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Doctors can lead case to change Northern Ireland’s highly restrictive abortion laws

BMJ 2019; 365 doi: https://doi.org/10.1136/bmj.l4463 (Published 28 June 2019) Cite this as: BMJ 2019;365:l4463
  1. Elisabeth Mahase
  1. The BMJ

The trusted voices of doctors and medical staff are the key to changing abortion laws to give women in Northern Ireland choice, according to a panel of experts.

The panel—which met in Belfast on 23 June to discuss access to safe abortions—shared their experiences of caring for women and seeing the impact of restrictive abortion laws.

In Northern Ireland, women can only have an abortion under exceptional circumstances, such as if the pregnancy poses a serious risk to their life. Women who undergo an abortion outside of these circumstances can face life in prison.

Emma Campbell, co-chair of the campaign group Alliance for Choice, said Department of Health guidelines on abortion in Northern Ireland, published in 2013, had left doctors in a “sticky situation” because the guidelines interpreted the law in a more conservative way than was previously practised.

She said: “Until 2013 there were around 80 legal abortions performed in Northern Ireland each year, and last year it was around 12. The interpretation, in terms of mental health, was that the woman will need to have been sectioned or have had at least two psychotic episodes. That is a high bar. Or it will have to be a condition which would mean her pregnancy would kill her or put her life at risk.

“We have people going through cancer treatment or with contra-indicated illness that are not ‘serious’ enough, who still have to travel.”

The guidelines also reiterated that criminal sanctions can be imposed on medical staff who know about someone accessing early medical abortion and not reporting it.

Campbell added: “We now know there is not any legal reason why medical staff here can’t provide information, and yet the health department still has not put in any clear guidelines or pathways to the services provided by the British Pregnancy Advisory Service. There is also a hangover from the terrorism law which means we are obliged to report a crime which has a sentence of more than five years.”

In the Republic of Ireland, the government introduced the Regulation of Termination of Pregnancy Act from 1 January 2019, which permits terminations to be carried out up to 12 weeks of pregnancy, or under other circumstances such as risk of life or serious harm to health. This follows a referendum last year in which 66% of voters supported the repeal of the eighth amendment.

Marion Dyer, a Dublin GP who campaigned for repeal, said the medical voice was important in the campaign. “We found through polling that the two most trusted voices were women who had been through the experience and doctors.”

Dyer said doctors could influence in different ways, not just by speaking at public meetings, but by having “kitchen table” conversations with families or colleagues.

“It’s about opening a door to ask a question, and to gently encourage colleagues to identify themselves as being unhappy with the lack of provision of care,” she said.

Belfast midwife Ciara McHugh spoke about her experiences as someone from Northern Ireland working at the Marie Stopes centre in London, which provides abortion services and treats women, including those from across Ireland.

McHugh stressed the importance of not just changing the law but overcoming cultural and mental barriers for clinicians and women, something she has tried to do on a daily basis while treating women from Ireland who had travelled to London.

“Even if just one woman walked out of that clinic realising she didn’t do anything wrong, that she wasn’t a criminal or a murderer, and had a right to her own body, then I’m happy we did a good job, but it’s still not good enough,” she said.

McHugh recently moved back to Belfast having trained and worked in England. Upon returning, she saw first hand the difference in the way women are treated.

“When you book an initial midwife appointment in England, you ask her if she’s happy about her pregnancy, you do not ask that question here. When I asked why we didn’t, I was told, ‘Of course they’re happy about their wee babies’,” she explained.

McHugh also recounted the case of a woman she had looked after recently whose waters broke in her 22nd week, meaning her pregnancy was “very unlikely to make it to the point of viability.” The woman was refused a medical abortion and a few days later passed the pregnancy in the back of her car, while her neighbour drove. “She went through that because in this jurisdiction we will not entertain humanity. She could have delivered in a hospital setting, with dignity and privacy. Our women deserve better,” McHugh said.

While there appears to be a desire for change, the political situation in Northern Ireland makes this difficult. For over two years the country has had no government after a power sharing agreement between the Democratic Unionist Party and Sinn Féin broke down.

Katherine O’Brien, from the British Pregnancy Advisory Service, said, “The government has previously said abortion is a devolved matter and Westminster should not act, but that is not holding with MPs any longer. Recently the Women and Equalities Committee actually recommended that Westminster should legislate for abortion law reform in Northern Ireland.”

Dyer called for doctors and the public in Northern Ireland to voice their views to their local politicians, as many did during the Republic of Ireland pro-choice campaign.

She said, “The population are way ahead of the politicians on this. Email your politicians. What you need to say is, ‘I live in our constituency and I vote pro-choice.’ Once they become convinced that their seat may be affected by a pro-choice vote—it was amazing to see how many of our politicians went on a journey.”

This panel was convened just ahead of the BMA annual representative meeting, which took place in Belfast between 23 and 27 June. At the meeting, doctors voted for a motion which called on the UK government to repeal sections 58 (offence of using drugs or instruments to procure abortion) and 59 (offence of supplying or procuring poison or instruments for the purpose of criminal abortion) of the 1861 Offences Against the Person Act, as well as section 25 (punishment for child destruction) of the Criminal Justice Act (Northern Ireland) 1945.

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