Complications from Abortions (Annual Report) Bill [HL]

Committee

12:26:00

Clause 1: Annual report

Debate on whether Clause 1 should stand part of the Bill.

My Lords, it was a great honour to listen to the last debate. I commend my noble friend Lord Patel for leading a wonderful debate. However, we move on, and I shall explain to the Committee why I am opposing this clause standing part. First, I have always understood that a Private Member’s Bill in either House should seek to remedy one problem or issue which needs primary legislation to do so. I say respectfully that I do not think that the Bill of the noble Lord, Lord Moylan, fulfils this criterion. It is not a necessary solution to a problem or lack of something, because there is not a problem to be solved that requires primary legislation. That is why I have not sought to amend the Bill. The reason why there is not a problem to be answered is that the information about complications from all medical procedures, including abortions, are already collected. We might question the efficacy of data collection, the fact that systems do not talk to each other across our NHS, and all of those things; they definitely need to be improved, but we do not need primary legislation to do so. In the case of abortions, it is the only kind of healthcare in the UK that is governed by specific criminal law. Regulations issued under the Abortion Act 1967 require that for every abortion, a woman’s name, date of birth or personal identifier is submitted and provided to the Chief Medical Officer via the abortion notification system. NHS numbers are not required. This data includes complications which are identified before patients are discharged from clinics and the information is managed by the Department of Health and Social Care. My second reason is, why should abortion be singled out as a medical procedure? This particular and singular primary legislation would require the UK Government to publish “an annual report on complications from the termination of pregnancy in England”. Why not knee replacements, appendicitis operations, operations to remove tumours, heart bypasses, cataracts, hernias and the many other everyday or complex procedures, all of which carry both cures and risks which are explained to patients and whose outcomes are recorded? The Secretary of State will be required in this case to include the complication rate for abortions by the age of the woman, by the method of abortion, by gestation and by complication type as a minimum. The Royal College of Obstetricians and Gynaecologists is very clear that the proposal in this Bill is neither practical nor deliverable and, if passed, this Bill would therefore require the Secretary of State to produce an annual report using data collections that are inadequate to fulfil its aims.

12:30:00

Also, an important aspect of providing abortion care to women is confidentiality. A woman may not wish to have the abortion on her personal medical record. This could be due to fear of an abusive partner or relative, who may work for the NHS, being able to access this file and cause them harm. It is essential that, when seeking to improve data collection, this right to confidentiality is retained, particularly as a matter for women’s safety.

Where I suspect the noble Lord, Lord Moylan, and I would agree—and all others in this Committee, including my noble friend the Minister—is that, in the 10-year health plan and the updating of the women’s health strategy, the Government need to improve data collection on women’s health and ensure that women’s confidentiality is prioritised at every opportunity. I am sure that we are all supportive of improving data collection that will benefit patient safety and allow clinicians, NHSE, abortion providers and researchers to have fully informed conversations about how to reduce complications and improve women’s health.

While this may not be the noble Lord’s intention, the effect of his Private Member’s Bill would be to exceptionalise and stigmatise abortion care for both women and the medical professionals who provide the care. It would also contribute towards a false narrative that there are significant levels of complications in abortion care such as to require political intervention to reduce women’s access. This in the face of all the evidence, which tells us that abortion is a safe and effective medical intervention. However, those opposed to abortion seek to paint it as dangerous for women; this is the approach that anti-abortion groups in the USA have used, without any clinical evidence. This is not a path we would want to follow in the UK.

As the Royal College of Obstetricians and Gynaecologists says:

“The obligation on the Secretary of State to publish a yearly report including details of complications in abortion care to ‘inform policy and safe practice regarding the termination of pregnancy’ suggests a politicisation of what is, and should remain, an area of healthcare decided by medical experts. It could also hold back modernisation of abortion law and innovation within care by adding a further layer of legislation. This would not be tolerated in other areas of healthcare, and we would encourage Parliament to recognise this and speak against the Bill”.

I agree with this, and that is why this Private Members’ Bill is not needed.

I will not divide the Committee, but I will return to it on Report if the noble Lord, Lord Moylan, is not convinced by my argument that this is not a necessary Bill.

