Response to Professional bodies' submissions on abortion in NI

You may have come across today’s article on the BBC about Royal Colleges’ and other professional bodies’ advise on the issue of abortion legislation in NI.

The full, unedited text of the article (not on the website) is instructive, so I’ve attached it below, and I’ve penned a response below that to tackle some of the issues raised.

Professional bodies recommend a legal framework which prioritises safe and compassionate abortion care for women in Northern Ireland

The Royal College of Obstetricians and Gynaecologists (RCOG), the Royal College of Midwives (RCM) and the Faculty of Sexual and Reproductive Healthcare (FSRH) recommend that any future legal framework for abortion care in Northern Ireland must be based on evidence-based best practice.

The professional bodies, who represent a large proportion of the workforce involved in providing abortion care across the UK, have published their responses to the proposals for a new regulatory framework for abortion services in Northern Ireland.

The organisations strongly encourage the Government to establish a legal framework which removes the barriers to abortion care and ensures the needs of girls and women are met.

The professional groups agree that restricting access to abortion care at arbitrary gestations before 24 weeks will only create barriers for women. This is particularly true for women who are most vulnerable or disadvantaged – such as victims of domestic or sexual abuse, or who are experiencing social or economic deprivation – who, as a result of their circumstances, are more likely to present at later gestations.

Importantly, they state, there is no clinical basis for introducing a restriction at either 12 or 14 weeks, and that introducing such restrictions would present a series of difficulties, including a number of women having to travel to the rest of the UK to complete their abortions – which would represent a failed regulatory framework.

Professor Dame Lesley Regan, Chair of the Royal College of Obstetricians and Gynaecologists’ Abortion Taskforce, said:

“Just eight women had an abortion in Northern Ireland in 2018/19 but more than 1000 women had to endure long journeys to other parts of the UK to access abortion care, or resort to illegal purchase of abortion medication. A new framework to enable our doctors to deliver safe abortion care services within Northern Ireland cannot come soon enough.

“Northern Ireland has a unique opportunity to establish an abortion care service which is safe, legal and compassionate, which sees abortion in the context of women’s sexual and reproductive health, and which is supported by high quality education and access to contraception.

“It is our collective view that in order to provide women with the healthcare they need, abortion should be regulated like any other clinical procedure. Women and healthcare professionals should not be threatened with criminal prosecution and women should not need to travel out of their home country to access this care.

“We urge the Government to introduce a legal framework which will allow best-practice care without introducing unnecessary barriers and restrictions. We are committed to working with healthcare professionals in Northern Ireland to train and deliver these services.”

Dr Carolyn Bailie, Chair of the Royal College of Obstetricians and Gynaecologists’ Northern Ireland Committee, said:

“For too long women in desperate circumstances have been unable to access abortion care in Northern Ireland. In recent years, women have had to travel to access services where a diagnosis of a life-limiting fetal anomaly has been made and where women have felt unable to continue the pregnancy to term.”

“The Government now needs to introduce a legal framework compliant with the requirements of CEDAW so that we can begin to provide a safe and compassionate abortion care service which serves the needs of women and girls in Northern Ireland. This must include improved sex education in schools and timely access to excellent contraceptive services.”

Karen Murray, from the Royal College of Midwives, said:

“The RCM joins the RCOG and FRSH in urging the Government to introduce a legal framework which is based on the best available evidence and does not introduce clinically unnecessary and administratively burdensome restrictions which create barriers to care. This system will not only safeguard women’s rights, in fulfilment of the requirements set out by the Committee for the Elimination of Discrimination Against Women (CEDAW), but will also facilitate our members to provide high quality care to women in Northern Ireland.”

Dr Asha Kasliwal, President of the Faculty of Sexual and Reproductive Healthcare, said:

“The new framework for abortion care in Northern Ireland is the perfect opportunity to strip down the barriers to what is an essential part of sexual and reproductive healthcare. Women should be able to access safe and legal abortion care wherever they live in the UK.

“Currently, just over one quarter of women of reproductive age use contraceptives in Northern Ireland whilst more than three quarters do so in all of Britain. Sexual and reproductive healthcare services in Northern Ireland are underfunded, understaffed and are unable to offer women the full range of contraceptive methods. Waiting lists can be up to three months in some cases, especially for contraceptive care such as long-acting reversible contraceptives (LARCs), the most effective methods of contraception.

