Wednesday, 14 May 2014

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'Abortion is the one thing that unites us.' Stalemate in Northern Ireland since 1994

Last week, the High Court ruled that women from Northern Ireland are not entitled to free abortion care in England. The judgement put the spotlight back on the injustice that there are women living in the UK on 2014 who are not able to access abortion care when they need it. 

Pro-choice campaigners have been arguing for decades that all women in the UK should be entitled to free, legal abortion when they need it. Seems rather basic, really. Yet any drive for progress is blocked by anti-choice politicians using the same tried, tested, and quite frankly tired, excuses for years. The parallels in this article we found in our archive from the Independent on Sunday on 13th November 1994, for example, are astonishing.

Cartoon from Independent on Sunday, 13th November 1994 

The article below, by Kenan Malik, looked at the ‘implacable opposition to abortion [that] crosses the divide in Northern Ireland.’ Change the date in the top right hand corner of this  and despite being 20 years old the entire article could quite easily be taken from a paper over the weekend. You wouldn’t even need to go to the hassle of getting some new quotes from politicians – the excuses and, to put it politely, misleading statements about the lack of support for abortion among the general population are still trotted out. 

'Abortion as a unifying force in Irish politics' is sadly still very much a barrier to change. Steve Bell’s cartoon in the Guardian on Friday, below, was particularly on the money, and at a recent seminar the fact that abortion is one of the few issues both sides agree on was cited as a key factor in the continued stalemate.

Steve Bell cartoon published in the Guardian on Friday 9th May 2014 

Inconveniently for anti-choice politicians, surveys and polls have been showing for years that a significant proportion of Northern Ireland just don’t agree with their views. Malik’s 1994 article looks at a survey conducted that year by Ulster Marketing Surveys for the Birth Control Trust which showed just that

Belfast Telegraph, 11th November 1994 

Clearly politicians were out of step with public opinion in 1994 – and they still are today. FPA polling has shown that the majority support liberalising the abortion law, and this figure is still growing.  A Belfast Telegraph survey in 2012 also found that one in four in Northern Ireland support abortion on demand – a more liberal system than is currently in place in the rest of the UK. Despite these compelling statistics, politicians have continually ignored the mood for change. The then Secretary of State for Health, Virginia Bottomley, declared in 1994 that ‘there is no will in Northern Ireland for such change.’ In 2014 we have SDLP MLA Pat Ramsey taking over the reigns of blind denial stating that there is ‘no appetite for abortion.’

The experience of women facing unplanned pregnancies women of Northern Ireland in 1994 is also sadly similar to those facing unplanned pregnancies today. The personal stories in this piece of women feeling too ashamed to tell anyone about their pregnancy, of feeling isolation, and of struggling to meet the huge financial burden sadly echo those of the women of Northern Ireland today.

You get a sense of Groundhog Day when reading this article. Women in Northern Ireland are having abortions and they are paying a huge emotional and financial cost. This cost has been imposed by their own politicians, united in their ability to ignore both women’s experiences and the support for change. 

We were all very disappointed with last week’s ruling that women from Northern Ireland aren’t able to access free abortions on the NHS in England. But let's hope in another 20 years time these women will not only be able to access free NHS care, but most importantly able to do that at home. 

Independent on Sunday, 13th November 1994

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Tuesday, 13 May 2014

‘Repeat’ abortion and ‘late’ abortion: the reality behind the controversy

Two important new studies examine women’s reasons for having abortions, dispelling many the myths that surround abortions later in pregnancy, or women who have more than one abortion.

Access to later abortion in Scotland

Carrie Purcell of the University Edinburgh and colleagues conducted in-depth interviews with 23 women presenting for abortion at 16 or more weeks’ gestation in Scotland. Scottish women face a particular problem in accessing abortion, as abortion for reasons other than fetal anomaly is not usually provided in Scotland after 18-20 weeks.

The study found that some of the women did not realise they were pregnant until relatively late in pregnancy, sometimes because they were using contraception. Some of the women took ‘were ambivalent about both the pregnancy and the prospect of having an abortion’, which leading a delay in accessing services. A further group of women ‘had initially decided to carry their pregnancies to term experienced changes in life circumstances that were largely beyond their control, and the subsequent decision to have an abortion led to a later presentation for health services.’

These findings support those of other studies about British women’s reasons for seeking late abortion – notably, the work by Roger Ingham and colleagues, which revealed why, no matter how much access to abortion early in pregnancy is improved, a proportion of women will always need access to later abortions – because they don’t realise they are pregnant, or their circumstances change, or they need time to make their decision.

The new study by Purcell and colleagues additionally found that in Scotland, access issues in later abortion present a major additional problem. While 13 out of the 23 participants were able to have an abortion locally, others had to deal with the financial, logistical, and emotional burden of travelling to England. The authors write:

‘Women who did travel to England had to mobilize a range of resources, including financial, practical and emotional support, and access to these varied. Travel costs – train tickets or flights and 2–3 nights’ accommodation, booked at short notice – were high. The women who travelled were in a range of socioeconomic positions, but none found it easy to obtain such funds, and none was clear on how to claim reimbursement from health services. Una – who was 24 and had an abortion at 21 weeks –had been able to fund a trip to England, but she was informed while en route that because of a health complication, she could not have the procedure at that time. This necessitated her returning home (a 17-hour round-trip) and rebooking travel and accommodation for the following week.’

