WHEN Jade discovered she was pregnant at the age of 14, she says she knew "straight away" that she wanted an abortion.
"You can't win either way," she says. "They are going to label me as this pregnant teenager, you know, underage mum; people are just going to look at me and think, 'Oh, dirt', you know?
"At 14, basically you can't look after yourself and you've got everyone going, 'Don't have sex then', but at the end of the day what are you going to do? It's just experimenting you know, you make mistakes."
The issue of abortion is once again sparking controversy after recent calls by politicians to reduce the 24-week limit at which they can be carried out.
Meanwhile, a new study by researchers in the US has revealed the proportion of terminations being carried out among teenagers in Scotland is one of the highest in more than 40 countries across the world where abortion is legal. In fact, the country ranks second.
More than 40 years after the introduction of the legislation that made it available to women, what is the reality of abortion in Scotland today?
NHS figures show just under 12,000 women had a termination in Scotland last year. About three-quarters were carried out before the tenth week of pregnancy, and about 95% before the 14th week.
The statistics show that just 0.4% of all abortions were carried out after the 20th week of pregnancy.
Among those who have spoken out in favour of cutting the current 24-week cut-off point is UK Health Secretary Jeremy Hunt, who said he would prefer a 12-week limit.
Scottish Health Secretary Alex Neil also said there was a case for looking at a reduction in the limit, although he declined to specify what it should be.
However, Sheila McLean, emeritus professor of law and ethics in medicine at Glasgow University, pointed out that very few pregnancies are currently terminated at a late stage.
"It seems to me really what is being disguised in much of the debate about this is the fact that some people really don't think women should have rights to make those choices," McLean said.
"Tinkering with the stage at which a pregnancy can be terminated either means that women will be forced to have children that they think will suffer or that they don't feel equipped to bring up."
According to the new US research, about 24% of all abortions occurred in the under-20 age group in Scotland. Only Cuba was found to have a higher proportion in this age range, at 29%. The proportion of abortions among teenagers in Scotland increased by two percentage points between 1995 and 2010, it found. The majority of the 42 other countries included in the study also saw a rise – but some recorded a dramatic decline, such as Iceland, where the figure fell from 25% to 14%.
Report lead author Gilda Sedgh, of the Guttmacher Institute in New York, said: "We can only speculate that the levels of unprotected intercourse among adolescents are relatively high in Scotland, and relatively low in Iceland."
The study also found that adolescents, defined as 15 to 19-year-olds, accounted for a disproportionate proportion of abortions in relation to their share of the population in Scotland.
While teenagers of this age make up 15% of the population north of the Border, they account for 24% of all abortions. In contrast, in 35 of the 45 countries studied they accounted for a smaller share of abortions than their share of the population would predict.
Linda Birnie, director of the Brook Advisory Centre in Inverness, which provides sexual health advice for under-25s, said there was a wide range of reasons why teenagers were likely to become unexpectedly pregnant.
"We know alcohol can affect decision-making and people make decisions or find themselves in situations they just wouldn't get into if they hadn't been drinking," she said. "Embarrassment and not knowing about [sexual health] services would also be relevant – people not feeling able to make that step that will enable them to protect themselves maybe until it is too late."
Birnie said that about 4% of clients visiting Brook services during 2010-11 were seeking pregnancy advice, although not all would opt for an abortion.
She said: "Those that do may feel they are not ready to continue with their pregnancy at that time because they have not finished their education, or it would be detrimental to their career. They may not be in a relationship that would support parenthood at that stage or are not having family support or the economic and social support to continue at that point."
The US study found the highest proportion of abortions occurs in the 20-24 age group in Scotland, at 31%. Among 25-29 year olds it was 20%, falling to 3% in the over-40 age group.
It also showed the abortion rate – based on the average number of abortions a woman will have in her lifetime – was 0.38 in Scotland in 2010, placing the country 23rd out of 42. The highest was in the Russian Federation, at 1.14.
However, separate figures published by the NHS in Scotland show the overall abortion rate has dropped slightly in recent years, falling from a rate of 12.6 per 1000 women aged 15-44 in 2009 to 12 per 1000 women last year.
Factors that have been suggested to account for this include the impact of health education campaigns through to shrinking employment opportunities – which may mean women opt for having a child rather than worrying about the impact on their career.
The number of unwanted pregnancies remains much higher in the poorest communities. The abortion rate was 16 per 1000 women in the most deprived parts of Scotland in 2011 – nearly double the rate of 8.5 recorded in the most affluent areas.
The NHS figures also show the abortion rate in the 16-19 age group fell from 21.6 in 2010 to 18.8 last year.
Hawys Kilday, chief executive of sexual health charity Caledonia Youth, said there was improved access to sexual health services and "perfectly adequate" sex education Scotland. But she said one difficulty was often a lack of discussion with teenagers about their sexual health.
"One of the things we have probably missed the boat in Scotland is openness about discussing some of these issues," she said.
