incorporating: margaret wort & co › appg on population... · with their pregnancies either...
TRANSCRIPT
Incorporating: Margaret Wort & Co WB Gurney & Sons
ALL-PARTY PARLIAMENTARY GROUP ON POPULATION, DEVELOPMENT
AND REPRODUCTIVE HEALTH
MINUTES OF PROCEEDINGS
at a
PARLIAMENTARY HEARING
held in
Room 17, Houses of Parliament, London SW1A 0AA
on
Wednesday 29 November 2017
Before:
Baroness Tonge, in the Chair
Baroness Barker
Viscount Craigavon
Baroness Uddin
--------------
From the Shorthand Notes of:
AUSCRIPT LIMITED
Central Court, Suite 303, 25 Southampton Buildings, London WC2A 1AL
Tel No: 0330 100 5223 Email: [email protected]
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Witnesses: EMMA CAMPBELL, Alliance for Choice; POLLY BARKLEM and
BARBARA DAVIDSON, London-Irish Abortion Rights Campaign; RUAIRI ROWAN
and LAURA RUSSELL, UK Family Planning Association.
THE CHAIRMAN: Welcome to all of you. I am Jenny Tonge. This is Janric Craigavon.
VISCOUNT CRAIGAVON: I am an independent Cross-Bench Peer in the House of
Lords.
BARONESS BARKER: Liz Barker, Liberal Democrat Member of the House of Lords.
As the FPA knows, I am Chair of the All-Party Parliamentary Group on Sexual Health.
BARBARA DAVIDSON: My name is Barbara Davidson. This is Polly Barklem. We
are from the London-Irish Abortion Rights Campaign. We are a grass-roots organisation
founded about a year ago. We campaign for free and safe legal abortion across the island
of Ireland.
I am going to give you a brief outline of the law in Northern Ireland just to set our whole
discussion in context. The law governing abortion in Northern Ireland is one of the most
restrictive in both the European Union and the Council of Europe. The maximum
criminal penalty imposed - life imprisonment for both the woman undergoing the abortion
and any individual who assists her - is the harshest in Europe and among the harshest in
the world. Attempting to procure an abortion, having an abortion or performing an
abortion are criminal offences under the Offences Against the Person Act 1861, as is the
destruction of a child then capable of being born under the
Criminal Justice Act (Northern Ireland) 1945. The current law is that abortion is illegal in
Northern Ireland unless the continuance of a pregnancy threatens the life of the
pregnant woman or would adversely affect her mental or physical health. The adverse
effect on her mental or physical health must be “real and serious” and must also be
“permanent or long term”. The Abortion Act was never extended to Northern Ireland.
There is no exception to the general prohibition on abortion in cases of foetal abnormality
or where pregnancies are as a consequence of rape or incest. This was the subject of
a High Court claim in December 2015, when it was found that this was a breach of
Article 8 of the European Convention on Human Rights. That was appealed and
overturned in the Northern Ireland Court of Appeal in June 2017. An appeal to the
Supreme Court was heard in October of this year and judgment is expected soon.
Abortion policy was devolved to the Northern Ireland Assembly in 2010 and the reform of
abortion policy has been the subject of debate in the region ever since. Of the parties
represented in the Northern Ireland Assembly, the DUP, the SDLP and the TUV oppose
any change to the law in abortion whatsoever. Sinn Féin passed a motion at its most
recent ardfheis extending the party’s support for abortion to when a woman or girl’s
physical or mental health is at risk. The Alliance Party and the Ulster Unionist Party offer
their members a vote of conscience. Only the Green Party and the
People Before Profit Alliance are in favour of full decriminalisation, but those two parties
represent a tiny minority of the Northern Ireland Assembly.
Former politics do not tell the whole story. There is a young, post-conflict society in
Northern Ireland which remains deeply divided. This is reflected in voting patterns,
which tend to be along constitutional lines rather than along issues of social reform.
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There is strong evidence that the general public in Northern Ireland supports reform of
abortion laws. Most recently, the Northern Ireland Life and Times Survey of June 2017
reported that over 80 per cent of the people in Northern Ireland believe that abortion
should be legal when a woman has become pregnant as a result of rape or incest and that
73 per cent believe that abortion should be legal in local hospitals in cases of foetal
abnormalities. The Northern Ireland Assembly collapsed in January 2017 and there is no
immediate prospect of it reforming.
POLLY BARKLEM: I am just going to go on to the impact of the law. Ultimately, the
impact of the law is that the majority of women and girls who do not want to continue
with their pregnancies either travel to England for an abortion or they buy abortion pills
illegally over the internet. There were only 16 legal abortions in Northern Ireland in 2015
and 2016. That is the same figure as 2014 and 2015. It is generally understood that that is
as a result of the guidance that came out in Northern Ireland, which I think the FPA are
going to talk about a little bit more. That guidance had a really chilling effect and so there
are now fewer terminations carried out legally.
