemed capable of making their own decisions. Social attitudes to abortion have changed significantly, and in today’s clinical context women are – and should be – regarded as capable of making their own decisions about their bodies. It is clear that the Abortion Act is increasingly at odds with contemporary social attitudes and healthcare provision.^[15]

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 of the review was to identify potential proposals for reforms to ensure that abortion services are first and foremost a healthcare matter.^[16] As part of this review, the Minister for Public Health and Women’s Health established a new Expert Group (hereafter the “Group”) 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.

There has been a recent increase in the number of women being investigated or prosecuted in England and Wales, suspected of inducing abortion at or beyond the legal gestation limits. This led to a vote in the House of Commons in June 2025 to remove women acting in relation to their own pregnancy from the criminal law related to abortion in those jurisdictions. The conversation around this change to the law has also progressed to discussion about wider reform of abortion law, including the decriminalisation of healthcare professionals involved in abortion care.

This follows substantive reform of Northern Ireland abortion law in 2019 and 2020 which began with the repeal of underlying criminal statute up to the point of viability via Westminster legislation, and the creation of regulations for legal abortion care provision by the Secretary of State for Northern Ireland. As a result of the law change, in the year ending March 2024, there were 2,792 abortions provided in Northern Ireland, compared to just 8 in the year ending March 2019.

Further, the work undertaken by the Group has taken place in the context of significant changes in abortion rights in many parts of the world.^[17] Guided by a set of overarching principles, set out later in this introduction, the Group has considered very carefully and in detail, how the Scottish Government could ensure that access to abortion care is not only protected but improved through changes to the law. We have benefited from the input and expertise of a wide range of stakeholders in reaching the recommendations presented throughout this report. Our overarching goal is to ensure that abortion is seen primarily as a healthcare matter regulated by a law which is fit for purpose. We have aimed to balance the need to ensure patient safety whilst seeking to enhance the rights of everyone who requires access to these essential services.

3.1 Scope of the Review

The Group recognises that abortion can be a topic that may attract strongly held, sincere, and often competing views, which should be respected. The Group benefited from a private seminar on the ethics of abortion, to provide helpful context on the perspectives that have been contributed throughout the review. However, the review itself does not cover the complex moral and ethical questions relating to abortion (such as when human life begins or concepts of personhood). Rather, the purpose of this review, and the remit of this group, was to consider the law and regulation of abortion as first and foremost a healthcare matter, similar to other equivalent healthcare services, and to make recommendations where the law could be improved. Within this, the importance of ensuring continued access to abortion was also recognised.

Further, the focus of this review is on the law on abortion and not on service provision. To provide an example, the Group did not discuss in detail the safety and practice of Early Medical Abortion at Home (EMAH), which was evaluated separately in 2023, alongside recommendations on how to improve provision and access to EMAH across Scotland.^[18] However, the Group did consider how EMAH might be reflected within the law, taking into account the EMAH approval.^[19] Some of the Group’s discussions did cover aspects of service provision, where it was necessary to consider whether, and if so what, elements of service provision should be specified in legislation.

The Group was clear that their recommendations should not seek to deregulate abortion provision, which should remain subject to the same robust regulation that ensures the safety of other healthcare services. However, the Group have carefully considered where it is appropriate to shift that 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.

Much of the campaigning to modernise abortion law has focused on the decriminalisation of abortion, and discussions on offences (current offences and potential future models) have therefore formed a significant part of this review. However, at the start of this process, and as part of the terms of reference provided to the Group, it was considered important that all aspects of the current law relating to abortion should be covered. Decriminalisation of abortion alone, while a major step towards reproductive freedom in the UK, would not be sufficient to guarantee delivery of high-quality abortion care, as has been learned from other contexts globally. The Group certainly recognised that improvements to abortion care often originate from outwith the legal framework. However, it is fundamental that the regulatory framework itself should support excellent and high-quality abortion services for women and pregnant people in Scotland.

There were a number of reasons for expanding the scope of the review beyond just decriminalisation. These included aims of:

• Modernising – ensuring the regulation of abortion recognises major shifts in clinical practice since 1967, alongside ongoing innovation in service provision, and is able to support evolving standards of clinical best practice.
• Removing unnecessary barriers that can cause difficulties for Health Boards and healthcare professional and create delays for patients accessing time-sensitive procedures.
• Understanding abortion as healthcare – to align with the Scottish Government’s rights-based approach to healthcare, and to respect the review’s terms of reference.

The review therefore included an in-depth analysis of the Abortion Act 1967. It examined the common law, noting that abortion provision outwith the terms of the Act may be considered a common law crime in Scotland. Additionally, the review considered other relevant laws to ensure appropriate controls and/or regulations around abortion services are recommended.