The authors also note the contradiction that women having treatment for miscarriage, or abortions for fetal anomaly, did not have to go to England for these procedures, and the women in their study ‘felt there was judgment in this disparity’. The authors’ conclusions are worth quoting in full:

‘Many reasons for later presentation at health services could not have been foreseen by the women we interviewed. Our findings suggest that women need adequate time to consider the conflicting candidacies of motherhood and having an abortion, and that the additional work required to obtaina later abortion is a source of inequity. Indeed, women who have to travel for an abortion are aware of the differential service provision between themselves and others being treated locally for later miscarriage or fetal anomaly. The burden of traveling to England presents one of the most significant barriers to later abortion for women in Scotland, exacerbates an already potentially difficult experience, and contributes to abortion stigma and discrimination. This study highlights that it is not only in countries with restrictive abortion laws that women face barriers to service access. Future efforts to improve health care services should include a policy focus on reducing barriers to abortion access and improving provision of later abortion.’

Young women’s contraceptive use after abortion
Another study, conducted for the reproductive health charity Marie Stopes International, looked at the contraceptive use of women aged 16-24 having one or more abortions. Interviews were completed by 430 women aged 16 to 24 who booked an abortion at its centres, 121 of whom had previously had an abortion.
This study found, strikingly, that more than half (57%) of women were using contraception when they became pregnant. The majority were using short-term methods, such as the pill (54%) or condoms (40%); and 12% had used emergency contraception.
The study further found that uptake of contraception at four weeks post-abortion was high, at 86%, but 67% used their chosen method for less than a year. Reasons for stopping included menstrual irregularities for long-acting reversible contraception (LARCs) and not renewing supply in time for pills and injections.
The full report of the MSI study has yet to be released. However, an excellent commentary by Lisa Hallgarten on the Reproductive Health Matters website provides some context. Hallgarten writes:
‘When I and a colleague at Education For Choice undertook research into the phenomenon of repeat conceptions leading to repeat abortion amongst teenagers in 2007, it became clear very quickly that the term “repeat abortion” is a misnomer. It suggests that a woman is in some way thoughtlessly or compulsively repeating a negative action, whereas the truth is that each abortion is a separate and unique event in a woman’s life. Whether her abortions take place within a year, or twenty years apart, her circumstances, health, the status of her relationship and her emotional attachment to the pregnancy may all be very different. The way in which she got pregnant, her chosen method of contraception and consistent or inconsistent use of that method may also have changed from one unintended pregnancy to the next. Having a “repeat abortion” may engender feelings of guilt at ‘failing’ to prevent a second pregnancy, or it may feel safe, straightforward and familiar the second time round. When we talk about “repeat abortion” we make this complexity and the stories of women’s real lives invisible.’
Hallgarten goes on to talk about the way in which the stigma surrounding ‘repeat’ abortion can have an adverse effect on women’s contraceptive decision-making. ‘Feeling bad about a first or “repeat” abortion is not a good basis for making a positive choice about future contraception,’ she writes. ‘It can result in feelings of fatalism (which is very bad for decision-making); lack of trust in service providers or feeling untrusted by them; or agreeing to, rather than positively choosing, a recommended method of contraception. Likewise professional anxiety about preventing future unintended pregnancy may result in promoting, rather than offering, long acting reversible contraceptive methods.’
Hallgarten concludes:
‘I only wish that we could lose the idea that the most effective way to reduce stigma is by reducing the incidence of “repeat abortion”. This idea reinforces the messages from politicians, funders and the media that tell us “abortion just about ok, repeat abortion bad”. But what if we can’t eradicate “repeat abortion” simply by improving contraceptive services? What if, as our research found, women’s complex and sometimes chaotic lives and relationships play as much part in unintended conceptions as contraceptive provision or lack of it? What if, as is increasingly being articulated, there are women who simply cannot find a contraceptive method that works for them. Shouldn’t we focus on reducing the stigma of “repeat abortion” in and of itself?

‘Abortion is not the onerous journey it once was: the procedures can be provided very early and are extremely safe. If a woman feels happiest using a less reliable contraceptive method such as condoms and doesn’t see having one, two or three abortions across her 35 fertile years as a problem, why should we?’

This post was originally published on the bpas Reproductive Review

Thursday, 17 April 2014

A 'United' Kingdom? Disparity in abortion legislation between Great Britain and Northern Ireland

Last week, we attended a seminar by Jennifer Thomson, a PhD student at Queen Mary’s University London, looking at the continued disparity between abortion legislation in Great Britain and Northern Ireland. It was mainly students in attendance and we thought, why should they hog all the learning fun?’, so decided to write this short post.