The official figures are that 724 women travelled to England for an abortion in 2016. That
figure is likely to be much smaller than the real figure because that is the number of
women that gave their address as being in Northern Ireland. There is likely to be - who
knows - a lot more than that travelling and not giving an address in Northern Ireland or
going to a country other than England.
The economic cost of travelling was for a long time extremely high. The Stella Creasy
amendment has recently changed that and is a great harm reduction measure. We will talk
a little bit about the funding - Barbara will come back to that later on - but basically
abortions are now free for Northern Irish women in England. Travel is means tested at
quite a low bar, but there is funding available for some of the poorest women, which is
really helpful.
Obviously the wider impact of travelling, now that the economic cost is alleviated, means
that it is marginalised communities that are worst affected by this law: women that cannot
travel because they do not have papers; women that are in abusive relationships and so
cannot get out, or even make an appointment to see their doctor. They might have
children and so they cannot leave them behind. Who is going to look after those children
for the number of days that they have to travel? It is obviously more worrying for those
women in the traveller communities. There are women as well who might not even know
they are pregnant for a long time, until it is later down the road, and then having to get all
of the information together to travel across is going to impact them in a worse manner. It
is not better just because it is now free. In particular, adolescent girls are at risk because
they would have to tell their parents; if they do not have a passport, they need to find some
other way to get to England; and that is extremely difficult. So it is those girls and girls in
care.
There is the effect of criminalisation as well. It is obviously a criminal offence to procure
an abortion, so to buy the pills online, which we know that a number of women do. We
obviously do not have statistics on exactly how many, but we know that Women on Web
has sent pills to 1,000 women over the last two-year period in Northern Ireland and 5,000
for Ireland and Northern Ireland. Between 2010 and 2017, there have been
nine prosecutions under the Offences Against the Person Act against women who have
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bought abortion pills or have been caught with them. There have been a few high-
profile cases:
- In 2016, a 21-year-old woman was given a three-month sentence, suspended for
12 months, after pleading guilty to purchasing abortion pills online to induce an abortion.
She said that she could not afford to travel. She bought the pills online, took them, and
then her flatmates took her to the police and she was ultimately arrested and prosecuted.
- A woman was charged for helping her teenage daughter access pills after her daughter
was raped and then became pregnant as a result. That is under judicial review at the
moment, which I think has been held up until the NIHRC trial. We are waiting to see
what will happen.
Obviously just the threat of criminal sanction has a horrible effect on women in
Northern Ireland. They either will not buy the pills or they will go down some other
route. The Abortion Support Network has countless horror stories of what women will do
if they do not have any other option. As well as simply the criminal effect it is
stigmatising, affecting employment opportunities, educational opportunities, travelling,
work permits, aside from just the situation of having a criminal record.
I think Barbara is going to quickly go into the funding.
BARBARA DAVIDSON: Just because of time reasons, I do not propose to go into the
details of the Stella Creasy/Justine Greening arrangements. I think they are well-known.
From our work with Justine Greening, we have some updates that are perhaps not so in the
public domain, which I am happy to answer questions on, but perhaps we will just move
on to the next topic.
THE CHAIRMAN: Can we hear from Alliance for Choice now?
EMMA CAMPBELL: Thank you for the invitation to give evidence. Alliance for Choice
is a civil society organisation based in Belfast. It campaigns for safe, free and legal
abortion in Northern Ireland. We would like to highlight the social discrimination
experienced by women in Northern Ireland with crisis pregnancies. It is important that the
APPG is aware of the strong anti-abortion socialisation process that manifests in
Northern Ireland through schools, churches, the media and political sphere. Being called
“murderers” by politicians and protesters inevitably leaves abortion-seekers with
additional emotional scars and further problematises an already complicated decision.
I will first talk about experiences of women after treatment, then changes due to funding
and then abortion medications and the societal changes in Northern Ireland.
The Marie Stopes clinic opened in 2010. Since then, there has been a steady and constant
presence of protestors outside calling themselves “pavement counsellors”. They
physically block access or pretend to be clinic workers. We face comments such as “We
have christened your dead baby Teresa”, or “You are now the mother of a dead baby”. If
they believe someone has accessed the pills, they will say, “If you’ve taken anything, we
will report you to the police” and “Don’t flush your baby down the toilet”. This is despite
the fact that women who do qualify for an abortion at Marie Stopes will have had
grave health conditions in order to have been accessing treatment there. I am a volunteer
escort, escorting women in and out of the clinic. As advised by the PSNI, we wear body-
worn CCTV to collect evidence and write a report for every single incident of abuse, yet,
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despite hundreds of logs and many interviews with police, as of yet no prosecutions have
been made. Two of our escorts have faced physical assault. We currently have an
ongoing case against one of the protestors, with a temporary injunction served. Jim Wells,
ex health minister of the DUP, has been known to call the clinic protestors “close personal
friends” and has recently been to visit the protestors outside the clinic during opening
hours to shake their hands, thus legitimising their abusive behaviour.
