Second Reading of the Isle of Man Abortion Reform Bill 2018

23 February 2018

The Isle of Man Abortion Reform Bill 2018 received its Second Reading on 30 January 2018 by a unanimous vote (22-0). The debate transcript is at the following link: http://www.tynwald.org.im/business/OPHansardIndex1618/1696.pdf

Abortion in the 21st Century: Is Decriminalisation on the Horizon?

Abortion, if it is not carried out according to the strict requirements of the Abortion Act 1967, is technically still a criminal offence in England and Wales, carrying a maximum penalty of life imprisonment. Over the past year, there has been increasing support from Members of Parliament (MPs) and healthcare organisations to remove abortion from the criminal law. There is a drive for abortion to be seen as a healthcare issue, which can and should be regulated, rather than a legal issue attracting criminal penalties.

The current legal framework surrounding abortion

Under Sections 58 and 59 of the Offences Against the Person Act 1861, it is a criminal offence for:
• a woman to cause her own abortion;
• someone else to cause a woman to have an abortion; and
• someone to supply the medication/equipment required to cause an abortion.

The maximum penalty for these crimes is “to be kept in penal servitude for life”.

The Abortion Act 1967 did not take abortion out of the criminal law, but rather provided circumstances under which abortion can be legally carried out. A woman may only have a legal abortion “if two registered medical practitioners are of the opinion, formed in good faith:
(a) that the pregnancy has not exceeded its twenty-fourth week and that the continuance of the pregnancy would involve risk, greater than if the pregnancy were terminated, of injury to the physical or mental health of the pregnant woman or any existing children of her family; or
(b) that the termination is necessary to prevent grave permanent injury to the physical or mental health of the pregnant woman; or
(c) that the continuance of the pregnancy would involve risk to the life of the pregnant woman, greater than if the pregnancy were terminated; or
(d) that there is a substantial risk that if the child were born it would suffer from such physical or mental abnormalities as to be seriously handicapped.”

Section 1(1), Abortion Act 1967

In addition, the abortion must be carried out by a registered medical practitioner in a hospital or approved place.

Why should abortion be decriminalised?

The law surrounding abortion is problematic for several reasons. One of these reasons is that the law takes control of women’s bodies out of their hands and puts it firmly in the hands of doctors. It is not sufficient for a woman to state that one of the criteria in Section 1(1) of the Abortion Act 1967 has been met. What makes the abortion legal is if two doctors believe that one of the criteria is met. This emphasis on opinion necessarily leaves room for subjectivity. Nobody knows the woman’s circumstances better than the woman herself, and yet her views on the impact of a continuing pregnancy are not relevant in the eyes of the law.

The fact that two doctors must authorise an abortion makes the process longer and more bureaucratic. Time can often be of the essence when it comes to abortion. Certain procedures are available at certain gestations and delaying the approval process can limit choice for women. For the few women who are approaching the 24-week limit, even a short delay could be the difference between being able to proceed with the abortion and having to continue the pregnancy.

Even though there are few prosecutions under the Offences Against the Person Act 1861 for procuring an abortion, prosecutions do happen, and it is inevitable that the threat of criminal sanctions will deter both women from seeking an abortion and doctors from providing abortions. Women should not be made to feel like criminals simply for exercising autonomy over their own bodies, and doctors should not be made to feel like criminals for carrying out safe and legal medical procedures.

What would decriminalisation look like?

We do not know for sure what decriminalisation would look like, but much of the discussion has focused on abolishing the criminal penalties associated with abortion and removing the approval of two doctors. There has been much emphasis on the fact that the 24-week time limit would still apply and that decriminalisation does not mean deregulation. In order to ensure its safety, abortion would still be regulated, just like any other medical procedure.

Support for decriminalising abortion

Several healthcare organisations have spoken out in favour of decriminalising abortion. Back in May 2016, the Royal College of Midwives (RCM) published a position statement in which it confirmed that it supported the campaign to remove abortion from the criminal law. More recently, in June 2017, members of the British Medical Association (BMA) voted to back decriminalisation of abortion. In September 2017, members of the Royal College of Obstetricians & Gynaecologists (RCOG) followed suit, and also voted in favour of removing the criminal sanctions associated with abortion. In October 2017, the Faculty of Sexual & Reproductive Health (FSRH), a Faculty of the RCOG, published a statement following a discussion amongst its members confirming that it too supports the decriminalisation of abortion.

