While health was established as a legitimate ground for abortion in 1938, the Abortion Act 1967 further cemented the medicalization of abortion. As John Keown has observed, the Act more closely resembles the recommendations made at the time by medical bodies than it does the proposals of reform campaigners (Keown, 1988: 85; see also Sheldon, 1997; Fyfe, 1991; Gleeson, 2007; McGuinness and Thomson, 2015). This chapter develops this account. It argues that while medical recommendations did come to dominate the Act, medicalization was not an easy process. Rather, the Act came about as the result of protracted struggle and negotiation – ‘horse-trading’, as some activists saw it (Munday 2007: 11; Houghton, 2007: 30) – between diverse elements and actors. There was a great deal of resistance to the new regime – among parliamentarians, of course, but, crucially, also among the medical profession, many of whom did not initially accept the ‘social’ role entailed by performing abortions for reasons other than the pregnant woman's physical health. Establishing the logic of medicalization underpinning abortion regulation therefore required multiple redrafts and negotiations of the so-called ‘social clause’, which allowed abortions for reasons generally considered ‘non-medical’.

David Steel's Medical Termination of Pregnancy Bill, which eventually became the Abortion Act 1967, was not the first attempt to liberalize abortion law. Several such Bills were introduced in the 1950s and 1960s (Marsh and Chambers, 1981: 13; Brookes, 2013: 133– 63). However, the most successful of these was the Silkin Bill, which was later passed to Steel. One of the most controversial clauses of this Bill was clause 1(c), nicknamed the ‘social clause’, which allowed for abortion if ‘the health of the patient or the social conditions in which she is living (including the social conditions of her existing children) make her unsuitable to assume the legal or moral responsibility for caring for a child’. Other clauses were also thought by many critics to contain inappropriate ‘social’ concerns, for example allowing abortion if it was considered that the strain of caring for a child might damage a woman's mental health. The various incarnations of these clauses remained controversial throughout the passage of the Steel Bill.