The 1967 Abortion Act, which legalised abortion in England, Scotland and Wales, was never extended to Northern Ireland. In 2008, Diane Abbott MP’s amendment to the Human Fertilisation and Embryology Bill presented an opportunity to do just that, but it was sadly unsuccessful. A transfer of justice powers to Stormont in 2010 means that this was probably the last chance for Westminster to effect such a change in Northern Ireland. The power to end the inequality now firmly resides with Northern Irish politicians.

Abortion is, in theory, legal in Northern Ireland in ‘exceptional circumstances.’ However, a complete lack of clarity as to what actually counts as an ‘exceptional circumstance’ means that it is impossible for the vast majority of women to obtain an abortion in Northern Ireland when they need to.

Social attitudes are now out of step with the law, with a recent poll by the Belfast Telegraph finding that 46% support liberalisation. Thomson pointed out that the majority of polling suggests a greater acceptance for abortion on medical rather than social grounds: the Northern Ireland Life and Times survey found that only 25% thought that abortion was wrong in cases where there was a strong chance of “a serious defect in the baby” whereas a greater proportion, although still the minority, thought abortion on the grounds of a family’s financial difficulties was always wrong (43%). Currently, the government is only considering legislation for abortion in cases of fatal foetal abnormality which, while incredibly important, would only help a very small handful of women.

Why has there been so little movement on abortion rights in Northern Ireland? Thomson suggested that the continuing power of religious authority, much greater than that in the other nations, plays a crucial role, with abortion one of the few issues that bridges the strong religious divide. Thomson also argued that the idea of equality is largely seen in the context of creating parity between the two communities, rather than between men and women. Abortion rights campaigners are not alone in facing these difficulties and Thomson pointed to similarities with the LGBT rights movement. Northern Ireland refused to follow suit when the rest of the UK legalised same sex marriage and adoption, with the Northern Irish Attorney General stating at the time: "what happens in Scotland, England and Wales does not constitute a line into which Northern Ireland must be brought”, a phrase which could easily have been said in the context of a debate on abortion.

So after it was thoroughly - and depressingly - established that politicians are content to keep their heads firmly stuck in the sand, the discussion moved on to what pro-choice campaigners can do to help bring about the change Irish women so desperately need.

The government’s decision to act on abortion for fatal foetal anomaly only occurred because brave women were able to tell their stories, leading to a public outcry that couldn’t be ignored. But, as Thomson pointed out, it is very difficult to create a similar wave of public sympathy when a culture of silence and stigma still presides, in particular around terminations for social reasons.

Luckily, we were joined by Speaking of I.M.E.L.D.A., a group challenging the ongoing problem of Ireland making England the legal destination for abortion (hence the name.) One campaigner said it is very hard to get the public to support a cause that is barely spoken about, but there is a growing pro-choice movement working to raise the awareness that is needed for change.

It is unjust that women in Northern Ireland are denied the rights offered to women in other nations in the UK. Campaigners have been working to end this inequality for decades, and the polls are now showing that the public attitude to abortion is shifting. Try as they might (and they really are trying very hard), politicians can’t continue to ignore this issue, and they can’t continue to ignore the needs of the women of Northern Ireland. As one activist said as the event was closing, “we’ve have been campaigning for 20 years – and this time we’re not shutting up.”

Hear, hear. 


Friday, 11 April 2014

Abortion: Ten Years On - articles from 1978

In the third post from the bpas archive we are sharing extracts from a publication called ‘Abortion: Ten Years On’. The Abortion Act received Royal Assent on 27th October 1967, and six months later on 27th April 1968 it came into force. This booklet was published by the Birth Control Trust in 1978 and features articles written by those closely involved in campaign for legal abortion in England, Scotland and Wales.

The first piece is from Alastair Service, the chairman of the Family Planning Association, and paints a fascinating picture of his time as a lobby organiser for the Abortion Law Reform Association  while the 1967 Abortion Act passed through Parliament.

He takes us through the initial repetitious days he spent scurrying across the Central Lobby approaching MP’s – some of them were “fiercely bearded”, a wonderful description I hope to hear more often. There were also mass lobbies, but unfortunately MPs didn’t really turn up. So they went to the Bar where funnily enough they found a large number of MPs to lobby. There were some barriers to cross: one MP told Service “send me all your stuff and I’ll talk it over with my wife”, while another declared “I don’t vote on things like that – I concentrate on the major issues”, presumably referencing the  Domestic and Appellate Proceedings (Restricting of Publicity Bill) which was competing for members attention at the time. Crucial stuff….

Service and his fellow campaigners ploughed on, rounding up MPs, nagging them during the late night sittings until they promised to stay to vote. Eventually while Service and Houghton were in a café and chatting about a campaign for free contraception, the final stage passed. The lesson: a watched Parliament never votes. Best to go and have a cup of tea.


One MP who Service definitely didn’t need to nag in the late hours of the evening to back the Bill was it’s architect David Steel. He is naturally pleased to celebrate the ten year anniversary of the abortion law reform in 1978. A parliamentary inquiry in to the Act found that it was responsible for “relieving a vast amount of individual suffering.” He took on those who said he wanted to kill babies, that he was going to hell, that he didn’t care about families, and he won. And yet he still speaks of the “respect” he has for his opponents. It seems more than fair that the authors of this booklet decided that he should be depicted as a knight (albeit at first glance a little confusing.)

