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© The Society for the Social History of Medicine 2005, all rights reserved
‘Big White Chief’, ‘Pontius Pilate’, and the ‘Plumber’: The Impact of the 1967 Abortion Act on the Scottish Medical Community, c.1967–1980
* Centre for the History of Medicine, University of Glasgow, Glasgow G12 8QQ, UK. E-mail: g.davis{at}arts.gla.ac.uk
School of History and Classics, University of Edinburgh, Edinburgh EH8 9JY, UK. E-mail: roger.davidson{at}ed.ac.uk
The social history of abortion law reform and its aftermath have, in recent years, attracted increasing attention from historians, sociologists, and political scientists. However, previous research has tended to focus primarily on the English experience, and on the social politics surrounding abortion legislation rather than its impact upon the medical community. Using a range of legal, medical, and governmental files, supplemented by oral testimony, this article seeks to address these limitations by exploring the medical experience of the 1967 Abortion Act in Scotland. First, it outlines the medical problems which were perceived to have been created by the Act, as articulated by Scottish witnesses to the Lane Committee; in particular, concerns surrounding the pressure on existing gynaecological services and staff, geographical variations in the interpretation of the Act, the statutory time limit for termination, and the appropriateness of medical involvement in terminations of pregnancy where social criteria were involved. Secondly, the article explores how the medical community responded to those concerns and to the challenge of new responsibilities, and reviews the range of strategies employed by those medical practitioners wishing to minimize or devolve their role in the decision-making process.
Keywords: abortion; 1967 Abortion Act; Lane Committee; Scottish medical community; gynaecology; general practice; psychiatry; nursing
1 Full details of the Act can be found at Public General Statutes, Elizabeth II, CH. 87.
2 Two doctors were required to certify that those indications for abortion existed, except in cases of medical emergency, where one was deemed sufficient; and the operation was only to be performed in a National Health Service (hereafter NHS) hospital or another officially-approved location.
3 See, for example, J. Weeks, Sex, Politics and Society: The Regulation of Sexuality since 1800 (London, 1989); L. A. Hall, Sex, Gender and Social Change in Britain since 1880 (Basingstoke, 2000), ch. 10.
4 See, for example, B. Brookes, Abortion in England, 1900–1967 (London, 1988); A. Wivel, ‘Abortion Policy and Politics on the Lane Committee of Enquiry, 1971–1974’, Social History of Medicine, 11 (1998), 109–35; M. Durham, Sex and Politics: The Family and Morality in the Thatcher Years (Basingstoke, 1991).
5 See, for example, M. Latham, Regulating Reproduction: A Century of Conflict in Britain and France (Manchester and New York, 2002); L. Hoggart, Feminist Campaigns for Birth Control and Abortion Rights in Britain (New York, 2003).
6 Some exceptions are S. MacIntyre, ‘The Medical Profession and the 1967 Abortion Act in Britain’, Social Science and Medicine, 7 (1973), 121–34; J. Keown, Abortion, Doctors and the Law: Some Aspects of the Legal Regulation of Abortion in England from 1803 to 1982 (Cambridge, 1988); G. Davis and R. Davidson, ‘"The Fifth Freedom" or "Hideous Atheistic Expediency"?: The Medical Community and Abortion Law Reform in Scotland, c.1960–75’, Medical History (forthcoming).
7 See, for example, S. Sheldon, Beyond Control: Medical Power and Abortion Law (London, 1997).
8 Davis and Davidson, ‘"The Fifth Freedom" or "Hideous Atheistic Expediency"?’.
9 National Archives of Scotland (hereafter NAS), HH61/1315, draft memorandum by the Secretary of State for Social Services, 1970. It should be noted that the terms of reference did not cover any review of the wording or principles of the existing Act. See Report of the Committee on the Working of the Abortion Act, P.P. 1974 (Cmnd. 5579) XVI, volume I, p. 1.
10 Replies were received from some 30 Scottish medical bodies, including the 12 Health Boards, the Royal Colleges, medical and nursing organizations, and four University medical faculties.
11 For a discussion on how this consensus was reached, see Wivel, ‘Abortion Policy and Politics on the Lane Committee of Enquiry’, pp. 109–35.
