In theory, Northern Ireland has had the most liberal abortion legislation in the UK and Ireland since decriminalisation through Westminster in 2019. The right to end a pregnancy is now enshrined in law, without the risk of prosecution which exists in Great Britain under some circumstances, or the medically unnecessary three-day waiting period between consultation and treatment in the South. The law says abortion is permitted for any reason until twelve weeks gestation, up to 24 weeks if the person’s physical or mental health is at risk by continuing the pregnancy, and later if medically necessary or in the event of a severe foetal anomaly. So, those are our rights.
In practice, due to a lack of political will locally, and dragged out by the lack of a Health Minister while Stormont isn’t sitting, full services haven’t been commissioned here. Currently, only Early Medical Abortion (EMA), which involves taking medication, is available, and only until 9 weeks 6 days. For anyone past this date or needing a surgical procedure for any reason, women, girls and pregnant people still have to travel to GB. So, that’s our reality. We can’t access all our rights.
There are multiple obstructions to access. Even someone with regular periods is unlikely to realise they are pregnant until at least four weeks gestation at the earliest; the clock is ticking. To obtain services here, the patient must have a BT postcode and be registered with an NI general practice. This won’t apply to the unhoused or recent arrivals here, for example. Access is via a central booking service provided by a charity, the British Pregnancy Advisory Service. There is no GP pathway, although many might assume that’s the first place to seek help. Most NHS staff have not received any information at all on the new system, unless they’ve sought it outside the workplace (the nurse’s union, RCN, set up a voluntary training module.) Travel, although funded by the NHS, may not be possible due to work or childcare demands (around three in five abortion seekers are already parents) or a need for privacy, especially for someone in an abusive relationship. It is also difficult to impossible for someone undocumented or without recognised ID. Patients may want to be accompanied for support, but this can only be funded in cases of clinical necessity. The cost is a barrier in that case, and private procedures cost at least £600 if someone isn’t entitled to NHS treatment. Telemedicine, where a patient can be sent EMA pills after an online or telephone consultation, is safe and effective, and pre-pandemic pilot study in Scotland found it very popular with women who used it. Telemedicine was introduced in GB during Covid lockdowns and is now permanently available there, but in NI, despite a requirement for an initial teleconsultation, a clinic visit is still mandatory for the first medication. This can run the risk of an abortion seeker facing harassment from anti-choice protesters outside: while protest exclusion zones at clinics have recently been legislated for, safe access zones have not been designated yet and are not being enforced. Rogue anti-choice “clinics” like Stanton Healthcare and Advocate Women’s Centre mislead abortion seekers, trying to dissuade them and stall for time to get closer to gestational limits. Finally, the lack of commissioned services and proper funding means services have sometimes been withdrawn in individual NHS trusts as there simply weren’t enough staff available. In a time-sensitive and potentially very stressful situation like an unwanted pregnancy, all these obstructions just make matters worse. As before decriminalisation, abortion seekers still turn to buying pills online, although at least now without risking prosecution. This can lead to unsafe providers, counterfeit pills or pills simply failing to arrive. Both Women On Web and Women Help Women provide genuine EMA medication, advice, and support to women around the world.
Surveys show most people in Northern Ireland support the right to choose. We have now had legislation in place to allow anyone with an unwanted pregnancy to choose safely since 2019. Yet there is minimal provision, falling far short of legal entitlement. There has been no awareness campaign, there is no NHS signposting of the pathway for patients and no training or support for most healthcare professionals. There are multiple institutional obstructions and anti-choice groups are being allowed to create even more. Services need to be properly commissioned, staffed and funded. People who can get pregnant in Northern Ireland deserve better.
Rights without access to them aren’t really rights at all.
By: Claire Murray, Placement Student.