Despite my determination a few years ago not to be a GP with a Women’s Health interest that’s exactly what I’ve found that I love!  Having exhausted the UK Diplomas and Letters of Competence and with a long-standing interest in working in developing nations, I wondered just how much difference a GP can make in these settings. So I took three months off work and went to Liverpool to do the Diploma in Reproductive Health in Developing Countries (DRH).

So what is the DRH?

The DRH is a 12-week program run each year between January and the end of March and organised by the Maternal & Newborn Health Unit at the Liverpool School of Tropical Medicine, in partnership with the Royal College of Obstetricians and Gynaecologists.

It is designed to equip a variety of health professionals, from program developers to doctors, to understand some of the complexities and challenges of providing quality reproductive healthcare to developing nations,. It examines what kind of interventions have evidence to support improvement, encompassing everything from family planning services to post-natal care .  The DRH is the only course of its kind – hence people travel from all over the world to undertake it.

What did I learn?

Loads.  On the academic side, I can now tell you about strategies for improving aspects of reproductive healthcare; everything from stemming the tide of STIs, providing evidence based obstetric care, initiating quality improvement activities to tackling issues of sexual and gender based violence…but as with many things, what I gained from the course was as much about the people I met and the relationships built as writing papers and sitting exams.

There were 15 students on the course – from all disciplines, ages, backgrounds, religions and countries; many of them will take back what they have learnt directly into their districts and hospitals, being agents for change. Each had stories to tell and a wealth of experience whilst being willing to learn – they were inspiring to listen to and a privilege to spend time with.  It was also an environment where no conversation was off limits so matters of faith, ethics and conscience echoed around wherever we met – often in quite heated and passionate debate.

Faith-based organisations and faith-based challenges

It was interesting to hear different understandings of the place of faith in medicine, and to see how this played out both in the classroom and in the places where participants are working. One example of this was a lady who works for a faith-based organisation trying to set up what we would understand as a family planning clinic in an environment where it is perceived that ‘God determines how many children and when.’ She is desperately trying to reduce the maternal death rates in very young primagravidas, grand multips and those with significant chronic illness, while providing contraceptive options that would be acceptable to their faith and their husbands.

As expected there are no easy answers! The more we delved, explored and debated tools and solutions, the more complex things became – on the one hand we began to have a structure of how to tackle certain problems and on the other we became more aware of just how difficult it is to implement lasting and life-giving change to those who need it the most. The importance of understanding the convoluted and multifaceted nature of different cultures is paramount in achieving any enduring improvement.  The dilemmas and difficulties are endless, but those who hope in Jesus as their Saviour are not prepared to give up the fight!

Who should do the DRH?

This is quite a specific qualification but if you intend to work in this area you may find that it provides you with a very different skill set to the traditional tropical medical diploma. It also gives an opportunity to do some specific research into an area of interest with a literature review – great if you know where you are going and want to work out how best to help and not hinder.

Want to find out more? Contact me at chollingsworth@doctors.org.uk

CMF’s Developing Health Course is coming up – June 30- July12, with two excellent days on Women’s Health…could be a great forerunner to the next DRH!

Posted by Dr Claire Hollingsworth, CMF member

The question of whether restrictive laws on abortion lead to fewer maternal deaths, or more maternal deaths, is hotly debated.

Those who are ‘pro-life’ and want to see more restrictive abortion laws say that fewer abortions leads to fewer maternal deaths, with Northern Ireland providing one example close to home: ‘Ireland and Northern Ireland show a low incidence of maternal and infant conditions known to be abortion sequelae: still birth…and maternal deaths. Liberalisation of abortion laws in Ireland and Northern Ireland can be expected to result in higher abortion rates and a corresponding deterioration in respect of these conditions affecting the health of women.’

Those who are ‘pro-abortion’ argue that where laws on abortion are more restrictive, more illegal (‘back street’) abortions take place leading to more complications and deaths. So, where abortion is safe, legal and accessible, maternal mortality drops: ‘Evidence demonstrates that liberalising abortion laws to allow services to be provided openly by skilled practitioners can reduce the rate of abortion-related morbidity and mortality.’

Into this debate comes some interesting research by Elard Koch, published in BMJOpen a few months ago, based on analysis carried out across 32 states in Mexico.

Koch does not take ‘sides’, instead making a simple, but important, claim based on his research in Mexico, that that differences in abortion legislation do not correlate ultimately with maternal mortality ie. abortion laws do not make the difference in women’s mortality rates (in Mexico).

This is useful. There has been a well funded (see here too) campaign for many years by pro-abortion groups pushing for all national abortion laws to be more permissive (using the euphemism ‘reproductive rights’), even within those countries culturally and legally opposed to abortion. It is argued that restrictive abortion laws are harmful to women. Maternal mortality rates and maternal health are both key to these claims.

This new analysis shows that such arguments are not tenable:

• Permissive abortion laws do not reduce maternal morbidity and mortality;
• Restrictive abortion laws do not harm women’s health and increase abortion-related mortality rates;
• States with restrictive laws do have lower maternal mortality rates, but this was not explained by abortion legislation itself.

Instead, not unsurprisingly, most of the differences (up to 88%) in maternal mortality between the Mexican states were largely explained by factors such as women’s literacy, maternal healthcare, emergency obstetric care, individual-level risk factors, clean water, sanitation, fertility rate and intimate-partner violence against women.

It is worth briefly explaining why this research in Mexico is particularly useful.

Each of the 32 Mexican states has its own political constitution, criminal code and abortion legislation. Some are more restrictive and some more permissive. Mexico therefore provides a unique epidemiological scenario to test the impact of abortion legislation on maternal mortality in a population that shares the same history and culture and (importantly) that has a homogeneous healthcare system. The authors were also able to use virtually complete official vital statistics of live births and maternal deaths in the 32 Mexican states between 2002 and 2011.

Koch and colleagues have since published in the BMJ (August 2015) an even more detailed analysis, in response to criticism of their research by a pro-abortion activist. They claim their research is: ‘Methodologically sound, with perhaps an uncomfortable result.’

They tackle directly the argument that: ‘Theoretically, in Mexican states exhibiting less permissive legislation, maternal mortality should have been higher because the practice of unsafe abortion should be more frequent.’

Instead, they found that: ‘Paradoxically, over a 10-year period, those states almost univocally exhibited lower figures for maternal mortality ratio (MMR), MMR with any abortive outcome and induced abortion mortality ratio.’