My Lords, it might be helpful if I spoke next so I could update the House on various developments that have taken place since Second Reading. I am grateful to the noble Baroness, Lady Thornton, for her remarks about the importance of improving data and the importance of that data for women’s health. Nearly all of the other points she made were dealt with and debated at Second Reading, which the noble Baroness was unable to attend. However, the fact is that there is nothing in the Bill which exceptionalises abortion, because the statistics on abortion complications already have to be collected under the existing abortion regulations using a system that relies on data provided by the abortion provider. That might have been sensible when the regulations were put in place, but currently the majority of abortions take place by the use of pills at home. Therefore, if there are complications, they are presented, in most cases, at hospitals in A&E and they are not part of the abortion notification system, so the majority of those complications are no longer captured by the current system. The royal college says it is impossible to capture the complication statistics, but it seems to be completely unaware that, in November 2023, the Office for Health Improvements and Disparities produced a report that, with some labour, did actually capture them and showed that it could be done. All that is in this Bill is a requirement that that report, which is being treated by the department as a one-off and not to be repeated, should be repeated. It is wrong to suggest that this cannot be done; it has been done, and it can be done again. I want to be brief, as I am conscious of the words of the Chief Whip before we started. I will move on to some developments that have occurred since Second Reading, because at the end of Second Reading, thinking that perhaps the Bill would not proceed to Committee, I tabled some Written Questions on this matter. I had one reply from the noble Baroness, Lady Twycross, on behalf of the Cabinet Office, which effectively introduced me to Mr Ed Humpherson, the director-general for the Office for Statistics Regulation, with whom I have since had correspondence. Before I read from his letter to me of 20 February, I will remark that, as was mentioned at Second Reading, these statistics are referred to as national statistics and they are required to comply with the statistics code. In that light, the last compliance check was carried out in 2012 and because of that, Mr Humpherson says: “We have agreed with DHSC that a compliance check of the statistics would be beneficial”. A great deal of what the Bill seeks to achieve is likely now to be pursued by the Office for Statistics Regulation in consultation with the DHSC. Since it is very unlikely that any compliance check would consider that the current system was successfully capturing complications arising from abortions, I am therefore very pleased with what Mr Humpherson said. I will continue with his letter a little bit, because my pleasure at his agreement to carry out a compliance check is slightly modified by his timetable and approach. He goes on to say: “We plan to carry out this review in the first quarter of 2026/27, giving DHSC time to undertake its planned developments. These include supporting data providers to move to DHSC’s digital submission system and working with digital experts and system users to improve the design of the Abortion Notification System”. I am certain that the noble Baroness, Lady Thornton, and I would agree that that work would be very welcome. My only quibble with Mr Humpherson—and I have written to him to say this—is that I would have thought the sensible thing would be to have the compliance check first, in order to identify the deficiencies and agree between DHSC and the regulator what the deficiencies are, and then for the department to invest in the digitisation of the collection of the statistics in such a way that they will comply with the regulator’s requirements. When the Minister comes to reply, I am sure she will say that she will collaborate fully with the Office for Statistics Regulation and its work, because I fully expect the department to do that—it is the responsible thing to do. Can she agree that she will consider whether this is being done in quite the right order? Would it not be sensible to bring the compliance check forward so that the developments being carried out, which will involve investment and time, are not wasted but achieve what the regulator will be satisfied with at the end of the day?

My Lords, I apologise for not being able to attend Second Reading. I begin with the observation that, as a healthcare service, abortion is highly regulated and subject to the same oversight as any other care. As a result of the Abortion Act 1967, it is also subject to additional oversight which predates many of the regulatory and monitoring systems in place across the health service today. This context is relevant to the Bill before us, which seeks to build on this 58 year-old framework. I am wholly in favour of monitoring all forms of healthcare provision and entirely agree that further work needs to be done on the collection and analysis of large datasets relating to women’s reproductive health. However, I have concerns that this Bill in primary legislation is not the best way to approach this important work. I am aware that both the Royal College of Obstetricians and Gynaecologists—the RCOG—and the British Pregnancy Advisory Service have shared with noble Lords their concerns that, as the noble Baroness, Lady Thornton, has said, singling out abortion for new legislation in this way exceptionalises it and fails to treat it like other forms of healthcare. This would potentially stigmatise abortion care for both women and the medical professionals who provide the care. It would also indicate that abortion is considered to be such a high-risk intervention that it is in need of particular oversight. The RCOG points out that abortion is a “safe and effective procedure”. Some one in three women in the UK will have had an abortion before the age of 45 and international studies have repeatedly found that abortion is of less risk to women than complications that can arise from continuing a pregnancy to term and giving birth. As a result, I am concerned by any indication that this House considers abortion to require increased monitoring and oversight, over and above that of comparable healthcare, and indeed the message that it would send to the nearly 300,000 women who access abortion services across the UK every year. I agree with my noble friend Lord Moylan that we need to improve collection of data, but this must be done across women’s healthcare more broadly, and I would be interested to hear from the Minister about what plans the Government have to achieve this. We know that in many areas, women wait a disproportionately long time for diagnoses of devastating conditions, such as endometriosis, and in that time often suffer complications that come from lack of treatment. It was for this reason that the previous Government published the widely welcomed, first ever women’s health strategy for England, to take a holistic approach to women’s healthcare. I pay particular tribute to my former colleague, Emma Dean, for her tireless and excellent work to make this happen. We also appointed the brilliant Dame Lesley Regan as the first women’s health ambassador to support the implementation of this strategy. I was pleased to note that the Minister for Secondary Care confirmed in the other place the Government’s commitment to the women’s health strategy, though I am concerned about the lack of progress against the strategy’s widely welcomed commitments, especially the Government dropping targets for ICBs around the creation of women’s health hubs. The RCOG has said that the existing hubs have reduced unnecessary referrals, provided training opportunities for professionals and enabled women to access support quickly. The NHS 10-year plan and monitoring of the women’s health strategy would, I hope, offer an opportunity to address the challenge of good monitoring without adding unnecessary legal burdens to the healthcare system. I hope that we can all agree that the purpose of this monitoring has to be to improve information and care for women, and that singling out abortion is unfortunately likely to do more harm than good. Before I close, I want to touch on the practicality and operability of this legislation. I understand that the information currently used by the department to produce abortion statistics, such as the type of abortion, gestational age, and information about women accessing care, is separate in the majority of cases from a woman’s broader healthcare record. It seems incredibly important to protect this right to privacy for women accessing abortion care, particularly for women at risk of domestic abuse, honour-based abuse or reproductive coercion. I know that my noble friend will not want to place women at risk as a result of this legislation, so I wonder if the Minister can confirm that the department is able to link abortion records with wider healthcare records in the way this legislation would require, and if so, whether that would mean that abortion care would appear on a woman’s medical record, whether or not she had given consent. Given my concerns about the impact of the proposals in the Bill on women and the wider healthcare system, I am not able to support it in its current form and support the noble Baroness, Lady Thornton, in her opposition to the clause standing part.