We welcome the recent Government announcement on funding, but this will not reach
everyone. In the week of the announcement, I personally took two calls from women who
could not travel. The first was from a support worker who was risking her job in even
speaking to me about her client needing to travel to England. Her client was fleeing
a violent relationship and had young children already. They had made an appointment in
England, but all of the woman’s personal documents and ID had been burned by her
ex partner in a controlling violent outburst. The second woman had an infant with
cystic fibrosis. She was pregnant again, but there was a 25 per cent chance the pregnancy
would result in another child with the same condition. Cross-contamination is dangerous
for such an illness and so her maternity care had offered her testing, yet they did not
advise her that she would not be eligible for treatment in Northern Ireland. We were
effectively the people breaking the news to her that she would have to travel, and so the
great news of being funded in England did not seem so great to her, with a young ill child,
when she had been left in the dark about the availability of treatment by
medical professionals.
As brought up by my colleagues here, we also know that women face other barriers to
travel: time off work from precarious employment, disability, immigration status,
mental health, abusive relationships and child care. Many of these women then go to
abortion pills as the answer. As noted by my colleagues, the use of telemedicine
abortion pills has been highlighted over the last few years due to multiple legal
proceedings. Women on Web offers reputable services, but there are other less reputable
services available. The pills are listed in the World Health Organisation’s list of essential
medicines. Between January 2010 and December 2015, 5,650 women in Northern Ireland
and Ireland requested at-home medical abortion through online provider Women on Web,
but we know this figure does not account for all providers and could conservatively be
double that. They examined the experiences of 1,023 women. Of those women,
97 per cent felt they had made the right choice and 98 per cent would recommend it to
others in a similar situation. They commonly reported serious mental stress caused by
their pregnancies and their inability to travel abroad to access abortion. The feeling most
women commonly reported after completing were “relieved” (70 per cent) and “satisfied”
(36 per cent). Women with financial hardship had twice the risk of lacking
emotional support.
However, police raids on homes, workplaces - my own and my colleagues’ included -
arrests and customs seizures have meant that women are now fearful of the repercussions
if they need to seek medical help after taking abortion pills. There is a direct danger to
women’s health - and lives - if treatment for rare, but possible, haemorrhage is not sought
in a timely manner from a professional. There is also a lack of willingness to engage in a
harm-reduction approach to the pills and instead we are faced with scaremongering by
local and UK media. Criminalising women who access these pills is in breach of the
recommendations of a number of UN committees, including CEDAW and the
Committee on the Rights of the Child, which the UK previously noted in 2014 and 2016.
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The UK Government has failed to respond to calls from CEDAW committees to have this
reformation of the law.
In the absence of Government consultation, public opinion polls have provided insight
into support for legal reform. Large-scale polls have been conducted in recent years, all of
which have demonstrated broad public support for reforming the law. In polls conducted
by Amnesty, BBC and RTE, respondents indicated support for abortion in cases where a
woman’s life was at risk.
THE CHAIRMAN: Emma, you need to wind up, I am afraid.
EMMA CAMPBELL: Eighty-seven per cent of people do not want to criminalise women
in Northern Ireland. These are my concluding points. Harassment and stigmatising
language are an unnecessary additional barrier to the difficult access to
reproductive healthcare with crisis pregnancies in Northern Ireland. New funding
measures are welcomed. However, this was introduced for political expediency. Funding
is a step forward for abortion-seekers who can travel, but it leaves so many behind.
Despite the changes, healthcare professionals still lack clear guidelines. In the absence of
easily accessible abortion healthcare, many turn to online providers. Criminal sanctions
are therefore directly endangering lives. We should not wait until the first woman bleeds
to death before we get the change we deserve.
THE CHAIRMAN: Sorry, you will have to stop there.
RUAIRI ROWAN: Thank you for having us here today. FPA is one of the UK’s leading
sexual health charities. It is a national affiliate of the International Planned Parenthood
Federation in the UK. For over 30 years we have provided the only non-directive
pregnancy choices counselling service in Northern Ireland. Other organisations will talk
about two options. We will give women information about abortion, as well as adoption
and continuing with the pregnancy. We also provide post-abortion counselling, although
we receive no Government funding currently for it.
