The Great Divide: The Policy and Practice of Abortion in 1960s Scotland

To cite this article: Gayle Davis, ‘The Great Divide: The Policy and Practice of Abortion in 1960s Scotland’, online publication, Royal College of Physicians of Edinburgh (2005)

This paper is based on some of the findings of a Wellcome-sponsored research project entitled ‘Health, Sexuality and the State in Scotland, 1950 to 1980’, a joint project conducted with Professor Roger Davidson at the University of Edinburgh. It examines one particular area of sexual policy-making in post-WW2 Scotland – abortion. The paper compares and contrasts central government policy and legislation with developments at the local level, using Aberdeen and Glasgow as case studies. I will begin by outlining the terms of the 1967 abortion legislation, before problematising interpretations of that Act, based upon two key medical figures – Dugald Baird of Aberdeen and Ian Donald of Glasgow – in order to illustrate how much Scottish abortion policy differed depending on locality.

The 1960s saw a flurry of legislative activity in regard to abortion. A number of bills were presented in Parliament, success finally coming in 1967 for the young, Scottish Liberal MP, David Steel. The 1967 Abortion Act did not sanction all abortions – rather, it outlined the legal circumstances under which any registered medical practitioner might perform therapeutic abortions in Britain. In short, the Act made termination legal on two grounds: firstly, if the risk to a woman’s life, health or child was greater than the risks from abortion; and secondly, if there was substantial risk that a baby would be seriously handicapped. Unlike previous abortion legislation, the 1967 Act applied to Scotland as well as to England and Wales.

This Abortion Act was ‘fundamentally underpinned’ by the idea that reproduction was an area for medical control and expertise, and that the doctor was the most appropriate expert to deal with abortion. As Sheldon argues:

it was hoped that mere contact with the responsible and reassuring figure of the doctor might dissuade the woman from seeking to terminate a pregnancy – the need for an abortion often being posited as a direct consequence of her own hysteria and derangement, rather than a rational decision reflecting a reasoned assessment of her situation. 

She continues:

The point is repeatedly made in the parliamentary debates that the rule of the doctor would be one of taking control of the pregnancy and managing it in a responsible way.

Thus, during this decade, abortion was arguably transformed into a procedure closely monitored by the State and largely controlled by the medical profession.

Indeed, the medical profession exerted a significant influence on both the enactment of the 1967 Act and on the scope of its provisions. This influence was exerted chiefly through the major professional bodies, but also by individual practitioners who were consulted by the sponsor of the Bill and by other MPs. Significantly, the opinions expressed were not confined to strictly medical questions, such as the methods and dangers of abortion, but included recommendations on the desirability of reform, the appropriate scope of the Bill, and the wording of particular provisions. Equally significant, the bulk of these recommendations were accepted.

However, it would be unfair to suggest that the 1967 reform of the abortion law was some kind of victory for the medical profession. It is more accurate to see the Act as a victory for the Abortion Law Reform Association (hereafter ALRA), the most notable of the women’s campaign groups involved in this issue. The British Medical Association claimed that only doctors were adequately trained to make the abortion decision, but this was in fact in the face of opposition from many obstetricians and gynaecologists. In fact, there was a substantial amount of medical opposition to induced abortion at the time of the Act. In particular, many doctors were wholly unprepared to subscribe to the idea that abortion should be done on social grounds. It would seem that abortion was ‘medicalised’ by the State, rather than the medical profession actively taking control of this sphere. The Government expressed their neutrality on the abortion issue, leaving it to the conscience of individual MPs as to how they voted on the matter. Meanwhile, doctors found themselves in a largely unsought position of power in deciding issues that were not medical and for which they had no special training. They were forthwith open to the criticism of either unreasonably withholding abortion or of practising abortion on demand.

Part of my research interest has been to explore how this Act was interpreted in Scotland. Already, it has become apparent that individual personalities and localities made a substantial difference. One key example here is Sir Dugald Baird in Aberdeen. Baird was born in Greenock in 1899. He spent a few years in house positions in Glasgow, then, attracted by an advertisement, Baird went to work as a registrar in gynaecology at the Royal Infirmary under Munro Kerr. It was here in Glasgow during the Depression that Baird grew to recognise the various influences that social and economic factors could have upon maternal health and female physiology. His experience in the city would lead to his long-lasting involvement in social research in obstetrics and reproductive health.