Whilst midwives and doctors have come out strongly in favour of decriminalising abortion, the Royal College of Nursing (RCN) has, until recently, been notably silent on the issue. However, on 16 February 2018, it launched a consultation seeking the views of its members on decriminalisation of abortion. In its briefing paper, the RCN stated that it expected this project to be the initial phase of ongoing work in this area.

Proposals to decriminalise abortion

In March 2017, Diana Johnson MP put forward a motion in the House of Commons for leave to bring in the Reproductive Health (Access to Terminations) Bill repealing “certain criminal offences” relating to abortion. In support of the Bill, Ms Johnson argued that the current law compromises women’s care and leads doctors to think twice about practising in this area. By removing the stigma of the criminal law, she proposed that an environment could be created in which “women can come forward for advice and high-quality, woman-centred healthcare as early as possible in pregnancy”.

Ms Johnson addressed objections to the Bill by pointing out that decriminalisation would not make it easier to access abortions after 24 weeks, would not lead to unlicensed practitioners practising abortions, and would not permit gender-selective or non-consensual abortions. She emphasised that decriminalisation does not mean deregulation.

The resulting vote was 172 in favour of bringing the Bill and 142 against. The Bill was due to have its second reading in May 2017, however as Parliament was dissolved in advance of the General Election, this did not take place. In October 2017, Diana Johnson spoke at a conference to mark 50 years of the Abortion Act 1967 held at the RCOG, and she confirmed that she is still working on the Bill and intends to bring it forward in Parliament once again. It is reassuring to know that this time round she will have the support of the RCM, the BMA, the RCOG and the FSRH. One can only hope that the RCN will also follow suit.

Andrea Adams, MA, Registered Nurse, St Mary’s Hospital, Imperial College Healthcare NHS Trust, London, and Non-practising Solicitor; andrea.adams4@nhs.net

“I told my Mum I was going on an R.E. trip” now available on iPlayer

The Performance Live, BBC and Arts Council England commissioned TV piece “I told my Mum I was going on an R.E. trip” was aired on BBC Two on Saturday 20 January 2018 at 11.15pm. For those who missed the live broadcast, it is available on BBC iPlayer from 20 January to 20 February 2018.

“I told my Mum I was going on an R.E. Trip…”

Young women’s stories of abortion, in their own words

Written by Julia Samuels. Directed for television by Lindy Heymann.

Adapted from Contact and 20 Stories High’s 2017 touring theatre show, “I told my Mum I was going on an R.E. Trip…” is a frank drama told verbatim through the voices of four young women.

The show will be broadcast on BBC Two with an introduction from Julie Hesmondhalgh, and poses the question: What would happen if we started to talk openly about abortion?

Featuring interviews from Great Britain, Northern Ireland and beyond, we meet health professionals, women, men and young people on all sides of the debate.

13th FIAPAC Conference, September 2018

13th FIAPAC Conference on ‘Liberating Women – Removing Barriers and Increasing Access to Abortion Care’, Nantes, France, 14–15 September 2018

A little more than 40 years after the adoption of the Veil law, the care provision of abortion and contraception is being continually modified by input from new organisations, as well as the evolution of techniques and thoughts. This topic will be re-explored and discussed at this FIAPAC conference, which is supported by the National Association of Abortion and Contraception Centers ANCIC, and the National College of Gynecologists and Obstetrics (CNOGF) and the Réseau Sécurité Naissance.

http://www.fiapac.org/en/program/22/Nantes-intro/

BSACP Request for Evidence for Home Office Review of Protest Activity Outside Abortion Clinics

[NB. Closing date for submissions: Monday 5 February 2018]

The Home Office has been tasked by the Home Secretary to undertake an evidence-based in-depth assessment of protest activity and other related pro-life activity outside abortion clinics following concerns about the actions of some campaigners. The text of Sarah Gawley’s letter is included in full below.

The Home Office have requested BSACP participation through an online questionnaire that can be accessed at the following link: https://www.homeofficesurveys.homeoffice.gov.uk/s/8KA5N/

BSCAP wishes to do this by collating feedback from its UK-based members and others working in the field of abortion care provision.

We would be grateful if you could submit your response/and comments to admin@bsacp.org.uk by Monday 5 February 2018 latest to give us sufficient time to collate the responses we receive and compile BSACP’s submission to the Home Office.