Pregnancy choices is Government funded, but because our counsellors discuss abortion as
a choice for women, as Emma said, like Marie Stopes, our office is picketed on a
daily basis. The only day that we do not have a picket is on a Friday - and that is because
we do not hold counselling on Fridays. Individuals will gather outside. They will have
misleading leaflets. They will follow women down the street. We sometimes have
protestors waiting in the back alley in case women leave via the fire escape. Chalked
messages will be written on the ground, such as: “FPA, how many kids have you killed
today?” All these sorts of activities impact negatively on women. It means that they are
either fearful of coming in or they will not come to seek counselling at all.
We have a comments book in our waiting room where individuals can write down an
incident that has happened or their thoughts. I will read one comment from that book:
“Leaving the building with my sister, mother and uncle at approximately 12.30 pm. My
sister has been attending for counselling sessions for the previous few weeks which have
been really helping her. Accosted outside the door by a red-haired woman. I told her we
didn’t need her advice. She told me rudely that she wasn’t speaking to me; she wanted to
speak to my sister. I told her we’d phone her if we wanted her advice. She proceeded to
follow us down the street, trying to push leaflets on us. In the meantime, the man with her
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followed my uncle, shouting about how this would be his grandchild. Very intimidating,
pure harassment, and the first week it happened my sister didn’t want to come back.
Something needs to be done about these people.”
In 2015, one of those individuals was convicted for assault against one of our members of
staff - the only conviction there has been in Northern Ireland - yet that individual
continues to stand outside our office every day and harass other women. I think it is clear
that we need legislation either around safe access or buffer zones to prevent these sorts of
activities.
I am going to touch briefly on the guidelines that came about in Northern Ireland. FPA
took the Department of Health to court in 2001 over its failure to provide guidelines for
medical professionals. Following a successful appeal, a number of documents came and
then were retracted. A document called The Limited Circumstances for a
Lawful Termination of Pregnancy in Northern Ireland was released for consultation in
2013. The language used throughout the document was described as “intimidatory” and
“threatening”, both to healthcare professionals and to women themselves. The opening
sentence of the document stated: “The aim of the health and social care system must be
protection of both the life of the mother and her unborn child”. It then went on to say:
“The circumstances where termination of pregnancy is lawful in Northern Ireland are
highly exceptional. This document is intended to guide clinicians on the application of the
very strict and narrow criteria… consistent with the law. It details the very limited
circumstances under which a termination of pregnancy may be lawful in
Northern Ireland…”
The chilling effect of that document was clear. There were 51 abortions carried out in
Northern Ireland the year before. It dropped to 23, and now to 16. Commenting on the
mood within the medical profession at the time, Dr Carolyn Bailie, chair of the
Northern Ireland Committee of the Royal College of Obstetricians and Gynaecologists,
said: “There is a real sense of fear and concern that one of us could end up in prison”.
There was guidance then released in 2016 by the Northern Ireland Executive, but by that
stage the damage had been done, and, as other colleagues have mentioned, women are
now taking the matter into their own hands and ordering pills online.
The current guidance does deal briefly with abortion pills online, but I am going to read
this paragraph which mentions it. Bear in mind that this document was supposed to bring
clarity to the law. It states:
“If a health and social care professional knows or believes that a person has committed
certain offences, including an unlawful termination of pregnancy, he/she has a duty under
the Criminal Law Act (NI) 1967 to give [that information to the police]… However, the
health and social care professional[s] need not give that information if they have a
reasonable excuse for not doing so; the discharge of their professional duties in relation to
patient confidentiality may amount to… a reasonable excuse. Professionals should be
clear, however, that patient confidentiality is not a bar [on] reporting offences to the
police.”
So there is nothing clear about that statement. We feel that if admission is made to a
counsellor during a counselling session that our duties and obligations lie with the client
and their best interests and that dragging them through the court would certainly not be in
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their best interests. We also feel that the policy to prosecute in these circumstances is
having a wider effect in the fact that women who do acquire pills online are less likely to
seek medical support if they need to.
So in summary, the criminal law on abortion in Northern Ireland is unclear. The law on
when it is necessary to disclose personal information to prosecuting authorities is unclear
and unhelpful. The risk of criminal prosecution seems increasingly high. If that risk
continues any further, it will become difficult for charities such as FPA to provide
services.
LAURA RUSSELL: I know some of this has been covered already and so I will not go
into too much detail.
Abortion legislation in Northern Ireland is in contravention of human rights. The UK is
signatory to a number of conventions. The Committee on the Elimination of
Discrimination against Women, the UN Committee on Economic, Social and
Cultural Rights, the UN Committee on the Rights of the Child and the
UN Human Rights Committee have at various stages all issued statements saying that the
UK really needs to ensure safe access to abortion and post-abortion care services.
