In the nineteenth century abortion was widely available in Britain but abortionists risked life imprisonment. In 1927 The Lancet suggested that doctors should be allowed to act in good faith and in 1929 abortion to save a woman’s life became legal. Calls for change grew and the Abortion Law Reform Association was formed in 1936. In 1937 an investigation found that abortion caused 14% of all puerperal deaths. In 1938 a leading gynaecologist, Aleck Bourne, was acquitted after performing an abortion on a 14-year-old rape victim. In 1939 a committee recommended that grounds should include serious risk to health. War changed Parliament’s priorities and in 1952-4 abortion was the third commonest cause of maternal death: 80% of the women were married with children. Abortion was the leading cause in the 1960s, and, in 1967, after many failed attempts, Parliament passed the Abortion Act sponsored by David Steel, a young Liberal MP. The number of legal abortions rose to equal pre-1967 estimates and levelled off. By 1979 deaths from abortion – including those classed as spontaneous – had almost disappeared. Medical opinion was still split and NHS provision remained patchy for years.

Chapter 6 focuses on that part of the UK that was omitted from the Abortion Act: Northern Ireland. We show that, notwithstanding this formal exclusion, the Abortion Act has played an important role in the region such that a biography of the Abortion Act necessarily offers the story of not just a British law but, rather, of a UK one. Over the past five decades, Northern Irish women have travelled in large numbers to access legal abortions in Britain, with the Act offering a ‘release valve’ that would limit the numbers of dangerous backstreet abortions and the mortality and morbidity that have driven reform elsewhere. Further, the Abortion Act would form a key focus of campaigns for and against abortion law reform within Northern Ireland; when reform eventually came, the Act would play a role in shaping it, and the reform of Northern Ireland’s abortion law has given significant momentum to the campaign for the decriminalisation of abortion.

Chapter 7 considers parliamentary debates regarding the reform of the Abortion Act from 1990 to 2021. Those leading the fight for restrictive reform would now be mainly Tory women who placed particular emphasis on Christian faith in driving parliamentary work and made the case for narrowly focused reform measures in a language of clinical advance, female empowerment and civil liberties. Pro-Choice MPs would move off the defensive and argue for further liberalisation of the law. Reflecting a significant shift in the centre ground of the debate, each side would now claim to be defending the interests of women, and each would claim to be supported by clinical science and medical opinion, with the gulf between them more than ever presented not as a moral but an empirical one. Above all, each would claim to be offering necessary modernisation of an outdated Abortion Act, whilst relying upon radically different visions of what such modernisation required.

Physician approval or condemnation, advocacy or opposition, to abortion have often determined whether women can avoid the complications of unsafe abortion and, sometimes, early death.In the USA organized medicine’s early opposition to abortion outlawed it.A century later, obstetricians recognized the importance of abortion to public health.They fought to end restrictions, eventually making abortion legal in several states. At first, individual physicians violated restrictive laws, risking jail and their medical licenses.Colleagues soon supported this “civil disobedience” and influenced their professional organizations, first the American College of Obstetricians and Gynecologists then the American Medical Association, to take political action in support of abortion law reform.In many other nations, physicians advocated locally and through global organizations like WHO and FIGO for safe abortion to reduce maternal mortality.At medical schools, students insisted that their curriculums include contraception and abortion founding Medical Students for Choice to support advocacy for safe abortion despite official opposition at some schools.Those who planned careers in women’s health sought post graduate residency training that included abortion and became political adversaries of abortion bans in conservative states.