Nevertheless, despite this correlation, Koch et al do not attribute the cause to abortion legislation, but instead they say that the differences can be explained by other independent factors known to influence maternal health.

The main conclusion by Koch is that addressing disparities in these other factors – such as women’s literacy, maternal healthcare, water, sanitation, fertility rates and violence against women – will most likely facilitate a transition towards low maternal mortality rates in developing countries.

There is more to Koch’s work however.

In his rebuttal to criticism, he mentions a few other associations with reproductive health outcomes, which I found of interest (not related to Mexico or maternal mortality). For example:

1. Klick et al. assessed gonorrhoea incidence rates and found that, compared with very restrictive abortion laws, a switch to more permissive abortion laws is associated with large increases in gonorrhoea incidence. According to Klick, economic theory predicts that abortion laws affect sexual behaviour since they change the marginal cost of having high-risk sex (when barrier contraception is not used) leading to a higher risk for both STD acquisition and unintended pregnancy: ‘these results are consistent with a story whereby increased access to abortion leads people to engage in more risky sex.’
2. In a Spanish study over 10 years Duenas et al. reported an increase in the use of contraceptives (49% in 1997 to 80% in 2007), but at the same time an increase in the abortion rate (5.52 to 11.49 per 1,000 women), especially in young women, who reported engaging in high-risk sex more frequently. Interestingly, a Russian Longitudinal Monitoring Survey report begins by stating that: ‘Internationally, high abortion rates often are considered an indication that women’s access to effective contraceptives is inadequate’ yet these authors found that the availability of abortion was one of the reasons specifically cited for women not using contraceptives.

3. The prevalence of Down syndrome at birth is higher in settings with less permissive abortion laws: Chile (2.47 per 1,000), Argentina (2.01 per 1,000) and Ireland (2.1 per 1,000 in Dublin). The converse of this is that prenatal screening and more permissive laws of abortion have a strong impact on Down syndrome, decreasing the prevalence at birth to less than 1 per 1,000 in Europe.

But back to my title question, the answer to which is ‘yes’ and ‘no’. There appears to be a link, in that restrictive state laws have lower maternal mortality rates, but this is NOT explained by abortion legislation itself, according to this research.

If, therefore, the key determinants of maternal mortality are actually education, maternal health, sanitation and drinking water etc, then the implications for international policy are clear. But, as Peter Saunders has questioned here, will the lavishly funded birth control and abortion industry take note?

At last! The media has finally picked up on the ethical and exploitative mess that is egg ‘donation’.

I have blogged on this, included it in submissions, asked questions in conferences and, most recently, raised it when giving oral evidence to a Parliamentary Select Committee in April. The aim being to expose the industry around egg ‘donation’ and egg freezing that exploits women’s health and purses.

Now, thanks to the Daily Mail’s front page undercover investigation, the Humn Fertilisation and Embryology Authority (HFEA) has said they are investigating several fertility clinics accused of exploiting couples desperate to have children. Health Secretary, Jeremy Hunt says the allegations are serious and worrying.

 The major allegation against the fertility clinics visited by undercover journalists was that women were being convinced to donate their healthy eggs in return for free IVF, at clinics in London, Hertfordshire and County Durham.

But this is not just a story for journalists.

I personally know of a woman who was persuaded a few years ago to ‘donate’ half of her eggs for someone else’s fertility treatment, in order to have reduced cost IVF for herself and partner. Not only was she hospitalised by the procedure, years later, she is still highly traumatised having been unsuccessful in her own IVF treatment but knowing that her ‘donated’ eggs resulted in a successful birth for another woman.

Somewhere, she knows, she has a daughter, who she will never know.

This is real life. This is the dark side behind the industry. This woman has never had any longer-term practical or emotional help or support from the fertility clinic. She is on her own, literally (with no child), collateral damage from an industry that does not seem to care for the women it is exploiting.

Of course it could be argued that the other woman, who had a child from one of the donated eggs, has benefited. But has she? Has her husband/partner? What effect will it have on the child who will never know his/her biological mother?

Anecdotally, we know anonymous gamete donation can cause a lifetime of harm. The lessons to be learnt from adopted children are that they frequently feel a deep sense of loss if they don’t know about their genetic parents, despite having loving adoptive parents. Plus their medical histories are being denied them (indeed, the woman I know has a medical condition that has a genetic basis but has only recently been diagnosed, so it will never be known to the other family).

This website reveals some of the life long heartache of people who have been donor conceived.

To clarify, adoption is a biblical, positive and mutually beneficial act, providing a child for a childless couple and a loving home for a child in need. It is making the best of a difficult situation, whereas the fertility industry deliberately and intentionally creates difficult situations, and loss, for financial gain.

Unfortunately, I have to rely mainly on anecdotal evidence of harm because the HFEA, Government and regulatory bodies all fail to follow up women who have donated eggs, or women who have received donated eggs, or children who are born of donated gametes. It is an industry left to its own devices. We and others have called time and again for proper follow up.

But our concerns with egg donation go further than the Daily Mail investigation.

We urgently need more exposure of:

1. The unethical marketing of egg freezing to women. The success rate of egg freezing to live birth is just 0.95 per cent! And yet egg freezing costs £3,000 for three years.
2. The health risks of egg donation (here too). There is no follow up of women’s health after egg donation yet we know it can cause major, long-term, health issues, as well as psychological harm (as my story above illustrates).
3. The exploitation involved. Only disadvantaged, economically needy, infertile, vulnerable and – deliberately targeted – students donate eggs, rarely wealthy women. Why? Because it is risky, painful, invasive and emotionally damaging, so only those needing an incentive will consider doing it, ie for cash (£750 per cycle of donation) or free IVF.
4. The research industry. Women’s eggs are needed for embryo research (including for gene editing, creating three parent babies, hybrids etc), so how do scientists get hold of the hundreds of eggs needed for research? By enticing women with cash or cut price IVF. (See this advert here). Such incentives are essential because there are no health benefits for women donors – and it is ethically dubious research.

Does the health and well being of women count for nothing? Where are the feminists standing up for them? Where are the regulators? The lack of tracking, research and data is shocking. Egg donors need to know that long-term research simply is not there.

This is an industry built on the eggsploitation of women and it needs exposing.

For the past five years, the charity Marie Stopes International (MSI) has been given £163 million in UK taxpayer money to spend on abortions in developing countries. This money also went on helping to liberalise laws on abortion. No other country gives as much money to MSI than our own Department for International Development (DFID).

