Survey on community attitudes on early and late abortion

Do Australians’ believe that women should be able to access abortion later in pregnancy? A new survey (Australian attitudes on access to early and late abortion. Lachlan de Crespigny, Dominic Wilkinson, Thomas Douglas, Mark Textor, Julian Savulescu MJA 2010; 193: 1-4) of 1050 Australians published in the Medical Journal of Australia shows that the answer is overwhelmingly yes; when there is good reason. These results have broad implications in both Australia and elsewhere.

The survey gives a detailed picture of attitudes in a wide range of clinical and social situations using personalized questions.

The findings contradict a previous Australian Federation of Right to Life Associations survey that suggested that Australians strongly oppose women accessing later abortion. They also contradict some data in surveys from UK, Europe generally and USA (also here). Surveys have tended to be simple yes/no polls asking impersonal non-contextualised questions. Contextualised personal survey questions in other countries may also show greater support for women being able to access late-abortion. The findings are relevant to calls – including from Prime Minister David Cameron –to further limit the gestational limits for abortions in UK.

On simple yes/no questions, 87% of respondents believe that abortion should be lawful in at least some circumstances in the first trimester (61% unconditionally and 26% depending on the circumstances); 69% indicated this for the second trimester and 48% for the third.

However when asked contextualised questions about access to termination after 24 weeks for loved ones, in most of the clinical and social circumstances a majority believed that treating doctors should not even face professional sanctions.

Most Australians respondents believe that they or their loved ones should be able to access abortion services after 24 weeks’ gestation; support varies depending on circumstances.

Only a small proportion of respondents (≤ 21%) believe a doctor should face professional sanctions for performing termination after 24 weeks when there is a risk to physical or mental health of the woman, or risk that the baby may have physical or mental impairment.

Respondents were more equivocal about sanctions in scenarios regarding late termination for reasons relating to the preferences or social circumstances of the woman. But less than 50% of respondents indicated that a doctor should face professional sanctions for performing a termination after 24 weeks’ gestation, even when there is no medical reason for the termination.

Even among respondents who thought that abortion in the third trimester of pregnancy should be unlawful there was majority support for professional sanctions in only five of the 16 circumstances. Personalised questions provide a better sense of why a woman seeks abortion.

The prevailing criminalization of abortion across much of Australia is contrary to respondents’ views. Respondents with a religious affiliation were slightly less likely to oppose sanctions than those without a religious affiliation.

The survey suggests that the widespread belief that an MP risks votes by being prochoice is wrong.

One possible explanation for the difference in responses to questions about lawfulness and sanctions is that respondents with ambivalent attitudes to abortion may favour removal of sanctions but retention of a legal bar on abortion as an intermediate position between full legalisation and full prohibition. Another possibility is that respondents may have an in-principle objection to abortion but are more prepared to accept it, especially when there is a medical reason for abortion, when they understand the reason so had a greater ability to identify with women seeking an abortion. Whatever the explanation the findings support a change of policy to one in which sanctions are explicitly withheld.

There were several differences between this survey and many previous ones:

     Polls have tended to ask simple yes/no questions such as should women be able to access abortion? Such questions do not allow people to accurately express the subtlety of their views. Single general questions provide a limited view of community sentiment (VLRC).

    The questions were contextualised. They were asked to consider specific, realistic clinical and social situations in which late abortion might be considered.

    Questions were personalized, potentially enabling respondents to understand and identify with the situation facing a woman seeking an abortion. Respondents were asked to think specifically about a situation where either they or someone close to them such as a partner, sister, daughter or close friend was facing such circumstances and then to picture how they would respond in the scenario presented.

    Surveys on attitudes to abortion are widely quoted in medical journals although unlike ours most are not themselves published in peer reviewed journals.

    The survey was conducted on line.

    When asking respondents views, many surveys do not specify the gestational age.

The more permissive attitude elicited when context was provided may have implications in other ethical debates including euthanasia, the use of medicine or technology for human enhancement, organ donation, and embryonic stem cell research. Perhaps people would be more likely to support the creation and destruction of embryos to produce stem cells if the therapeutic uses of those stem cells were fully specified, rather than being put in abstract terms, such as ‘to treat a serious disease’. However it is an open question whether policy formation should be informed by views about abstract propositions or about cases containing contextual details.

Additional tables of our data are available. http://www.practicalethics.ox.ac.uk/abortion_attitudes.html

Acknowledgements and thanks to coauthors Dominic Wilkinson, Thomas Douglas, Mark Textor, Julian Savulescu

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