12 NAS, HH102/1232, Professor E. McGirr, University of Glasgow, to M. Macdonald, Scottish Home and Health Department (hereafter SHHD), 1974.
13 Nonetheless, Scotland remained behind England and Wales in this regard. In 1968, there were 1,492 abortions performed in Scotland, or about 2 per cent of the number of live births in the year (as compared with 23,641 in England and Wales, or 4.2 per cent). By 1970, the Scottish figure was 5,036 or 5.76 per cent (as compared with 83,851 in England and Wales, or 10.69 per cent). See NAS, HH61/1258, Lane Committee to the British Medical Association, Scotland, 2 August 1971.
14 ‘Aberdeen Shows Way on Abortion’, Medical News, 18 July 1969, 1–2, p. 2.
15 I. Donald, ‘Naught for your Comfort’, Journal of the Irish Medical Association, 65 (1972), 279–89, p. 286.
16 The incidence of termination in married women was fairly constant between 1958 and 1966 at 2.3 per cent of all pregnancies, rising sharply to 3.7 in 1967, and 4.5 in 1969. See D. Baird, ‘The Abortion Act 1967: The Advantages and Disadvantages’, Royal Society of Health Journal, 90 (1970), 292–5, p. 293.
17 Wellcome Library for the History and Understanding of Medicine (hereafter WL), SA/ALR/G.69, D. Steel, Speech to the AGM of the Abortion Law Reform Association, ‘Abortion Act Vindicates 16 Years of Effort’, 19 October 1968.
18 NAS, HH102/1232, E. McGirr, University of Glasgow Department of Medicine, to M. Macdonald, SHHD, 30 July 1974.
19 WL, SA/ALR/C.41, Proceedings of the Lane Committee (hereafter PLC), Submission of Lothian and Peebles Executive Council, Edinburgh, 2 November 1971.
20 WL, SA/ALR/C.27, PLC, Submission of A. Smith, Scottish Association of Executive Councils, 20 December 1971.
21 WL, SA/ALR/C.22, PLC, Submission of Board of Management for Coatbridge, Airdrie and District Hospitals, 1972.
22 WL, SA/ALR/C.27, PLC, Submission of Glasgow Maternity and Women's Hospitals Board of Management, 9 December 1971.
23 WL, SA/ALR/C.22, PLC, Submission of Board of Management for Coatbridge, Airdrie and District Hospitals, 1972.
25 A. W. G. Weir, ‘Three Years' Experience of the Abortion Act’, Midwives Chronicle and Nursing Notes, 85 (1971), 232–3, pp. 232, 233.
26 I. MacGillivray, Correspondence, British Medical Journal, 1 (1969), 167–8. This pronounced variation was to continue throughout and beyond the life of the Lane Committee, the abortion rate per 1,000 women aged 15–44 for the last quarter of 1974 being 12.6 in the Grampian region compared with 7.4 for Scotland as a whole. See B. Thompson, ‘Problems of Abortion in Britain—Aberdeen, a Case Study’, Population Studies, 31 (1977), 143–54, p. 153.
27 Scottish Daily Record, 16 May 1973.
29 H. Homans (ed.), The Sexual Politics of Reproduction (Aldershot, 1985), pp. 84–5. Abortion statistics should, however, be regarded with suspicion since an unknown proportion of women might have given either a false address or none at all.
30 Todd estimated the Roman Catholic proportion of the population of the City of Glasgow to be 30 per cent compared with 17 per cent for Scotland as a whole and 8 per cent for England and Wales. See N. A. Todd, ‘Psychiatric Experience of the Abortion Act (1967)’, British Journal of Psychiatry, 119 (1971), 489–95, p. 491.
31 Scottish Daily Record, 16 May 1973. It should be noted, however, that post-1970 statistics indicated that Scottish patients obtaining abortions in England were younger on average than women remaining in Scotland, with a particular over-representation of women in their early 20s. It is thus likely that women leaving Scotland to obtain a termination also did so as a matter of personal preference, particularly to safeguard confidentiality.