MSI is one of the main providers of abortion in England, but most of their business is to provide contraceptives and abortions in developing countries in order, they claim, to reduce the number of ‘unsafe abortions’ in developing countries and to reduce maternal mortality rates.  In 2016, they said they have ‘averted 7.6 million unintended pregnancies’.

Not only is this flawed reasoning for increased abortion provision, we have to ask if MSI can be trusted to carry out ‘safe abortions’ across the globe.

MSI abortions in the UK

It is hard to find out facts and figures. Data collection is very poor on abortion follow up in the UK. Even the RCOG acknowledges that there is ‘a lack of standardisation in reporting which hampers collection of accurate data.’ Private abortion providers do not record NHS numbers so health events cannot be linked to a prior abortion. In other words, many complications are missed off records and not collected by Government stats so we have no accurate figure of how many complications post abortion there are nationally.

Bearing that in mind, unannounced inspections of MSI clinics give us an indication of some of the outcomes of abortion. A highly critical Care Quality Commission (CQC) inspection report published in December 2016 found major safety flaws at MSI clinics, with more than 2,600 serious incidents reported in 2015. Now MSI has again hit the headlines here (and here) with news that they carried out nearly 400 botched abortions in just one month, earlier this year.

The latest report found:

• 373 abortion failures in one month
• 12 emergency transfers from MSI clinics to NHS hospitals in a two month period
• One recorded case where consent was given after the abortion had taken place
• Employment of an unregistered nurse
• Significant concerns with staff training, procedures, oversight of care, leadership and evaluation of equipment quality

One can only guess at what is happening in clinics where there have been no unannounced inspections.

This is happening in UK clinics, under relatively strict health and safety rules and regulations. Yet the irony of claiming to reduce unsafe abortions in developing countries while carrying out hundreds of unsafe abortions in the UK is probably lost on the provider of a significant proportion of MSI’s income, DfID.

DfID funding for abortions abroad

 In a Parliamentary answer Alistair Burt MP, Minister of State for International Development says: ‘By helping the world’s poorest women access modern contraception, we will prevent an estimated 6 million unintended pregnancies and 3 million abortions on average each year.’

 But even that is not enough.

Priti Patel, the Secretary of State for International Development, recently pledged an extra £225 million a year for family planning ‘aid’ for the next five years, including on ‘safe abortions’, up to a total of £1.1 billion. Much of this money goes directly to MSI.  How is it spent?

MSI abortions globally

Between 2011-2106 DfID gave nearly £100 million to one specific project called Prevention of Maternal Death from Unwanted Pregnancy (PMDUP), run by MSI and close partners. This money went to 14 counties across African and Asia with three of the four targets being to:

• Train over 12,000 health care workers in comprehensive abortion care
• Provide nearly 5,500 more service delivery sites
• Support locally led changes to the regulatory and/ or policy environments for abortion services at national level and across the Africa region
• A review of the project outcomes in 2015 reported that they had prevented 1.9 million ‘unintended pregnancies’ (read abortions) while in 2014 they prevented 1.4 million in these 14 countries.

Not only that, they also targeted and measured the number of ‘disability life years saved’ (their words, their metrics).  In 2015 this was 1.5 million and 2014 it was 1.2 million in 14 countries.

I find all these shocking statistics.

We talking about millions of lives lost and mothers harmed, using our money. I also find the language of ‘disability life years saved’ (a term I have not seen used elsewhere) incredibly offensive and the numbers very sad.

Then there are the MSI targets to liberalise abortion laws in Africa and Asia, again, funded by us. MSI ‘encourages’ countries to make policy changes (which of course gives them more ‘business’ and helps achieve higher target numbers of abortions).  As a consequence of this campaigning, eleven countries reduced restrictions on access to abortion or increased their own funding for abortions, and five regional declarations ‘adopted progressive language’ across the African region.

Here are a few quotes from one annual PMDUP report illustrating how UK taxpayer money is used to push deliberately for legal changes on abortion in Africa and Asia:

• MSI is ‘…proactive in all countries seeking Government money for reproductive health services.’
• ‘Advocacy for legal reform continued in Malawi…’
• ‘It is appropriate that PMDUP are proactive in all countries seeking options for government financing of reproductive health services.’
• MSI report success in ‘…directly influencing decisions by policy makers to allow expansion of services.’

Will this reduce illegal abortions and maternal mortality?

Again, facts and figures are hard to ascertain. Illegal abortions undoubtedly take place in developing countries but I suspect that the actual numbers are significantly below WHO estimates. A useful catalogue of known abortion statistics on line is that of William Johnston who challenges official figures here because of incomplete reporting.

As for maternal mortality, I explored this here in more detail. Research in Mexico where abortion legislation varies from State to State (and thus provides a unique scenario to test its effects) found that:

• Permissive state abortion laws do not reduce maternal mortality and morbidity
• States with restrictive abortion laws have lower maternal mortality and morbidity rates

While the research showed a clear correlation between restrictive laws and lower maternal mortality the authors did not claim this was necessarily a cause. Instead they said lower maternal mortality was best explained by literacy, maternal health care, obstetric care, sanitation and clean water.

However we cannot ignore the effect of abortion legislation, as the example of Chile shows. Strikingly, after abortion became illegal in 1989 in Chile, deaths related to abortion continued to decrease. A tighter law reduced deaths.

 The best way to transition towards low maternal mortality rates in developing countries is to address other factors – maternal healthcare, trained birth attendants, water, sanitation and women’s literacy etc. As Nigerian Obianuju Ekeocha says: ‘My lifeline out of poverty was education.’

It is not through a lucrative, unsafe, abortion trade, whose leading beneficiaries are paid more than government ministers from a shrinking health budget, operating under the protection of a bestowed charitable status, funded by us.

A year ago, I blogged about some of the global health challenges that Christians and Christian organisations would be facing in 2017. At the start of 2018 I thought it would be good to revisit some of those issues and look to others that are emerging in the coming year.

Changing Aid Climate

As predicted by almost everyone, the new Trump administration has proposed significant reductions in the US aid and development budget. This includes reducing funding for work on containing infectious disease outbreaks by the Center for Disease Control (CDC) in Atlanta; given the World Health Organisation’s poor track record on this issue, the withdraw of the CDC’s support could further weaken the global response to the next major infectious disease outbreak.