We are very keen to include responses from clinicians from a wide range of abortion provision centres so do please feel free to forward this e-mail to relevant colleagues.

NB. Just because BSACP is submitting an organisational response to the Home Office doesn’t mean that individuals/clinics/providers cannot also make their own separate submission.

Many thanks in anticipation. Kate Guthrie and Jo Fletcher (BSACP Co-Chairs)

Janie Foote
BSACP Administrator
Tel: +44 (0)1243 538106
E-mail: admin@bsacp.org.uk
Website: www.bsacp.org.uk

Police Powers Unit
2 Marsham Street
London SW1P 4DF T 020 7035 4848
F 020 7035 4745
www.gov.uk/home-office

Dr Kate Guthrie and Joanne Fletcher
Co-Chairs – British Society of Abortion Care Providers
British Society of Abortion Care Providers
Office 34, New House
67–68 Hatton Garden
London EC1N 8JY

17 January 2018

Dear Dr Guthrie and Mrs Fletcher

Abortion Clinic Protests Review

The Home Secretary has asked my team to undertake an in-depth assessment of protest activity and other related pro-life activity outside abortion clinics following concerns about the actions of some campaigners. The Home Secretary is clear that any action taken as a result of this review should be based on clear evidence. I am therefore writing to request your input into the review.

The first stage of the review is focused on drawing together evidence of what is happening nationally in order to understand the scale and nature of the protest activity and any associated action, legal or otherwise. As well as seeking your input, we are gathering evidence from healthcare providers; police forces; local authorities; representative groups of the clients of healthcare clinics and also of employees; and those engaging in protests and demonstrations.

The review is also considering international comparisons and, in response to calls for their introduction in the UK, gathering information on the justification, use and effectiveness of buffer zones in countries such as Australia, Canada, the USA and France.

Please note this review is not considering the question of abortion or any aspects of the Abortion Act 1967.
An online questionnaire has been developed which sets out a range of questions that apply to a wide range of interested parties. A link to the questionnaire is included below. Please respond to all questions which you deem applicable to you or your organisation. There is no obligation or requirement to answer all or indeed any questions.

https://www.homeofficesurveys.homeoffice.gov.uk/s/8KA5N/ .

We would appreciate if you could complete the questionnaire by Monday 19th February 2018. If you have further, additional, information that you would like to provide or have any other comments regarding this review, please send them to ACPReview@homeoffice.gsi.gov.uk.

Please note that information provided in response to this review, including personal information, may be published or disclosed in accordance with the access to information regimes (these are primarily the Freedom of Information Act 2000 (FOIA), the Data Protection Act 1998 (DPA) and the Environmental Information Regulations 2004).

If you want the information that you provide to be treated as confidential, please be aware that, under the FOIA, there is a statutory Code of Practice with which public authorities must comply and which deals, amongst other things, with obligations of confidence. In view of this it would be helpful if you could explain to us why you regard the information you have provided as confidential. If we receive a request for disclosure of the information we will take full account of your explanation, but we cannot give an assurance that confidentiality can be maintained in all circumstances. An automatic confidentiality disclaimer generated by your IT system will not, of itself, be regarded as binding on the Home Office.

The Home Office will process your personal data in accordance with the DPA and in the majority of circumstances this will mean that your personal data will not be disclosed to third parties.

Once the evidence is gathered, we will present the review findings to the Home Secretary before consideration is given to any further action the Government should take.

I would like to take this opportunity to thank you for your time and effort in taking part in this review.

Yours sincerely

Sarah Gawley
Head of Police Powers Unit
Directorate for Policing and the Fire Service
Email: ACPReview@homeoffice.gsi.gov.uk

Oireachtas Committee Recommends Abortion Decriminalisation and Free Access up to 12 Weeks with Overwhelming Support for Free Contraception

14 December 2017

An article in The Times newspaper today illustrates two pieces of compelling oral evidence presented to the Oireachtas Committee that were heavily influential in this decision: Abigail Aiken’s data on the number of women known to be buying abortion pills online, and Patricia Lohr’s evidence on flaws in UK legislation. Both of these issues are just as relevant and harmful to women in mainland UK, and this recommendation for Eire further emphasises the totally unacceptable position for the women of Northern Ireland. Furthermore, the reduction in access to contraception, which will especially hit the highly effective long-acting reversible contraceptive (LARC) methods, further increases the risk of unwanted pregnancy. [Sexual health services on the brink, BMJ 2017; 359; doi: https://doi.org/10.1136/bmj.j5395]

