The Struggle to Access Medical Abortion in Northern Ireland During the Pandemic: An Interview with Alliance for Choice’s Naomi Connor
In the last week of February, the UK government agreed to make abortion pills for use at home accessible during the COVID-19 outbreak. In a bat of an eye, they turned back on their decision. Later, after much pressure, the Department of Health and Social Care, appointed that emergency measures were necessary to ensure that women could access essential abortion services from home for two years or until the pandemic comes to a close.
Those in the UK have been able to access those services. Scotland and Wales already have medical abortion at home available, and the legislation above applies to England. However, it still doesn’t apply to Northern Ireland (NI), though abortion was decriminalized there in October 2019. Abortion services were to be introduced in Northern Ireland in April of this year, but did not come to fruition given the pandemic. As of right now, it isn’t clear how or when this situation will be sorted.
In an interview via email, Alliance for Choice co-convener Naomi Connor explains how this ordeal affects pregnant people and their families in Northern Ireland, the obstacles presented to abortion services by religion and the educational system and talks about how the public system is turning their backs on those in need.
Scarleteen (ST): Women and gender-diverse people in England are able to access medical abortion (abortion pills) at home during quarantine. What does that say about human rights in UK?
Naomi Connor (NC): Women and pregnant people were eventually able to access abortion pills in the UK after campaigning organizations put pressure on the Minister and Department of Health (Robin Swann) to do so. When lockdown commenced, the department initially published information on their website saying they intended to provide telemedicine and, without explanation, this was removed within hours and they said they had no plans to do so. Organizations such as BPAS (British Pregnancy Advisory Service) began to put significant pressure at governmental level and eventually telemedicine was provided in the UK.
Abortion still operates in the UK under the 1967 Abortion Act and is, therefore, operating in a criminal framework, when it belongs in a healthcare framework.
There are organizations campaigning to decriminalize abortion in the UK. The need for human rights is well understood and what recent developments in respect of telemedicine for abortion has demonstrated is that it is less about misunderstanding but more about unwillingness and opposition to a rights-based society.
ST: Those from Northern Ireland don’t currently have this option. Why isn’t it available in your country?
NC: The current Minister for Health in NI is anti-choice and has refused to act to enable abortion services to roll out once the regulations came into effect. Instead, he passed it to the NI Executive to decide, whereby the DUP (Democratic Unionist Party) blocked the introduction of any services, including telemedicine. Alliance for Choice and political and civic society’s allies, including medical professionals and feminist organizations, then turned their campaigning attentions to service provision, as women were being told by the NIO (Northern Ireland Office) and Dept of Health to travel to Liverpool on a 16 hour (round trip) to access abortions.
Huge pressure was placed on the NI government to provide a service, including calling out the stalling tactics of the DUP and others who claimed there were “legal concerns” over the regulations. Alliance for Choice and sister organizations were providing assistance to women directly throughout this period and eventually Chief Medical Officer for NI (Dr. Michael McBride) announced that there was no legal impediment to service provision.
Limited service provision then commenced, but, to date, has not included telemedicine and those who can access services are forced to travel to clinics to do so. We are continuing to campaign on this as it goes against the grain of every other piece of advice during the pandemic that insists, we must stay home to stay safe.
ST: What will be the implications of this situation to those pregnant in Northern Ireland and their families?
NC: Aside from COVID-19, firstly and despite the regulations saying otherwise, abortion in NI is only available at service level up until 9 weeks and 6 days of pregnancy which is in direct contravention of the regulations and becoming more and more problematic. We have been contacted by unprecedented numbers of women who have found themselves over the 9 weeks and 6 days available service and have nowhere to go, despite the fact they should be receiving legal abortion care in NI. Medical professionals have also expressed their frustrations at a lack of clarity from the government on why they have not moved to provide the full service.
Alliance for Choice are helping women where they can, with others being told they still have to travel to England under the circumstances described in the previous question. This is hugely risky, traumatic and inhumane. Some women have told us that they simply cannot travel even without a pandemic and given our previous experiences of an almost blanket ban on abortion, we are extremely worried about these women and pregnant people.
In the context of COVID-19, the World Health Organization notes that abortion is essential healthcare in a pandemic, and yet the Northern Ireland Office and the Department of Health in NI have found it acceptable to do absolutely nothing other than to obstruct the use of abortion telemedicine, which is safe and effective. The World Health Organization recommend it at present moment to ensure women and their families are not placed at through unnecessary travel.
Outside pandemic circumstances, a number of countries already use telemedicine. England, Scotland, Wales and the South of Ireland now have telemedicine, but due to ideological opposition, we do not have this in NI. This senseless restriction of access makes women fugitives. It impacts anyone seeking abortion healthcare by forcing them to travel to clinic to take one tablet. The remaining four tablets are taken at home anyway, so women are being forced to travel for the sake of a single pill which can be taken at home safely.
This travel places them, their families and wider society at needless risk of contagion. It also places health workers at risk. We are aware of two women who have attempted suicide because they could not access the abortion healthcare they needed. One required acute treatment for attempted suicide which was hugely traumatic for her but also demanded health resources for a situation that could have been prevented.