However, the issue that is at the top of most of the development community’s concerns it that the Trump administration has reinstated the so-called Mexico City Policy or Global Gag Rule. This means that USAID (US department for Aid and International Development) requires any aid agency that receives US funding to commit to not providing, counselling or informing women about abortion as a family planning option. This has already slashed funding from Marie Stopes International (MSI) and International Planned Parenthood Federation (IPPF) to the tune of $80 million and $100 million respectively. But the impact is wider, hitting national and non-US agencies, and some estimate that over twelve hundred NGOs will between them lose $2.2 billion in funding. While other governments and movements have increased funding to some of these agencies to the sum of around $450 million, the shortfall remains significant.

This will have two impacts. A lot of family planning services continue but are being provided by agencies that do not provide or counsel abortion. In other areas, services will be lost altogether or significantly reduced. While this is causing outrage in much of the development community, faith-based organisations are continuing to provide effective services, many funded by USAID, and many stepping into the breach left by MSI, IPPF and their like. The consensus that IPPF and MSI have created about family planning is being challenged. In fact, most countries, and indeed the UN itself do not include abortion in family planning definitions. Furthermore, the track record of bodies like IPPF and MSI is increasingly in question. While many in the development community are up in arms about the current US funding policy, the impact on maternal and child health may well be less disastrous than many claim.

Conflict

At the start of 2017, the war in Iraq and Syria was the big concern. Forcing millions to flee and become refugees in surrounding nations, Europe and beyond, while millions more left as internally displaced people (IDPs) within their war wracked countries. By the end of the year, while that war has begun to wind down, the biggest health crisis has shifted to Yemen where over a year of civil war supported by regional powers (and indirectly by many western and eastern governments including the UK) has led to the biggest outbreak of cholera on record, the re-emergence of long controlled infectious diseases such as diphtheria, and the near total infrastructural devastation that means the country could take a generation or more to recover, as and when the fighting ceases. At the time of writing, the prospects of this situation are so remote as to be laughable, but it is no laughing matter.

Meanwhile, civil wars and conflicts in Central African Republic and South Sudan leave many unable to grow food, get clean water or access health services, while also generating refugee situations of their own.

The persecution of the Rohingya in Myanmar has also created a major humanitarian crisis on the Bangladeshi/Myanmar borders that may rumble on for years.

War will continue to generate health problems for millions this year, both those directly affected and those in surrounding countries and regions to which refugees are fleeing.

Health Workforce

This is no new challenge, but it has once again come to the fore that there is a huge shortfall of health workers across the developing and developed world. In the UK we are seeing one in ten nursing vacancies unfilled and a shortage of General Practitioners and junior doctors. The US and other western nations are facing comparable shortages. This creates an opportunity for millions of doctors, nurses and other skilled health workers from developing nations to migrate, leaving their own nations even shorter of professionals than the West.

Another, largely ignored issue within this is that most of these health workers are women (at least 75%). While the #MeToo movement started in the West with celebrities, the realities not just of sexual harassment, but of discrimination and lack of access to education, good pay and chances for promotion that women face in many parts of the world mean the health workforce is still often ignored and under-resourced. As I have said elsewhere, just increasing our investment in training nurses has an impact not only on health, but also on development and the status of women in society. But the same challenges face midwifery, medicine and other health professions, and one of the issues at the heart of this is the status of women and whether female healthcare leaders will be listened to at national and global levels.

At present, the global health workforce is short of 18 million trained health workers. To achieve the SDGs by 2030 the WHO reckons the world needs another 40 million health professionals. Without adequate pay, training, working conditions and recognition, this simply won’t happen. And this is not just a developing world issue – as the current NHS winter crisis reminds us, the wealthy nations of the world are also falling short of health professionals at an alarming rate. The only difference is that we can afford to poach them from poorer countries, exacerbating the problem.

And the good news?

Has it all been bad in the past year? And is the future all grim? Leaving aside the natural pessimism of the British in January, especially when faced with the catalogue of disasters and challenges I have listed above, there turn out to be many encouragements and guarded reasons for optimism.

Firstly, some disasters never happened. A famine in South Sudan was averted, and overall the chances of people dying of famine has dropped globally to 0.06% of the figure in the 1960s. Famine early warning systems, better coordination of aid and emergency relief have all reduced the incidence of famine. Wars have killed fewer people in the last year. The war against ISIS has begun to wind down, and while the wider civil war in Syria may well wind back up with a focus on Syria, Iraq and now Turkey trying to supress various separatist groups on their borders (in particular the Iraqi and Syrian Kurds in the north of the region), overall the fighting has (for now) abated and reconstruction begun (at least in Iraq). This could all change at the drop of a bomb, of course, and the regional conflicts across the globe are almost all far from resolved. And the West’s tensions with North Korea threaten a conflict on a global scale!

We have plenty of reasons to give thanks, but also to pray for peace.

We also saw fewer deaths from natural disasters, such as floods, droughts, and (despite the awful hurricane seasons in the Gulf of Mexico last autumn) high winds.

Secondly, the global community is making progress on coordinated preventative health programmes. Vaccination rates are at their highest ever (86%) for the major infectious illnesses (diphtheria, pertussis, measles, Hepatitis B and rotavirus). New Zealand has completely eliminated measles in the last year, joining the UK, Australia and the Americas. Overall deaths from measles have now dropped from 550,000 in 2000 to 90,000 in 2016. It is significant progress, but there is still a way to go. Meanwhile, only 19 cases of wild poliomyelitis were recorded on Earth in 2017.

Life expectancy continues to rise in most countries (the UK being a notable exception over the last few years, where life expectancy is stagnating and even declining). Infant and maternal mortality rates are also coming down. Malaria vaccines will be rolled out to children in some of the most at-risk regions, and clinical trials of an HIV antibody that offers the potential of an effective preventative measure begin soon.

Finally, poverty is being reduced. Fewer people are living on less than $2 (£1.50) a day – about 200,000 people are being lifted out of extreme poverty every day. This is mostly due to a robust and currently booming global economy. The potential of poorer nations and communities to benefit from a strong global economy remains a challenge and an issue of social justice. One of the surest ways to improve health is improve personal and national wealth. Literacy has continued to increase, as has access to primary education (especially for girls) – both linked with increased health and wellbeing for communities.

Challenges for Christians

Persecution of Christians continues to be a major global issue – one that has been increasingly acknowledged by the West (albeit reluctantly).

