A Health Minister who backs away from providing accessible reproductive healthcare in a time of international crisis should be held to account, and Stormont Health Minister Robin Swann has proven he is incapable of navigating that terrain.
Decades of campaigning, covert networks providing illegal support, lobbying, arrests and countless other acts of feminist resistance led to the eventual decriminalisation of abortion in Northern Ireland. The landmark achievement transported us from one of the most regressive states in Europe in terms of reproductive rights, to occupying the vanguard of states who have removed reproductive healthcare from the criminal justice system completely – surpassing the achievements of the 1967 Act in Britain.
And while decriminalisation merited celebration, that was somewhat tempered by reservations that evidence-based research would continue to be ignored when it came to actually implementing new abortion services. Activists have consistently braced themselves for low expectations from the overwhelmingly conservative, out of touch politicians occupying power in Stormont. 1
And it didn’t take long before fears were legitimised. A period of consultation was mandated, whereby the concerns of anti-choice organisations with a detestable record were weighted equally against international best medical practice and the lived experience of women.
What resulted was the imposition of a 12 week limit; a measure which has shown itself to be a socio-economical barrier to access.2 Moreover, we were told there could be a fine for doctors who performed abortions outside of that remit – flying in the face of decriminalisation, and with no apparent legal basis.
The COVID-19 outbreak struck before provision could be put in place or the Northern Ireland Office framework had made its way through Westminster, and the new normal under COVID-19 poses unforeseen challenges for the provision of abortion. Not least because isolation and social distancing makes access to pills or treatments infinitely more difficult.
In response, Britain and the Republic of Ireland have begun utilising telemedicine as a way of supporting people who find themselves pregnant and do not want to be. This means that abortion pills – mifepristone and misoprostol – can be taken at home are taken following a telephone consultation with GP and pills in the post. This mode of access alleviates the strain on our already besieged GPs and healthcare workers, enables social distancing, and allows women to induce an abortion without leaving quarantine and endangering themselves or other pregnant women.
In Northern Ireland, under the new regulations, however, women can only take the first pill – mifepristone – with a doctor, and can take the second misoprostol at home, mirroring the pre-COVID-19 position in Britain.
Telemedicine for the north?
Abortion pills are not new to the north of Ireland. They have long been in use despite the 1861 Offences Against the Person Act which previously criminalised their use. In fact, research has consistently evidenced that about 1,000 women a year in the north have used underground telemedicine networks to obtain pills and there have been no reported serious adverse incidents. 3 4 With decriminalisation, it was hoped that there would be an end to the use of underground networks and women could make their decisions with the assistance of medical professionals, if needed, without fear of criminality.
The Northern Ireland Office legal framework for abortion services has created an opportunity for Robin Swann to enable both pills to be taken at home, however. Point 3.7 provides that:
The appropriate power for decisions to be taken by the Northern Ireland Health Minister to approve other premises where medical abortions can be performed, to respond to service needs and developments over time as the services are commissioned and embed into the health and social care setting in Northern Ireland.
Swann’s failure to do so will have devastating consequences. One woman has already been hospitalised for attempting to take her own life after her trip to procure abortion in England was cancelled because of Covid-19 measures. But failure to act is precisely what we have seen from Swann, despite public pressure.
Yesterday (April 2), People Before Profit MLA Gerry Carroll, and Alliance Party MLA Paula Bradshaw, used the Stormont Health Committee to echo concerns from Alliance for Choice Belfast and Derry activists to Swann, as well as advice from the World Health Organisation, the Royal College of Obstetricians and Gynaecologists, the Royal College of Midwives and Doctors for Choice Northern Ireland.
Swann responded to declare that ‘abortion is a cross-cutting issue because of what it is in Northern Ireland and that’s why I have to refer it to the Executive’.
This is false, of course. The power to enable telemedicine lies in Swann’s hands.
Frustrations at Swann’s reticence extend much further than activist circles, too. Dr Laura McLaughlin, a Consultant Obstetrician and Gynaecologist working in Northern Ireland said that, ‘abortion is known to be an essential component of healthcare’ and ‘it is inhumane to subject women to the possibility of life-threatening complications in the context of an unwanted pregnancy’ during the COVID-19 pandemic.
By kicking the can down the road, Swann’s insistence that this issue must be referred to the Executive – a wilful misreading of the NIO framework – epitomizes the tired rhetoric that has been the beleaguered war cry of conservatives in this region for decades: that the north is somehow a special case.
This exceptionalism isn’t unique to Robin Swann as a politician. It has long been the mantra of the largest unionist party, the DUP, whose own councillor recently accused pro-choice activists and the LGBTQ+ community of incurring the wrath of god, for which we are being punished with the coronavirus. 5
Such exceptionalism has also been spouted by anti-choice commentators who, for too long, have been given an equal hearing in the media despite a lack of medical or scientific evidence to back up their claims, and the fact that they represent a minority of the population.
But Northern Ireland is not an exceptional case. Poll after poll suggests that public opinion on this issue is, in fact, similar to that which led to a landslide victory for Repeal, south of the border. 6 Women in Northern Ireland have abortions. They have had abortions in backstreets, they have travelled to have abortions, and they have had abortions in their homes. As long as there has been sex, there has been abortion, and the desire to do it freely, safely and legally.
Lockdown: threat to women
There is another crucial reason for Robin Swann to act now allow people to access abortion pills freely, safely and legally in their homes, which is specific to the Covid-19 crisis.
With society on lockdown, as is the case in the south and inevitable in the north, women face an increased threat of domestic violence and sexual assault. Of this situation, Women’s Aid have said ‘we are in uncharted territory and all domestic violence charities are bracing themselves for a marked increase in numbers of people coming forward’ – indicating the fears of a sharp rise in service-users.
Indeed, we are already seeing cases of domestic violence that have been exacerbated by the lockdown situation: on March 30 2020, mother-of-three Victoria Woodhall was stabbed to death by her husband outside her home in South Yorkshire. Last weekend, the Domestic Abuse Commissioner for England and Wales reported that use of the national abuse hotline went up by 65%. Meanwhile, the UN has warned that women in poorer countries and smaller homes are likely to have fewer ways to report abuse in this time of Coronavirus.
As a predominately rural region, many women in the north of Ireland are now at the mercy of their homes, living remotely. For urban women, being in close quarters every day with an abusive partner is equally dangerous. Lockdown conditions are predicted to spike an increase in unintended and crisis pregnancy rates, and coupled with increased levels of domestic violence and sexual abuse, a perfect storm fuelled by misogyny is brewing – a storm which Stormont Health Minister Robin Swann has proven he is incapable of navigating.
It is clear that there is no political will in Stormont to care for women in Northern Ireland. Indeed, the success of decriminalisation has been largely because the Stormont Executive was leapfrogged by activists who knew better than to expect meaningful progress at home. The cowardice of key decision makers such as Robin Swann MLA is now markedly on display and once again it is women who pay the price.
Please sign the petition to Allow Remote Abortion Provision here.
- See: Aiken, A, Gomperts R, Trussell J.(2017), Experiences and characteristics of women seeking and completing at-home medical termination of pregnancy through online telemedicine in Ireland and Northern Ireland: a population-based analysis. British Journal of Obstetrics and Gynaecology, 124(8):1208-1215