While, as Lena Jager MP notes in another chapter in the book, “nobody will ever be able to prove statistically the impact of the 1967 Act” that Steel fought for, Madeleine Simms, the former press officer at Abortion Law Reform Association, quotes from an inherited scrapbook full of late 1930’s news clippings that prove in a much more powerful way than numbers ever could what the Abortion Law has meant for women.

These articles document the tragic conditions under which illegal abortion took place, and the risk women took with their lives and health when faced with an unwanted pregnancy. One case detailed is of a 36 year old woman who died from a “septic abortion followed by acute blood poisoning”, after deciding that 10 children in 17 years was enough. Even the Coroner expressed his sympathy, stating that he could “understand the desperate feeling that she must have had when she found herself once again pregnant.”

These also show how, despite the illegality, there was a community that worked together to provide abortions for these desperate women in a safer environment than those found down a back-alley. These “medical men” were breaking the law, but they were valued and supported, with defence funds raised when they faced prosecution. And when Dr Daniel Powell of Tooting , “the most watched medical man by Scotland Yard” died, “women from all parts of the country journeyed to London” to pay their respects.

Simms wrote that the scrapbook demonstrated the importance of free, legal abortion to those who in the late 1970s wanted the return of a restrictive abortion law, but the picture they paint serves as just a useful a reminder of life without legal abortion today.

For further updates from the bpas archive follow us on Twitter or search the hashtag #bpasarchive

Tuesday, 8 April 2014

Protecting pregnancies with a slice of bread – why we should back flour fortification

There are many circumstances that affect whether a woman decides to end a pregnancy which we simply can’t change.

We can’t conjure up the financial security she wants before she brings a child into the world, however important the campaign for secure maternity benefits and high quality, affordable childcare.

We can’t transform the man she’s accidentally conceived with into the man she wants to start a family with. We can’t eliminate the needs of her existing children whom she feels must come first. 

But every now and then, there are things we really can do to make a difference.

Everyday, women find themselves in the tragic situation of being told their pregnancy is affected by a neural tube defect (NTD) such as spina bifida or anencephaly. Spina bifida causes serious lifelong disability while anencephaly, where the baby’s skull and brain do not form properly, is always fatal. This country has one of the highest rates of these conditions in the European Union, resulting in an estimated 1,000 cases per year, not including those that end in miscarriage.

The most effective way to reduce NTDs is for women to take a supplement of folic acid in the months before they start trying for a baby, as the neural tube develops in the very early stages of pregnancy - before a woman often knows she’s expecting. But as we in our service know only too well, pregnancies happen when women are often least expecting them. Two thirds of the women we see with an unplanned pregnancy report using contraception when they conceived.

Many unplanned pregnancies end in abortion, but many others are greeted as welcome surprises. It's estimated that between one third and a half of babies are the product of these happy accidents.

But happy endings are not guaranteed.

We believe it's simply unrealistic to expect women who are not planning a pregnancy to be taking folic acid supplements on the basis that they might conceive. Fortifying our flour with folic acid would mean that this vital nutrient entered everyday foods widely consumed by women of childbearing age, whether they were trying for a baby or not, and prevent hundreds of cases of spina bifida and anencephaly a year.

It could spare a couple a day from the heartbreaking decision to end what was a much wanted pregnancy. These cases are among the saddest we see in our clinics.

It is now six years since the Scientific Advisory Committee on Nutrition (SACN) first recommended flour be fortified –  and the UK’s chief medical officers considered and approved that recommendation. The UK has been adding  calcium, thiamin, niacin and iron to wheat flour for more than 50 years so both the principles and the mechanics of fortification are already in place.  
The move is supported by disability organisations and those involved in women's pregnancy care like bpas. The decision now lies in the hands of UK health ministers.

They should follow the example of the US, Canada and Australia, which have all introduced fortification. There is now no evidence of any adverse impact on the rest of the population, but plenty to show this protects women and their babies.

It was scientists from the UK’s Medical Research Council who proved in the early 1990s that folic acid could prevent these defects. More than two decades have passed and it’s now high time that UK women and their babies were able to reap the full benefits of their work.

Thursday, 3 April 2014

Happy 40th Birthday, free contraception!