We are also unpopular because we are challenging the consensus on issues like gender, sexuality, family planning, personal autonomy and freedom of conscience. The western aid and development movement do not particularly like working with us, and while bodies like the WHO and UN are recognising the need to work with faith communities, Christians who hold to their values and beliefs are more likely to be marginalised. Yet the narratives of the secular West are increasingly challenged and other voices are being heard.  I also suspect that the relevance of the WHO and UN in global health will change in the coming year.

In 2017 we remembered the 500^th anniversary of the start of the Reformation. Its impact on the world continues to this day, not least in medicine and healthcare. Christians of all theological persuasions continue to minister to the poor and sick in the most deprived areas of the world because of our faith in a Saviour who reached down into the mess and misery of rebellious humanity to reconcile us to God. Let’s continue to challenge the world’s values not so much by our words, but by our actions.

After successful lobbying by abortion providers, women in Scotland are now allowed to take the abortion pill at home, in a first for the UK. Since 83% of abortions in Scotland use medical methods (abortion pills) this will have a significant impact.

I’ve recently blogged on this change in Scotland, citing medical concerns with allowing women to take the abortion drug misoprostol in their own homes, as well as highlighting the ideology behind the change. However, as I’ve researched these blogs, I’ve realised that for abortion campaigners this is just a ‘step in the right direction’ towards all medical abortions in the UK being carried out on a fully at-home basis.

As I have spent time reviewing the physical and psychological costs, and dangers, of taking abortion pills at home, I have begun to realise how ironic it is that we are coming full circle and are returning once again to having abortions taking place in homes, or perhaps friend’s homes, or perhaps schools, or colleges, or in the house of an acquaintance or … why not in a park or other so-called ‘back street’?

Because once an abortion pill is no longer administered and taken in a clinic under medical supervision then, whatever campaigners claim, there is absolutely no control over where a pill is taken. Or when. Or by whom. Or if it is taken freely or under coercion.

Of course it will be countered that home medical abortions are much safer now than in the past.  But I’ve shown in previous posts (here and here) that complications from medical abortions are common, not rare, according to official criteria, and the regimen can take longer and be much bloodier and much more painful than advertised.  Indeed the Scottish guidance (but not the law) says a woman must have another adult with her and the pill must only be taken up to ten weeks gestation, thereby acknowledging it’s really not such a straightforward procedure.

In the UK we have poor data collection (so complications are often not linked to abortion) but in countries where data collection on abortions is better, we know that complications after medical abortion are four times higher than after surgical abortion – 20 percent compared to 5 percent. These complications include haemorrhaging in approximately one out of six women (15.6 percent) while more than three out of every 50 women (6.7 percent) had fetal tissue left inside, most of whom (5.9 percent) required surgery to get the tissue out. In one UK study over 50% of women needed subsequent surgical intervention!

Added to this is the increased potential for emotional trauma when one’s own home (or wherever) becomes the place of one’s abortion and women can see – and have to flush away – the baby.

We are not talking about small numbers of abortions here. In 2016 in Scotland there were 7,926 medical abortions while the number in England and Wales  was 107,873.  If we assume a complication rate of say 20 percent of 115,799 medical abortions, that is more than 23,000 women per year with complications, and this is with some medical supervision!

Any decriminalisation of abortion would clear the way for all medical abortions to take place outside of medical supervision, by removing the 1967 Act’s requirement that abortion take place in a hospital or other ‘place approved [for abortion]’.

Readers who still think my title ‘Back to the back streets’ is overblown hype should consider the longer-term direction of travel, as campaigners push for less regulation of abortion pills.

Given the growing availability of abortion-inducing drugs distributed through illegal websites that circumvent regulations, what will stop women obtaining abortion pills off the internet? Currently in the US there are already at least 86 websites from which the abortion pill regimen can be ordered online, without a medical prescription.

It will not be long before abortion starts on a smart phone. A girl can be in her bedroom at any time of the night, take a pregnancy test, realise she is pregnant, go on her smartphone and in 15 seconds be connected to an abortion provider who will ship her the abortion pills.  They’ll be aborting in their bedrooms and flushing their babies down the toilet. That is the reality of abortion in the not so distant future.  It will not be because these girls and women do not have access to medical facilities but because they don’t want others to know about the abortion and because they will be fed the line that it is safe, quick and easy.

But ordering powerful drugs off the internet poses real dangers. A recent paper published by Contraception sought to demonstrate the safety of purchasing abortion pills online, but their findings showed quite the opposite. For a start, all of the pills were successfully ordered without needing a prescription or any medical documents and none of the packages received had any instructions!  Packages were damaged in shipment, and incorrect dosages of the drugs were sent, mostly too low a dose (not that a woman or girl receiving the pill would know this).

Showing little concern for the health and safety of women, or for the importance of taking correct doses at the right times and gestation, the researchers concluded: ‘We encourage reproductive health providers, advocates and policy makers to think creatively about how the internet might be useful for enhancing access to safe and effective abortion.’

But with no prescription required by such websites, and no medical oversight at all, the safety nets in place to protect women are gone. Those who profit are the pill manufacturers and providers, as well as sex traffickers and disgruntled boyfriends. Already stories of such abuse have emerged from  London, New York, Kansas, Florida, Wisconsin and we can only expect to hear more cases.

Wikipedia defines an unsafe abortion as ‘the termination of a pregnancy by people lacking the necessary skills, or in an environment lacking minimal medical standards, or both.’  And it states that ‘an illegal abortion may be called a back street abortion.’   In a further ironic twist, most people think that unsafe, illegal abortions only take place now in developing countries yet by this definition, self-administered home abortions, with no medical oversight, some using illegal drugs off the internet, takes us into a new era of unsafe, illegal ‘back street’ abortions in the ‘developed’ world.

The current campaign to remove the administration of the abortion pill, misoprostol, from medical supervision and oversight is part of a long-term goal for abortion activists. Their goal is to bypass medical professionals in the process of medical abortion and remove as many legal restrictions on abortion as possible.

This will be achieved step by step. Incremental extension is the name of the game.

A recent BMJ comment piece, celebrating the progress abortion providers believe that they have made towards full decriminalisation and easier access to abortion in the last few years, comments that: ‘A permissive legal framework is not sufficient to ensure access to abortion; skilled, willing providers are [also] essential…’ 

Interestingly, it seems that doctors may be increasingly reticent to be involved in carrying out abortions, thus leaving a potential gap in provision. So a goal for abortion activists is to increase the ‘abortion workforce’ by encouraging and training more doctors in abortion provision and by enabling nurses and midwives to become more involved in abortions, to fill the opening gap.