My Lords, I join others in apologising for not being here at Second Reading—on medical grounds, in my case—which seems to be a consistent theme in this debate. In looking at the amendment and legislation today, it is important that we actually focus on what is there rather than debating—I appreciate that the noble Baroness does not intend to push this to a Division—something that is not there.

12:45:00

Down the years, abortion—whatever anyone’s view on the subject—has clearly been a significant issue. It has been controversial, and sensitivity is needed when dealing with it. Indeed, I am sure that, at some point in the future, some piece of legislation will lead to a range of arguments from those who support the status quo on abortion regulations, those who would seek a more permissive law and those who would seek a more restrictive law. But that is not the subject before us today; it is a debate for another occasion. Still less, the divisive social issues in the United States are not particularly relevant to what is before us today.

The Bill tabled by the noble Lord, Lord Moylan, seeks to ensure that we have the most accurate data on the complications around abortions. The issue has been raised as to why it is specifically about abortion, and the noble Lord clearly indicated that one of the major problems we have at present is that the ANS figures are out of date. They are not fit for purpose, because they do not operate to collect all the data. An enormous gap—or, at least, a level of gap—was highlighted by the OHID report in 2023, because of the changing situation with how abortions are carried out. That means, frankly, that we do not know how reliable the current data is.

On any aspect of public life, if someone is taking a decision, data is needed that is accurate, reliable, focused on the issue at hand and timely. That is true whether you are a policymaker or an individual citizen taking a decision. I was a policymaker—a Minister in the Northern Ireland Executive—during Covid. A reasonable amount of information and data came our way. However, looking back four or five years after those events, I wonder whether, had we had more real-time data that drilled down more into the detail and that was more appropriate to what we sought, better decisions could have been made, either in Northern Ireland or throughout the UK. Obviously, that is a question for the inquiry. As public policymakers, the better the data we have, the better our decisions may be.

That is particularly relevant when looking at data and evidence for the individual citizen—or, specifically, the individual patient—in a medical situation. It is the case for most of us, I think, that we do not think about medical issues until they directly affect us. I will use myself as an example. Approximately a year and a half ago, I was diagnosed with a condition in one of my feet called Charcot, something I had never heard of before. Some noble Lords, if they have been fortunate, might have avoided me as I have zoomed around on an electric wheelchair; I hope that I have not managed to injure any noble Lords in the process. I came to that diagnosis from a position of complete ignorance. It had a major impact on me. I faced surgery at one stage, and at another I was given the option to amputate part of my leg.

In moving that forward, I had to take a number of decisions at different junctures. In reaching those decisions, I wanted to make sure that I sought out the data and the evidence. It was critical that that was the most expert and accurate data. I met, for example, with amputee ward staff to see what the longer-term implications would be. That is just one example. That would never have crossed my mind until I was faced with the position. It is critical for any individual patient that they have the strongest and most reliable data, and that is what the Bill will achieve.

When we get that data, it may produce inconvenient results for some of us. It may well be that some of us who would argue for a different regime for abortion, for example, may find the figures very inconvenient. But the mark of a tolerant and open society is tolerating a wide range of opinions and sometimes dealing with inconvenient opinions. If we can deal with inconvenient opinions, how much more important is it to deal in facts and evidence? It seems to me that, at times, we may be faced with inconvenient facts and evidence, but the stronger and more reliable those facts and evidence, the better. That is why I believe that this is a productive way forward, and why I am not minded towards the opposition to the clause but am supportive of the original wording of the Bill from the noble Lord, Lord Moylan.