33 See, for example, Sunday Standard, 24 May 1981, which highlighted the ‘crisis’ facing Edinburgh medical services due to this growing number of women travelling the ‘Abortion shuttle that stops at Edinburgh’.
34 NAS, HH102/1232, Notes of Meeting between SHHD and Representatives of the Scottish General Medical Services Committee, 24 September 1974.
35 WL, SA/ALR/C.27, PLC, Submission of A. Smith, Scottish Association of Executive Councils, 20 December 1971.
36 WL, SA/ALR/C.35, PLC, Submission of Board of Management for Glasgow Royal Infirmary and Associated Hospitals, December 1971.
37 WL, SA/ALR/C.68, PLC, Submission of W. Fulton, Medical Secretary, Glasgow Local Medical Committee, 9 March 1973.
38 Report of the Committee on the Working of the Abortion Act, volume I, pp. 86–92.
39 NAS, HH60/665, R. Fraser to G. Monro and Secretary of State for Scotland, 8 December 1973. In fact, by 1973, 98.4 per cent of all notified abortions in Scotland had been carried out by the end of the 19th week. See NAS, HH102/1232, ‘Lane Committee Report—Appendix B’, December 1974.
40 NAS, HH102/1232, M. E. Lindars, Honorary Secretary of the Society of Chief Nursing Officers, to M. E. G. Fogden, Department of Health and Social Security, 2 August 1974.
41 NAS, HH102/1232, PLC, Submission of Royal College of Midwives (Scottish Council).
42 NAS, HH102/1232, PLC, Submission of Lanarkshire Health Board, 23 July 1974.
43 The Aberdeen-based gynaecologists, MacGillivray and Dennis, defined ‘social’ indications as being: ‘[W]here the external environment, both economic and cultural, [was] considered to be seriously prejudicial to continuation of the pregnancy’. See Keown, Abortion, Doctors and the Law, p. 117.
44 NAS, HH102/1232, PLC, Submission of Dr W. J. Gordon, Argyll and Clyde Area Health Board's Area Medical Committee, September 1974.
45 Donald, ‘Naught for your Comfort’, p. 286.
46 MacIntyre, ‘The Medical Profession and the 1967 Abortion Act in Britain’, p. 123.
47 Scottish Daily Record, 16 May 1973. It should be noted that this issue may not have been one of purely medical ethics, but also professional status, as many gynaecologists were said to be averse to performing this procedure on ‘social grounds’ because it was viewed as ‘technologically-unchallenging’ and potentially de-skilling. See ‘The Royal College of Psychiatrists' Memorandum on the Abortion Act in Practice’, British Journal of Psychiatry, 120 (1972), 449–51, p. 449.
48 J. Aitken-Swan, Fertility Control and the Medical Profession (London, 1977), pp. 169–70. However, she also reflected that: ‘Their lack of sympathy with abortion seem[ed] due to a failure of imagination rather than to principle, for nurses themselves ask[ed] for abortions when they want[ed] them in much the same proportion as other professional women and students.’
49 WL, SA/ALR/C.27, PLC, Submission of A. Smith, Scottish Association of Executive Councils, 20 December 1971.
50 WL, SA/ALR/C.25, PLC, Submission of Royal College of Midwives (Scottish Council), 28 February 1972.
51 D. Baird, ‘The Galton Lecture, 1970: The Obstetrician and Society’, Journal of Biosocial Science, 3 (1971), 93–111, pp. 107–8.
52 D. Baird, ‘The Changing Pattern of Human Reproduction’, Journal of Biosocial Science, 7 (1975), 77–97, p. 90. Baird refers to the study by G. Horobin (ed.), Experience with Abortion: A Care Study of North-East Scotland (Cambridge, 1973).
53 Aitken-Swan, Fertility Control and the Medical Profession, foreword.
54 Medical Tribune, 15 July 1969.
55 Or, as the Board of Social Responsibility of the Church of Scotland later put it, social problems ‘paraded as clinical decisions’. See Board of Social Responsibility of the Church of Scotland, Report to General Assembly (1987), p. 316.