3.1.1 Ways of Working

The topics covered by the review include, but are not limited to: gestational limits, grounds under which abortion is permissible, patient and provider pathways (including, but not limited to, the places where abortion can be provided, who can provide abortions, and what legal requirements should exist for patients before they can get an abortion), data and reporting, conscientious objection, regulation, and offences, including patient and provider offences and third party offences. For each topic, the Group considered the current law, international examples, stakeholder views and evidence (the views of around 50 organisations were sought in advance of each meeting), and considered potential models for a reformed Scottish law before coming to an agreement on the model to be recommended. Further details on the process taken by the Group can be found in Annex A.

From the outset, the Group was clear that it would remain open to considering other issues based on input provided by stakeholders, and any additional topics that arose from the evidence that has been carefully considered. Feedback from stakeholders led to discussions on topics such as mandatory counselling, mandatory waiting periods, and the potential for specific offences around forced abortion or coercion.

3.2 Composition of the Expert Group

The membership of the Expert Group was carefully considered, with members selected to reflect a diverse range of expertise relevant to the healthcare focus of the review and its aim to develop recommendations that best serve the needs of those seeking and providing abortion care, while also considering the complexities of the matter. The composition of the Group has been criticised by a number of Pro-Life and Faith based groups for being 'unrepresentative'. When agreeing the membership, consideration was given to expertise in abortion law, medical law and provision of services in Scotland under the terms of the 1967 Act. The Group membership therefore focussed on experts and not 'representatives'. No core members of the Group specifically represent Pro-Life or anti-abortion organisations since the question of the morality or permissibility of abortion under the law was outside the remit of the review.

However, the Group has, from the start of the process, engaged with organisations and individuals representing a wide range of views, and has carefully considered submissions made by all stakeholders regarding the regulatory or legal status of abortion. Around 50 organisations were contacted in advance of each topic and invited to submit written evidence. The Group reviewed the perspectives put forward, and the quality and relevance of the supporting evidence

The membership of the core Group comprised:

• Professor Anna Glasier, Women’s Health Champion and Expert Group Chair
• Professor Marion Bain, Deputy Chief Medical Officer, Representing the Chief Medical Officer
• Professor Sharon Cameron, Scottish Abortion Care Providers and consultant gynaecologist
• Dr Alastair Campbell, the Royal College of Obstetricians and Gynaecologists
• Rachael Clarke, British Pregnancy Advisory Service
• Dr Sinead Cook, College of Sexual and Reproductive Healthcare and Consultant in Sexual and Reproductive Health
• Professor Anne-Maree Farrell, Professor of Medical Jurisprudence at The University of Edinburgh
• Andrew Lothian, Law Society of Scotland, Health and Medical Law Sub-Committee
• Dr Lynsey Mitchell, Senior Lecturer in Scots Private Law, University of Strathclyde
• Dr Carrie Purcell, Research Fellow in Sexual and Reproductive Health, The Open University
• Professor Sally Sheldon, Professor of Law at the University of Bristol and expert in the UK’s abortion law
• Dr Sarah Wallage, Scottish Abortion Care Providers and Consultant in Sexual and Reproductive Health
• Jill Wood, representing the Advisory Group of reproductive rights, women's and equalities groups .

3.3 Overarching Principles

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.”^[20]

The Group understands that abortion raises important moral questions upon which reasonable people have sincerely held, yet sometimes starkly opposed views. In recognising that abortion services should be treated ‘first and foremost as a healthcare matter,’ it does not deny these moral views. The Group notes that many other areas of healthcare practice likewise raise important moral and ethical issues. It believes that all healthcare provided in Scotland should be underpinned by a strong regard for medical ethics, human rights, equality law, and the principles set out in the Scottish Patient Rights Charter and the Scottish Government’s Health and Social Care Standards.^[21]

The Group interprets its terms of reference to require consideration of how abortion services should be regulated and delivered as part of a comprehensive and integrated health service designed to secure improvement in the physical and mental health of the people of Scotland. It notes that effective and timely fertility control is essential to health and wellbeing, and that abortion is a common procedure that has been offered within Scottish health services for many decades. It has worked to consider how best to ensure effective and proportionate regulation that supports the continued development of high quality, accessible abortion services, taking account of the best available national and international clinical evidence and guidelines, as well as the views of stakeholders.

These concerns have been integral to all aspects of the Group’s work and underpin the recommendations to follow throughout this report. In addition to the overarching remit provided by Ministers, the Group established some overarching principles against which it has measured all potential models for reform. These principles are as follows:

1. Supports equitable access to abortion care – Does the potential model promote equal access to abortion as a means to improve healthcare outcomes for all, taking intersectionality into account?

2. Advances gender equality – Does the potential model situate abortion appropriately within wider structural gender equality aims?

3. Positive impact on service delivery – Does the potential model improve provision of, or access to, care for patients and abortion providers and avoid creating unnecessary barriers to future potential beneficial innovations in service delivery?

4. Complies with international human rights standards – Does the potential model comply with various international human rights standards on abortion?

5. Evidence-based – Does the potential model have a strong evidence base, including clinical and academic evidence and consideration of stakeholder feedback?

These overarching principles guided the discussions carried out during the Group’s review.