Should doctors support restrictions on anti-abortion protests?BMJ 2017; 359 doi: https://doi.org/10.1136/bmj.j5070 (Published 09 November 2017) Cite this as: BMJ 2017;359:j5070
- Francesca Robinson, freelance journalist, Hampshire, UK
On the 50th anniversary of the Abortion Act, on October 27, more than 100 MPs put their names to a letter urging the government to introduce buffer zones to prevent anti-abortion activity outside women’s and reproductive health clinics.
It follows a groundbreaking vote by Ealing Council to explore the possibility of introducing a public space protection order to stop activists picketing women and staff outside its local Marie Stopes reproductive health and abortion clinic.
These moves are welcomed by doctors who provide abortion care, but some people argue that such restrictions on the activities of anti-abortion pressure groups amount to a ban on free speech.
The British Pregnancy Advisory Service, which runs more than 40 abortion clinics and sexual health centres in England, Wales, and Scotland, has campaigned for the introduction of buffer zones since 2014. It says anti-abortion activists carry large banners of dismembered fetuses, distribute leaflets containing misleading information about abortion, and follow and question women as they enter or leave the clinics. It claims that anti-abortion activity is escalating in the UK.
Caroline Gazet, a surgeon and deputy medical director at reproductive health and abortion service provider Marie Stopes, agrees. “I have provided abortion care for 10 years and I have definitely noticed that over the past few years there are more protesters outside clinics, particularly at times such as Advent and Christmas,” Gazet says.
Retired obstetrician and gynaecologist Wendy Savage says that although there have been violent incidents outside clinics in America, so far nothing similar has occurred in the UK. Savage, spokesperson for Doctors for a Woman’s Choice on Abortion and a voting member of the BMA Council, does not believe that protests would turn ugly here because we have a different cultural tradition from that of the US.
Buffer zones have successfully been introduced by two provinces in Canada: Ontario and British Columbia. However, in the US in 2014 the Supreme Court in Washington quashed a statute in Massachusetts that had created a no entry zone outside abortion clinics, on the grounds that it violated activists’ rights to freedom of speech.
No other option
Savage argues that the only realistic alternative to introducing buffer zones is siting services entirely in NHS hospitals, which protesters would not be allowed to enter.
The BMA has not discussed the idea of introducing buffer zones, Savage says, but she believes that most doctors would support women being able to receive healthcare without harassment. “An individual should be free to speak on a public platform but not to harass women going into a health facility,” she says.
However, retired general practitioner Mark Houghton argues that a ban on anti-abortionists picketing clinics would be “way over the top.”
“From what I have seen in the debate around this issue, the actions of the protestors probably wouldn’t fulfil the legal criteria for harassment,” says Houghton, who has recently published a book, Pregnancy and Abortion—Your Choice.
“These picketers aren’t hostile, and they don’t give out moral advice but offer practical support to pregnant women such as financial help, baby care, or help with housing. I don’t see any evidence that the protestors act in a degrading or hostile way towards women outside the Marie Stopes clinics.
“British people really value free speech, and there would have to be a very big reason for curtailing it.”
The Royal College of Obstetricians and Gynaecologists (RCOG)—whose council recently voted to support removing criminal sanctions associated with abortion for patients and healthcare professionals—has for several years supported the introduction of buffer zones to limit anti-abortion activity. It argues that limiting the ability to interfere with women as they try to access a lawful medical service in confidence does not represent an undue restriction on existing freedoms.
RCOG president, Lesley Regan, says members have experienced picketers harassing women in various ways. These include filming people approaching clinics, giving women unsolicited advice that is contrary to that provided by doctors, and providing erroneous information about clinical risks, such as linking abortion with breast cancer.
“The RCOG appreciates that there is a wide range of views about abortion, and that there must be opportunities for these diverse and strongly held views to be heard. However, intimidating staff who are providing a lawful and necessary service, and approaching women accessing these services who may already feel vulnerable, are unacceptable ways to promote anti-abortion views,” she says.
This potential deterrent against practising in abortion care is part of the college’s wider concerns about the future and welfare of the abortion workforce, Regan adds. She claims the shift towards provision of abortion services by the independent sector has led to a reduction in the training opportunities and placements available to doctors working in the NHS. This has resulted in fewer doctors with the requisite skills to deliver abortion care to women across the UK.
“There is also an overall feeling that abortion care has low prestige in the NHS, and, as a result, staff working in this field report feeling undervalued and isolated, rather than feeling as though their work is regarded as an essential part of delivering improvements to women’s health,” Regan says.
“This sense of low prestige for the workforce is exacerbated by the intimidating tactics of anti-abortion groups outside clinics as well as negative press coverage around abortion.”
The right thing
Gazet says the presence of protesters outside clinics does not stop doctors doing abortions because those who choose this field are passionate about their work. “They believe it is the right thing to do for women’s health. If you go into abortion care it is not a decision you make lightly,” she says (box).
Responding to the MPs’ letter, the Home Office says: “This government is absolutely clear that the right to peaceful protest should not extend to harassment or intimidating behaviour. We will carefully consider the important issues raised in this letter, and work with the police and local authorities to ensure they are able to make full use of their existing powers to prevent this kind of behaviour.
“We will also explore whether any further action is needed to ensure clinic staff and patients can go about their lawful business free from harassment, offence or alarm.”
Personal view: “It’s hard to battle through this harassment every day”
Caroline Gazet regularly experiences anti-abortion protests in her role as deputy medical director at reproductive health charity Marie Stopes, which involves visiting clinics around the country.
“The male surgeons don’t get hassled, but the female surgeons do because the activists assume that we are clients and are having an abortion. The intimidation can range from people sitting outside quite quietly with leaflets and banners, to trying to put rosaries or leaflets with pictures of fetuses into your hand or to bar your way as you go in.
“I went to Birmingham last week to do some teaching and somebody tried to stand in front of my car and put a leaflet on the windscreen as I tried to drive into the premises. The same thing happened as I was leaving. It’s very worrying as there is the potential for an accident.
“The protesters are not aggressive in the physical sense; it’s more that they put emotional pressure on women. It’s quite intimidating and it’s certainly not pleasant. If you put yourself in the clients’ shoes it is just another awful thing they have to endure before they can get the treatment they need.
“The activities of the picketers do sometimes upset our clients. The front of house staff will comfort them and escort them in if necessary, but if a woman is still shaken by the time she gets to the treatment room then we would probably postpone the procedure in order to make sure that that is what she really wants.
“It is hard for staff who work in these clinics to have to battle through this harassment every day, and it’s unnecessary. However, the protests won’t intimidate me or any other doctors and nurses from doing this job because those of us who perform abortions are all very passionate about our work and feel we provide an important and necessary service for women.”
Competing interests: I have read and understood BMJ policy on declaration of interests and have no relevant interests to declare.
Provenance and peer review: Commissioned; not externally peer reviewed.