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. 

 

Photo via Alliance for Choice

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

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.

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

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.

 

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

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.