56 Scottish Daily Record, 16 May 1973.
57 Greenock Telegraph, 3 July 1969.
58 This ‘new fashion in sexual behaviour’ was seen to have started in London and the south-east of England in 1958 in the non-manual classes, gradually moving north to reach Aberdeen in 1963. See D. Baird, Proceedings of the Royal Society, 65 (1972), 160–2, p. 160.
59 Quoted in Baird, ‘The Abortion Act 1967’, p. 293.
60 See, for example, B. Thompson, ‘Social Study of Illegitimate Maternities’, British Journal of Preventive and Social Medicine, 10 (1956), 75–87.
61 R. Illsley and D. Gill, ‘New Fashions in Illegitimacy’, New Society, 12 (1968), 709–11.
62 In part, this simply reflected growth in the student population, as much as three-quarters of which came from outside the district by this point. See British Medical Journal, 1 (1969), 167–8.
63 Baird, ‘The Galton Lecture, 1970’, p. 110. SHHD figures for this year revealed that just over half of the women whose pregnancy was terminated in a NHS hospital were married (2,634), with the remainder being either unmarried (1,712), or widowed, separated, or divorced (527). See NAS, SOE12/525, SHHD, ‘Background Notes’, 12 March 1970.
64 See E. M. Briggs and A. E. Mack, ‘Termination of Pregnancy in the Unmarried’, Scottish Medical Journal, 17 (1972), 398–400, for a discussion of some of the problems these doctors faced, recognizing cases involving premarital sexual intercourse to be the greatest threat to their respectability.
65 A similar dilemma can be seen in the history of family planning. The Family Planning Association refused until 1970 to give contraceptive advice to unmarried girls so as not to compromise its respectability. For medical debates on the subject, see, for example, WL, SA/FPA/A16/24.62a, Family Planning for Scotland: Conference Proceedings (Bristol, 1969). Scottish policy-makers likewise stressed the need for family planning campaigns to be specifically targeted towards the ‘easier and less controversial issue’ of the married woman. See NAS, HH61/970, Dr A. Yarrow, Scottish Health Education Unit, to R. M. Bell, SHHD, 3 November 1970.
66 Weir, ‘Three Years' Experience of the Abortion Act’, p. 233.
67 Todd, ‘Psychiatric Experience of the Abortion Act’, p. 491. Similarly, Hamill and Ingram found there to be ‘significantly more married women in the recommended group’. See E. Hamill and I. M. Ingram, ‘Psychiatric and Social Factors in the Abortion Decision’, British Medical Journal, 1 (1974), 229–32, p. 230.
70 WL, SA/ALR/C.25, PLC, Submission of Royal College of Physicians, Edinburgh, 1972.
71 Donald, ‘Naught for your Comfort’, p. 287.
72 Horobin (ed.), Experience with Abortion, pp. viii and 366.
73 N. A. Todd, ‘Follow-up of Patients Recommended for Therapeutic Abortion’, British Journal of Psychiatry, 120 (1972), 645–6, p. 645.
74 Todd, ‘Psychiatric Experience of the Abortion Act’, p. 492. The demand for abortion from the better-educated girl and her parents does seem to have elicited some sympathy from the medical profession. Many doctors acknowledged that pregnancy in this patient population was bad for both career prospects and parental reputation, and that abortion under these circumstances appeared ‘the least damaging solution’. For such patients—educated young women ‘anxious that their future should not be imperilled by one mistake’—some doctors upheld abortion as giving ‘a second chance’. See Aitken-Swan, Fertility Control and the Medical Profession, p. 11; Baird, ‘The Abortion Act 1967’, p. 293; Baird, ‘The Changing Pattern of Human Reproduction’, p. 90.
75 NAS, SOE12/525, press release by the Catholic Press Office, Glasgow, 24 December 1970.
77 They claimed that, ‘as a result of treating the patient in a clinical way the emotional trauma seems to have been minimised’, ensuring that anyone who wished to contract out on grounds of conscience would be ‘easily able to do so’. See WL, SA/ALR/C.35, PLC, Submission of Board of Management for Glasgow Royal Infirmary and Associated Hospitals, December 1971.
