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On my bookshelf I have David Paintin's slim book entitled Abortion Services in England and Wales published by the Birth Control Trust in the early 1990s. Over the years I have referred back to it but I now have a new authoritative text to sit by its side. Sam Rowlands has successfully encouraged leading experts in the field of unplanned pregnancy to write comprehensive and up-to-date chapters on the subject ranging from the ethics of abortion to staffing issues and ‘conscientious commitment’ to provision of this service. Apart from some Australian states this is the only area of health care regulated by criminal law and open to interpretation by the judiciary. This book helps to provide some clarity and is aimed at a global audience. Rowlands has compiled an informative text that is highly readable yet fully referenced.
In the introduction, Rowlands states that his aim is to assemble the main evidence to date on abortion care in the hope that its dissemination will improve the effectiveness and safety of treatment for women with unwanted pregnancies. To this end I hope this book is read by all health care professionals working in the field of sexual and reproductive care and that it takes pride of place in the gynaecology section of all libraries.
The book starts with a historical perspective written by James Drife. In 1952 abortion was the third leading cause of maternal death in the UK after hypertensive disease and haemorrhage. Few of us can remember the ravages brought about by unsafe, illegal abortion but, as a recent BMJ Personal View article1 reminded us, “just ask your grandmother”. However, in the early 1990s we were able to witness the rapid decline in maternal deaths in Romanian women with the legalisation of abortion and improvements in the provision of modern contraception.2
There is a chapter that provides thoughtful insights into the psychosocial factors in women requesting abortion and another discussing the current epidemiology from a worldwide perspective. Practical guidance is given on support and counselling of women presenting with an unplanned pregnancy, with the authors of this chapter providing evidence that most women attending early in pregnancy are usually sure of their decision and the suggestion that they should receive “compulsory counselling” would conflict with their wishes and be a waste of resources.
Other chapters give practical details concerning different abortion methods and the value of effective pain control. Difficult subject areas are covered including feticide, provision of services for women with fetal anomalies, and the long-term outcomes in women requesting abortion. Several chapters deserve a special mention. I think all who work in women's health should read the chapters on ‘Stigma and issues of conscience’ written by Kelly Culwell and Caitlin Gerdts and ‘Staff perspectives’ by Edna Astbury-Ward. ‘Myths and misinformation’ related to abortion, authored by Toni Belfield, should be included in every school's sex and relationships education programme.
I have only one minor criticism of the book, namely that the Faculty of Sexual & Reproductive Healthcare is not listed separately in the appendix of useful organisations but is instead subsumed under the entry for the Royal College of Obstetricians and Gynaecologists!