Women in Northern Ireland still need help to access safe abortion
The publication today of the Report on Sexual and Reproductive Health in Northern Ireland by the Northern Ireland Abortion and Contraception Taskgroup (NIACT) marks a year since new regulations for legal abortions, came into force in Northern Ireland. The report provides an evidence base to inform the funding and commissioning of Relationships and Sexuality Education (RSE) provision, and integrated sexual and reproductive healthcare for the population of Northern Ireland. It is also demonstrates how clinician-led collaborative working can transform sexual and reproductive healthcare despite considerable political resistance.
The report provides an evidence base to inform the funding and commissioning of Relationships and Sexuality Education (RSE) provision, and integrated sexual and reproductive healthcare for the population of Northern Ireland. It is also demonstrates how clinician-led collaborative working can transform sexual and reproductive healthcare despite considerable political resistance.
As the 1967 Abortion Act was never extended to Northern Ireland (NI) most women needing an abortion had to travel to England in order to procure an abortion. In the last decade, increasing numbers had self-managed abortions outside the law using pills obtained online, with an estimated 700 such abortions in 2016.
Although the change in law had been signalled since October 2019, the NI Department of Health had not taken any action to ensure services would be available once regulations came into effect on 31st March 2020. Indeed, it steadfastly refused to commission services. Thus, women continued to be advised to travel to England if they needed an abortion. Even at the height of the coronavirus (Covid-19) pandemic, when flights were cancelled and an eight hour ferry journey was the only means of accessing mainland Britain, women were still being advised by the Department of Health, if they needed an abortion, to access abortion services outside of Northern Ireland. Fortunately, NI clinicians seeking to influence policy had established NIACT, bringing together doctors, midwives, academics and the charity sector, which lobbied at every level to have local services established.
When hospital admissions of two young women who had attempted suicide because of being unable to travel for abortion came to light, NIACT doctors pushed Trusts to agree an interim service. Three weeks into the first lockdown, there was still no way someone needing to end a pregnancy could do so without having to travel to Britain. On 16 April 2020, the Chief Medical Officer wrote to the five NI Trusts stating that, since abortion was now legal, medical professionals could legally terminate pregnancies. This gave the Trusts the go-ahead to provide staff and facilities in order to carry out abortions, in the interim, in accordance with the Regulations.
History has been made. Women now have a legal, reproductive voice in Northern Ireland for the first time
A regional central access point was established through Informing Choices NI (ICNI), formerly the Family Planning Association NI, providing a means for self-referral and counselling. Non-funded NHS early medical abortion (EMA) services were implemented within existing Sexual and Reproductive Health services and Gynaecology services across all five Trusts. As each service was non-commissioned as a whole they relied heavily on the good will of conscientiously-committed clinicians.
There is a clear need for services with more than 40 women per week self-referring to ICNI. Unlike those who travel to England, those availing of the EMA service are offered long acting reversible contraception at the time they attend the clinic and up-take of this is high. Unfortunately, telemedicine is not permitted for home use in NI, necessitating one clinic visit. For those in rural areas this can be difficult given poor public transport links which have worsened during the pandemic.
There is an ongoing struggle to engage with an unwilling and non-communicative Department of Health to acquire commissioned funding. With no fully commissioned service there is the over-hanging threat that the EMA service could be pulled at any stage, particularly as SRH and gynaecology services start to return to a new normal following the pandemic. This threat has been tested as temporary cessation of the EMA service has occurred in two Trusts within the last 12 months. These collapses, together with the absence of services for surgical treatment and treatment beyond 10 weeks gestation, mean many women still need to travel to England during the pandemic.
The work is still ongoing and the recent intervention by the Brandon Lewis, secretary of state for Northern Ireland, looks to ensure that commissioning for abortion services will be granted in the near future. With that on the horizon, the NIACT report published today, and available for download from the Faculty of Sexual and Reproductive Health website, makes evidence-based recommendations on better sex education, accessible contraception and will assist in the development and delivery of safe compassionate abortion care within high-quality SRH services.
History has been made. Women now have a legal, reproductive voice in Northern Ireland for the first time, and there are an ever-growing number of people who are working hard to ensure that this remains so.
Dr Laura McLaughlin is a Consultant Obstetrician and Gynaecologist