Some MPs, including Nadine Dorries, want to force women to have 'independent' counselling before an abortion. What would that mean for the staff and clients at one London clinic?
By five past seven in the morning, there are two women sitting in the stillness of the waiting room at the British Pregnancy Advisory Service (BPAS) clinic in Streatham, south-west London. One is alone, perhaps in her mid-30s; the other, younger and wearing an abaya, arrives in a taxi with a friend.
Both are here for the second part of a late abortion, a surgical procedure carried out over two days to end pregnancies that are between 22 weeks' gestation and 24 weeks, the legal limit. They are not widely available on the NHS, so women at this stage of pregnancy come from all over the UK to the Streatham clinic, staying overnight at B&Bs after the first day and getting into the clinic early to complete the process.
At the end of the corridor the operating theatre is locked. Faded floral curtains are pulled back on two changing cubicles, where clients don surgical gowns before being taken to the anaesthetist. Upstairs in "extended recovery", where clients who had been less than 12 weeks' pregnant are taken after surgery, a sick-bowl and a box of tissues are carefully arranged next to each of the five sleek reclining chairs upholstered in BPAS purple. They too have curtains for privacy.
Outside, the air already holds the promise of a stifling summer's day. The consultation centre, a separate building on the curved drive that leads in from the main road, is quiet. Not for long though, says Alice, a counsellor taking her turn to staff the front desk. This is where clients come when they first visit the clinic ? usually having been referred by their GP or a sexual-health clinic, with costs to be covered by the NHS ? for an initial consultation that includes counselling, a medical screening and an ultrasound scan to determine the stage of the pregnancy. Future contraception is also discussed. Appointments start early to allow women who do go on to have a termination to do so that day if they wish. Over the last year 17.3% of women seen by BPAS had consultation and treatment on the same day, and in recent months they have made more same-day appointments available because of demand.
By the Tory MP Nadine Dorries's reckoning, this system is flawed: the counselling is biased, she claims, because providers such as BPAS and Marie Stopes have a financial incentive to pressure women into choosing a termination, leaving women feeling rushed and unable to control the process. Next week she will attempt to amend the coalition's health and social care bill to guarantee that all counselling is "independent" of abortion providers. Meanwhile the government has said it will launch a consultation on the "best" form of counselling for women.
If Dorries's amendment is selected to be debated next week, it will be a free vote. Cameron, Clegg and other senior government figures will vote against it, but with no way of predicting how new Tory MPs and Roman Catholic Labour MPs will vote, it's unclear which way the result will go.
Bids for independent counselling work could come from the network of crisis pregnancy centres (CPCs) linked to churches and run by CareConfidential, and the anti-abortion charity Life.
BPAS has insisted it does not encourage women to have abortions, pointing out it is a not-for-profit organisation. Alice says she won't let Dorries's campaign upset her. "I'm offended by it, of course," she says. "All of us are. But I know what I do and there's not one day I doubt it. I wake up with a clear conscience every day.
"The client takes the lead. We help them explore all their options. None of us are here to say you should do this or that." Appointments take as long as a woman wants, from 15 minutes to an hour and a half. "If they need to come back more than once they can, and sometimes they do. It's up to them." Sometimes they will have a scan and find it helps them make up their mind.
In the last year, 15.3% of the women who visited BPAS for a consultation did not go on to have an abortion. "Once they're here, sometimes that's it," says Alice. "Sometimes just sitting in the waiting room is enough."
Alice's colleague, Lea, comes by to pick up some notes. "There have been many times when I've said to them, 'Everything you're saying to me is telling me you want to continue with the pregnancy,' And they'll smile and say, 'Yeah, it's true.' I want her to do whatever she wants to do." Katy, the third counsellor, recently had four women in a row decide to carry on with their pregnancy after talking to her.
And yet for women who do want to have an abortion, Katy fears, Dorries's proposals will cause delays that mean they miss out not just on meeting cut-off points for simpler types of procedure, but even knowing about them. Many women who come to them will already have discussed their options with friends, family, a GP or nurse, and will have all but decided on abortion. But for others it will be the first time they've talked about their pregnancy. The clinic's manager, Anne Cowee, thinks Dorries's move insults her staff and their clients: "It's implying they don't have the intelligence to make their own decisions."
By 9.45am the consultation centre waiting-room is almost full, with new arrivals every 10 minutes or so. There's a thin, nervous-looking young woman on her own, and an older woman in a tracksuit who encourages her friend to leave. ("She won't be staying long," she tells Alice.) The friend stays.
A couple in their 40s arrive; the woman rubs her arm anxiously as they check in. A much younger couple turn up, the boy in box-fresh trainers. There are self-assured women in their 20s and 30s, a girl in her late teens who arrives an hour late saying she's been at the wrong clinic, and another of a similar age who's out of breath, as if she's been walking at speed. "I'm really early," she says, apologetically.