Along with Alliance for Choice and others, we recently made an intervention in the
Supreme Court in a case that was initially brought by the Northern Ireland
Human Rights Commission. The court heard that case on 24-26 October 2017 and is
currently considering whether the existing criminal law in Northern Ireland in relation to
abortion is lawful in three circumstances - where the pregnancy results from rape or
incest, or where there is a serious foetal abnormality - in relation to Article 3 (the
prohibition on torture), Article 8 (the right to respect for private and family life) and
Article 14 (the prohibition on discrimination), when read with Article 8 of the
European Convention on Human Rights.
With no Assembly in place, it is unclear who is going to be responsible when the
Supreme Court rules for making sure that whatever verdict is upheld is implemented. If
the Supreme Court rules in favour of the Human Rights Commission, it would probably
be the Northern Ireland Office. Even if it is the case that it does not, it is the responsibility
of the Northern Ireland Office to uphold human rights in Northern Ireland. It is not a
devolved issue. It is interesting to note that UK Government policy when it comes to
international development is that it should protect family planning and reproductive rights.
In a 2014 DFID document, the Department stated:
“In countries where it is highly restricted and maternal mortality and morbidity are high,
we can help make the consequences of unsafe abortion more widely understood, and can
consider supporting processes of legal and policy reform.”
So in cases of other countries they are in favour of supporting reform, whereas, when it
comes to Northern Ireland, even when she was making her statement about the new rules
which allow free access to services for women who are normally resident in
Northern Ireland and travelling, Justine Greening repeated, “None of this changes the
fundamental position that this is a devolved issue in Northern Ireland”, and that is
something that the Secretary of State for Northern Ireland has himself said in response to
various questions from MPs.
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But there is no Executive in place and so, if it is the responsibility of the Assembly, there
is no one who is going to implement it anyway. As I have mentioned previously,
human rights are still the responsibility of the Northern Ireland Office, and so it is really
clear that the Secretary of State cannot be absolved of any accountability. The
Northern Ireland Office has to take responsibility for human rights and take steps to
ensure that the law is performed.
It is the 50-year anniversary of the introduction of the Abortion Act in Great Britain. It
has never been extended to Northern Ireland. Women who face a crisis pregnancy suffer
the discrimination that we have heard about from my other colleagues here.
THE CHAIRMAN: As you know, we have a very short time for questioning. I do
apologise. I will kick off. Is there any chance at all that we can get this concept changed?
Abortion was deemed a health issue. To me, it is not a health issue. It can be a
health issue, but primarily it is a human rights issue - which is not devolved. I do not
know how we can get round this with the Government. It seems to me that it has got it
wrong.
LAURA RUSSELL: It is the case that the Supreme Court might also agree and rule that it
has got it wrong.
RUAIRI ROWAN: Yes.
LAURA RUSSELL: In that case, though, it is trying to ensure that the
Northern Ireland Office takes responsibility and does not say that it is actually a
responsibility of a devolved government that currently does not exist.
RUAIRI ROWAN: I think we have seen in the A and B case, which was defeated 3-2 in
the Supreme Court, the momentum that was built after that ruling. I think if the
Supreme Court decision came out early next year and stated that actually it was not a
breach of human rights, the momentum there would be, I think, even greater this time,
particularly without any Northern Ireland Executive in place. At the moment we do have
a Government in the UK that has quite a small majority and so it is quite possible to get
things through.
THE CHAIRMAN: Backed by the DUP.
RUAIRI ROWAN: Backed by the DUP. That does make it more difficult.
EMMA CAMPBELL: But there is also the point that devolution has been a flimsy barrier
when welfare changes were needed - and block grants were clearly a powerful motivator
in that case - so I do not see how it can be used as an excuse in this case for human rights.
THE CHAIRMAN: You do not see how it could be used?
EMMA CAMPBELL: No.
VISCOUNT CRAIGAVON: Thank you so much. I am sorry you are having to deal with
such an impossible situation. Well done for your work. I am slightly surprised at the
percentage figures which you have given. I think Barbara said 80 per cent were in favour
of legalising abortion, and I think you said 87 per cent were in favour of decriminalising
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abortion, which seem quite high percentages. Is it only in the very limited circumstances
that the 80 per cent are in favour? With that percentage, I am just wondering why the
people opposing you have so much power. Can you say something about the majority
percentages?
BARBARA DAVIDSON: I think the first thing to note is that when people think about
abortion they do not see it as a binary issue. It is unlike gay marriage, for example.