My Lords, as part of my work in Cambridge, which is in my register of interests, I was involved, and still am, in the making of decision aids to help NHS patients make decisions about their healthcare treatments. Part of my work was to find the evidence about the risks and benefits of different treatment options, so I am very familiar with the lack of data in many respects on the efficacy and, in more cases, side-effects of different treatment options. I would absolutely stand by any Bill that aimed to improve the data for individuals to make decisions, but I do not see why abortion is being singled out in this way in this particular Bill. I am bearing in mind the Chief Whip’s notes, and although I could speak for some time on the lack of data for side-effects in many treatments I will give just two examples. I was involved in the decision aid for osteoarthritis in hips. Hip replacements are an example where, again, we have large numbers of treatments being done outside of NHS clinics. We are really lacking in long-term follow-up, particularly asking patients about the really important patient-reported outcome measures—the things that are important to them. Cataracts are another example. It is one of our biggest and most numerous operations, and more than half of them are done outside of NHS clinics. Again, you would think that actually asking how many people would say afterwards that their vision has improved would be a very basic thing, but we are lacking that data. I would absolutely love to have more data on side-effects and the efficacies of these things, including side-effects that are not expected and not on the official list to be collected. I did a decision aid on gall bladder surgery. Diarrhoea is a very common outcome of this surgery—in more than 10% of cases—and yet it is not often recorded. Sexual dysfunction is a side-effect of many treatments, but it is not something that patients want to bring up. These are all really important. There are so many issues about data, but if you look at the data on abortion statistics and complications, you find that the 2023 report is very good. It highlights the numbers that patients would need to make decisions. The rates are not changing every year. We do not update our decision aids every year. The data remains stable, unless there is a very dramatic change in clinical practice. I would absolutely support the better collection of data, and I am hoping there are opportunities to do that in the future. But on this particular occasion, I very much support the noble Baroness, Lady Thornton.

My Lords, I do not support the noble Baroness’s opposition to Clause 1 standing part of the Bill. My noble friend Lord Moylan has mentioned the 2023 analysis by the Office for Health Improvement and Disparities. It based its evidence solely on NHS England statistics: the database of admissions, A&E attendance and outpatient appointments. Using this data, different outcomes were recorded. It used only the data contained in records for patient admissions and for abortion-related complications as the primary or secondary diagnosis, not those for incomplete abortions that did not have a further complication. We see, therefore, that the complication rate varies depending on the evidence that is before the statistician. For these reasons, there is little disagreement among the groups concerned that we all, whether parliamentary or non-parliamentary, want good data collection. Some of us are more concerned with data collection on one kind of procedure, and others with another, but, now that we are updating and digitising the NHS system, this seems an opportunity to improve data right around the system. But this should not be excluded, and I do not think that noble Lords should suggest an exception. It is an exceptional thing to require accurate data where possible and where it can be obtained, so that we can use the digitisation of the system to encourage the best statistics. My noble friend referred to some of the changes that we have seen. The position has changed since the statistics were last checked for compliance with the code of practice for statistics in 2012, with the increase of medically induced abortions from 48% to 85%. In England and Wales, 75% of abortions were completed at home. As a result, complications may not be recorded on the HSA4 forms that are the basis for the present statistics under the abortion notification service. With women administering medication at home, if there is a complication, they may go to their GP surgery, dial 111 or go to A&E. The fact that these episodes are complications will not necessarily be recorded on the HSA4 forms that are used to compile the reports we have. But it has been used, which is why I find this a statistically interesting debate, by the 2023 analysis, which I mentioned on opening, and it can be used. For these reasons, I welcome that the statistics regulator is going to check on the compliance and that the Department of Health and Social Care has agreed to this—I applaud that. The timing is quite important. As the NHS system is digitised, it can prepare things so that the records can be read digitally, accurately and cheaply, with the data on complications from abortions entered into the system. I suggest that, as my noble friend Lord Moylan proposed, the compliance check should be instituted in advance of digitisation so that the statistics authority can then report on—and, as a result, the Department of Health can be made aware of—where and what digitisation is needed, so that the records can be used in digital form cheaply and with the transparency that we need for statistics. This will save money on any further necessary updates later. I do not take the point that some noble Lords have made about confidentiality. Confidentiality is extremely important—I agree with all confidentiality requirements; it is vital if one is to have trust in one’s health service and provider—but these things are done by codes. As far as I know—I ask the Minister to correct me if I am wrong—every operation has codes. People are not named, but there are codes for referring to whatever procedures take place. This is very useful for digitisation.

13:00:00

If things are done earlier, it will save money later if any further updates are needed as a result of the compliance check. Accurate national statistics on abortion complications are obligatory under the Abortion Regulations 1991—Regulation 4 and Schedule 2 specify the complications to be reported. It is not exceptionalising this procedure; this is a matter for law. More generally, it is vital that, wherever statistics are prepared to inform policy and its operation, they are based on the best available evidence. This is important for transparency and accuracy. It is also important that health service statistics prompt confidence, especially among users and the medical profession.

For these reasons, I hope that we will move rapidly to the compliance checks, so that the NHS can take advantage of whatever suggestions or proposals are made by the statistics regulator. If public confidence in the statistics systems drains because they are based on merely partial evidence, open government will be the loser. I hope that, on Report, we can consider some of the questions again. I oppose, for the moment, the proposal of the noble Baroness, Lady Thornton.

