Abortion on the NHS - Northern Ireland's fight for the right

The British government’s U-turn on abortion policy should enhance equality between women in Northern Ireland and the rest of the UK. But, despite reports that Northern Irish women can now access abortions funded by the National Health Service, this is not yet the case.

When it was announced on June 29 that women from Northern Ireland  would be allowed to access pregnancy terminations for free in England, a report from the Guardian said that the UK government had “dramatically changed its policy” on abortion. The change put Northern Ireland women on the same footing as those in the rest of the UK.

With this move, British society was a step closer to “vindicating the reproductive rights of Northern Irish women,” wrote Marie Fox, chairwoman of law at the School of Law & Social Justice at University of Liverpool, and Sheelagh McGuinness, senior lecturer in law at the University of Bristol.

The announcement followed the unsuccessful Supreme Court case of ‘A’ and ‘B.’ They are a daughter and mother who have been attempting to get the law changed to permit women from Northern Ireland to have abortions paid by the National Health Service after they traveled from Northern Ireland to England for A, who was 15 at the time, to have a private abortion. The court decided to dismiss the appeal out of “respect” for the democratic decisions of the people of Northern Ireland.

There is a near-total ban on abortion in Northern Ireland, even in cases of rape, incest or fetal abnormalities. A pregnancy can be terminated only if the mother’s life is at risk or if it would damage her mental health. The situation mirrors that south of the border in the Republic of Ireland where abortion is heavily restricted and only legal when a woman’s life is at risk. Abortion pills are routinely – but illegally – ordered over the internet to both regions from online services like Women on Web for women to administer medical abortions at home.

But in 2016, 724 women traveled from the province to England and Wales for abortions, and in 2015, 833 women made the trip, paying the financial and emotional price. A small number are also thought to seek the procedure in Scotland.

Given this, the government’s announcement that it would fund abortions for all UK women was seen as a U-turn by campaigners.

But the it isn’t as radical as it seems.

A protest staged by the London-Irish Abortion Rights Campaign that saw women march to the Irish Embassy in London demanding a referendum to repeal the 8th Amendment to the Constitution of the Republic of Ireland (Photo: Alastair Moore via London-Irish ARC)

A reproductive misunderstanding

Women in England, Scotland and Wales are entitled to an abortion up to 24 weeks’ gestation paid for by the NHS under the 1967 Abortion Act. The act was not adopted by Northern Ireland, so the Offences Against the Person Act 1861 and the Criminal Justice Act (Northern Ireland) 1945 dictate Northern Ireland’s strict abortion rules.

The province can dictate its own legislation to an extent because health policy and policing laws were devolved to the Northern Ireland Assembly from central government in Westminster.

Abortion has long been a sensitive and divisive issue in Northern Ireland, largely due to the powerful influence of religion. The maximum penalty for an illegal abortion is life imprisonment.

It has been reported in numerous publications, including The Guardianthat Northern Irish women have access to “free NHS abortions” as a result of the June change. The Belfast Telegraph cited “free NHS terminations” but later went on to drop mentions of the NHS.

Kylie Harrison, media and PR advisor at Marie Stopes International, the sexual and reproductive-health organization, told WikiTribune that “women traveling from Northern Ireland are already able to access abortions for free in the NHS”.

Equally, Goretti Horgan, founder-member of Alliance for Choice in Northern Ireland wrote of “NHS abortions” in an opinion piece in The Guardian.

But such a statement could be considered premature if not inaccurate.

Cara Sanquest of the London-Irish Abortion Rights Campaign said the change sketched out by Westminster “has not yet been defined or implemented.” Her colleague, Claire Johnson, said the full sequence of events since the announcement has been complex and confusing.

While private abortion clinics like Marie Stopes International, Family Planning Association and British Pregnancy Advisory Services have stopped charging  women from Northern Ireland for abortions – the clinics waived their fees within days of the policy anouncement – the women are not receiving NHS-funded abortions.

The cost of treatment for women from the province is paid for by clinics before it’s claimed back from the Government Equalities Office. There is no up-front cost to patients.