People are not “Yes” or “No”. They usually sit on a spectrum. That spectrum is usually
to do with the kinds of situations in which they feel that women ought to have an abortion
and what makes them feel comfortable. That is why you get people saying things like
they are happy in situations where a woman has become pregnant as a result of rape or
incest, or where there is a serious foetal abnormality. So the 80 per cent figure that
I quoted from the Life and Times Survey referred to abortion in cases of rape or incest,
which of course is still illegal, and 73 per cent - slightly fewer - in cases of foetal
abnormalities. Those three incidences were the subject of the Human Rights Commission
case, judgment for which we should get before Christmas. There is another point to be
made about that, which is that those exceptions are legally unworkable. How do you do
justice to the criminal justice system if you are having to prove to doctors that you have
been raped, for example?
My colleagues who work in Northern Ireland can speak more in terms of the power of the
opposition in Northern Ireland, but I think it goes back to what I was saying about voting
patterns, which we have in our evidence in our more detail, and that people simply do not
vote along social issues in Northern Ireland. They vote along what might be described as
the Green and Orange issues. People will not vote for Sinn Féin in circumstances where
they think that Sinn Féin might get in if they are normally DUP supporters, for example,
and vice versa. I do not know if Emma might want to say something about that.
EMMA CAMPBELL: I would agree with everything that Barbara has said. We also do
a lot of educational workshops on abortion throughout the country and so some of the
statistics seem anomalous, where we have 77 per cent believing that abortion should be
available when a woman’s life is at risk, yet 87 per cent believe a woman should not be
criminalised for having an abortion. This is because people answer these questions
initially as in “I don’t agree with it personally in circumstances of…”, yet when you
further push people they do not want to criminalise women. In fact what we did find was
that when a woman was criminalised for accessing the pills there was a huge public
outcry, and many of the MLAs as well were also talking about having to treat women with
mercy, yet being reluctant to change the law.
BARONESS BARKER: Is there any breakdown in terms of age? Can you tell us a bit
more about that?
EMMA CAMPBELL: So the demographics are actually rather surprising on age.
Young people are broadly pro choice. However, very young people, so between the ages
of 15 and 20, are pro life. This is exactly to do with sex education in schools. We find
that as people get older, unless they are extremely religious --- Only nine per cent of the
population disagrees with abortion in all circumstances. The older demographic have
actually experienced life. That is how we look at the details anyway. Amnesty did a poll
in 2016 and the support for abortion law reform across all political parties was exactly the
same. It is the same across the demographics, apart from that very young age, because we
do not have proper sex education in schools. It is given by religious organisations.
10
BARONESS BARKER: Does the unavailability of legal abortion have any bearing on the
availability of contraception?
RUAIRI ROWAN: We were talking about this earlier. In terms of availability, there
have been various cuts in recent years, which basically means maybe if you live in Belfast
you have slightly more access, because there might be a couple of centres that are open
every day, although, saying that, it is maybe only for a couple of hours every day. If you
live in a more rural area, you might have a clinic nearby that is open for two hours on a
Wednesday afternoon. So there are problems with that. We were speaking also about the
waiting list to have a coil fitted. I think Emma said it was 18 months in Northern Ireland.
EMMA CAMPBELL: Yes.
RUAIRI ROWAN: So the availability is that. In terms of GPs, there are not many GPs
offering contraceptive services. It does have an impact. On the societal issues, I was just
going to mention that this conversation has changed dramatically in the last number of
years, particularly now that more women are speaking about their experience of having to
travel, and that has changed public opinion dramatically. In previous years, most women
who would have come for a counselling session at FPA would have almost always begun
by saying: “I’ve always been against abortion until now”. They partly may not have felt
that but felt that that was what they were supposed to say because that is how they have
been brought up. It would be rare now that that conversation is brought up. I think most
people now will know someone who has had an abortion. They probably did in the past
but just did not speak to one another. So I think the conversations have moved on
dramatically and particularly now that women are speaking out.
THE CHAIRMAN: I do not know how many times in my life I have heard that phrase:
“I don’t believe in abortion but…”
BARONESS UDDIN: I just wanted to give my profound apologies for the delay. I have
been caught up in another Committee. As someone who is pro choice, I just want to say
to those of you who have been working in the Northern Ireland discussions that I have
been a real admirer of yours. So I just wanted to make apologies and to just add to a point
that you made about the demographic in terms of where young women are now much
more questioning the issue of abortion. Because I was going to do this Committee, I made
this point earlier in our Committee meeting here, with a group of women that I had spoken
to, and the feelings were very similar. I think it has a lot to do with the fact not only of the
education but that there is not a counter choice and that there is not very much about
women’s rights anyway in the education system, whether you are in Northern Ireland or
here, and the second point being that there are some implications about what is available
on the internet. So I just wanted to make that point. I am really sorry that I was not here
for your introductions.