My Lords, I offer Green group support for the proposition from the noble Baroness, Lady Thornton. I almost feel that I do not need to, given that the noble Baroness, Lady Freeman of Steventon, very powerfully made the argument that the Bill unnecessarily exceptionalises abortion when there are very comparable procedures conducted in similar procedural ways—hip replacements and cataract operations. Yes, we need to improve the collection of statistics, but we do not have a Bill before us to do that. By definition, the exceptionalising that is going on is very obvious. I want to pick up on two comments made by the noble Lord, Lord Weir of Ballyholme, and most respectfully to disagree with him. The noble Lord said that what is happening in the US is not relevant here. I spoke at Second Reading about the influence and money flowing from the United States of America into the UK. I can update your Lordships’ House on that. I was going back as far 2014, and a chapter of a book I wrote addressing these issues. This has been highlighted by Peter Geoghegan, who wrote Democracy for Sale, and others. The so-called Alliance Defending Freedom from the US provides massive funding. In 2020, it put £324,000 into a similarly named organisation in the UK. By 2024, that had risen to £1.1 million of the organisation’s total income of £1.3 million. We are debating this Bill in the context of that flood of US money seeking to influence what is happening in the UK. I put Written Question HL6542 to the Government about this. I am afraid that the Government are not taking this with the seriousness that it deserves for defending our democracy. The Answer referred to lobbying of the Government and what measures the Government have in place. We need to think about the measures that we need across our society to deal with the inequality of financial arms that is occurring in these debates because of the money flooding in from certain forces within the US. The noble Lord, Lord Weir, also said that the context did not really matter. However, this Bill appears before us in the context of more than 60 MPs in the other place backing one amendment—there is another one too—to decriminalise abortion, to end the exceptionalisation of abortion right across our law. That would make this Bill look particularly strange and ill-fitting. For those reasons, I support the proposition from the noble Baroness, Lady Thornton.

My Lords, unfortunately, I too was unable to be at Second Reading. I speak today to support the stand part notice from the noble Baroness, Lady Thornton, and on what the noble Baroness, Lady Finn, said about the important review of data collection—actually, across the health sector, as I will explain, but particularly of data relating to abortions. The noble Baroness, Lady Thornton, spoke of how some elements of this short Bill are inconsistent, which makes it unable to deliver what the noble Lord, Lord Moylan, hopes for, despite what he said—I will come on to explain why—even if it were the right thing to do. I agree with the points that the noble Baroness, Lady Thornton, made. One issue at the heart of this inconsistency is the use of patients’ confidential health personal data. There is an absolute presumption by patients that their health personal data will always be kept confidential between them and their medical practitioners. Indeed, noble Lords may remember, when the then Government proposed care.data plans a few years ago, it became clear that we were likely to move to a US-type system of allowing researchers, insurers et cetera access to anonymised and pseudonymised data. I can tell the noble Baroness, Lady Lawlor, that, during that debate, it was important to note that it is possible to reverse most anonymised and pseudonymised data, particularly when dealing with an unusual circumstance. Once you have one or two identifiers, you can get to a very small geographic position very quickly—sometimes to a postcode, frankly. Therein lies the problem: confidentiality is lost. More worrying were the original proposals in the Bill that became the Police, Crime, Sentencing and Courts Act 2022, which gave the police and the Home Secretary—then Priti Patel—the power to demand from any relevant person or authority, which included health authorities at the time, to see data that might be of interest in an investigation. I was working on that Bill and, when I queried this power in your Lordships’ House, it transpired that it was not just for suspects of crime but for anyone connected with the incident, who might or might not be a witness. That went completely against everything in a doctor’s sacred oath of confidentiality with regard to their patient. I am pleased to say that, following my amendments to that Bill and pressure from doctors, the then Clause 16(4)(a) was modified to prevent access to health data compared to data from other bodies, where it still sits. That was followed by a debate, on the Health and Care Bill, about the use of patients’ personal health data for research. My noble friend Lord Clement-Jones, other noble Lords and I made it very clear that assuming that anonymised or pseudonymised data could not be reverse-engineered was not acceptable. Out of that, a new system of a black box, where the anonymity of patients is guaranteed, was introduced. However, abortion data is different because it is not within these safeguards. The Abortion Act 1967 requires that the woman’s name and date of birth or a personal identifier must be submitted on every abortion and provided to the Chief Medical Officer via the abortion notification system. While, as others have said, this data includes complications prior to discharge, the “Hospital Episode Statistics” referred to in Clause 1(3)(b) of the Bill from the noble Lord, Lord Moylan, are based only on abortion data from trusts, which are not linked to abortion records. This means that the data is coming from two different sources, which are collecting different data. As the briefing from BPAS tells us, neither dataset actually captures all abortion complications, nor can the hospital episode statistics be analysed by methods of gestation or abortion—another difference, yet again. I do not think that the noble Lord, Lord Moylan, covered that point of disparity when he spoke earlier. My worry is that the annual report would not actually reflect the wider picture. The second issue that I will raise is of those other delicate areas that might inadvertently be drawn into this type of reporting on complications of abortion. In the debate earlier today in your Lordships’ House, we discussed miscarriages and preterm births. Nearly 50 years ago, I had an early miscarriage and, when I went to the hospital, I was told that I was having a “spontaneous abortion”—a ghastly phrase. I still had remnants inside my body that needed to be removed to ensure a “complete abortion”—an even more ghastly phrase. In the middle of my grief at losing my first baby, the medics were talking about “abortion”. The very helpful briefing from the Royal College of Obstetricians and Gynaecologists points out that the differing terms that can be entered into hospital coding are “induced miscarriage” and “spontaneous abortion”. It says: “This can result in a code being applied for an abortion complication when it should have been for a miscarriage complication and vice versa.” This is not just about words such as “spontaneous abortion”. Following on the speech from the noble Baroness, Lady Bennett, in the USA, since the Dobbs case, miscarriage has increasingly been brought into the debate about abortion. West Virginia has one of the toughest sets of abortion laws, allowing it only for cases of rape, incest or if the woman has an ectopic or totally non-viable pregnancy. But it gets worse. Last week, in Raleigh County, West Virginia, the prosecuting attorney, Tom Truman, advised women to get in touch with police, law enforcement or a doctor if they were worried that they might be charged with mishandling foetal remains. The example cited was the arrest of a woman for disposing of foetal remains in her bins. He said that a number of criminal charges under state code, including felonies, could be levied against a woman who flushes foetal remains, buries them or otherwise disposes of them following an involuntary abortion, also called a miscarriage. A West Virginian woman in my situation, which I talked about earlier, could well be prosecuted. The miscarriage that I referred to is not unusual. I lost the tiny foetus down the toilet, and I was distressed beyond measure. In West Virginia, you would now have to retrieve the foetal remains or be at risk of prosecution. I am sure that there is absolutely no intention in the UK for this to happen, but the debate happening in the US is beginning to colour the debate we are having here. I am very clear that the problem is that some people want miscarriage to be treated as suspicious. They clearly are not medics. It is thought that 15% to 20% of pregnancies end in miscarriage. It is surprisingly common, and good luck to that prosecutor in West Virginia. He is going to spend his entire time on people reporting miscarriage. Above all, the issue of miscarriage and spontaneous abortion is yet another that muddles the data proposed in this annual report and demonstrates, sadly, that it is not fit for purpose.