But that is not all. When more doctors refuse to be involved in aborting their unborn patients, what else is a pro-abortion industry to do?  One answer is direct to patient marketing:

1. Encourage more self-administration of medical abortions at home
2. Expand use of medical abortions at home, initially to the first trimester, (not just the first nine weeks), and then beyond
3. Encourage the two abortion pills (mifepristone and misoprostol) to be given simultaneously, not 24 hours apart.
4. Greater involvement of nurses and pharmacists in prescribing and providing pills (and doing abortions?), removing doctors from the process.
5. Encourage women to obtain pills off the internet and to bypass legal restrictions
6. Encourage women to lie if they cannot get hold of pills from a medical professional or pharmacist (more details below)
7. Carry out post abortion check-ups simply by using mobile phone apps
8. Get rid of as many legal restrictions as possible (see here too).

However:

1. Medical abortions are not as safe as usually implied, especially when self-administered (ie. do-it-yourself). There is limited data on the outcomes of self-administering abortion pills but one peer reviewed study found that 78% of participants had excessive bleeding, 13% had severe anaemia and 5% shock. 63% had incomplete abortion and 23% had failed abortion. They also found that surgical evacuation had to be performed in 68% of the patients, 13% with a blood transfusion. The authors’ conclusion? ‘Unsupervised medical abortion can lead to increased maternal morbidity and mortality.’ If they are so safe, why do medication guides for these pills warn they may cause a number of very serious side effects? And why are they only available in the USA through a restricted medical program (REMS) and only in certain healthcare settings? Furthermore, the medication guides note that there is no research on any possible link to cancer, while a package leaflet for the two pills admits there is only limited data on their use by adolescents.Even one of Ireland’s most vociferous campaigners for abortion, obstetrician Peter Bolyan, recently admitted that: ‘there are serious dangers when women take [abortion pills] without supervision. We have knowledge of women who have taken them in excessive dosage and that can result in catastrophe for a woman such as a rupture of the uterus with very significant haemorrhage…And if that happens in the privacy of a woman’s home or perhaps in an apartment somewhere, that can have very, very serious consequences for women. So, it’s really important that these tablets are…dealt with in a supervised way…’

2. The later in gestation that medical abortions take place, the less effective and the more dangerous they are. Ten weeks is the maximum gestation recommended. Because of increasing uterine sensitivity to misoprostol with advancing gestational age, regimens for medical termination change in the late first trimester and second trimester to repeated, lower doses of misoprostol. The woman’s experience will also be more painful later in gestation, with an exponentially increasing rate of haemorrhage and complications after just seven weeks gestation. Abortion advocates realise that ‘…Gestational age assessment before undergoing medical pregnancy termination is necessary to ensure women take the recommended dose and regimen of medications, and in the appropriate setting’ and yet even they report large variances in self-calculated gestational age. They found that one‐third of women who were followed up after receiving ‘treatment’ had pregnancies of ten weeks gestation or more, when checked by ultrasound. Some even had pregnancies of 18-28 weeks, far off the recommended maximum of ten weeks.
3. Taking both medicines at the same time causes more side effects and is less effective than when they are taken at least one day apart – the recommended protocol. One study (by authors who are pro-abortion) found that for women under 49 days’ gestation, the failure rate was 27% if they took the misoprostol immediately after mifepristone. For women between 50-56 days’ gestation, the failure rate was 31%.  The authors of this study strongly recommended that buccal misoprostol not be taken immediately after mifepristone because of the high abortion failure rate. Another study also concluded that a six hour gap ‘…is not as effective at achieving a complete abortion compared with the 36- to 48-hour protocol.’

4. As noted in a previous blog, self-administration of abortion pills removes any control over who takes the pills, where they are taken, whether they are taken, when in the process they are taken or if an adult is present. It also removes an opportunity to ascertain if abuse or coercion is involved. Little data is available however we know that coercion can take many forms and come from different sources. As well as direct pressure to abort (often from a parent or partner), it can include receiving false information from others, withholding of support from one’s family or emotional blackmail. Several news stories have described abortions forced on a woman by a partner who has given her a drug in food or drink without her knowledge.

5. Internet abortion providers deliberately encourage women to lie to get hold of abortion pills! One well-known provider states openly on its website: ‘To obtain one of these medicines, one could, for example, say that your grandmother has rheumatoid arthritis so severely she cannot go to the pharmacy herself, and that you do not have money to pay for a doctor to get the prescriptions for the tablets.’ And: ‘In many countries the pharmacy will ask for a prescription from a doctor, but sometimes you can get it without prescription if you are persistent and say it is for an ulcer (Cytotec), or for your grandmother’s arthritis…Don’t stop after the first “no”!’  Women on Waves also ‘helpfully’ shares that Mifeprex can also be bought on the black market from ‘places where you can also buy Marijuana‘.Women on Waves suggests: ‘If there are problems getting the medicines in one pharmacy, try another pharmacy, or a male friend or partner might have fewer problems obtaining them.’ While Women on Web say that while ‘Mifepristone is not registered in all countries … this should not be a problem because the medicines are for personal use only. Mifepristone can also be used as a morning-after pill, for the cure of depression, to treat breast cancer etc.’
6. Follow up using mobile phone apps is highly irresponsible, since complications from medical abortions are common, not rare. I cite above an example of the high rates of haemorrhage after medical abortion and the significant numbers of women requiring surgical follow up. Abortion pill provider, Women on Web, also found from their own surveys that 12–21% of women subsequently needed a surgical intervention and almost half of women who were over twelve weeks gestation (45%), required a surgical intervention. Information about abortion history becomes particularly and critically important when evaluating a woman for infection after abortion and yet, knowing this, Women on Web and Women help Women tell women that they can lie to their doctor, and claim they are ‘having a miscarriage’.

In order to increase access to abortions, it seems that abortion-rights advocates have gone from warning of back-street abortions to promoting do-it-yourself black-market ones. So much for the well-worn phrase, ‘Let’s make abortion safe, legal and rare’.

Not only does all this encourage illegal and dangerous practices (including the ability for abusers and pimps to get hold of pills, which can be discounted for packs of ten or more), with no medical professional involved there will be no objective gestational age dating, no guarantee that women read and follow the instructions, no objective screening for the medical and psychological contraindications (more common than for surgical abortion), no medical follow up with scans or visit, no access to emergency services.  And also….no potential malpractice issues to deal with.

