Isle of Man Becomes First Part of the British Isles to Decriminalise Abortion

29 January 2019

The move towards reproductive choice in the world is often incremental – allowing abortion in some cases but not others, gradually increasing the number of abortion service providers. So it comes as a particular (but welcome) surprise to see the Isle of Man change its laws on abortion from one of the most restrictive in the British Isles, together with Northern Ireland, to the most liberal in a single step. Crucially, the Isle of Man is now the only place in the British Isles where abortion has been decriminalised.

The Isle of Man is a Crown Dependency, and whilst the Tynwald (the parliament of the Isle of Man) commonly adopts statutes from Westminster, this is not automatic. The Tynwald did not adopt the 1967 Abortion Act and abortion was instead governed by the Termination of Pregnancy (Medical Defences) Act 1995. Abortion at any stage of gestation was highly restricted, and access was further complicated by requirements in the Act that multiple consultants must agree the criteria for legal abortion. On an island with one hospital and a very limited number of consultants, the result was women faced a lengthy wait, which could take them beyond the cut-off date for terminations.

Consequently 1076 Manx women travelled from the Isle of Man to access abortion in England and Wales between 2007 and 2016, and a further 204 over 8 years requested medical abortion from Women on Web. Those who came to England or Wales had the expense of private treatment, compounded by travel costs, whilst those seeking medical abortion were performing an illegal act, which would make it difficult for them to seek either physical or psychological aftercare on the island.

The Abortion Reform Act 2018, which passed the final legislative step of receiving royal assent on 15 January 2019 after being passed by both houses of the Tynwald in late 2018, radically changes women’s access to reproductive healthcare on the island. It allows termination on request in the first 14 weeks of pregnancy, abortion up to 24 weeks if there are serious social grounds to justify it, and after 24 weeks if pregnancy would cause risk to the life of the mother, or if the baby when born would suffer serious impairment or die shortly after birth. Midwives and pharmacists as well as doctors can dispense the medication for medical abortion. The Act also makes the Isle of Man the first place in the British Isles to create statutory ‘buffer zones’, preventing protestors from gathering within a certain distance of abortion care providers. The Act was first introduced as a Private Members’ Bill in 2017 by Dr Alex Allinson, a general practitioner and member of the House of Keys, the lower house of the Tynwald. He steered the bill through the Tynwald in order to take abortion “out of the realm of the criminal justice system” and make it “strictly a health care issue”.

Abortion in England, Wales and Scotland is widely available – there were 192 900 abortions in England and Wales in 2017 – so many do not realise that abortion is still regulated by criminal law. Crucially, by decriminalising abortion this makes the Isle of Man the only place in the British Isles where abortion is regulated like any other health service. In England, Wales and Scotland, abortion service providers rely upon the 1967 Abortion Act, which provides exceptions to the crime of administering or procuring an abortion. These exceptions mean that a pregnancy can be lawfully terminated if two medical practitioners agree that the pregnancy has not exceeded its 24th week and 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. Abortion can be carried out after 24 weeks, though this accounts for a tiny percentage of abortions overall, in the event of risk of death or grave injury to the mother, or severe fetal abnormality. Any abortion which is not carried out under these exceptions is a crime under the 1861 Offences Against the Person Act, and carries a potential prison sentence.

Four key UK medical associations – the British Medical Association (BMA), Royal College of Obstetricians and Gynaecologists (RCOG), Royal College of Midwives (RCM) and Royal College of Nursing (RCN) – now are explicitly calling for the decriminalisation of abortion across the UK. If abortion is to be recognised as a normal healthcare procedure, it is stigmatising for both the providers and the patients if that procedure is singled out as regulated by criminal law, rather than regulatory and professional guidelines. Professor Lesley Regan, RCOG President, is clear that “decriminalisation does not mean deregulation and abortion services should be subject to regulatory and professional standards, in line with other medical procedures”. Most importantly, the restrictions imposed by the current law indicate a lack of trust in women, and serve to place obstacles in the way of those seeking bodily autonomy.

At the start of 2019, attention is turning to abortion law reform in Northern Ireland and continuing the momentum of 2018’s changes in Ireland. The reforms in the Isle of Man provide evidence that dedicated campaigning, and a recognition that the majority of the population support abortion, can lead to a dramatic change in women’s reproductive freedoms in a single legislative act.

Charlotte Kelly, BSACP Patient and Public Involvement (PPI) Representative; charlotte.kelly@balliol.ox.ac.uk 

Note on the Author

Charlotte Kelly is BSACP’s Patient and Public Involvement (PPI) Representative, and so brings a lay perspective to the BSACP Committee. She is also a member of the Women’s Voices Involvement Panel of the RCOG and has a long-term gynaecological disability. She is a DPhil (PhD) student in Socio-Legal Studies at the University of Oxford, and her research spans children and disability law.