The British Society of Abortion Care Providers (BSACP) notes the groundswell of public and professional opinion, and fully supports legal and regulatory changes that increase access to evidence-based abortion care in both Eire and across the entire United Kingdom.

https://www.thetimes.co.uk/article/women-buying-illegal-pills-swayed-abortion-decision-tvp2kffst

Kate Guthrie/Joanne Fletcher (BSACP Co-Chairs)

BSACP/ARHP Joint Webinar on Simultaneous EMA: 14 December 2017

Outcomes with Simultaneous Administration of Mifepristone and Misoprostol for Early Medical Abortion

with Patricia Lohr, MD MPH, BPAS Medical Director and BSACP Treasurer

Thursday 14 December 2017 at 6:30 PM GMT / 1:30 PM EST

This joint webinar with the British Society of Abortion Care Providers (BSACP) and Association of Reproductive Health Professionals (ARHP) is the first of a new series of members-only educational opportunities. We will provide several of these webinars throughout the year at no cost to BSACP/ARHP members, so although this inaugural webinar is open to non-members, we encourage you to join BSACP or renew your membership for 2018 to participate in future activities.

[NB. BSACP will shortly be contacting current members individually about membership renewal arrangements for 2018.]

In this webinar, Dr Patricia Lohr, Medical Director of British Pregnancy Advisory Service, will discuss reduced-interval medical abortion regimens including outcomes from a large cohort study comparing simultaneous dosing with a 24–48 hour interval. As legislative restrictions continue to affect the provision of medically-induced abortion, reduced interval regimens offer an opportunity to protect patients’ access to care but at the expense of greater effectiveness.

By the end of this activity, participants will be able to:
1. Identify the primary impact of legislative restrictions on medical abortion care
2. Explain the rationale for reduced interval medical abortion regimens
3. Describe the effectiveness and acceptability of reduced-interval medical abortion regimens
4. Compare outcomes using simultaneous administration of mifepristone and misoprostol to those using a regimen with a 24- to 48-hour interval between medications.

We hope you will consider joining us for this FREE webinar and future ARHP/BSACP activities.

Kate Guthrie/Joanne Fletcher (BSACP Co-Chairs)

Health Canada Further Increases Access to Early Medical Abortion

8 November 2017

Abortion was decriminalised in Canada. Health professional scope of practice regulation is now in the jurisdiction of the respective health professional regulatory colleges. In Ontario, nurse practitioners can prescribe and dispense mifepristone if they have undertaken the prescribed training programme. Health Canada has now removed all restrictions on distribution, prescription and dispensing of mifepristone in Canada, giving it federal regulations similar to other prescription drugs. This means women can collect both mifepristone and misoprostol from the pharmacy and take both at home, unsupervised.

More information is available at this Health Canada link: http://healthycanadians.gc.ca/recall-alert-rappel-avis/hc-sc/2017/65030a-eng.php

Kate Guthrie (BSACP Co-Chair)

Joint RSM/BSACP Conference on ‘Excellence in Abortion Care’ at the Royal Society of Medicine, London, UK on 11 October 2017

On Wednesday 11 October 2017, I attended the joint conference organised by the British Society of Abortion Care Providers (BSACP) and the Royal Society of Medicine (RSM) with the theme ‘Excellence in Abortion Care’. I was particularly excited to attend, as I am currently the President of the Society of Medical Students for Choice in QUB, as well as a volunteer with Alliance for Choice, an activist group based in Belfast, and I have a keen interest in abortion care and women’s health.

The day was packed with informative sessions, split into six main sessions: Update on Abortion Statistics; Clinical Update in Abortion Care; Using Telemedicine to Increase Access and Satisfaction of Abortion Care; Inspection and Regulation; Access and Management of Abortion After the First Trimester; and Nurses and Midwives in Abortion Care. With such a varied and mixed day, I believe that the conference was accessible and interesting for people involved in many different areas of abortion care.

The abortion statistics session contained many interesting points about the implications of Northern Irish and Irish pregnant women and people travelling to Britain for abortion access. The point was made that the numbers of women and people travelling from Northern Ireland and Ireland to undergo abortions in Britain are always underestimates, on account of stigma and fear leading to people not providing accurate addresses and postcodes.