In 1936, Baird was appointed to the regius chair of midwifery at the University of Aberdeen. In an interview he gave the year before he died, he said that he came to Aberdeen because the chair of Midwifery was advertised and that this appealed to him because he wanted to lead ‘an academic type of life’. Baird also mentioned that he moved from Glasgow because he felt he ‘was never going to get anywhere or have any influence there’. Furthermore, the strong catholic influence frustrated his liberal leanings. He tells an illuminating story of meeting, around 1936, a pregnant patient who had very severe kidney disease. He suggested she have her pregnancy terminated, and asked if he could see her husband. The man came up to see Baird, who told him:

Well, I didn’t say it to your wife, but [she] will die if she doesn’t have her pregnancy terminated. You’re a Roman Catholic, and where do you stand on this? ‘Oh’ he said, ‘my wife comes first’. And I said ‘Alright, so we can go ahead’. So I went up to the operating theatre to see the wife and she was hysterical. Oh, she was going to Hell Fire and all the rest of it, kind of thing. Then I realised I had passed a priest on the way up to the room you see. So I went out and I said to him ‘Have you been in seeing Mrs so and so?’ ‘Yes’ and so I said ‘You shouldn’t have done that.’ He said ‘I’m her spiritual adviser, and I’m much more important than you are.’ So I took him by the back of the neck and marched him down the stairs and chucked him out onto the street.

The priest called on Baird’s mother-in-law in Lanarkshire and said he was halving his subscription to the maternity hospital because of a young man that she knew who was saying things they didn’t approve of. As a result, Baird asked his wife if he should ‘just let my hair down and say what I really think? Can we afford it?’ [having 3 children by this time]. Her response was ‘Oh yes, you’ve just got an Honours M.D. and the best M.D. thesis in Obstetrics that has ever been put forward so far. We can take it.’

The social conditions in Aberdeen in the late 1930s were similar to those of Glasgow. While Aberdeen was the third largest city in Scotland, its staple industries – fishing, textiles and granite mining – were in slow decline; in fact, there would not be significant growth in the economy until oil was discovered off-short in the 1960s. Much like Glasgow, Aberdeen was plagued by severe housing shortages. However, when Baird was offered the appointment in Aberdeen, he accepted for various further reasons. He thought the city ideal for the research he believed necessary to establish the factors necessary for efficient childbearing, and to evaluate the significance of social conditions. The area was of appropriate size for epidemiological research, the settled population allowing follow-ups of women and their families. Two further factors were the small percentage of Roman Catholics, and the high status of university clinical professors.

Another key factor was the centralised medical service. Baird discussed how, in the largest area of Scotland – the Western – the organisation of the regional maternity service was complicated by the fact that there were many large obstetric hospitals in and around the city of Glasgow. However, the North-east and Eastern regions had only one main teaching hospital each. This had many advantages, such as a common administrative policy, agreement on methods of investigation and treatment of patients, and organisation of clinical trials. Frequent staff meetings were also seen to be of great value in preventing intellectual isolation. The Medical Officer of Health during the 1950s and 1960s was also instrumental in helping Baird construct his maternal care policies for the city, and assured the backing of local health authorities. As such, Aberdeen was able to offer both financial and popular support to Baird. In addition to the local health authorities, the Aberdonian community, which was marked by ‘liberal’ political attitudes and religious diversity in the post-war era, provided an accepting environment for Baird’s policies. Finally, Baird’s wife, May, became Chair of the Health Board. The ultimate combination of chairman of the Board and Professor of Obstetrics was a powerful one. It added greatly to Baird’s power to influence policy and appointments. Many of those who moulded hospital practice in Aberdeen in the 1950s and 1960s were personally chosen by Baird.