On 25 July Louise Brown, the world’s first baby born via in-vitro fertilisation (IVF), celebrates her 40^th birthday.

40 years after her birth it is estimated that more than seven million babies have been born as a result of IVF and other assisted reproduction treatments. Around 2.4 million assisted reproductive technologies (ART) cycles are estimated to take place each year world-wide, with about 500,000 babies born as a result. If rates stay at current levels, then an estimated 157 million people alive at the end of the century will owe their lives to assisted reproductive technologies (1.4 per cent of the global population).

40 years ago it was generally assumed that IVF would remain rare. However there has since been an explosion of assisted fertility services:  intracytoplasmic sperm injection (ICSI), gamete and embryo freezing, gamete and embryo donation, embryo genetic diagnosis and surrogacy, to name some. The most common fertility treatment now is ICSI, accounting for around two-thirds of all treatments worldwide, with conventional IVF around one-third (proportions that vary across countries).

Infertility is deeply distressing and can affect every area of life for those struggling to conceive – as many as one in six couples. The Bible views childlessness as a painful, personal tragedy (Samuel’s mother Hannah’s anguished prayer illustrates the stress of infertility, as does Rachel in Genesis 30) while the Psalmist praises the God who ‘gives the barren woman a home, making her the joyous mother of children’ (Psalm 113:9).

IVF can provide couples with a child they desperately want. And it has brought many precious new lives into being, and real happiness to millions of parents.

Therefore, many now think IVF is the answer to infertility.

But it is not. While the IVF industry and media focus on and market the success stories, the average delivery rate from ART treatments are around just 19 per cent per cycle – a global IVF cycle failure rate of around 80%. In the UK, the Human Fertilisation and Embryology Authority reports a ‘success’ rate of 26.5% . This ‘success’ rate actually means that 73.5 % of cycles do not lead to a birth.

Success rates for IVF diminish rapidly after 35 years of age for women, largely because of loss of ovarian follicle reserve and oocyte quality with age. Even a woman under 35 years has less than a one in three chance of having a baby per embryo transferred, using her own eggs and partner’s sperm. A woman in her early 40s only has about a one in ten chance of having a baby per embryo transferred. And the success rate drops to a mere two per cent for women over 44. This is highly relevant in a time when more and more women are delaying childbirth to concentrate on jobs and careers. When celebrities in their 50s become pregnant, what the media do not tell you is that it is almost always with a donor egg (indeed, 59% of women over 44 years used donor eggs in their treatment).

IVF heartbreak is real. IVF is no guarantee of success, despite all too often being touted as such. Added to this is the significant financial, emotional and physical toll that IVF can have on women.

Yet still, with one in six couples experiencing problems conceiving, the fertility industry is thriving. It is estimated to be worth over £600 million in the UK alone, with one cycle of IVF costing up to £5,000 or more.

There are some very troubling aspects of the fertility industry.

For instance, the number of babies born with health challenges (see here and here too), the use of medically unproven techniques and ‘add-ons’, poor regulation, the shocking commercialisation and exploitation of women’s wombs and eggs (see here too) and the change to ‘traditional’ notions of family structure and biological parenthood, through gamete donation (which can bring much heartache to the offspring) and surrogacy. A dead or dying person can have their reproductive tissue removed to enable someone else to have a child – even a grandmother.

IVF has also opened what many regard as a Pandora ’s Box of genetic engineering, cloning, pre-implantation genetic diagnosis (screening out of embryos), embryonic stem cell harvesting, research on three parent babies and animal-human hybrids. Many IVF programmes involve the production of spare embryos, which are then used for research, disposed of, or frozen for future use. Between 1990 and 2013 over two million were allowed to perish, according to a Parliamentary answer. Now, over 170,000 IVF embryos perish every year. Embryos are experimented on, donated to other couples, frozen indefinitely … or even turned into jewellery.

The last 40 years of IVF and ART have given many couples happiness but even more couples, dashed hopes. The next 40 years will undoubtedly bring even more possibilities for the fertility industry, but what is possible is not always right.

What should we think as Christians?

Some biblical reflections on infertility treatments can be found in a CMF Nucleus article here and are summarised in a blogpost. Central to our response should be upholding the marriage bond and honouring embryonic human life. If these principles had been followed over the last 40 years many of the difficult issues that have come out of the fertility industry’s Pandora’s Box would not have happened.

I have also written a booklet with Dr Jason Roach which provides both information and guidance on some of the ethical dilemmas IVF raises for Christian couples considering IVF, and considers how we might seek treatments for infertility in line with God’s character and commands. We included two personal testimonies from Christian couples who both considered IVF and decided to take different courses of action.

A moral vision, especially one shaped by a Christian understanding of the person and family, has to be prepared to say ‘no’ to some exercises of human freedom and to turn away from technology that is possible but unwise. With fertility treatments, while we can and should use our God-given skills to help alleviate infertility we should also be prepared to acknowledge that there may be suffering we are free to end, but ought not to, that there are children who might be produced through artificial means, but maybe ought not to be.

Peter Saunders reflects in a blog here that some infertile Christian couples will go on to conceive, either naturally or with ethical infertility treatment, after a period of waiting. But this does not happen for all, and God in his wisdom has left some couples childless despite good treatment and patient prayer.

So this IVF anniversary could serve as our reminder to recognise God’s sovereignty, acknowledge we live in a fallen world, serve the childless with compassion, uphold marriage and honour all life.

Many abortion activists will have been delighted at the news that women will be able to self- administer abortion pills in their own homes. The head of the RCOG is on record claiming that having an abortion is no different to having a bunion removed.

Ironically, with this change that activists have been campaigning for, women will soon realise abortion is definitely not the same as removing a bunion – when they see the baby they have to flush down the toilet.

The boyfriend of one young girl describes what happened after his girlfriend took the second pill:

‘The day she took the final pill and came back to my flat to wait for it to pass truly drew a new line in the sand. The hours of pain she suffered, it utterly ripped me apart to see her writhing in agony, interspersed with trips to the toilet as the process started. It culminated in one trip from which she didn’t return, all I heard was sobs, drained of energy she couldn’t even cry with the force the pain deserved. I soon discovered that it wasn’t the pain the sobs were for, it was for what she had seen in the toilet. A recognisable shape. Then flushed away.’

But say we ignore any possible emotional damage to women (that not all will experience of course) and instead look at the claims being made that medical abortions are safe and self-administering the abortion pill is progress for women. What does the peer reviewed evidence show us?