My Lords, I was here for Second Reading and I was here to hear the noble Lord, Lord Moylan, tell us about how the abortion landscape is shifting quite rapidly. Between Second Reading and today, we saw a vivid example of just how that landscape is shifting and why it needs to shift very rapidly, because we saw the conclusion of the trial of Nicola Packer. Thankfully, the jurors recently cleared the 45 year-old of illegally terminating her pregnancy. She suffered more than four years of police and criminal proceedings. In fact, the number of women being prosecuted on suspicion of breaking abortion laws has increased over recent years, so the landscape is getting worse. That is partly why I am very pleased to support the noble Baroness, Lady Thornton, in opposing the clause standing part, because the Bill does nothing to improve the abortion landscape. Personally, I am quite surprised that the noble Lord, Lord Moylan, has brought it back today to Committee, because it was made evident to us at Second Reading by the Minister and other speakers, including my noble friend Lord Scriven, that it was absolutely unnecessary and very unhelpful. Indeed, we heard from the noble Baroness, Lady Freeman of Steventon, today exactly why that is. I hope that this House will soon have the opportunity to debate and enact real change, along the lines of the two amendments tabled in the other place, referred to by the noble Baroness, Lady Bennett. I want to check something with the noble Lord, Lord Moylan. He said at Second Reading—and I expect he is thinking it again today: “What is so strange about the advocates of choice in this debate is that they are so defensive; they speak as if they are surrounded by conspiracy ... If I thought I was surrounded by conspiracy, I would want to live in a world of facts and not hide myself from them”.—[Official Report, 13/12/24; cols. 1994-5.]

13:15:00

The facts in this case are that all medical opinion, from the BMA and the Royal College of Midwives to obstetricians, gynaecologists, nurses and GPs, is behind the decriminalisation of abortion and none sees the data issue as critical, whereas decriminalisation is critical because it is a healthcare matter adversely affecting women. The general population agree. Numerous polls since 2020 show that, whether it is 76% or 82%, the vast majority of people agree that abortion is a woman’s right to choose. By debating this in in your Lordships’ House even further, I fear we are getting more and more out of touch when we talk about data and not about the fundamental issues that the other place has been debating. I am very pleased to support the clause not standing part today, and I hope that the noble Lord, Lord Moylan, may, on reflection, decide not to continue with this Bill.