78 NAS, HH102/1395, M. Macnaughton to W. Hamilton, House of Commons, 12 September 1979.
79 NAS, HH102/1232, Professor E. McGirr, University of Glasgow, to M. Macdonald, SHHD, 1974.
80 Donald, ‘Naught for your Comfort’, p. 279.
82 NAS, HH102/1232, M. E. Lindars, Honorary Secretary of the Society of Chief Nursing Officers, to M. E. G. Fogden, Department of Health and Social Security, 2 August 1974.
83 NAS, HH102/1232, A. G. Welstead, Secretary of Borders Health Board, to M. Macdonald, SHHD, 1 August 1974. This submission was the more notable given that, in actual practice, no abortions were performed within the Borders Health Board area at this time, such cases being instead referred to Edinburgh with its superior facilities. See, for example, Sunday Standard, 24 May 1981.
84 A. Sclare and B. P. Geraghty, ‘Termination of Pregnancy: The Nurse's Attitude’, Nursing Mirror, 140 (1975), 59–60, p. 60.
85 See, for example, WL, SA/ALR/C.27, PLC, Submission of Glasgow Maternity and Women's Hospitals Board of Management, 9 December 1971.
86 NAS, HH102/1232, E. McGirr, University of Glasgow Department of Medicine, to M. Macdonald, SHHD, 30 July 1974.
87 NAS, HH102/1232, E. U. E. Elliott-Binns, SHHD, to G. G. Hulme, Department of Health and Social Security, London, 10 December 1974.
88 NAS, HH102/1232, F. N. Mitchell, Honorary Secretary of the Scottish Association of Nurse Administrators, to M. Macdonald, SHHD, 3 July 1974.
89 Although a number of local authorities were making arrangements for the provision of family planning services at this time, it was only as a result of NHS reorganization in the mid-1970s that contraceptives became freely and widely available throughout Scotland.
90 WL, SA/ALR/C.35, PLC, Submission of Board of Management for Glasgow Royal Infirmary and Associated Hospitals, December 1971.
91 WL, SA/ALR/C.22, PLC, Submission of Board of Management for Coatbridge, Airdrie and District Hospitals, 1972.
92 NAS, HH102/1232, Professor E. McGirr, University of Glasgow, to M. Macdonald, SHHD, 1974.
93 WL, SA/ALR/C.22, PLC, Submission of Board of Management for Coatbridge, Airdrie and District Hospitals, 1972.
94 NAS, HH102/1232, R. Stewart, Secretary of Highland Health Board, to M. Macdonald, SHHD, 22 July 1974.
95 NAS, HH102/1232, PLC, Submission of Royal College of Physicians and Surgeons of Glasgow, 25 July 1974.
96 Interviews with retired psychiatrists, 30 January 2004 and 12 March 2004. The exception was the practice in Aberdeen, where emotional and anxiety states were a common rationale for granting an abortion from the early 1960s. See Baird, ‘The Abortion Act 1967’, p. 292.
97 ‘The Abortion Act—Scotland 1968’, Health Bulletin, 27 (1969), 60–74, pp. 67 and 69.
98 See, for example, R. G. Priest, ‘The British Candidate for Termination of Pregnancy: A Quantified Survey of Psychiatric Referrals’, British Journal of Psychiatry, 118 (1971), 579–80, p. 579; Todd, ‘Psychiatric Experience of the Abortion Act’, p. 489.
99 Todd, for example, found that only 13 per cent of abortion cases referred to his two psychiatric departments in Glasgow had any history of psychiatric illness. See Todd, ‘Psychiatric Experience of the Abortion Act’, pp. 490 and 493.
100 Interviews with retired psychiatrists, 30 January 2004 and 12 March 2004.
101 Hamill and Ingram, ‘Psychiatric and Social Factors in the Abortion Decision’, p. 229.
102 R. G. Priest, ‘The Impact of the Abortion Act: A Psychiatrist's Observations’, British Journal of Psychiatry, 121 (1972), 293–7, p. 294.
103 WL, SA/ALR/C.35, PLC, Submission of Board of Management for Glasgow Royal Infirmary and Associated Hospitals, December 1971.