To explain the process, in a medical abortion an oral dose of mifepristone is given at a clinic/hospital which will (usually) kill the fetus. Women leave the hospital or clinic then, with the current system, return up to 48 hours later to be administered misoprostol, either orally or vaginally. This expels the dead fetus. The change is that women will not have to return to the clinic but can take the second pill outside of any clinical setting or medical oversight.

It sounds simple and safe so what is my concern?

1. Medical abortions are not as safe s surgical

This is rarely acknowledged yet all the evidence is clear on this. The largest and most accurate study of medical abortions, a Finnish study of 42,600 women, found that women had four times as many serious complications after medical abortions than surgical abortions: 20% compared to 5.6%.

For medical abortions after 13 weeks, subsequent surgical evacuation rates vary widely between studies, but in one UK multicentre study reported by the RCOG (p42), it reached up to 53%.

 Research by pro-abortion authors found that for women over seven weeks the failure rate can be up to 33%.

2. Self-administering abortion pills is medically risky

Campaigner for abortion, obstetrician Peter Bolyan, has admitted that: ‘there are serious dangers when women take [abortion pills] without supervision. We have knowledge of women who have taken them in excessive dosage and that can result in catastrophe for a woman such as a rupture of the uterus with very significant haemorrhage…And if that happens in the privacy of a woman’s home or perhaps in an apartment somewhere, that can have very, very serious consequences for women. So, it’s really important that these tablets are…dealt with in a supervised way…’

One peer reviewed study of self-administering pills  found that 63% had incomplete abortion. Surgical evacuation had to be performed in 68% of the patients.

When self-administering pills, there is no control over: who takes the pills; where the pills are taken; whether the pills are taken;; when in the process the pills are taken; if the girl is vulnerable or in an abusive/coercive relationship; if abuse or coercion is involved in taking the pills or if another (competent) adult is present.

3. There is no demand for self-administration of medical abortion

Despite claims by abortion campaigners, there is no hard evidence or data showing that women are having problems with the current arrangements. Campaigners rely instead on (limited) anecdotal evidence.  The reality is that onset of bleeding is within four to six hours after taking the second of the two pills, giving sufficient time for most women to get home.  Surgical abortion is an option for those who cannot get home before bleeding begins, including those who cannot access medical services quickly after the abortion. Medical abortion is contraindicated for women with transport problems or issues.

So why the campaign to change the current situation?

This is just one step towards a longer term goal for abortion lobbyists, to make abortions as easy as possible, using nurses, pharmacists and internet suppliers, and to remove legal restrictions on abortion. Abortion providers have obvious financial and ideological vested interests in increasing numbers of abortions. And our Government knows that it is cheaper to pay for a couple of pills than a surgical abortion.

It seems that ‘progress’ today consists of moving abortions from unsupervised backstreets into unsupervised bathrooms.

Under the guise of the coronavirus lockdown, abortion campaigners have taken the opportunity to lobby the UK Government to substantially change the rules around abortion pills, something they have wanted to do for years, as this blog explains.

This week, they have been successful in their campaign. Now women will be able to take two powerful drugs, the abortion pills mifepristone and misoprostol, in their own home in the first ten weeks of pregnancy.

Previously women had to be given mifepristone (which kills the fetus) at a clinic or hospital by a registered medical professional. Up to 48 hours later they would be administered misoprostol, which they could take at the clinic or (since 2018) at home, to expel the fetus.

Now, to the delight of the abortion lobby, the pill manufacturers and abortionists, the Government have also removed any requirement for one (no longer is it even two) registered medical practitioner to actually see or even talk to a woman. Instead ‘consultations’ can take place by video, telephone or ‘other electronic means’.

Perhaps the abortion lobby persuaded the Government that using telemedicine is the way to go since many more GP surgeries are introducing it. However the use of the vague term ‘other electronic means’ does not just mean that consultations must only take place by video or facetime or even telephone calls, there is nothing to stop it including ‘consultation’ by email or texts, or why not twitter?

With an email or text, there would be no means of knowing:

• who really is on the other end of an email or text;
• if what (she) is saying is correct;
• if (she) really is only ten weeks gestation or less;
• if (she) really lives where she says;
• if (she) is following medical protocols;
• if the pills will be used by (her) or someone else;
• if (she) is on her own at home or has adult support;
• if there is someone coercing her into having an abortion;
• if the respondent is an abuser controlling her.

All remaining protections for women’s health and safety have been removed in one go.

How much debate or scrutiny did this significant change in abortion practice receive? None.

It was done pretty well overnight and undercover, despite the Government spokesman stating literally a few days before that they had no intention of changing the law.  Yet its effect will be significant since 71% of abortions are now medical, using pills, in England and Wales, while 86% are medical in Scotland.

These two powerful drugs can cause serious complications, particularly if not used within the medical protocols, or in spite of contraindications. I have detailed in this briefing paper some of the significant safety concerns with their use. For example, medical abortions cause four times more serious complications than surgical, and a quarter of women experience serious complications from medical abortions, including heavy bleeding, infection, severe abdominal pain and hospitalisation from incomplete or failed abortions.

Moreover, what is less well known, the pills are less effective, and more harmful, when taken later in gestation, which is presumably why the Government regulations stipulate their use only up to 10 weeks of pregnancy. But many pregnant women do not know their gestation until they have a dating scan. And women, when guessing, tend to underestimate their gestation. Usually, the last menstrual period (LMP) is used to estimate gestational age, but LMP alone is not the best obstetric estimate because it assumes a regular menstrual cycle. Studies report (p10) that approximately one half of women do not accurately recall their LMP.

The later women take the two pills, the more dangerous it becomes and the more emotionally traumatic, as they flush a recognisable baby down the toilet.

The previous President of the RCOG and vociferous abortion campaigner, Lesley Regan, has said that ‘abortions should be treated no differently from other medical procedures – including something as simple as removing a bunion.’

The irony now is that bunion removal requires fully informed consent, provision of information on its risks, and the direct, face to face, involvement of medical professionals. Bunion removals are not arranged by texts or emails and then left for the patient to carry out!

So Regan has got even more than she asked for. Medical abortion is now being treated as even more minor than removing a bunion, despite the fact that it requires two sets of chemical drugs powerful enough to destroy and then expel a living human being from the safety of a mother’s womb.

This blog is also being published on the Conservative Woman blog