Under the common law of Scotland it had long been possible for a doctor acting in good faith in the interests of the mother, to terminate pregnancy after a careful study of all the circumstances of the case and after due consultation with the family doctor and appropriate medical specialists.6 However, with Baird’s direction, Aberdeen was one of the few cities in Britain to begin to exploit the vague law and to adopt such a lenient policy while abortion remained technically illegal. In other areas of Scotland, obstetricians and gynaecologists remained more wary of terminating pregnancies, believing anything other than ‘therapeutic’ abortion [ie to protect the life of the mother] to be criminal. Baird was aware of the tenuous legal standing of abortion when he arrived in Aberdeen. Indeed, in the late 1930s he sought the advice of Thomas Smith, Professor of Law at the University, for clarification on the issue. According to Baird, Smith explained that there was little likelihood of the Lord Advocate, initiating prosecutions against Baird for terminating pregnancies unless they were convinced of ‘criminal intent’. Baird was informed that if a medical practitioner performed a therapeutic abortion in ‘good faith because he thought that continuation of the pregnancy would harm the woman’s health, he would not be prosecuted’. Given such assurance, Baird adopted an active policy of therapeutic abortion. However, as much as three decades later, as Glanville Williams noted in the Observer: ‘Not all [doctors] have the courage, in the existing state of the law, to behave as Sir Dugald does.’ Many of Baird’s arguments were challenged both in the law and medical press, but he seemed to get the Aberdeen public’s vote. He stated ‘I couldn’t go along Union Street, I thought women were trying to seduce me to begin with, then I realised they were just patients.’

Despite being a member of a traditionally conservative medical profession, Baird also took an active interest in policy-making. He met with politicians and publicly supported the suggested provision of contraception under the National Health Service. Baird even became involved in drafting the Abortion Act. In November 1966, together with Malcolm Millar, Professor of Mental Health in Aberdeen, Baird met Steel in Scotland. He took the opportunity to urge the MP not to separate social from medical factors in the Bill as ‘there was virtue in combining both in the same clause’. Steel himself recognised the importance of this discussion. In his biography, Against Goliath, Steel states: ‘I was greatly influenced by going to lunch in Aberdeen with Professor Sir Dugald Baird, who persuaded me to accept amendments creating a single socio-medical clause rather than a series of individual categories.’

To promote the passage of the Bill and to counteract anti-abortionist writings, the ALRA publicised the support of medical practitioners, including Baird, for the legislation. Baird was also asked to persuade other gynaecologists to deliver statements to national and local press in order to ‘counteract [negative] publicity’. Baird responded generously to their requests and continued to make himself visible at conferences and forums on fertility control. He recognised, though, that it was also vital to involve the new generation of medical practitioners, especially consultants, in the campaign. In private correspondence to a member of the ALRA, Baird explained that it would be politically constructive for ‘younger men … to come out into the open on the matter. It could easily be put about that my views were very exceptional in clinical circles’. Also significant for the political campaign, as a result of Baird’s stance, the ALRA could uphold Aberdeen as an example of a city with a successful, active abortion policy.

Underpinning many of Baird’s activities and writings are implicit or explicit recommendations for social or legal reform. However, it is possible to argue that he was not particularly a part of the ‘medicalisation’ of abortion. In fact his views greatly differed from those of the medical bodies. Although he was in favour of consultant obstetrician/gynaecologists terminating pregnancies, he envisaged their role to be a fundamentally advisory one. Ultimately, in Baird’s opinion, the decision-making powers should rest with women, who could best assess their own situation. This should be placed within the context of Baird’s increasing politicisation. His arguments for fertility control were frequently couched in terms of aiding females to achieve freedom and power. For instance, in promoting the idea of NHS-sponsored contraception and sterilization in 1965, Baird explained:

It would help to free women from the tyranny of unwanted pregnancies and also make them more independent and able to choose freely how they will use their training and skills … women, as well as men, need the satisfaction of education to their maximum potential ability and the opportunity to exercise their skills in a wider sphere than the immediate family.

He raised issues which were prevalent among women’s organisations at this time, such as providing wide-ranging opportunities for women in the labour market, particularly in academia, and suggested women’s potential contribution to the economy.