From 1 April 1974 all contraceptive advice and supplies became free on the NHS, and available to all women. 40 years on, we celebrate the anniversary of free contraception in the UK and call for the next step forward.
The contraceptive pill was first licensed in 1961, yet initially restricted to those deemed wise enough to use it, and worthy of its privileges – those bastions of moral responsibility who are older married women. So hoorah for the less celebrated year of 1974, when contraception became free of charge for all women, regardless of age or marital status.
It’s hard to think of a development which has brought about such a monumental change in women’s lives, their role in society, and their relationships with men as free access to contraception.
The Pill enabled women to take control of their biology. Family sizes shrunk, motherhood was delayed, and women began to occupy those spaces that had previously been the sole domain of their male counterparts. Alongside access to safe, legal abortion, women could start to make genuine reproductive choices.
Yet while we can celebrate the 40th anniversary of free access to this revolutionary pill, this birthday is also the occasion to reflect on what we want from contraception over the next four decades – and ideally before we reach the last half of the 21st Century.
We should be asking why we are not seeing the investment, effort or drive to develop new methods of contraception that actually meet women’s needs. There seems to be a prevailing sense of “job done” when it comes to contraception, and ongoing barriers to technological advances in this field. While we have seen a few new methods enter the market over the last decade of so, these are by and large variations on the dose and delivery of the same medication.
Hormonal contraception should be celebrated for the huge advances it has brought, but it’s not for everyone. While there are women who will swear by their contraceptive implant, there are others who find themselves begging the doctor to remove it. We need new methods without the side effects such as irregular bleeding, weight gain, nausea or lower libido. We need a greater choice of non-hormonal methods for those women who do not wish to use hormones or who cannot.
We need methods better suited to the reality of women’s lives and an acceptance that some women don’t want to use barrier methods like condoms or diaghrams but also don’t feel they are having sex regularly enough to warrant remembering a daily pill or having a long acting IUD or implant inserted. A pericoital pill, which could be taken at the time of sex, would represent a huge breakthrough for those women.
And we need to take politics out of pills. Researchers have noted that one of the major barriers to contraceptive development is the fear of controversy – so, for example, it would be possible to create a monthly pill that would either stop a fertilised egg implanting or detach it from the lining of the womb, yet concerns about the reactions from those who would see this as an abortion have put the kybosh on its development. Some women may well have their own personal position on whether this method is right for them – but shouldn’t that be their choice to make?
And lastly, we need methods for men. Men need something in between the two extremes of condoms and vasectomies, and the argument that most women wouldn’t trust men with their birth control is insulting to the many men who we know are keen to share the burden of contraception with their partner.
So hooray for free contraception. Thank you 1974. But it’s 2014 now – and women deserve more.
This piece was originally written for and published by Feminist Times

Thursday, 27 March 2014

Nick Clegg calls opposition to morning-after pill “patronising” and “sexist”

Earlier this morning on his LBC show, Nick Clegg, perhaps fired up from his head-to-head with Nigel Farage last night, launched a passionate attack on those who oppose making access to the morning-after pill easier for young women.

Yesterday, National Institute for Health and Care Excellence (Nice) produced new guidance stating that young women should be allowed to keep emergency contraception at home, so they have immediate access to it if they need it. Nice also called for the morning-after pill to be available free of charge to all women under 25.

Yet there has been the inevitable outcry from certain politicians and journalists – a reaction which Clegg described as being based on out-dated "medieval" attitudes towards women.

The Deputy Prime Minister said "I am absolutely appalled and really very angry on behalf of many, many women across the country about the suggestion that giving a woman the right to buy a morning-after pill will somehow automatically lead to more promiscuous behaviour.

"I think it is demeaning, I think it is patronising, I think it is sexist.

"Women don't take a morning-after pill lightly. It is not something you casually do. To say to a woman she can't have the right, in case she has unprotected sex, to have a morning-after pill available because we - the Government, society or whichever newspaper columnist is pontificating about this - think she will suddenly become terribly promiscuous, I think is an absolute insult to women across the country.

"I believe the experts, who have quite clearly said that providing the morning-after pill and other forms of contraception - the evidence is very clear - doesn't lead to more promiscuous behaviour. It does help prevent unwanted pregnancies.

"This is lifting the lid on a really fundamental difference in attitudes towards women. Women shouldn't be told 'We are not going to give you the freedom to buy something from a chemist because we don't trust how you will behave sexually'. It's a Victorian - worse than that, medieval - approach to women."
Nick Clegg said that doctors should encourage girls under 16 who are considering contrac eption to talk to their parents, but that : "At the end of the day, when you are faced with the reality of a teenager who is in trouble, you as a medical expert want to help them, and I think for us to decree that they can or can't help someone isn't going to alter the fact that that 16-year-old is in trouble.

"I don't want to see teenagers - or anybody, it at all possible - suffering an unwanted pregnancy. I don't want to see the very high rates we have had in the past of unwanted pregnancies.

"The way to deal with that is to make sure we go with the evidence that if you provide people with education and information and make contraception available on a responsible basis, that is the way we stop unwanted pregnancies, not by resorting to really out-dated attitudes towards women."

We agree with Nick.

Monday, 24 March 2014

Maternity care is not just a British right - it's a human right

The right of pregnant migrant women in the UK to access and receive vital maternity care is in jeopardy, as a result of proposed NHS charging policies and the Immigration Bill, currently in the House of Lords. We are working with Maternity Action and the Royal College of Midwives to campaign to ensure that all women have access to the maternity care they need.

Below is a guest post from Maternity Action, the UK’s leading charity committed to ending inequality and improving the health and well-being of pregnant women, partners and young children.

Maternity care is classified as a human right and as such is protected by the European Convention on Human Rights, which prohibits all pregnancy-related discrimination, including making it unlawful for NHS organisations or clinicians to discriminate against pregnant women on the basis of disability, race, religion, immigration status and national origin. In line with this, a pregnant woman’s right to receive maternity care on the NHS is protected in the UK as ‘immediately necessary treatment’, which means it should not be refused or delayed for any reason.

