Abortion Provision in Northern Ireland – Liberalised and Yet Still Restrained

26 June 2020

Years of campaigning; thousands of women forced to travel to the ‘mainland’ or procure abortions from online sources or backstreet means; a ‘chilling effect’ caused by threats of sanctions and prosecutions to doctors for performing abortions, regardless of the reason; a long-drawn-out emotional legal case by one brave woman; the prosecution of a mother for helping her young daughter procure an abortion. These are just some of the plights faced by Northern Irish women, health professionals and campaigners in trying to gain legal access to abortion in Northern Ireland for the women of Northern Ireland.

And then, in July 2019, in the midst of an outgoing Prime Minister, political in-fighting amongst Northern Irish politicians and a non-functioning Northern Irish Government, quickly and quietly an amendment was successfully attached to the Government’s Northern Ireland (Executive Formation) Bill. Passed by a margin of 332 votes to 99, it required the British Government to act to liberalise the abortion law in Northern Ireland if the Northern Irish Assembly did not reconvene by 21 October 2019.

As the 21 October deadline drew near, there was a flutter of political outcry from the Democratic Unionist Party (DUP) which was all but a political publicity stunt. And then, on 22 October, the Northern Ireland Bill came into effect. Northern Ireland went from having one of the most restrictive abortion laws in Europe to being fully decriminalised. This was a day of celebration for some, a day of mourning for others. Importantly, however, it was a day of hope for the reproductive rights of the women of Northern Ireland.

Subsequent to that momentous day in October, there followed a short consultation period in order to devise new regulations which would help develop and guide abortion services within Northern Ireland. Doctors for Choice Northern Ireland (DFCNI) held an event in January 2020 entitled ‘Shaping the Future of Women’s Sexual and Reproductive Health in Northern Ireland’. The event brought together healthcare professionals throughout Northern Ireland, political representatives and experts in the field of abortion care from the UK. It allowed for open discussion, engagement and learning, and there was a real sense of excitement regarding the opportunities to be explored with a new service come March 2020.

So, some 7 months after decriminalisation, where are we now?

One situation no one anticipated was the world being effectively brought to a standstill as a result of the coronavirus (Covid-19) pandemic. The Abortion (Northern Ireland) Regulations 2020 that were laid in Parliament on 25 March 2020 came into effect on 31 March 2020, but still no abortion service was in place, though there were healthcare professionals willing and able to commence an early medical abortion (EMA) service as of 1 April. The political plan of the Northern Irish Government had been to continue with the existing central booking system run by the British Pregnancy Advisory Service (BPAS) (whereby women call a single telephone number to make an appointment with the most appropriate provider) as they saw no immediate need to support or commission any type of abortion service within Northern Ireland with this option still available to them. Their intention was to continue to export the issue of abortion to the mainland, since with the central booking system in place women still had to/were able to travel to England (fully funded) for an abortion.

However, the travel restrictions put in place because of the Covid-19 pandemic quickly highlighted that this could not continue as a viable or safe option. Abortion services were urgently needed within the region and could (and should) be provided now that regulations were in place. What followed were 10 days of intense media coverage of the issues women were being presented with in order to access an abortion during lockdown in Northern Ireland. Women were being told by the Department of Health to continue to travel to England, which contravened the Government’s advice to stay at home and to stay safe. The issue was further compounded by the fact that flights to the mainland had all but ceased, and the only travel option was an 8-hour ferry crossing followed by up to a 12-hour train journey. Something had to give.

The breakthrough came on 16 April 2020. The Chief Executives of the five Trusts within Northern Ireland received a letter from the Chief Medical Officer stating that abortion was now legal within Northern Ireland and that medical healthcare professionals could now legally terminate pregnancies. The Department of Health was under no obligation to fully commission a service but Trusts within Northern Ireland had to provide facilities and staff in order to carry out terminations in accordance with the Regulations. With that pronouncement, the Chief Medical Officer had allowed the instigation of abortion services within Northern Ireland.

We now have an EMA service in all five Trusts within Northern Ireland – some better functioning than others, but all staffed by dedicated and passionate health professionals. There is, unfortunately, no provision within the Regulations for telemedicine. Women seeking further information regarding unintended pregnancies are currently being directed towards Informing Choices NI (previously known as the Family Planning Association). Following a telephone consultation with Informing Choices NI, if a woman wishes to proceed with an abortion her details are sent to the local EMA service. A further telephone consultation is carried out with the nearest EMA provider and then the patient attends, in person, their local EMA clinic in order to complete the first stage of the procedure. The second part is then completed at home 24–48 hours later. To date, regionally, more than 350 women have utilised the EMA service since it started on 11 April 2020.

There is still plenty of work ahead, and change does not come quickly or easily to some. On 15 June 2020, the Regulations were backed by the House of Lords with 355 votes to 77, and 2 days later they passed their final legislative hurdle in the House of Commons with a majority vote of 253 to 136. With the Regulations being approved by both the Lords and the Commons there is now legal certainty regarding abortion in Northern Ireland and a framework for service provision. This result was greeted with satisfaction and relief by some and fury and anger by others, most notably within the DUP. Those within the party opposing the Regulations are now changing the direction of their fight against the new law. They are seeking to interfere with the Domestic Abuse Bill 2019–21 (which underwent its second reading in the House of Commons on 28 April 2020) and attach an amendment regarding coercive abortion in order to place restrictions on accessing abortion. So the battle to ensure abortion services remain within Northern Ireland and that they are easily accessible goes on.

There is also the ongoing struggle to engage with an unwilling and non-communicative Department of Health in order to acquire commissioned funding. With no fully commissioned service there is the over-hanging threat that the service could be pulled at any stage, particularly as services start to return to a new normal following the pandemic. Work is ongoing to make the service more visible and attainable to women, and to support those health professionals who encounter/manage women with unintended pregnancies who are looking for more information on the choices available to them. Guidance is also needed in order to manage those women in the ‘grey’ area with pregnancies between 10 and 11+6 weeks’ gestation.

However, history has been made. Women now have a legal, reproductive voice in Northern Ireland for the first time, and there are an ever-growing number of people who are working hard to ensure that this remains so.

Laura McLaughlin, BSACP Northern Ireland Representative; Consultant Obstetrician and Gynaecologist; laurajmclaughlin@yahoo.co.uk

 

Note on the Author

Dr Laura McLaughlin is the Northern Ireland Representative on BSACP Council, and is a Consultant Obstetrician and Gynaecologist working in Belfast, where she is the Trust Service Lead for Abortion. Laura is also Co-Chair for Doctors for Choice Northern Ireland (DFCNI) and is a member of the Northern Ireland Abortion and Contraception Taskgroup (NIACT).