Horgan agreed that it could be argued abortions under the current scheme are not NHS abortions. “However, few worry about who is actually funding them,” she said, “and free ones are seen as NHS because the pathways are similar to NHS ones.”

Yet the changes do not reflect the fully funded NHS abortion care called for by the British Pregnancy Advisory Services head of media and policy research, Katherine O’Brien.

Although the new system in place does mean free abortions in England for Northern Irish women, as promised, they women still have to make private appointments. They cannot go to an NHS hospital to have an abortion.

But women with high risk factors or ongoing health conditions, such as high blood pressure, respiratory disorders or diabetes, need to be treated in a hospital, Johnson said.

There is only one NHS hospital in England that provides private abortion appointments, according to Mara Clarke, director of the Abortion Support Network, a small, England-based charity.

“The U-turn still doesn’t alter the fundamental fact that [women from Northern Ireland are] barred from accessing NHS abortions,” Claire Johnson of the London-Irish Abortion Rights Campaign said.

The cost of traveling for an abortion

The change in abortion policy will save women traveling to England for an abortion at least £330 (the minimum cost of an abortion in a clinic), Clarke said.

However, “They will still have to pay for flights and accommodation, childcare and time off work. Not to mention the fact that there will still be women who aren’t in a position to travel and still need abortion access in their own locality.”

So low-income women are most affected by financial consequences of strict abortion laws.

“We only hear from the super marginalised, poor women,” Clarke said. “Otherwise, quite frankly, you are not going to take what should be a personal and private decision and involve a group of strangers in England.”

If money isn’t a concern, there are other reasons Irish women can’t make the trip to England.

“Complicating factors get in the way… [some women will] never be able to travel because of abusive relationships [or] caring responsibilities that they have at home,” Johnson said. “Things like that, where they just cannot disappear for a couple of days to England on their own, and come back again.”

According to a written ministerial statement made on October 23 by UK Secretary of State for Education and Minister for Women and Equalities Justine Greening, women who meet financial hardship criteria will be eligible for support with travel costs.

Women earning less than £15,276 will also receive funding for a parent, caregiver or guardian to accompany them on the journey, according to Buzzfeed News.

Stella Creasy told WikiTribune that having abortions funded through the Equalities Office “gives us the opportunity to make sure that there is equal access” and makes it easier to fund travel costs. She said the policy “can be built around women rather than around the NHS and separate services on top.”

“What I don’t want is women waiting or delaying procedures whilst we get [the policy] right, because that could cause them more stress and mean a much more invasive procedure,” Creasy said.

But money isn’t the only issue. There are also the personal and emotional costs of abortion in a foreign country. As Mara Clarke said of early medical abortion: “It’s not fast. It’s quite messy. So it’s like OK, do you fly [to England] and take the pills and jump back on a plane and cross your legs and hope for the best. Or do you come over here and stay in a B&B for three days trying desperately not to bleed all over the sheets. It’s crappy.”

According to Greening’s statement, women from Northern Ireland seeking abortion services in England will be eligible for:

  • A consultation with an abortion provider in England, including an assessment of whether the legal grounds for an abortion are met.
  • The abortion procedure.
  • HIV or sexually transmitted infection testing as appropriate.
  • An offer of contraception from the abortion provider.
  • Support with travel costs if the woman meets financial hardship criteria.

A centralized telephone booking service is due to be put in place before the end of the year.

“It means that women from Northern Ireland will have a single telephone number to call, and an appointment will be made with the most appropriate provider, based on the woman’s requirements, her medical condition and the availability of the providers,” Greening said.

She said this system is “comparable with the service that women in England receive.”

A small number of procedures will also be provided through the NHS where necessary for medical reasons. However this is to be paid for by the Department of Health, according to the statement.

Creasy said she doesn’t consider the latest developments to be “the end of the matter.”

“I don’t believe that women in Northern Ireland should have to travel at all to access a service that other women in the United Kingdom are able to access in their home communities, but it [is] a step forward,” she said.

As for access to legitimate abortions on the NHS in England, A and B are taking their case to the European Court of Human Rights in Strasbourg.

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