Under current rules, women are chargeable for maternity care if they are not ‘ordinarily resident’ in the UK and do not fall within other exempt groups. Women who are chargeable should receive an invoice for treatment, often early in their pregnancy, but should not be refused care if they are unable to pay. If a woman does not pay, the Home Office may be notified and choose to deny subsequent immigration applications, pending payment of the debt.
Present rules on charging for maternity care are already complex and confusing, poorly understood by migrant women, and poorly implemented by trusts and NHS staff. Government research suggests that NHS trusts have incorrectly classified as many as 30% of the people that were assessed and so charged people entitled to free care.

Recent government proposals in the Immigration Bill are very likely to exacerbate the problem pregnant migrant women already face in accessing maternity care, including in some recent instances of women being denied care because of their inability to pay, despite the rules against this. These provisions are part of a broader programme of changes to migrants’ access to NHS services, proposed in a Department of Health consultation last year. Among other things, the Bill: introduces a ‘migrant levy’ on visa applications, whereby an upfront fee will have to be paid to access healthcare; significantly expands the group of migrants who are chargeable for NHS care; and, extends charging to aspects of primary and emergency care. Crucially, and in addition to this, it identifies and pursues chargeable migrants much more aggressively, including requiring NHS staff to essentially ‘police’ who is chargeable for care based on their immigration status.

Charges at the point of care create additional and unnecessary risks that women will choose not to see a midwife throughout their pregnancy or may even avoid hospitals altogether and try to have their baby at home. For those that do see a midwife, many only see a midwife very late in pregnancy, or try to see a midwife only to be denied access to care because of their inability to pay. This can prevent midwives from identifying and treating health conditions early in pregnancy such as, HIV, Hepatitis, Rubella and Syphilis – leading to significantly worse health outcomes for vulnerable migrant women and their babies, as well as complex, costly interventions at a later date. Furthermore, 20% of all maternal deaths are to women who commenced care later in pregnancy (after 22 weeks), missed more than four antenatal visits, or had no antenatal care at all.

We know that vulnerable migrant women already have significantly worse maternal and infant health than the rest of the population. The National Institute of Health and Care Excellence recognises this and has issued guidance, which identifies recent migrants, refugees and asylum seekers as a distinctive risk group and recommends that care providers take additional measures to promote early engagement with maternity services. Yet these changes are likely to make it much harder for vulnerable and at risk women to access maternity care.
Whilst it is true that under these proposals all pregnant women in the UK will still legally have the right to receive maternity care, the question remains, in practice will they receive it? Will they feel confident to access routine and vital antenatal appointments if they fear doing so will result in costly fees they cannot afford and may be used against their future visa applications? Will they choose not to endanger their life and that of their unborn child, by going to hospital when they are in labour, rather than staying at home, if they fear it will result in deportation? The reality is vulnerable pregnant migrant women residing in the UK are a lot less likely to feel empowered or supported to exercise their human right to maternity care should this legislation, in its current form, become law.
To learn more about the campaign or to get involved, such as through writing to your MP, visit the Maternity Action website here or contact Sarah LaPham, Public Affairs and Campaigns Officer at Maternity Action 

You can also follow this campaign on Twitter: #MatCare4All

Thursday, 20 March 2014

Ministers must act now to protect the health of women and their babies

At bpas, we see hundreds of women who are making the incredibly painful decision to end a much wanted pregnancy after a diagnosis of a neural tube defect such as spina bifida and anencephaly. There are an estimated 1,000 cases of these conditions diagnosed in the UK every year. Spina bifida causes lifelong disability while anencephaly, where the baby’s skull and brain do not form properly, is always fatal.

Sadly the UK has one of the highest rates of neural tube defects in the European Union, and it has remained largely unchanged since the early 1960s. Yet one simple measure could dramatically reduce the numbers of these cases – the fortification of flour with folic acid.
To avoid these conditions, women are advised to take folic acid supplements and up to 12 weeks in to their pregnancy. But in the UK nearly half of pregnancies are not planned, so many women are unable to take these supplements at the point when it will have an impact on the healthy development of their pregnancy.  The neural tube will have formed around the time a woman misses her first period. Mandatory fortification of flour with folic acid would mean the vitamin entered everyday foods widely consumed by women of childbearing age, like pasta and bread.
This is why we are calling on the UK’s health minister to implement the recommendations made seven years ago by the Scientific Advisory Committee on Nutrition that flour be fortified, recommendations that were approved by the UK’s chief medical officers.
This wouldn’t be a big change from current practice – the UK has been fortifying flour with calcium, thiamine, niacin and iron for over 50 years. The principle and the mechanics are already in place. And countries which have introduced mandatory fortification, such as the US and Canada, have seen a big drop in the numbers of cases of neural tube defects, with no evidence of adverse effects on the rest of the population. So why doesn't the UK follow suit?
Unplanned pregnancy is a fact of life, and it is often wonderful news for women and their partners. But it is completely unrealistic to expect all women to be regularly taking folic acid supplements on the basis that they might conceive.

