Abortion will never get restricted in Britain, right? Wake up, they’re already trying

When the TV adaptation of The Handmaid’s Tale came out in 2017, I was excited to see a classic Canadian novel brought to life on screen. Three episodes in, I couldn’t bring myself to watch any further. The terrifying world depicted in the series was not just traumatic to watch as a woman, but as a woman in the modern world, it felt all too possible. With the leaked news that Roe v Wade is likely to be overturned, I am frightened that my feeling at that time might have been right.

While the world has been moving away from all-out bans on abortion over the last few decades, most countries that allow it still require women to give “acceptable” reasons, and enforce restrictions, such as the need for the request to be approved by one or more healthcare professionals.

Now there are signs that the tide is turning in the wrong direction. Some of these have been splashed over the news. For example, Poland’s decision to remove the exemption for abortion due to foetal anomaly – the reason for 98 per cent of abortions in the country – thereby effectively banning it. Women in Northern Ireland have only recently won the right to have an abortion, and even then, in 2022, they still have to travel to England, Scotland or Wales for the procedure, because Northern Ireland does not yet have sufficient services to fulfil the demand.

But it is the small changes to which we should really be paying better attention. Because it is here where the real dangers lie.

In the UK, these have been implemented in the most boring of ways: via governance and clinical guidelines. In 2020, without anyone really asking, NICE announced that it was considering the mandatory and routine recording of pregnant women’s alcohol consumption, from the beginning of pregnancy through until a child has its own health record.

This took pregnancy surveillance to an unprecedented level, moving it from the realm of supportive antenatal care into unnecessary and unwarranted regulatory control. A glass of wine the day your period hit would suddenly become a black mark on your and your child’s health records, despite no existing evidence that this level of drinking might harm a pregnancy that began in the following two weeks. It was a tentative step towards regaining control of women’s bodies on behalf of the state.

After a two-year lobbying effort, including by me, NICE U-turned. This decision, and that of the House of Lords to uphold telemedicine along with the home administration of termination medication, is going against the ever-concerning, subtle global movement, in both medical and legal practice, to exert control over women’s bodies.

The fact that these initiatives were allowed to go so far as to be made public and debated in parliament means that we should really be paying better attention.

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While slow, small, and sometimes hard to detect, this push over the past two years carries a powerful message that we are only ever one influential extremist, one well-funded campaign, one misogynistic politician, one ill-conceived clinical guideline away from walking “under his eye”.

Given the lack of clinical and scientific evidence behind most recent changes globally to abortion regulations, and to reproductive rights more broadly, we can only assume that it was never really about what was best for the mother or baby after all. It was, and has been for a very long time, about who is in power and who has control.

Dr Alexis Paton is a lecturer in social epidemiology and the sociology of health and co-director of the Centre for Health and Society at Aston University. Dr Paton is also chair of the Committee on Ethical Issues in Medicine at the Royal College of Physicians and a trustee of the Institute of Medical Ethics