Clare Murphy, spokeswoman for the British Pregnancy Advisory Service, said one reason Scotland and the UK was often cited as having high figures on abortion in such surveys is because far more detailed statistical information is kept than in many other countries.
But she also said it as important not to see teenage abortion in an "incredibly negative" light. "These are young people who when faced with pregnancy are making a decision about the kind of life they want to lead," she said.
"Obviously at the end of the day you don't want any woman having a pregnancy she doesn't want in the first place, but with young women in particular their choice to end the pregnancy is often a very positive marker of how they see their life going forward."
Norman Wells, director of the Family Education Trust – an independent think tank that says it has no political or religious affiliations – argued British teenagers had more knowledge and access to contraception than ever before.
"It is not ignorance of contraception that has led to high rates of teenage abortions," he said. "It is more a case of the contraceptive culture making girls and young women feel they have a right to have babies to order and that they are free to dispose of any that would interfere with their chosen lifestyle. The answer is not yet more sex education and contraceptive schemes, but a change in the culture."
A spokeswoman for the Scottish Government said statistics showed the rate of teenage pregnancy and abortions in those aged under 20 in Scotland had fallen for the fourth successive year.
She added: "Education plays a vital role in reducing unintended pregnancy and our Sexual Health Framework 2011-15 promotes relationships, sexual health and parenthood education for all young people."
Clinic protest group bids to bring banners to Scotland
A CONTROVERSIAL organisation that displays graphic images of aborted foetuses outside clinics to try to deter women from going through with terminations is planning to come to Scotland, according to one of its founders.
The tactics of the group, called Abort 67 – named after the 1967 Act that legalised abortion – have been condemned by pro-choice activists, who accused them of harassment of vulnerable women who are accessing legal medical services.
Founder Andy Stephenson said the group now has a presence outside clinics in Brighton, Reading, Richmond and Bristol every week. However, he admitted it has a hardcore circle of just 50 to 60 volunteers to call on to participate in such displays.
He said: "We don't know too many people in Scotland but we are certainly hoping to reach up there."
Stephenson said they did not think of the displays as "protests" but rather an "education project".
Along with campaigner Kathryne Sloan, he was detained in 2010 for unfurling 7ft banners showing images of aborted foetuses outside a clinic in Brighton. Last month the pair were cleared of public order offences by a judge.
In the wake of the collapse of the case, Rt Rev Joseph Devine, the Bishop of Motherwell, sparked outrage by issuing a statement saying people should be able to see images of aborted foetuses in order to understand the "truth" of the situation. Responding to criticisms that the group's actions harass vulnerable women, Stephenson said: "We certainly do agree that the pictures are distressing and they will upset people, but that is because abortion is distressing. It's not true that we are harassing women – the truth may cause women to feel distressed.
"That is the reason why the abortion industry isn't giving this information as they know there wouldn't be the same number of women obtaining the abortions."
Ann Henderson, chairwoman of campaign group Abortion Rights, pointed out that about 99% of terminations are carried out on the NHS in Scotland.
"The figure is much higher than in England, so if you are picketing or protesting, it is not at an abortion clinic, it is an NHS service," she said.
"Are they going to start standing around every NHS hospital with these images?"
Meanwhile, the opening of the first private clinic offering abortions in Northern Ireland has triggered a wave of protests from anti-abortion campaigners. Charity Marie Stopes plans to offer early medical abortions to women – but only up to nine weeks into the pregnancy.
Northern Ireland is not covered by an Abortion Act and while terminations are not illegal, they are very strictly controlled. The clinic will also offer abortions to women from the Republic of Ireland – where abortion is effectively banned – who meet the legal criteria.
More than 1000 women travelled to England and Wales from Northern Ireland last year for an abortion and at least 4000 travelled from the Republic of Ireland, according to health department statistics. Pro-life organisation Precious Life has said it will launch a major challenge to stop the private abortion service going ahead.
SCOTTISH ABORTION STATS
Abortions by estimated gestation in Scotland in 2011 (cumulative percentage):
Under 10 weeks – 75.5%
10-13 weeks – 94.2%
14-17 weeks – 98.9%
18-19 weeks – 99.6%
20 weeks and over – 1
Percentage distribution of all abortions in under 20 year olds by country:
Cuba – 29 (2009)
Scotland – 24 (2010)
England and Wales – 20 (2010)
Canada – 18 (2009)
Norway – 13 (2011)
Japan – 9 (2009)
Russian Federation – 7 (2010)
(Source: Guttmacher Institute study)
Abortion rate per 1000 women aged 15-44 by deprivation category in Scotland, 2011:
1 (Most deprived) – 16
2 – 13.3
3 – 11.5
4 – 10
5 (Least deprived) - 8.5
(Source: ISD Scotland)
Grounds for abortion in Scotland 2011:
Continuance of the pregnancy risks injury to woman's physical or mental health – 93%
Risks injury to the physical or mental health of the existing child(ren) of the family – 5.8%
Substantial risk of child suffering from serious handicap – 1.1%
(Source: ISD Scotland)