THE CHAIRMAN: Can I come back and ask a question? Can you just clarify for me
two points? It is illegal to buy misoprostol abortion pills from the internet, but it is not
illegal to be a supplier of them?
EMMA CAMPBELL: Women on Web issue them via a registered doctor in the
Netherlands.
11
THE CHAIRMAN: Is that how they get around it?
RUAIRI ROWAN: Yes.
EMMA CAMPBELL: Yes. So it is not illegal to have the pills in your possession, but it
is illegal to take them with the intent to ---
BARBARA DAVIDSON: These suppliers are not based in Great Britain or in the UK.
THE CHAIRMAN: Can you not just say: “I thought they were Smarties”?
EMMA CAMPBELL: We do quite regularly have people’s addresses visited by
policemen or workshops raided.
THE CHAIRMAN: It is quite extraordinary, is it not?
EMMA CAMPBELL: Yes.
THE CHAIRMAN: It really is. It is so repressive. It makes me shudder. It is
Secret Service stuff really.
RUAIRI ROWAN: We have a specific law in Northern Ireland. Section 5 of the
Criminal Law Act (Northern Ireland) Act 1967 - which is specific to Northern Island and
nowhere else in the UK - makes it a criminal offence not to pass that information on to
police. If you are aware of a crime that has at least a sentence of
five years’ imprisonment, which abortion does, then you are legally obliged to pass that
information to police.
THE CHAIRMAN: But does the confidentiality of a doctor towards his or her patient not
override that?
RUAIRI ROWAN: It can do. I read you that statement from the guidance which says
that it may, but then the next statement says: “But there is no bar on reporting to police”.
THE CHAIRMAN: The BMA says that?
BARBARA DAVIDSON: That law originally was for national security reasons.
RUAIRI ROWAN: Yes.
BARBARA DAVIDSON: That law obviously originated in the Troubles, but it has now
just been appropriated.
THE CHAIRMAN: But foetuses were not involved in the Troubles.
BARBARA DAVIDSON: No. I know.
RUAIRI ROWAN: No one has ever been prosecuted under that law, but we used to
always say that no one would be prosecuted for having an abortion, and then last year we
started prosecuting women. So the fear is there. That one JR 76 court case, where the
mother is being prosecuted for procuring the pills for her 15-year-old daughter, came
12
about because the daughter was in an abusive relationship. They went to see her GP
a week later to kind of discuss that relationship and, somewhere between being referred on
to social services and child and adolescent mental health services, her GP records were
passed to the police, and that is how that prosecution has come to light. Women will not
go to GP on many issues and do not come to counselling because they fear it will be
passed on to the police - and that has happened.
THE CHAIRMAN: There is a bit of a movement, I believe, is there not, of women doing
it deliberately and announcing that they have done it?
EMMA CAMPBELL: Yes. That was our organisation. We got together over
200 signatures and said that we had either procured the abortion pills for other people to
take or we had taken them ourselves. We went to a police station in Belfast and handed in
a letter with our information on it. They are not willing to come and arrest any of the
activists.
THE CHAIRMAN: They have not arrested any of you yet?
EMMA CAMPBELL: No. But they have raided our premises before.
THE CHAIRMAN: But it potentially needs a critical number of people, does it not?
EMMA CAMPBELL: We have questioned the even application of justice in terms of the
Public Prosecution Service going after people in this particular situation yet refusing to go
after people where there are obvious incidents of assault and harassment or in a case
where somebody has been below the age of consent.
BARBARA DAVIDSON: There is a point to be made about how the democratic deficit
that we have described people in Northern Ireland experience is compounded by the fact
of the Troubles and the way in which legislation relevant to the Troubles has been
appropriated in ways that are oppressive to women in these circumstances. It is also true
with regard to the extension of the Abortion Act mooted in 2008, but a deal was done
effectively with the DUP in the interests of national security for 42-day detention, so
national security issues are things that people hide behind in this regard as well.
VISCOUNT CRAIGAVON: If somebody comes to search your home and there is no
prosecution, does something remain as a black mark on your record for the future? That is
a problem in this country.
POLLY BARKLEM: It would go on your CRIS report.
VISCOUNT CRAIGAVON: For the rest of time?
RUAIRI ROWAN: I am not 100 per cent. Thankfully, my home has never been raided
and so I am not sure on that point.
EMMA CAMPBELL: In my own experience, and in the experience of the other activists
whose homes were raided on International Women’s Day, when we were all out - so that
is interesting as well - they cannot get certain mail delivered to their house any more, and
we know that we will be on “watch lists” essentially.
