Speech Given by BSACP's PPI Representative at the RCOG World Congress 2019, London, UK, 17–19 June 2019

15 July 2019 

My name is Charlotte Kelly and I am the Patient and Public Involvement (PPI) Representative on BSACP Council. I’m speaking here today in order to offer the perspective of patients using abortion care.

Abortion is still illegal. It is illegal in every part of the United Kingdom, and all Crown Dependencies, with the exception of the Isle of Man. The 1967 Abortion Act, which applies to England, Scotland and Wales, but not to Northern Ireland, stipulates specific circumstances where a woman and her doctors will not be prosecuted for ending a pregnancy. This depends both on whether doctors believe that the pregnant woman falls into one of the exempt categories, and the time of gestation.

Research shows that most women, particularly young women, assume that they can have an abortion in the same way they can exercise their autonomy over other healthcare choices. In fact, the stigma and pressure on clinicians caused by criminalisation shapes all women’s experiences of abortion care.

For women in Northern Ireland, the effect is greatest, because The 1967 Abortion Act does not extend to Northern Ireland. Only if there will be a grave or fatal outcome to the pregnancy is abortion permitted. As a result any Northern Irish woman who wishes to end her pregnancy must travel to a clinic in England or else illegally obtain medication for a medical abortion. Anonymous testimony submitted to Alliance for Choice gives an insight into the effect of this. One woman who travelled to England spoke about how she lied to the abortion care staff that she would rest in a hotel after her abortion and instead took a flight back to Northern Ireland the same night, because she couldn’t afford the cost of a night in the hotel. Unable to afford the cost of travel, another woman remembers two occasions of “young women in their school uniforms lying on their sides asking her friends to ‘boot her in the stomach’ a few times because she thought her period was late”.

In the rest of the United Kingdom, there is also a shortage of National Health Service (NHS) providers of abortion, particularly abortion after the first trimester. There are only three NHS services which offer treatment up to the legal limit of 24 weeks on all grounds, and they are all in London. This is particularly a problem for medically complex women, who cannot be treated in a private clinic but who need to have their procedure in a NHS hospital. In 2017, a woman with a heart condition who had been subject to domestic violence presented at 22 weeks, and was unable to secure an appointment for an abortion. She had to continue that pregnancy against her will, as did 45 other women in 2016 and 2017. One woman who presented to bpas at 23+1 weeks, and for whom they were unable to secure a termination, said she would drink bleach to terminate.

Of course, as abortion care is part of broader obstetrics and gynaecology (O&G) medicine, so there are some factors which make good patient care which are common across the specialty. Speaking to one woman whose general anaesthetic failed and who was conscious during her surgical abortion, she stressed the need for acknowledgement of error, accountability and provision of proper aftercare. There is a need for empathy, for non-judgment, and for women to have sufficient time after their abortion to fully recover in a supported environment.

Women need choice and laws that trust them to control their own bodies. They need doctors to be their allies in this campaign wherever in the world this is challenged. We need more doctors able to provide termination of pregnancy services and to be supported by their colleagues in the conviction that providing abortion care is not morally dubious but rather an essential service as part of O&G.

Charlotte Kelly, Patient and Public Involvement Representative on BSACP Council