By Naomi Connor
‘Impractical’ was the word that Robin Swann, the Northern Ireland Health Minister, used to describe the inhumane forced travel for women from Northern Ireland (NI) to England in order to seek out abortion care during a pandemic. The stories of pregnant people travelling to England and further afield for abortion care isn’t new in NI, but the difference in April 2020, when Robin Swann made that particular statement, was that abortion in NI had been largely decriminalised. Having lost the legislative battle on abortion rights, those in power have instead turned their attentions to creating a hostile healthcare environment for the provision of abortion services. This continues to impede access to abortion care in NI, and is exacerbated by the disruptive circumstances of the COVID-19 pandemic.
Political Obstruction Since the October 2019 Legislation
The Health Minister is openly anti-choice, as are the Democratic Unionist Party (DUP) and individuals from a range of parties across the political spectrum in NI. Fortunately, they are not in the majority and, due to the immense work of Alliance for Choice and a collective of pro-choice organizations, the political landscape has changed significantly when it comes to abortion rights. Nonetheless, challenges remain.
Whilst on paper we have the much needed NI abortion regulatory framework, abortion access, provision and justice remain far from ideal. Robin Swann has declined his powers to commission services, as is explicit in the regulatory framework, and instead declared it a ‘sensitive and conscientious’ issue; this meant that it must go to the Stormont Executive under the terms of the Good Friday Agreement. However, it is doubtful that when the Good Friday Agreement was being drawn up in NI, that abortion was even a consideration by the powers that be. To use a democratic agreement and parliamentary mechanisms, which are aimed at power sharing for anti-sectarian reasons, is therefore most disingenuous.
Following the necessary legislative changes and a cumbersome consultation process, the Stormont Executive blocked the implementation of a fully commissioned service governed by the Health Department. Instead, each Trust was eventually advised, if they wished, they could provide interim abortion services and there was no ‘legal impediment’ in doing so. It was clear that a number of politicians had been desperately holding out for such an impediment in the hope that they could thwart the October 2019 legislation.
The ‘interim services’ referred to are really what each Trust can manage without central governance from the Department of Health, without any additional funding or resources to provide services and without any public information provision from the Department. Additionally, the Central Access Point is reliant, not on the Department of Health who have so far refused to fund it, but on a charity for its operation – Informing Choices NI. Informing Choices NI have assisted women and pregnant people for decades in the absence of adequate statutory funding. Information and pathways to access the abortion provision remains largely reliant on Informing Choices NI and campaigning organizations, such as Alliance for Choice, signposting and sharing as much as our own very limited resources will permit.
Furthermore, whilst those requiring early medical abortion up to 9 weeks and 6 days can mostly access abortion healthcare in NI, service access is less clear for those with particular needs, those of a later gestational limit and those seeking surgical abortion healthcare. Alliance for Choice have been contacted directly by women of both later gestational limits and those for which early medical abortion is unsuitable, asking what they should do as there was no adequate information or service available. Recent Freedom of Information requests, sent by Alliance for Choice to the various Trusts, have confirmed that women are still travelling either to another Trust area or to England to access the abortion care they should be receiving locally. In one Trust alone a health professional has recently advised that they have sent 11 women ‘elsewhere’ (since April 2020) who were beyond a ten-week gestational limit.
Information provision also remains inadequate and the consultation process risks being misused. When Alliance for Choice questioned the Department a number of months ago about the need to put information in the public domain about, at the very least, interim provision, they failed to respond and advised a local journalist they had no plans to do so. This was swiftly followed by the announcement of the Health Minister that he would not be commissioning any new services for two years and planned to do yet another consultation process – this time on the type of abortion service needed in NI. If they don’t know at this point what type of service is needed, either they aren’t listening to those of us who have been forced to travel or they wish to use the mechanism of a public consultation to dilute the regulations – it doesn’t take a genius to work out, it is both.
The COVID-19 Pandemic
In early 2020, Alliance for Choice had hoped for the introduction of abortion telemedicine to mitigate against the obvious risks of unnecessary travel during a global pandemic. However, unsurprisingly, our anticipations exceeded the expectations of those intent on creating as many anti-choice obstacles as possible. Consequently, we have neither the comprehensive abortion provision or the abortion telemedicine we need.
In the midst of a pandemic, those dedicated to abortion service provision in the five main Trusts set about providing what they could. However, on October 5th 2020 the Northern Health Trust took the decision to withdraw their early medical abortion service due to escalating pressures. With the absence of a telemedicine services and given the area was, at that time, one of the worst COVID-19 affected areas in the UK and Ireland, the deafening silence from the Health Minister on how women accessed abortion care in that part of the country was woefully negligent. The service was recently reinstated by the Northern Health Trust, only to be followed by the South Eastern Health Trust withdrawing their early medical abortion services. During the 2-month suspension of early medical abortion services in the Northern Health Trust, Informing Choices NI were contacted by 88 women from the Trust area requesting an abortion, with no local service to which they could be referred. The same picture is emerging in the South Eastern Trust whereby women are being forced to seek medical abortions elsewhere.
Consequentially, evidence has made clear that too many people are still being forced to travel unnecessarily within NI, and some to England, in order to access abortion care. While the anti-choice Stormont politicians fiddle with legislative loopholes to narrow abortion access, these people are being forced down an isolating and dangerous road of forced travel, a situation which is challenging in normal times and near-impossible in pandemic times. Once again, the Health Department is failing to respond to these concerns.
Any abortion care provision which falls short of international recommendations for best practice and places unnecessary barriers which are not rooted in medical evidence, credible research or the testament of abortion seekers and care givers, is nothing short of an abject failure to provide people with the healthcare they deserve. It is denial of their right to free, safe, legal, local and adequate access to abortion care and will ultimately affect those that need it most.
However, despite the continued impediments to access, the picture is not all bleak and we do need to take stock of the fact that a sizeable number of women and pregnant people in NI are getting access to abortion care. Alliance for Choice managed to exert the necessary pressure on government to stop the initial impasse in services and over 700 people up to 10 week’s gestation have gained access from March 2020 to present. This is significant progress, but it is not enough. There are still too many people who cannot access the abortion healthcare they require. Obstruction and stigma continue to affect those who are already at the margins. The pandemic has only increased these challenges. The Northern Ireland Human Rights Commission in mid-January 2021 announced their intention to pursue a legal case against the Secretary of State for NI and the Department of Health for the failure to commission abortion services in NI. Whilst that is welcome news, it should not be necessary. Those of us who have been forced to travel inhumanely or refused abortion care are asking, how many more times do we need to tell our stories or be dragged through the courts to access the healthcare we need and will always need?
We still have much work to do to ensure the human rights-based law is implemented, compliant services follow, and those who require it can access the abortion care they need in a stigma-free environment. We can’t stop and won’t stop until that is realised.
Naomi Connor is Co-Convener of Alliance for Choice, who campaign for free, safe, legal, local and stigma-free abortion rights, access, provision and justice. Naomi has personal experience of forced travel to England to access abortion care, having been refused an abortion in NI prior to decriminalisation. Naomi is a trade unionist and feminist advocate of intersectional reproductive rights and justice.