My Lords, I, too, spoke at Second Reading and I welcome the opportunity to speak again to set in context what the Bill is part of and is all about. I, too, have to disagree fundamentally with the noble Lord, Lord Weir of Ballyholme, though not on the necessity for accurate data and statistics. You cannot separate the Bill from the wider context of what is going on in the politics of reproduction, reproductive health and gender identity. I spoke last time about the international campaign being organised largely by religious nationalists across the USA, Europe and Russia, which has a specific aim to destroy human rights, reproductive rights and the international organisations responsible for upholding them. If people wish to doubt me, I suggest they read any number of reports, but the one that sets out the fundamental basis of the campaign is from 2018 by the European Parliamentary Forum on Population and Development, Restoring the Natural Order, which sets out how a small group of people have set out to overturn the human rights framework that we developed following the horrors of World War Two and over the past 50 years in order to “restore the national order”. They have a number of specific objectives within that. Key among them are making sure that the definition of marriage and family pertains only to heterosexual people, and definitely overturning access to abortion and contraception. Overturning divorce laws is part of what they want to do as well as rejecting compulsory sex, reproductive and health education and, perhaps most interestingly of all, making sure that the first and primary educators of children must always be the family, even if that is to the exclusion of public education. It is a clear agenda. The noble Baroness, Lady Bennett, was right. If you want to see how it is unfolding, just look at what is happening in states in America and in Hungary and Poland, because what is happening in the USA is not stopping there. It is funded by billions upon billions of dollars in Europe, mostly emanating from America but also from Russia, and in Africa. This is part of that. It is important and relevant that we look at that today because the data you get relies entirely on the questions you ask, and the questions you ask are determined by the outcomes you want to achieve. As some of us watch this campaign unfolding in its different manifestations, one thing we have noticed is that it is moving on. The people behind it—the Alliance Defending Freedom, the Heritage Foundation and all those massive Christian nationalist organisations and Catholic and other religious institutions in Europe—have realised that, to make to make their campaign more widely palatable, they have to move away from being largely a bunch of male-led organisations. They have removed themselves through a number of different front organisations and changed the language they use to talk about rights and so on. From those of us who have fought for human rights for 50 years, they have learned the importance of having your messages framed in terms of rights—the rights of people to resist a liberal elite that argues for things such as equality and equality laws, which are inevitably disproportionately affecting some people, particularly poorer people. They say, “Rather than relying on what we’ve done so far, we actually need to go further. We need to create the information that will back up our campaign”. Interestingly, in some cases they have set up private universities which produce research that appears to be proper academic research but is in fact grey research, always leading inevitably to the conclusions that support their back-up. They produce books and reports. This is not new. Noble Lords in this House have for years seen the dodgy dossiers that come from the Christian Institute—all that kind of stuff. That is what is happening and that is why it is important that we make sure that the statistics that we get on abortion—and, incidentally, access to contraception—are timely and accurate. Noble Lords have mentioned this, and they are absolutely right: the politicisation of data in this area is really important. The increase in the number of women being prosecuted because they have had a miscarriage comes as a direct result of this campaign. I do not think that those of us on our side of the argument have anything to fear. We kept statistics when we introduced telemedicine and medical abortion. In advance of it, those on the other side of the argument were full of dire warnings that all sorts of crimes would be committed. They were not; the statistics and the data have shown that. I have nothing against the improvement of the collection of data in the health service, but my plea to the noble Baroness, Lady Merron, is that, when the Government look at this issue—and I believe that we should—I ask her to ensure that the statisticians are able to resist the political pressure being exercised across all the different parts of government and organisations because of this campaign, which is being waged on a number of different fronts. Ultimately, it is a pernicious campaign that will damage all sorts of people, including minorities, but will be particularly harmful to women and girls.

My Lords, I join this debate to follow up the powerful speech by the noble Baroness, Lady Barker. I have been involved in women’s rights for a very long time; I started a magazine called Spare Rib in 1972 and within that we campaigned all our lives for things such as abortions. I can honestly say that I think the life facing a young woman today is more frightening than the life that faced me as a young woman. I look at what is happening online, where you can download a very simple app. I had a lunch for Laura Bates the other day, which many noble Lords came to. She explained that I could download an app, take a photograph of the noble Baroness, Lady Freeman, right beside me, press a button and have a photograph of the noble Baroness naked—not with Kate Moss’s body, but with the noble Baroness’s body. You can do this at 11 or 12. It is really threatening being a young woman today. There are many things that are out of our control. We, as older women who have had successful lives, have to fight fantastically hard to protect this next generation from a lot of the stuff that is coming down the pipe. I very much listen to and know about the conspiracies and the power happening in America to try to alter fundamental rights such as abortion. I find it extremely distressing that measures such as this should come to the House of Lords and even be debated seriously, and that there should be a politicisation of women who face abortion. Frankly, nobody wants an abortion; I cannot think why people ever thought that. Nobody wants one. There are several things you do not say when you ask yourself, “What do I want to do in my life?” No one says, “I want to be an alcoholic”, or, “I want to have an abortion”, or, “I want to be a druggie”. You do not put those on your wish list. They happen and we should protect women and support them all the way through, as the noble Lord, Lord Patel, spoke about in his fantastic debate earlier. These are people who need our protection and our love. I really support the noble Baroness, Lady Thornton, in bringing this forward. I will take part in any further debate because this is vital, and we are vital to this. Our voices really matter here.