When Baird published his seminal article, ‘A Fifth Freedom’, world population had passed the three billion mark. Predictions estimated that the global population would continue to grow to a staggering level unless the fertility rate dropped rapidly. Baird stated:

You will recollect that Franklin Roosevelt in a speech on 6 January 1941 said:
“In the future days, which we seek to make secure, we look forward to a world founded upon four essential freedoms.
 The first is freedom of speech and expression.
 The second is freedom of every person to worship God in his own way.
 The third is freedom from want.
 The fourth is freedom from fear.”
And I would suggest that it is time to consider a fifth freedom – freedom from the tyranny of excessive fertility.

Realization of this fifth freedom was said to be urgent in some quarters, if the Malthusian scenario of widespread starvation was to be avoided. This article, it should be said, sparked a significant degree of controversy and became an object of intense debate amongst both consultants and laymen in London.

To put Baird’s attitude into context, altogether about two out of every hundred pregnancies in the Aberdeen area were being aborted under Baird, while his successor Ian MacGillivray, within three years of taking over from Baird, was terminating five out of every hundred pregnancies. As a result of this policy, it was argued that fewer women died of child-birth in the poor city of Aberdeen than in the affluent South of England, fewer babies died in the first year of their lives, and Baird noted that ‘there seemed to be very little termination of pregnancy by unqualified persons, possibly because women [knew] their difficulties [would] receive sympathetic and unprejudiced consideration from the medical profession in Aberdeen’.

Despite Aberdeen’s famously liberal approach to abortion, all of the hospital regions in Scotland had an abortion rate which was roughly comparable – except the western region of Scotland which had a much lower than average rate. Glasgow, in fact, had the lowest abortion rate of any Scottish city. According to Baird, the comparatively low abortion rate in the Western Region was due partly to the existence of a large Roman Catholic minority, but basically to the anti-abortion views of several of the leading obstetricians in the region. Again, an individual seemed to be exerting considerable influence within the obstetrical community. Ian Donald was born in Cornwall in 1910, and educated in Scotland and South Africa. Service in the RAF stimulated his interest in gadgetry and he became familiar with radar and sonar, a skill he was to make brilliant use of in medical diagnosis by developing medical ultrasound. In 1951, he became Reader in Obstetrics and Gynaecology at St Thomas Hospital Medical School, moving to Glasgow in 1954 to accept the Regius Chair of Midwifery. As well as being a royalist, Donald was an active member of the Scottish Episcopal Church. He was a committed opponent of the termination of pregnancy for social reasons and a leading campaigner against the 1967 Abortion Act. In practical terms, Donald claimed that one pregnancy in 3,750 was terminated in Glasgow; and even after the Act partially legalised abortion, there were very few terminations performed in the departments under Donald’s control. In short, he refused to perform abortions unless the foetus was very grossly deformed.

In a later Lancet article, Donald stated his views fairly candidly:

It is a disheartening paradox that, at a time when there is so much scientific interest in interuterine fetal medicine, there should be such a rising tide of deliberate wastage of healthy unborn life. We may in fact be approaching an age in which we are more interested in extinguishing early pregnancy than securing its optimum development.

He discussed abortion within the context of the other ‘social evils’ of this time:

It would be a mistake … simply to take a narrow view of … the acceptance of abortion on demand. A more comprehensive survey would include all the other so-called liberalising pressures towards, for example, wholesale divorce, increasing social neglect of the elderly and helpless culminating in euthanasia, moves to tolerate soft drugs like cannabis, the acceptance of pornography and obscenity, and a queer disregard for the welfare of the very young and unprotected. It is not an age to be proud of.

Donald employed his celebrated ultrasound images as a powerful resource in the abortion arena. In a speech he made to a lay audience on an anti-abortion platform, he showed one of the earliest real-time films of fetal movement:

Here’s the baby see how he jumps … This baby is about a 12 week pregnancy … she has only missed two periods. She does not even know she is pregnant. She certainly cannot feel these movements but there is no doubt about the reality, …now you see it move its hand up to its face you see his head is up here and his chest is down here then he throws his legs out and his arms …

As Malcolm Nicolson points out, Donald draws from such identifiable individuality a strong moral message:

Anybody who says this is not alive is talking through his neck. It is a lie, which is intolerable and seeing is believing … There can be no argument about it and if I have done nothing else in my life, I have killed that dirty lie that the foetus is just a nondescript meaningless jelly, disposable at will, something to be got rid of.