“The new framework for abortion care has the potential to build a holistic, integrated sexual and reproductive healthcare service in Northern Ireland, meeting the CEDAW’s requirement to ensure the accessibility of these services, including safe and modern contraception across different settings.

“Healthcare professionals also need the certainty to provide essential healthcare without the fear of prosecution, harassment or stigma. We look forward to working with the Department of Health to ensure the new framework is human-rights based and is fit-for-purpose for both women and healthcare professionals.”

Response

I agree that arbitrary limits for abortion are incorrect. As the law in England and Scotland stands at present, the 24 week cut off is now arbitrary, seeing that it is possible in some cases for a child born at 22 weeks to survive. The claim is also made that babies in the womb cannot feel pain below 24 weeks – this has been contested in the recent paper in the Journal of Medical Ethics, arguing for foetal pain from 12 weeks – the argument could be made that there is now more weight to lowering the GB abortion limit – in a recent survey 60% of women supported lowering the limit to 20 weeks ( https://catholicherald.co.uk/news/2017/05/22/poll-most-brits-want-abortion-limit-reduced-to-20-weeks/)

The professional bodies in GB have a vested interest in maintaining the status quo. They first of all should look at their own houses. They demand that guidelines and best practice be adhered to in Northern Ireland, but there are multiple instances of their members in Great Britain not adhering to their own standards (e.g. the court case recently where the second doctor’s signature was being photocopied, abortion consent not done face to face by a doctor ( https://www.dailymail.co.uk/news/article-4284290/Marie-Stopes-abortions-signed-just-phonecall.html), sex selective abortion offered against guidelines ( https://www.telegraph.co.uk/news/health/news/9099925/Abortion-investigation-Available-on-demand-an-abortion-if-its-a-boy-you-wanted.html)) 

They also appeal to evidence based practice, which is right and proper, but fail to take account of the broad spectrum of evidence on abortion – recent papers linking abortion to breast cancer in later life ( https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6445797/), problems with conception following abortion, psychological trauma, rates of complications etc. In addition, some of us have a great deal of concern about the lack of informed consent for many women who are offered an abortion. There are clear guidelines on how to tell a patient about the need for a procedure, the risks and the benefits  ( https://rcpsg.ac.uk/college/this-is-what-we-stand-for/policy/consent/the-montgomery-case). Part of the process is giving the person enough time to think about all the information given to them, giving them a ‘cooling off period’. Abortion providers do not appear to be adequately set up to provide such properly informed consent, which flies in the face of all medico-legal guidance ( https://www.themdu.com/guidance-and-advice/guides/montgomery-and-informed-consent). 

The main reason offered for most women in the UK, 97%, to have an abortion is to avoid the risk of physical or mental ill health problems at a later date. The recent paper ( https://www.mdpi.com/1010-660X/55/11/741) by Sullins, showing that women who carry on with an unwanted pregnancy, are no more likely to suffer depression or anxiety than those had that child aborted. However, of the women who have an abortion for a wanted pregnancy (thought to be one out of every 7 abortions), their rate of depression is 4 times higher than if they had carried the child. Good practice would suggest that a clinical intervention which does not prevent the outcome for which it was offered, should be scrapped. A clinical intervention which causes a far higher rate of problems, which it claims to prevent, should have been scrapped a long time ago.  

One glaring omission from this report is the issue of protection for healthcare workers who may object to being involved with abortions on the grounds of conscience. It is patently clear that these professional bodies have no interest in accommodating workers within their ranks with these objections, above and beyond the bare minimum. I speak for many healthcare staff who are deeply concerned by these developments in Northern Ireland, and I have yet to see any reassurance from these bodies.  

What all of the professional bodies fail to address is that abortion is, the vast majority of the time, a procedure which is offered for no clear medical benefit to the woman. Abortion for social reasons cannot be argued for based on medical evidence. Sadly, the rest of the UK now have an abortion regime which is unfit for purpose, non evidence based, and generating untold amounts of harm to society. The UK government have already altered NI legislation against the wishes of the people here; now that we have a functioning Executive in Stormont, any further legislative changes should be decided locally – as Dr Kasliwal of the FSRH points out, there are very great differences in attitudes to sexual health in NI in terms of contraceptive use – a broad-brush UK wide approach is excessive. Professional bodies’ opinions are certainly welcome, but we need a NI-centric approach – it’s interesting to note that, of the four professional bodies who have written about this, only two of the opinions come from their NI representative. 

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