The UK abortion anomaly that can no longer be ignoredBMJ 2014; 348 doi: https://doi.org/10.1136/bmj.g3610 (Published 29 May 2014) Cite this as: BMJ 2014;348:g3610
- Ann Furedi, chief executive officer
For all the talk of commitment to equality for women throughout the United Kingdom, there is no equality of access to abortion for women who live in the six counties that make up Northern Ireland.
For women in the six counties, abortions are still available only in “highly exceptional circumstances,” which are undefined. In 2013, only 51 abortions were performed in Northern Ireland; meanwhile, more than a thousand women travelled to England for a procedure that is taken for granted by most women in the rest of the UK.1
While the recent death of a pregnant woman who had been denied termination of her pregnancy has drawn attention to the Republic of Ireland’s restrictive abortion laws,2 the plight of women in the north has remained in the shadows. Most people assume that, because Northern Ireland is part of the UK, British law applies. And why shouldn’t it? The reason is that in 1967, when the Abortion Act first provided legal, but heavily regulated, access to abortion in Britain, Northern Ireland was specifically excluded. As a consequence, abortion services—or funding for abortion—which is provided routinely by the NHS in Britain, is not provided by the Northern Ireland Health and Social Care Board.
The Abortion Act 1967 brought 19th century prohibitions on abortion into line with 1960s thinking. At the time, politicians believed that Northern Ireland, with its polarised religious and national conflict, was unaffected by the “liberal” climate that was bringing change to Westminster. In London, the 1960s was a decade in which capital punishment was abolished, homosexuality became tolerated (in strictly defined circumstances), and censorship in the theatre was ended. The contraceptive pill became available and divorce was easier to obtain. However, Belfast’s mood was very different as it prepared for a nationalist conflict that would, in 1969, result in the deployment of the British army. The government believed that neither politicians in Northern Ireland, nor its population, would have accepted the terms of the Abortion Act.
But Northern Ireland is very different now, and women in the six counties need access to abortion for the same reasons as women in the rest of the UK. These include contraceptive failure and failure to use it, broken relationships, economic hardship, and all manner of unpredictable reasons that “mess women up” and qualify them for abortion on mental health grounds. The rate of fetal abnormalities in wanted pregnancies is much the same in Northern Irish women as it is in English women. A woman in Newcastle County Down lives much the same life as a women in Newcastle upon Tyne or Newcastle under Lyme—she watches the same films, reads the same books, has similar expectations and life plans. The big difference is that if she needs an abortion her local health service cannot provide the safe, legal, local, state funded procedure that she needs.
Of course, just as in other countries where abortion is not lawfully provided, Northern Irish women have abortions. They travel to England, Belgium, or the Netherlands, and, since the development of safe effective drugs licensed for termination of pregnancy, they have used the internet (or friends abroad) to arrange for the means to self induce an early miscarriage. Access to safe legal abortions at not for profit clinics may help around a thousand women a year at a relatively low cost, but this is not a good enough solution, however much the charities subsidise the costs.
In April this year, the High Court of England and Wales ruled in a test case on the funding of abortions sought by Northern Irish women. It found against a girl from Northern Ireland who claimed that, as a UK resident, she should be afforded the benefit of those publicly funded healthcare services intended to be “free at the point of use for all UK residents.” Handing down judgment, Mr Justice King conceded that the differences in the legal position had “not surprisingly led to a steady stream” of pregnant women from Northern Ireland to England to access abortion services not available to them at home.3
But he ruled that the health secretary’s duty to promote a comprehensive health service in England “is a duty in relation to the physical and mental health of the people of England,” with that duty not extending “to persons who are ordinarily resident in Northern Ireland.” Nor, he confirmed, was it the responsibility of NHS commissioners in England, who have a duty to commission for English residents.
The girl’s mother told the Irish Times that if her daughter had some other health condition that necessitated her travelling to another part of the UK for treatment, she believed that “no obstacles would have been put in her way.” The mother thought that “every effort would have been made to ensure that she was treated in an appropriate NHS facility and had assistance with travel costs.”4 But abortion remains a stigmatised service that Northern Ireland needs but does not want to provide, pay for, or acknowledge. Politicians are content to depend on women begging and borrowing the funds for the abortion procedures they must travel to obtain, and yet the whole of society benefits from women being able to plan their families.
Today, it is morally unacceptable for politicians in Stormont or Westminster to ignore the needs of women in their constituencies. Northern Ireland needs a law that provides a local legal abortion service, and, until it does, there must be arrangements for women to obtain care in Britain. If women in Northern Ireland are to be seen as part of the UK, the Westminster parliament needs to consider their needs and not hide behind the rhetoric of “devolution.” Politicians in Westminster were the ones who decided to discriminate against women in Northern Ireland by denying them the benefits of legal abortion in 1967. Now, almost 50 years later, they need to take responsibility for making the situation good.
Cite this as: BMJ 2014;348:g3610
Competing interests: I have read and understood BMJ policy on declaration of interests and declare the following interests: I am employed as chief executive officer of the British Pregnancy Advisory Service (BPAS), a not-for-profit registered charity, which runs more than 60 treatment units and pregnancy advisory bureaus in Britain. Although 97% of its services are under contract to the NHS, BPAS treats more than 100 clients a month who travel from Northern Ireland and the Republic of Ireland for abortion. I am also chair of the Voice for Choice coalition, which advocates for abortion law reform and greater availability of access.
Provenance and peer review: Commissioned; not externally peer reviewed.