‘I worry that I seem cold or uncaring when really I just can’t ask. In practice, the law shrouds everything in uncertainty and silence’ Mary* says ‘women don’t know what they can ask me or tell me. They don’t know how much or how little I can help them. They don’t even know whether they can trust me. Frankly, it drives a wedge in the doctor-patient relationship.’
Mary is talking about Northern Ireland’s abortion law. She has been a GP there for 6 years and, before that, was a junior doctor for 5. In her practice of ‘6000 odd patients’ and she regularly encounters women who need to access abortion but, because abortion is not legal in Northern Ireland, all she can offer them is ‘tissues, a phone number and a website address’ which gives them information about leaving the country to get help.
The use of abortion pills in Northern Ireland is punishable by life imprisonment because of the Offences Against the Person Act 1861, which states that people ‘must not procure poison to end a pregnancy’. When abortion was legalised in the rest of the UK in 1967, the 1861 Act remained was only amended, it was not overturned. And, because the 1967 law does not apply to Northern Ireland, women there are still subject to a Victorian law.
As Grazia reported back in 2017, police in Northern Ireland have been pursuing women who they believe have ordered abortion pills online. And, this week, Belfast’s High Court will hear the case of a mother who is currently being prosecuted for obtaining pills for her 15-year-old daughter after their GP reported her to the authorities.
As a pro-abortion GP Mary says she is caught between a rock in a hard place. She wants to help her patients, but she can’t. ‘It makes my work very difficult’ she says, adding that she constantly worries that saying the wrong thing at her surgery ‘could mean prison’ for both her and her patients.
When she should be focussing on how to give the women who come to see her the best possible care, Mary says she finds herself ‘carefully crafting sentences’ to protect both herself and her patients.
When women come to Mary to discuss abortion it is mostly because they need to travel abroad for one and are looking for advice. Occasionally, she says, women tell her they’ve had a miscarriage when she suspects they’ve bought pills online.
‘I’m not someone who usually spends a lot of time second guessing myself or censoring my words’ Mary explains ‘but everything I say in my surgery has to have ambiguity and reasonable doubt built in. I make sure I leave certain things unsaid. I don’t ask women if they have broken the law, they don’t tell me if they did’.
At the end of October, we moved one step closer to seeing legal abortion in Northern Ireland after an amendment to the Northern Ireland bill put forward by Labour MPs Stella Creasy and Conor McGinn. It passed with 207 to 117 votes with cross party support. However, it is largely symbolic because it only compels Northern Ireland secretary Karen Bradley ‘to issue guidance’ which explains the law. It doesn’t actually change the law.
There has been a bigger spotlight on abortion law in Northern Ireland since Theresa May made a deal with the Northern Ireland’s Democratic Unionist Party in 2017. This amendment put further pressure on Bradley, who faces calls to step in on human rights issues (such as abortion and same sex marriage) because Stormont (Northern Ireland’s devolved government) has been collapsed since 2017.
Creasy and McGinn’s amendment passed days after another bill to scrap the 1861 Offences Against the Persons Act passed its first reading by 208 to 123 votes in the House of Commons. However, this too is symbolic as it is unlikely to become law without government backing.
But, while conversations in Westminster continue and campaigners keep the pressure on, women in Northern Ireland are being forced to travel aboard for abortions because they are denied access to a service that women elsewhere in the UK have.
And so, despite the increased attention being given to Northern Ireland’s abortion laws in Westminster, women on the ground are still suffering. Mary says she is frustrated. She thought that things would have moved forward after the Republic of Ireland voted to repeal the 8th amendment and legalise abortion earlier this year.
Politics, Mary says, is getting in the way of what people actually need. ‘With no Assembly in Northern Ireland and the DUP propping up the Tories, the people with the power to change this situation have no political reason to do it’ she explains ‘it seems like everyone keeps finding reasons why it shouldn’t be them to make the change and it shouldn’t be now to make it. The lives and health and human rights of 1.5million people mean less than the votes of 10 DUP MPs because of Brexit’.
Amnesty International has long argued that Northern Ireland’s abortion law is a breach of women’s human rights which has a ‘disproportionately negative impact’ on women with low incomes. This was ratified earlier this year when the UK’s Supreme Court ruled that it could not intervene to change the law but made it clear that there could be no doubt that denying women in Northern Ireland access to abortion was ‘incompatible with human rights legislation’.
And yet, still, the law remains unchanged in Northern Ireland. In 2017, then Health Secretary Jeremy Hunt agreed to provide funding for NHS abortions for women from Northern Ireland who travelled to the rest of the UK. However, a new study called The Impact of Northern Ireland’s Abortion Laws on Women’s Abortion Decision-Making and Experiences which was published in the BMJ’s Sexual and Reproductive Health journal last month has found that the number of requests to Women on Web (a Dutch organisation that provides mifepristone and misoprostol to people in countries where abortion is illegal) went down by only 3% after since funding came in.
This suggests that there are Northern Irish women who don’t want to or can’t travel to access abortion. Grainne Teggart, Amnesty International UK’s Northern Ireland Campaign Manager, told Grazia that because ‘the only option for women in Northern Ireland is to take a traumatic journey to have the procedure away from home and friends’ abortion is difficult and sometimes impossible to access for ‘women without the funds or who are in abusive relationships.
Women in Northern Ireland are currently caught up in the tumult of UK politics. Theresa May’s government does not have a majority, so Mary is right when she says that they rely on the support of the DUP to pass major legislation which, at the moment, mainly means any major laws relating to Brexit.
For now, women in Northern Ireland can only wait to see what happens this week, as midnight on Monday sees the ban revoked. The DUP have returned to Stormont to protest the changes. This follows a historic vote in the House of Commons last July, involving Stella Creasy and Conor McGinn’s amendment to the Northern Ireland bill.
‘It has never come to a point where I have been forced to make a choice between disclosing a criminal act on the part of one of my patients or making myself a criminal by keeping her secrets’ Mary says ‘I hope it never does. I feel ashamed that we’re in this position’.
*names have been changed to protect identities