Very late termination - Policy varies

There was a recent press flurry in the UK concerning an allegation of unlawful killing against an obstetrician who is said to have terminated a pregnancy because of cleft lip and palate at more than 24 weeks gestation. The police were informed about the case by a Church of England curate who noticed it in a table of statistics. The police investigated the matter and although the authorities decided not to prosecute, the curate and her lawyers have successfully sought High Court permission to seek a judicial review. This has raised once again an oddity of UK termination law that dose permit the procedure to be done even as late as term if there is a serious malformation. In 2002 there were 110 late terminations out of 185,000 in total.

Laws passed in 1967 and 1990 have clarified when a termination can be considered necessary. The woman requesting the termination has to see two doctors, who must agree and be able to certify in good faith that at least one of the following is true:

· Continuing with the pregnancy would be a greater risk to the woman's life than would ending the pregnancy.
· Continuing with the pregnancy would involve a greater risk of injury to the woman's physical or mental health than would ending the pregnancy.
· Continuing with the pregnancy would be more of a risk to the physical or mental health of any of the woman's existing children.
· There is a real risk that the child, if born, would have a serious physical or mental disability.
The Abortion Act of 1967 excluded Northern Ireland, where it is difficult to obtain an abortion unless at least one of the following is true:
· The woman has a serious physical or mental problem that would jeopardise her life if the pregnancy were to continue.
· The woman has a significant learning disability.
· The foetus has a significant abnormality.

An abortion must be done before 24 weeks, but can be done at any stage of pregnancy if:

· There is a risk of grave or permanent injury to the mother's physical or mental health, or
· There is a substantial risk that the child will be seriously mentally or physically handicapped.

Here's what we've been able to find about some other countries (mainly from the EUROCAT birth defect monitoring website):

Austria: Terminations of pregnancy following prenatal diagnosis of congenital anomaly are registered. Termination of pregnancy is legal in all cases for socio-economic reasons up to 12 weeks and thereafter, if serious psychological or health problems for mother or the fetus were to be expected. If a non-lethal congenital anomaly is diagnosed, most obstetricians in Austria would follow the maternal wish for TOP only up to 24 WG+0. Non-viable forms of congenital anomalies may be terminated at any stage of gestation.

Belgium. Termination of pregnancy is registered. Termination of pregnancy is legal up to 12 weeks of gestation. If a congenital anomaly is diagnosed, the upper gestational age limit for termination is approximately 24 weeks.

Bulgaria. Termination of pregnancy is legal, with an upper gestational age limit of 12 weeks without special permission and up to 20 weeks with permission. If a congenital anomaly is diagnosed, the upper gestational age limit for termination is 27 weeks. The timing of termination depends on the severity of the defect.

Croatia. Termination of pregnancy is legal and the upper gestational age limit set for termination is 24 weeks for all reasons. All induced abortions performed for fetal malformations are registered.

France. Termination of pregnancy is legal and there is no upper gestational age limit set for either social terminations or terminations as a result of diagnosis of a congenital anomaly. Terminations of pregnancy are registered.

Germany. Induced abortion for social reasons is legal. Terminations of pregnancy ("medical indication") have no time limitation by law in Germany. We have had complete information about terminations of pregnancy after prenatal diagnosis of fetal malformations since 1987.

Spain. (Basque region):Termination of pregnancy is legal for severe anomalies diagnosed prenatally. Gestations age limit for termination is 22 weeks.

Dows Screening News
2004; 11(1) 22-23