104 WL, SA/ALR/C.33, PLC, Submission of Royal College of Physicians and Surgeons of Glasgow, January 1972.
105 A. Hordern, Legal Abortion: The English Experience (Oxford, 1971), p. 115.
106 One retired gynaecologist, for example, contrasts this later confidence in operating the Act with the earlier ‘feeling our way’ concerns of doctors, initially unclear on how the legislation was going to operate. See interview with retired gynaecologist, 19 August 2004.
107 NAS, HH102/1232, G. C. Timbury, Honorary Divisional Secretary of the Royal College of Psychiatrists, Glasgow, to A. Laurie, SHHD, 20 November 1974.
108 I. M. Ingram, ‘Abortion Games: An Inquiry into the Working of the Act’, Lancet, 2 (1971), 969–70.
109 In developing his analysis, Ingram applied ‘transactional game analysis’ as previously employed by the Californian psychiatrist, Eric Berne. See E. Berne, Games People Play: The Psychology of Human Relationships (London, 1964). Although implying ‘fun’ or ‘enjoyment’, Berne in fact defined a ‘game’ as an ongoing series of superficially plausible transactions with a concealed and dishonest motivation, which progressed to a well-defined and predictable outcome (pp. 44–5).
110 Ingram, ‘Abortion Games’, p. 969.
111 Donald, ‘Naught for your Comfort’, p. 286. As Donald further noted, such a system generated a ‘streaming phenomenon’ whereby general practitioners quickly came to know which units would readily carry out abortion and which were ‘likely to prove sticky’; thus diverting a greatly increased workload to the units who took ‘a fairly free and easy view’.
112 Donald added: ‘You may attribute our attitude as you like to moral rectitude or sheer bloody-mindedness but we are nevertheless unrepentant.’ See ibid., p. 286.
113 Scottish Daily Record, 16 May 1973.
114 This is seen clearly in Lane Committee evidence from Glasgow-based sources. See, for example, WL, SA/ALR/C.68, PLC, Submission of W. Fulton, Medical Secretary, Glasgow Local Medical Committee, 9 March 1973.
115 Ingram, ‘Abortion Games’, p. 969.
116 Baird, ‘The Abortion Act, 1967’, p. 294.
117 Ingram, ‘Abortion Games’, p. 969.
119 See M. Sim, ‘Abortion and the Psychiatrist’, British Medical Journal, 2 (1963), 145–8. Although pressure might be brought to bear on the psychiatrist to recommend termination, including threats of suicide, Sim's answer was to refuse termination, which might indeed be harmful, and to instead ‘nurse the patient through her unstable phase’ (p. 148). This game title was also a pun, ‘Sim's position’ being a type of gynaecology examination position.
120 ‘The Royal College of Psychiatrists' Memorandum’, p. 449. Clause 1(a) specified that an abortion could be legally performed where the risk to health by continuance of the pregnancy was greater than if the pregnancy was terminated. Ironically, this clause was added by opponents of legal abortion in the final stages of debate in the House of Lords on their false assumption that early termination was in fact more dangerous than a full-term pregnancy. See M. Kandiah and G. Staerck (eds), The Abortion Act, 1967 (London, 2002), p. 50.
121 Ingram, ‘Abortion Games’, p. 969.
123 Illsley and Gill, ‘New Fashions in Illegitimacy’, p. 711.
124 ‘The Royal College of Psychiatrists' Memorandum’, p. 449.
125 Weir, ‘Three Years' Experience of the Abortion Act’, p. 233.
126 M. C. Macnaughton, ‘Termination of Pregnancy in the Unmarried’, Scottish Medical Journal, 17 (1972), 381–2, p. 382.
127 Homans (ed.), The Sexual Politics of Reproduction, p. 94.
128 See, for example, T. Newburn, Permission and Regulation: Law and Morals in Post-War Britain (London, 1992), ch. 6, for an outline of the importance of the medical hierarchy to the legislative process.
129 D. Baird, ‘The Obstetrician and Society’, American Journal of Public Health, 60 (1970), 628–40, p. 635.
130 I. Donald, ‘Abortion and the Obstetrician’, Lancet, 1 (1971), 1233, p. 1233.
131 A. Hordern, ‘Legal Abortion—The Act and its Effects, Part 2’, Midwife and Health Visitor, 8 (1972), 169–73, p. 169.