In the Queen Mother Hospital, it is said that Donald would sometimes show ultrasound images to women seeking abortions in a deliberate attempt to deter them from their chosen course of action.

However, it was not just Donald controlling Glasgow abortion policies. Glasgow’s Medical Officer of Health, Dr Thomas Scott Wilson, held that, wherever possible, abortion should be prevented. As he argued: ‘The obvious thing is that family planning services should be stressed for social and medical cases.’ Furthermore, it is likely that Glasgow’s Catholic population had an influence on policy. Of the criticisms of the way the 1967 Act was working, which began almost as soon as the legislation came into force, a disproportionate number came from the West of Scotland. MPs there were said to be under heavy constituency pressure to reverse much of the liberalising effect of the Act, according to Lancet commentaries.

However, a disturbing incident which occurred on 20 January 1969, further strengthened the resolve of Glasgow’s anti-abortion community. As a result of an abortion performed at Stobhill Hospital, a baby was thought to be dead on delivery and was, routinely, sent for incineration. It was, however, later heard to whimper by a member of staff in the boiler room. The baby was returned to theatre and subsequently transferred to the paediatric ward where, in spite of the efforts made to save his life, he died some nine hours after delivery. On the basis of the mother’s statement about her past period, the foetus would have been 18-20 weeks old at the time of termination. However, the evidence from the post mortem examination was that the baby was at least four weeks premature, and was probably aged between 30 and 32 weeks, and yet the abortion was performed quite legally within the terms of the Abortion Act 1967, under the primary reason that ‘the continuance of the pregnancy would involve risk of injury to the physical or mental health of the pregnant woman greater than if the pregnancy were terminated’. Thus M.P. Norman St John-Stevas, one of the foremost opponents of the Medical Termination of Pregnancy Bill, raised this issue in the House of Commons. He argued that this sort of case resulted from a permissive climate, and that: ‘The Abortion Bill [had created] a climate of disregard for infant and foetal life, of which this case is a dramatic example.’

Aberdeen and Glasgow seem to epitomise the two polar opposites of abortion practice in Scotland at this time. As Sally Macintyre discusses, the 1967 Act raised an issue increasingly facing medicine and society, namely the boundary of the profession’s sphere of competence and authority. During the passage of Steel’s Bill in the Commons, one group argued for the sanctity of life and the doctor’s duty to preserve it; while another argued that the doctor’s prime duty was to the health of his patient. Reflecting the latter view were Baird and MacGillivray, who said: ‘In considering abortion, the well-being of the mother is to my mind the prime factor. The preservation of life at all costs is surely not the point. Rather as doctors we should be concerned with the relief of human suffering.’ On the other side of the debate, the sanctity of life principle was frequently based on the ‘thin end of the wedge’ argument, i.e. that if destroying the foetus for any other reason than immediate danger to the woman’s life were to be permitted, the profession would utilise its expertise to destroy life in other situations. Donald summarised this argument in referring to abortion as ‘the thin end of the wedge that leads to Belsen, euthanasia of the old, infirm and imbecile, and a brave new 1984 world of test tube babies in artificial wombs’.

The controversy was whether the profession should utilise its clinical and surgical expertise to ‘ameliorate suffering’ by termination, even where there was no disease entity or pathological process present, or whether it should refuse to apply its techniques in this situation. Those who supported the former view argued that they were being true to their vocation by preventing ill-health. Baird stated: ‘The physical and emotional components of ill-health cannot be disentangled and both are profoundly affected by the environment.’ On the other hand, those who supported the latter view argued that the doctor’s role lay in the realm of the ‘purely’ medical. It is noticeable that apart from assuming that only the doctor can determine what is medical, the boundaries between medical and non-medical were unspecified. Baird, in fact, suggested that the distinction was untenable. Those supporting Steel’s Bill espoused a broader concept of health, and by extension, of their own functions and expertise. The doctor was being asked to enter into spheres on the periphery of medical knowledge. In so doing, the boundaries of their functions were being extended more in the direction of the so-called ‘generalized wise man’ role.