The fortification of flour with folic acid is a simple measure with huge benefits. Our message to the UK’s health ministers is simple – act now to protect the health of women and their babies.

Wednesday, 12 March 2014

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We hope it will be a space where people can ask questions, share experiences and advice, and get support on a a range of issues including abortion, sexual health, contraception, fertility, and pregnancy. All members can be completely anonymous, and we have one of our Nurses on hand for any specific medical queries.

It is completely free to sign up and only takes a couple of minutes - for more information or to join, visit the community here.

Monday, 3 March 2014

In Desperation - Letters to the Abortion Law Reform Association from the 1960s

During the 1960s, the Abortion Law Reform Association received thousands of letters from women, their relatives and friends, all desperate for advice about abortion. The booklet below includes a selection of these incredibly poignant letters.

These letters represent a tiny handful of all the women who needed abortion care before the Act of 1967, and the vast majority would have been forced to continue with their pregnancy despite their circumstances. These were women who were suicidal, women who had experienced multiple miscarriages, women with severe medical conditions, women who had been abandoned by their partners, women living in poverty without enough money to support their existing family, and women who just simply couldn't cope with having a child.

We will be sharing individual letters on Twitter for the next couple of weeks using the hashtag #bpasarchive , and a gallery of the full booklet is below.



Wednesday, 19 February 2014

Spain is heading for a self-made mess with their new abortion law.

Spain's controversial, and highly restrictive, new abortion law is now before Parliament, with approval looming.

If passed this would mean that abortions will be permitted in only two circumstances: rape, and risk of "lasting harm" to the mother's health. The move would effectively reverse the abortion law of 2010, which permitted abortion on request in the first 14 weeks of pregnancy, and up to 22 weeks where there was serious risk of fetal anomaly.

All photos via My Belly Is Mine
The widespread opposition, both within Spain and elsewhere in Europe, indicates that the Popular Party's interest in the abortion law is not underwritten by a wider public and political desire to restrict abortion access. Throughout most countries in the developed world, with notable exceptions such as the Republic of Ireland, women's need for abortion is recognized by law and provided for through services, which are often publicly funded.

But the Spanish situation provides a shocking reminder of how quickly things can change in a country -- and the extreme consequences this can have for women.

Back in 2004, a British newspaper wrongly accused bpas of referring women to Spain, when they were "too late" to have an abortion in Britain.

The reality was that doctors in Spain were, at that time, legally able to provide abortions at later gestations than the 24-week "time limit" permitted by British law. In the extremely rare cases where women were desperate to access abortion late in pregnancy, they would sometimes find that only a Spanish clinic was able to help them.

The Spanish law of 2010 restricted abortions in later gestations, but did establish abortion on request earlier in pregnancy. Yet barely five years on, Spanish women find themselves effectively deprived of any ability to access abortion at any gestation.

Will this mean that their need for abortion goes away? Of course not. What it means is that Spanish women, like Irish women, will be forced to travel for care to Britain and other European countries.

The Irish experience shows with heartbreaking clarity that when a nation makes abortion illegal, it does not prevent women's need for abortion, or their determination to access safe procedures. Outlawing abortion simply sends the issue overseas, increasing the financial and emotional cost to women and, of course, the gestation at which they are able to access a termination.

Politicians in the 21st century must accept that abortion is a necessary back-up to contraception, and that it should be a woman's private and personal decision that she is able to make according to what she thinks is best for her and her family. It is a travesty that abortion is included in the criminal statute in so many countries -- including Britain.

As a moral matter it should be for a woman to decide in line with her values; she should be allowed to take responsibility for life and choose what she thinks is best. As a medical matter, if should be regulated like any other medical procedure.

This point was put very nicely by the Times in December 2013, in a leading article challenging the new Spanish law.

"To bring the criminal law into an issue of women's health and conscientious reflection is an abuse of government power," argued this establishment newspaper. "A constitutional society does not intrude into areas of personal judgment that most citizens consider fall within the authority of the family. Social engineering is the practice of autocratic governments."

Spain is heading towards a self-made mess. We know from the situation in the Republic of Ireland, and Northern Ireland, what the consequences of its new law are likely to be. The lesson for other governments is that they should stay out of women's personal decisions. "Nosotras Decidimos," proclaim the Spanish women's organizations protesting against their inhumane new law -- "We Decide."

Throughout Europe, organizations such as BPAS will be standing behind them, and providing the services that these women need. But how much better it would be if they could access this care at home - as, until so recently, they could.

My Belly Is Mine campaigns to keep abortion legal and safe in Spain. The group is based in Britain and you can follow them on Twitter here.  
This article was written by our Chief Executive, Ann Furedi, and was orginally published by CNN.

Monday, 17 February 2014

From the bpas archive: The Abortion Law pioneers

Nearly half a century after the Abortion Act, the battle for women’s autonomy over their own bodies continues.

Over the last few years, there have been numerous attempts at restricting women’s access to abortion care. From legislation in the House of Commons to placards outside our clinics, we have seen a significant upsurge in anti-choice attempts to erode women’s hard fought for rights.

