The Lord Bishop of Leicester

I am very aware that there are risks to all forms of consultation. My argument is simply that the risks are minimised by in-person consultation. The considered view of safeguarding professionals in the NNDHP is that the current guidance put in place by the Royal College of Paediatrics and Child Health in 2022 is simply not robust enough. That guidance, I note, requires an in-person meeting for children under 13. Children under 16 are, “normally … required to complete their consultation in-person, unless there is a compelling indication to do otherwise”. Evidence, however, suggests that most providers of abortion care are arguing that the option of telemedicine itself is a compelling indication that an in-person consultation is not required. For those aged 16 or 17, the guidance says only that children—and, of course, 16 and 17-year-olds are still children under the Children Act—should “be encouraged” to attend in person. More fundamentally, guidance can currently be changed unilaterally, without parliamentary scrutiny or public consultation, at the discretion of the body that issued it. I believe, therefore, that legislation is required. What Parliament enacts, only Parliament can remove. The case for this amendment, however, does not rest on my view or the NNDHP’s alone. The Government’s own consultation found that safeguarding organisations specifically identified under-18s as the group for whom in-person assessment was most critical to reduce the risk from those who sexually exploit children, manipulate the system or force their victims to obtain abortion. Indeed, MSI Reproductive Choices has documented that face-to-face appointments are associated with a significant increase in domestic abuse disclosures compared with telemedicine. This is especially significant given that girls and young women face a higher risk of coercive or abusive relationships than those aged over 24, and are often less equipped to ask for help. The clinical risks compound this. Beyond 11 weeks’ gestation, home management is not appropriate and the risks to the patient increase significantly. As has been mentioned, accurate gestational age assessment is the foundation on which safe prescribing depends, and it cannot be done reliably by telephone. These are not theoretical risks. We have heard stories already. I would simply add that of a 16 year-old who was estimated by the clinic to be under eight weeks pregnant, but the baby she delivered was in fact 20 weeks. She later said, “If they had scanned me and I knew that I was that far gone, I would have had him”. An in-person appointment would have changed everything for that young woman. This amendment would require such an appointment. I echo the concerns of the noble Baroness, Lady Stroud, in her amendment. Without an in-person consultation, it is unclear how we will ensure that early medical abortions take place within the law. Indeed, challenges around vulnerability and correct gestational assessment apply to adulthood as well, which is why I fully support Amendment 425.