As the older couple leave the doctor's room, the man slips his arm round the woman's shoulders. "Bit of an education," she murmurs as they walk into the muggy heat. In the garden clients sit on benches, in mini gazebos and on the kerb, texting, phoning and smoking.
Inside, Lea and Alice lean on the desk, Magic FM tinkling on the radio. "Most people who work here stay a long time," Alice says. "It's not that kind of gloomy atmosphere you'd think. There's a before and after."
As their consultations end, the women who have decided to go ahead with an abortion straight away take their notes, in a brown A4 envelope, over to the large detached house where the clinic is based. For those who are less than nine weeks' pregnant the early medical abortion (EMA) is an option. The so-called "abortion pill" now accounts for around half of all terminations within this time period. But it's more complicated than it sounds: there is one pill to swallow but the woman must return to the clinic for tablets that are placed in the vagina. Cramps and heavy bleeding follow; within four or five hours most will have miscarried.
Surgical options depend on length of gestation and personal preference. Up to 12 weeks a woman can have a procedure under local anaesthetic; after that a general anaesthetic is necessary, and after 15 weeks the procedure becomes more complicated.
Before surgery there's a 10-minute appointment with a nurse to go through medical history checks. At each stage women are asked if they still want to go through with the procedure, Cowee says. A healthcare assistant comes to take clients to the theatre. After four years in the job Michaela says she can tell if a woman is going to change her mind just by looking at her.
"When you're sitting outside in a waiting area it's not clinical at all ? you don't expect it to be like this," she says. "They come here and they see the beds, hear the machines. A lot of times they're in the changing room and they know then it's the last moment. Reality sets in and they say they can't do it.
"That happens on a weekly basis. I always say to them, 'You don't have to go in, just because you're here now.'"
The procedure itself takes between five and 20 minutes. Afterwards the client is wheeled on her trolley to an initial recovery area with up to three others, where a nurse waits for her to wake from the anaesthetic.
Once upstairs, via a lift, those needing a longer recovery are brought to the wards ? five rooms providing a total of 13 beds. One is set aside for younger clients; anyone under 16 has to have an adult with them. "Sometimes if they're 13 or 14 they come with their teddy bears," Cowee says. "It's a different experience. Quite often the younger ones prefer not to be with older women, and I think older women prefer not to be with younger ones."
The rooms are light and airy, but the windows are frosted for privacy, and do not open far. In each room a sign implores clients: "Please do not vomit in the sink. Use the kidney bowls provided." Women generally stay a couple of hours; in extended recovery 30 minutes is normally enough.
"You do get a lot of people who've come in and haven't told anybody," says Michaela. "They just want to have their treatment and go home and forget about it. You do think, 'If that girl wants to go home and have a cry, she can't.'" She thinks too of the grief of couples who have ended longed-for pregnancies because of fetal abnormalities. "You try to help the woman and you can see the husband is devastated as well."
If Eniko Ercse, the Romanian-born theatre nurse manager, detects someone is particularly upset because they have a religious background, she reminds them of the story of Jesus forgiving the prostitute. "I tell them we all make mistakes, we're human, but Jesus forgave this woman so that you might get forgiveness as well," she says, "because nobody's perfect."
Some 3% of BPAS's clients are not English, Welsh or Scottish. Most of these are from Ireland, Northern Ireland or the Isle of Man, but women also travel from the Middle East and European countries with lower legal limits. At the nurse's station, a list of Italian and Spanish vocabulary is taped to the wall. As well as the basics there are translations for tea, coffee, blood, knickers and slippers.
Before women leave the clinic, they are directed to the "dining room", where they are served a pre-ordered sandwich. From here it is through one more door to the discharge room.
The last client leaves at 5.38pm. The staff have carried out 23 initial consultations, four post-procedure followup appointments, three medical abortions and 36 surgical abortions.
In their kitchen, photocopied feedback forms hang above a table. They are overwhelmingly positive, thanking staff for their compassion. But several complain of the time the process takes. "Make it quicker," one client writes. "Less waiting, adds to anxiety," adds another. No one says they felt rushed. (The dining room staff do even better: complaints are limited to a request for more options, less butter on the bread, and "Don't show Top Gear on the TV".)
Eleven hours after arriving at the clinic, Cowee tidies her desk. "We do this job to help other people," she says. "We want to make sure we provide a good service."
Some names have been changed
Source: http://www.guardian.co.uk/world/2011/sep/01/life-inside-an-abortion-clinic
Rudy Giuliani Jimmy Carter Dick Cheney Barack Obama George Soros
No comments:
Post a Comment