To conclude, broadly speaking there is a clear medicalisation of abortion within the policy-making process throughout the later twentieth century. Nonetheless, as my research is beginning to reveal, that process could be very geographically uneven in the post-war period, as well as being forced upon the profession to a large extent. Individual personalities such as Baird established a bridgehead of medical interventionism in sexual health far in advance of the main body of the British medical establishment, who continued to question the propriety of such interventionism both in terms of medical ethics and professional status. Figures like Ian Donald, on the other hand, reveal very clearly the tension between personal values and professional duty, articulating his own social and cultural values in this morally and politically charged arena.

I do not mean, however, to imply that the personalities of such ‘great men’ fully explain the extreme differences between the two cities. Let us remember that Baird deliberately moved from Glasgow to Aberdeen in search of an environment that was more suited to his personal values and professional ambitions. Aberdeen provided, for example, a more compact and fixed population, a smaller percentage of catholics, and an unusually co-operative and perhaps ‘malleable’ set-up within the health services; while Baird’s wife undoubtedly facilitated his manoeuvres through her political position. However, the fact remains that for two geographically close cities with broadly similar social make-ups, both located within an identical legal framework, the 1960s witnessed dramatically different practical interpretations of abortion policy.

References

1.This work constitutes part of a presentation to the Edinburgh History of Medicine group, given on 19 November 2004 at the Royal College of Physicians of Edinburgh.
2. S. Sheldon, Beyond Control: Medical Power and Abortion Law (London, Pluto Press, 1997), pp. 24-6.
3. See J. Keown, Abortion, Doctors and the Law: Some Aspects of the Legal Regulation of Abortion in England from 1803 to 1982 (Cambridge, Cambridge University Press, 1988), ch. 4.
4. For further details of the history of ALRA, see B. Brookes, Abortion in England, 1900-1967 (London, Croom Helm, 1988), ch. 4.
5. University of Aberdeen Archives, MS3620/21-22, Interview with Sir Dugald Baird, 3-4 April 1985.
6. For a fuller legal history of abortion in Scotland, see G. Davis and R. Davidson, ‘“The Fifth Freedom” or “Hideous Atheistic Expediency”?: The Medical Profession and Abortion Law Reform in Scotland, c.1960-1975’, Medical History (forthcoming, 2006).
7. G. Bhatia, ‘Social Obstetrics, Maternal Health Care Policies and Reproductive Rights: The Role of Dugald Baird in Great Britain, 1937-65’, M.Phil. Thesis (University of Oxford, 1996), p. 59.
8. Observer, 30 January 1966.
9. Interview with Sir Dugald Baird.
10.D. Steel, Against Goliath: David Steel’s Story (London, Weidenfield and Nicolson, 1989), p. 53.
11.Contemporary Medical Archive Centre, London (hereafter CMAC), SA/ALR/A.61, V. Houghton to D. Baird, 4 November 1966.
12.CMAC, SA/ALR/A.61, D. Baird to V. Houghton, 8 November 1966.
13.D. Baird, ‘The Fifth Freedom?’, British Medical Journal, 2 (1965), p. 1148.
14. Ibid., p. 1141.
15.K. Hindell and M. Simms, Abortion Law Reformed (London, Peter Owen, 1971), p. 55.
16. Scotsman, 23 December 1966.
17.I. Donald, ‘Abortion and the Obstetrician’, Lancet, 1 (1971), p.1233.  
18.Ibid.
19.M. Nicolson, ‘Ian Donald – Diagnostician and Moralist’, Online Publication for the Royal College of Physicians of Edinburgh, p.3
20.Ibid.
21.Scotsman, 16 January 1973.
22. Glasgow Herald, 10 June 1969.
23. S. MacIntyre, ‘The Medical Profession and the 1967 Abortion Act in Britain’, Social Science & Medicine, 7 (1973), pp. 121-34.
24.Ibid., p. 125.
25. Daily Sketch, 12 January 1967.
26.Scotsman, 15 December 1966