My Lords, I thank my noble friend Lord Moylan again for bringing to our attention the issue of the reliability of statistics on the complications of abortion. It is absolutely right that, in all healthcare, we have correct and accurate data that health service providers can use to understand the safety of procedures. It is the usual practice for Committee to include discussion of the amendments that have been tabled to the Bill, but here, of course, there is only the proposition that the only substantive clause should not stand part. This, therefore, has necessitated a general discussion of the underlying principles behind the Bill in a restatement on this side of the Chamber of our positions. At Second Reading, I said that our view was that the Bill performs “an important service” by highlighting “the absence of accurate, comprehensive statistics in respect of abortions”,—[Official Report, 13/12/24; col. 1990.] but I explained in the same speech that improved data collection and reporting does not require legislation for it to be delivered. In short, I do not depart from that view, but this Bill has allowed an informed debate to emerge about data in this field. It presents an opportunity to urge the Government to do more to rationalise data recording and collection, so that proper evidence-based medicine can be implemented. In this respect, I endorse what my noble friend Lady Finn said about data collection and statistics more generally. In answer to a Written Question asked by my noble friend, the director-general of the Office for Statistics Regulation stated that that office—the OSR—had not completed a compliance check on the abortion statistics collected by the Office for Health Improvement and Disparities since as long ago as 2012. That raises important issues of data quality. I am glad to note that it has now been agreed that the OSR will carry out a long-overdue compliance check on those statistics, but only after the Department of Health and Social Care has been able to update the design of the abortion notification system. This seems, to me and to others on this side, the wrong way round. Surely it would make more sense to complete these compliance checks before making alterations to the ANS. That way, the department will be able better to understand any deficiencies in the system—and we know there are some. I hope the Minister will be able to comment on this and address it. Overall, my noble friend has raised an important concern. I suggest that the Government must now take steps to ensure that the data are gathered on a more reliable and consistent basis.

My Lords, I thank the noble Lord, Lord Moylan, for tabling this Private Member’s Bill and my noble friend Lady Thornton for tabling an amendment. I very much appreciate the contributions made by a number of noble Lords. The stated main purpose of the Bill is to impose a legal duty on the Secretary of State to “publish and lay before Parliament an annual report on complications from the termination of pregnancy in England under the Abortion Act 1967”. The purpose of such an annual report, as I understand it, would be “to inform policy and safe practice regarding the termination of pregnancy”. I know that noble Lords appreciate that this Government are entirely committed to the priority of patient safety.

13:30:00

On the points that have been directed to the Government—the ones I am able to refer to—the noble Lords, Lord Moylan and Lord Sandhurst, and the noble Baroness, Lady Lawlor, asked about improving the design of the abortion notification system and whether it would be sensible to change the order to ensure a review by the Office for Statistics Regulation before investing in improvements. The department is engaging with digital experts and reviewing the design of the HSA4 form. We are also conducting research among system users in order to redesign the system. On the ordering of work, I confirm that the department is developing work with the OSR on improvements to the system that are required irrespective of the statistical impact. The reason for that is to improve the user experience for clinicians. However, the Bill is not required to make such an improvement.

For clarification, is the Minister saying that the digitising and adapting of the abortion notification system that her department plans to carry out will be done in collaboration with the Office for Statistics Regulation? Or is the intention that the department does the work in its own box, so to speak, and then the Office for Statistics Regulation comes in and checks it? She seemed to hint that, for the first time, it might be the former, which would be quite encouraging.

As I said, we are developing work with the OSR. As with all ways of developing work, that means working in a way that will get us to the place we wish to get to. I do not quite recognise the latter way forward that the noble Lord referred to, but I will be happy to write him further on this matter. I can assure the noble Baroness, Lady Finn, that our focus in the women’s health strategy is on turning those commitments into action. I draw the noble Baroness’s attention to the provision of free of charge emergency hormonal contraception at pharmacies from October this year. We are also setting out how we will eliminate cervical cancer by 2040 through the new cervical cancer plan, we are and taking urgent action to tackle gynaecology waiting lists through the elective reform plan. Those are all tangible improvements to women’s health. I assure the noble Baroness that the women’s health strategy is very much kept under review to see how and where it can be improved. The noble Baroness, Lady Finn, asked about the linking of records. It is not currently possible to link the abortion notification system with wider health records data, because of the unique identifiers on the abortion notification system data. However, as I said earlier, we are reviewing the wording of the form so that it will be easier for clinicians to complete, which will, I hope, bring about some improvements. I say to the noble Baroness, Lady Freeman, that the Government are focused on moving the NHS from analogue to digital across all areas of healthcare, in order to provide the improved data collection that many noble Lords have called for during the debate. The noble Baroness, Lady Bennett, called on the Government seriously to consider the implications of money flowing in from the USA with a view to obtaining influence—a point also referred to by the noble Baronesses, Lady Brinton and Lady Barker. I can confirm that this matter is being considered more widely across government. As noble Lords may remember, the Government have expressed reservations about the Bill as legislation is not required to produce an annual report. We believe that the aims of the Bill can be achieved through existing routes, thereby rendering further legislation unnecessary. In 2023, the department published a report on abortion complications and could choose to do so again. However, it has no plans to publish ongoing separate additional annual reports on abortion complications as there is no operational need to do so. I hope noble Lords will understand—some have made this point—that we have to uphold a duty of care not to legislate when other reasonable processes are available, as there are in this case.

Clause 1 agreed.

Clause 2 agreed.

House resumed.

Bill reported without amendment.