Dr. Jacqueline Montwill:

Deputy Conway spoke about abortion being a social solution and asked about the alternative. We must be very honest. There are only two options: the woman either will have her baby or she will not. The issue is whether we can accurately assess and diagnose somebody as suicidal so as to be eligible, under this law, for an abortion. The problem is that we cannot do so. We cannot say which woman will commit suicide and, more broadly, we cannot say which patient will commit suicide. It is important to understand that research has shown that we should be considering why the woman is seeking an abortion. Is the partner or boyfriend gone and is the woman on her own? Does the family know she is pregnant or is she on her own there as well? What are the pressures with regard to study and work? What coercive pressures will be placed on the woman in making her choice?

The alternative is a proper support care pathway for the woman when she presents and indicates she has an unwanted pregnancy and does not know what to do. That is if she feels suicidal. When we do our assessment, we must assess - as we do with every suicidal patient - whether immediate treatment is required, if the person must come to the hospital or if she can be treated in the community, if medication is required and if there is evidence of a depressive illness. We must consider whether there is evidence of an illness that leads people to commit suicide when pregnant, such as severe mental illness or psychosis. The two women in a million are not women with crisis pregnancies but with severe mental illness.

Considering maternity rates in the UK, it has been indicated in research that the women committing suicide have severe mental illnesses that are either under-diagnosed or inappropriately diagnosed. There is no reduction where abortion is freely available. They are not getting full and proper treatment, which is the issue. These women need best practice and full assessment. We should not skimp on that but this law will skimp on it.

A second issue is the idea that suicide in pregnancy is a real risk. It is absolutely a real risk. We deal with it all the time in pregnant women, and the highest risk is in the post-partum period. We are very aware of that, but it is not what this law is about. Listening to the four previous contributors, one can see that what we are talking about is not women with mental illness but rather women with a firm belief that they do not want to be pregnant. If a woman goes to a doctor and states that she is suicidal and will kill herself because of an unwanted pregnancy, if this Bill becomes law no psychiatrist will be able to say that this woman will not kill herself, and women will be processed through this law. They will also miss out on proper assessment, which is a problem.