There is also an adverse impact on women dealing with domestic violence, coercive relationships, disabilities, caring responsibilities, migrant women, young women under 18 who live with their parents and LGBTQ people. Many of these people have been in touch to with and explained how it is extremely difficult or impossible to travel when they have been told they cannot travel due to isolation or are unable to travel due to fear.
ST: Abortion was decriminalized in Northern Ireland last year. Are people still in the dark about their abortion rights? Where can Northern Irish people and immigrants get good information about abortion access in Northern Ireland right now?
NC: In recent days we have been in touch with the Dept. of Health to ascertain how they are communicating information about the limited services available and, in short, they are not at present and do not appear to have anything planned, despite the fact abortion was decriminalized in October 2019 and they have had months to prepare even before the pandemic hit.
Women are confused about where to go. Appointments are arranged through an organization called Informing Choices who are excellent and involved in abortion provision and rights for many years. However, the reality is that many women will be unaware of where to go and when you google search “abortion clinics” in NI, no statutory organizations come up. GPS, medical organizations and sexual health organizations have been provided with nothing by way of communicating services to the wider public, by way of the usual methods leaflets, online pathways, etc. Some GPS have directed women to Alliance for Choice and both ourselves and Informing Choices put as much information as we can in the public domain through social media and the usual methods. We are doing the job that the Dept of Health should be.
One migrant woman contacted us who advised that she was finding it impossible to access services because she was living in fear of her migrant status, which was legal, and was finding information very difficult to obtain because of the language barrier.
"If women are forced to continue pregnancies against their will, it completely dilutes their rights as human being and denies them bodily autonomy and what should be their absolute right to reproductive freedom. It makes hostages of them in this regard and for those that are vulnerable and in situations of domestic violence, it can exacerbate and make an already difficult situation worse in the long term."
Another woman who came to us searched the internet for services and because there was nothing, mistakenly ended up with an anti-choice organization who mislead and delayed her to the extent that she was over the 10-week gestation and could not get EMA (Early Medical Abortion) at a clinic.
ST: Northern Ireland is a religious country, and has considerable numbers of anti-abortion people. Now that abortion is legal, is the Catholic Church playing a part in abortion access or lack of it?
NC: NI is not predominantly Catholic, and church-led opposition to abortion comes from many quarters. Five of the main male church leaders assembled prior to the introduction of the legislation to lobby the government heavily to prevent abortion provision. Two of the main anti-choice organizations in NI, Precious Life and Both Lives Matter, have very close links with both the Catholic Church and the Evangelical church and use church communities and congregations to galvanize their campaigning, particularly around the public consultation responses on the regulations. The ideological opposition from anti-choice organizations is often rooted in religious rhetoric, moralism and fundamentalism, which hugely aids abortion stigma and shame.
Alliance for Choice work with pro-choice religious organizations and are currently undertaking an extensive piece of work with the University of Ulster to look at Abortion and Faith. We also work closely with Catholics for Choice. There are people of faith who are pro-choice and people of faith who have abortions. Their church hierarchies and institutions refuse to recognize that and are failing them as well as stigmatizing and shaming those who need abortion care.
ST: Now that abortion is legal, how is it absorbed into family planning policies and education?
NC: Despite the fact this should form part of the regulations as directed in the initial legislation, it was not mentioned in the regulatory framework and there are no plans to do so at governmental level. It is something that Alliance for Choice will continue to campaign on.
We have been invited to a number of schools, youth organizations and universities since abortion was decriminalized, and it has confirmed what we already knew: sexual health and reproductive education is woefully inadequate in our education system. The only time abortion is mentioned in these setting is in mandatory religious education, whereby the vast majority of children are taught nothing about abortion facts. The basis of the teaching is from a religious perspective and it is deemed morally reprehensible.
Worryingly, there is the same prevailing ideological opposition displayed at governmental level to introducing fitting sexual health education including abortion. No doubt, organizations like ourselves, Common Youth and Informing Choices will be left to fill in the blanks where we can whilst being blocked at every opportunity and being woefully underfunded.
ST: How can abortion help families during this Covid-19 outbreak, especially the low-income families?
NC: Economic factors feature in reasons as to why women chose to end their pregnancies. They cannot afford to extend their family, cannot afford childcare and doing so can place huge difficulties on women and other pregnant people who are struggling to make ends meet.
The impact of COVID-19 compounds all of these reasons, as the global pandemic places low income and working-class families in even more precarious financial circumstances whose incomes have been hit hardest.
Women have also reported to us how the uncertainty of the pandemic and being pregnant and giving birth is not something they want to do because of risk factors.
ST: How do you think lack of access to medical abortion during the pandemic will impact Ireland and those seeking abortion during this time in the long-term?
Some women will be forced to continue their pregnancies, which is extremely traumatic for them and has the potential to impact their mental health and well-being.
It is reproductive coercion and any form of coercion is damaging.
Others have explained how they will go to any lengths to end pregnancies and our previous experiences with an almost abortion ban have shown that women can self-harm or seek abortion by unsafe means, which will abuse them both physical and mental trauma.
If women are forced to continue pregnancies against their will, it completely dilutes their rights as human being and denies them bodily autonomy and what should be their absolute right to reproductive freedom. It makes hostages of them in this regard and for those that are vulnerable and in situations of domestic violence, it can exacerbate and make an already difficult situation worse in the long term.