This is why we felt it was important that we open up the bpas archive, and look again at the work of campaigners so vital to the foundation of abortion rights in this country. These campaigners from the 1960s are of course inspirational, and we can also learn from the ways the debates around abortion and women’s reproductive choices has shifted – and in some ways stayed painfully static – over the last 46 years.

Our first post from the bpas archive is by Diane Munday, an abortion rights activist and former general secretary and vice-chair of the Abortion Law Reform Association, who very kindly donated material to bpas and The Wellcome Trust which enabled this archive project to take place. Diane wrote this piece 40 years after the Act was passed, reflecting on why she became involved in the movement, along with extracts from a 1967 ALRA leaflet:

I once knew a woman who had a backstreet abortion and died: a married woman, already the mother of three young children, who just could not afford another child. I was absolutely shocked. It was the first time I had come across abortion. I was in my early twenties, working at St Bartholomew’s Hospital doing research, and I mentioned it to a group of doctors one lunch time. They looked at me in amazement, and said words to the effect: ‘Well, where have you been all your life? Stay behind on Friday.’ I discovered that Bart’s and all the other London hospitals put wards aside every Friday and Saturday night for women who were brought in as a result of backstreet abortions – Friday being pay day. Bleeding, septic, sometimes dying. This was accepted everywhere.

I put it to the back of my mind. Then, during my third pregnancy, I was very uncomfortable and not sleeping well – I am a diabetic and I had very large babies. My doctor gave me a prescription for Thalidomide (a drug found to cause disability), which I never took, and I was so thankful that my son was born perfectly alright. I was aware of a number of people in the area who had badly handicapped children. I saw a letter in the Observer, talking about the Abortion Law Reform Association (ALRA). I wrote and joined because, having thought about it deeply probably for the first time, I came to the view that if I had taken that drug, and had developed a handicapped fetus, I would have wanted an abortion.

Initially I was a fairly inactive member of ALRA – and then I became pregnant again for the fourth time in four years. I just knew that there was no way I could cope with a fourth child at that time. I was married, we had a reasonable income, but it was an instinctive drive telling me our family was complete. Nothing, nobody could have made me have that child. For the first time, I recognised the feeling, the strength of the drive that forced women, like the one who had died previously, to damage themselves, to take the risks they took to end a pregnancy. We all have our limits. For some it can be after one child, for others it can be before they have any children, and for some it can be after 10 children. It is an individual drive and so must be an individual choice.

I was fortunate. After a lot of asking around, a lot of heartache, I bought my abortion in Harley Street. The first NHS consultant I asked about an abortion treated me like dirt: ‘My wife’s got four children and she manages perfectly well, what’s the matter with you?’ Then a wet-behind-the-ears trainee psychiatrist informed me that my problem was in my relationship, that my whole life was a mess, and I should have this child and go up to London for psychiatric treatment three times a week. As far as I could see the only major problem in my life was that fourth pregnancy and to suggest I should travel 60 miles a time, three days a week with four underschool-age children just showed he didn’t know what real life was about.

A woman I had met on holiday gave me the number of a Harley Street doctor who her neighbour had been to. I was utterly terrified when I went in to see him. He said, ‘You look terrible, would you like a drink?’ and got out a bottle of gin. Everything I had ever read about backstreet abortionists flooded back to me! However, he was an extremely highly qualified man. Years later, when I persuaded him to give some money to ALRA, I asked him how he had got into doing abortions. He told me that, when he was a young doctor, a woman had asked him for an abortion and he had sent her away, told her to have the baby and that she would grow to love it. She hanged herself that same night, and he said he felt he had killed her as surely as if he had put a gun to her head.

He sent me to see a psychiatrist, for 10 guineas to get a certificate – this was 1961 – to show that I was so mentally disturbed I could not cope with another child. The gynaecologist then told me that he had booked me into a nursing home the next week and it would be £150. We could not raise £150 – that was the equivalent of over £1000 today. So in my naivetĂ© I asked him, ‘Could I take sandwiches in and I don’t mind sharing rooms?’ He came back and asked if £90 would be alright. It absolutely broke us. But I had my abortion. I was alive and well and without the pregnancy that I could not contemplate, and I knew other women in similar situations were dying.

When I came round from the anaesthetic, I could not thank God because I don’t believe in God, so I made a very muddled vow to myself. I woke up thinking of the woman who died and others who would die and that it was because I had a cheque book to wave in Harley Street that I was alive. At that point I thought, ‘I am going to get involved in this, I am going to do what I can for women who don’t have cheque books so that they too can have what I saw then and still see as the privilege of a safe abortion’

That provided the spark for 30 years of campaigning. I went to the next ALRA annual general meeting, and that was when I met Madeleine Simms. Before I knew where I was. I was on the ALRA committee, never having sat on a committee for anything in my life. But I became determined to go out and talk about it. I went to public speaking classes and took all my medals. I think I was probably the first person that said in public, on television and the radio, that I had an abortion. It was a word that you could not say, it was never mentioned. It is impossible to imagine those days.

We will be sharing more pieces from the bpas archive - for regular updates, search #bpasarchive