The session around clinical updates in abortion care was very interesting with regard to the woman-centred aspects of abortion care, and demonstrated how the patient experience is useful in improving clinical practice. This session focused on early medical abortion (EMA) and pain management during manual vacuum aspiration. I found the EMA session particularly informative about the benefits versus the negatives of EMA in terms of patient satisfaction and reducing the stress of unexpected pregnancies and the risks of EMA, including missed ectopic pregnancies.

Telemedicine is an area of medicine that is often underutilised; however, it has an important role to play in abortion provision, facilitating the care of patients living in remote areas or those who cannot attend clinics for a variety of reasons. It was stressed in this session how important the decriminalization of abortion care is in facilitating the provision of better access to abortion services to those patients who cannot access care within a clinic or hospital setting. This is an example of the Inverse Care Law being seen in action, namely those who are most in need of care being unable to access it, including those in controlling relationships or those with childcare or work responsibilities that they cannot abandon in order to attend a clinic or hospital for a day. Despite the National Health Service (NHS) being set up to reduce health inequalities, travelling for abortion care can result in many inequalities for those who are unable to travel for the reasons given above. This is also important to remember in respect of pregnant women and people in Northern Ireland and Ireland – free abortion services and funding in Britain is not a long-term solution for many women, and abortion services must be accessible within local care facilities or even at home. Unfortunately, however, legislation often stands in the way of providing high-quality, patient-centred care.

This focus on legislation continued into the afternoon, with the session on Nurses and Midwives in Abortion Care commenting on the limits of the 1967 Abortion Act, which we are celebrating 50 years of in Britain. This Act, which was extremely welcome in 1967, as women were dying or left with lifelong disabilities after unsafe and illegal abortions, is out of date for 2017. With developments such as ‘Women on Web’ and ‘Women on Waves’, that provide abortion pills to people who cannot access healthcare facilities, access to abortion can be as close as a mouse-click away. Similarly, legal limitations on who can provide abortions restricts abortion care provision to doctors and excludes nurses and midwives, despite them being highly trained members of the healthcare team, when their involvement in abortion care provision might sometimes be preferable in terms of resource allocation.

The day ended with a documentary film showcase led by Dr Jayne Kavanagh, a clinical teaching fellow at University College London. This film was incredibly powerful and emotional, and featured interviews with doctors who worked both before and after the 1967 Abortion Act; activists and politicians who were instrumental in bringing about changes in abortion legislation; and, of course, women who accessed abortion services before the Act was introduced. I personally found the film particularly moving because this year not only represents 50 years since the 1967 Abortion Act was introduced in Britain, but also because it represents 50 years of denial of abortion care to pregnant women and people in Northern Ireland.

However, to end on an optimistic note, I do believe that continuing activism and advocacy from leading healthcare organisations, including the British Medical Association, Royal College of Obstetricians and Gynaecologists, Royal College of Midwives and, of course, the BSACP, are helping to bring about a change of opinion and ensuring access to essential abortion care services to all pregnant women and people, regardless of their address or postcode. Similarly, the hard work and success of the British Pregnancy Advisory Service’s #WeTrustWomen campaign and Alliance for Choice’s #TrustWomen campaign are bringing abortion to the forefront for politicians to discuss, and are raising public awareness about this important healthcare and human rights issue.

Jill McManus, Third-year Medical Student, Queen’s University Belfast, Belfast, Northern Ireland; jmcmanus27@qub.ac.uk

Note on the Author

Jill McManus is president of the QUB chapter of Medical Students for Choice, and is an activist with Alliance for Choice, a pro-choice activist and advocacy group based in Northern Ireland. She also has a blog, where she writes about current events and information on abortion.

Scotland is the First UK Country to Allow Women to Take Abortion Pills at Home

26 October 2017

Professor Alan Templeton announced from the podium at the wonderful The Abortion Act 1967 Conference held at the Royal College of Obstetricians and Gynaecologists (RCOG) earlier this week that women in Scotland will soon be able to take the misoprostol component of early medical abortion at home. The date has yet to be announced but the decision has been made. We can but hope that this woman-centred, safe and compassionate change is also sanctioned in England and Wales. One would think it difficult to argue otherwise.

Link to BuzzFeed article: https://www.buzzfeed.com/laurasilver/scotland-first-uk-country-to-allow-women-abortion-pill-home?utm_term=.epnRNxpk8

BuzzFeed App available at: https://bzfd.it/bfmobileapps

Kate Guthrie (BSACP Co-Chair)