13
POLLY BARKLEM: In this country it would go on the Police National Computer.
I imagine it is exactly the same in Northern Ireland.
THE CHAIRMAN: Thank you all very much for a really shocking session. It has
shocked me to hear it all over again. We had sort of known of this situation, but it is just
unbelievable to hear you actually enunciate it. It really is. I cannot believe that this is
happening in our country. I just cannot believe it. It is extraordinary. Thank you for
coming.
14
Witnesses: ANN FUREDI, British Pregnancy Advisory Service;
LISA HALLGARTEN, Brook; and LORD STEEL.
THE CHAIRMAN: I am so sorry for the slight disruption to our schedule. It is through
no fault of anybody’s except the room bookings department, which seems to have had a
really bad weekend, because we ended up with no room at all about 10 minutes before we
were due to start and then we had to wait half an hour for the room. So we are sorry, but
welcome to the three of you. Do we need any introductions? I am Jenny Tonge, chair of
the Group. This is Liz Barker, Lib Dem Peer; Janric Craigavon, independent Peer; and
Pola Uddin, who is a Labour Member. We are going to start with BPAS because you are
first in order.
ANN FUREDI: First, thank you very much for inviting us to provide evidence in this
session. I believe this session is really framed around the idea of hard-to-reach women.
I will say first of all that British Pregnancy Advisory Service is a charity. It is a not-for-
profit provider that operates around 60 clinics around England and Wales. We have one
centre in Scotland. We collaborate very closely with the National Health Service. We see
around 70,000 women a year for termination of pregnancy. Ninety-eight per cent of those
are paid for by the National Health Service and are commissioned under NHS contracts.
The outstanding number is normally women who have travelled from overseas,
specifically usually from either the North or South of Ireland.
I think Britain is perhaps an example to bear in mind when we think about how we can
have a law and a regulatory system and a system of provision that appears in many ways
to be quite liberal. Access to abortion in Britain is clearly way, way better than most of
the country situations that you would have been hearing about. I always find myself in a
difficult position when I am presenting overseas because people find it quite difficult to
imagine a situation that appears to be as good as ours, in the sense that you have a law that
more or less provides abortion on request, even though it requires some interpretation, but
specifically where abortion is paid for by the National Health Service and is not paid for
by women.
However, when we think about the difficulties that women have in accessing services at
the moment, I think it speaks to a point that Baroness Tonge was raising in relation to the
earlier panel, where you were talking about whether or not something is seen as a
health issue or a rights issue. For us, despite the integration in some ways of abortion care
with the National Health Service, in some ways I think it really relates to whether abortion
is seen as something that women should be entitled to receive in the way that they are
entitled to receive other health services, so the fact that my organisation is providing
abortion services - a charity outside of the NHS - is in some ways a special situation that
you do not expect to find with other healthcare areas.
I would suggest that one thing it would be very useful to flag up for perhaps looking at in
the future might be exactly how abortion services are indeed organised and the
collaboration that indeed should really occur with the National Health Service. At the
moment, we have a situation where there is competition for contracts between different
independent organisations - and, indeed, the National Health Service - whereas in fact,
when it comes to a service like this, it should not be the case that organisations are
competing. It should be the case that there is collaboration to make sure that the skills and
the facilities are best provided for the constituencies that should be needed.
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That said, I would say that there has been huge progress with that in recent years. Women
who have complex underlying medical conditions may need to be cared for in services
that have a critical care facility. We now have much more effective pathways where
women who have previously found it quite difficult because their care cannot be provided
in standalone clinics of the kind that we run and Marie Stopes run can be dealt with within
the NHS. There is much more collaboration. It looks as though there will be more of that
going on.
We have a very robust regulatory framework in this country, which I think is right.
I think, though, going back to the point about competition, one of the things that we have
to be quite careful about is that in the environment at the moment, where everyone is
looking to make cost savings within the NHS, the cost of abortion services really does
have to be valued and seen, again, as being an integral part of what is required from
healthcare and not as an area where savings can be accrued by people trying to save
money on their commissioning.
Because I know that we are short of time and I would rather leave it for you to question,
I will finish with this example. You have to hold in mind an example like this because, as
I have said, we exist in a country where pathways are quite clear and where services can
be funded. I am not only chief executive of British Pregnancy Advisory Service. I am
also the chairman of the board of governors of MidKent College, a further education
college based in Gillingham, Kent. We were horrified earlier in the year when a young
woman was admitted to the local Medway Hospital Trust found to be severely bleeding.
She had been taken in as an emergency case. She was 20 weeks pregnant. She had tried
to induce her own abortion and had haemorrhaged. The foetus was delivered alive. It
took four hours to die, which was obviously an issue of great distress to the woman and to
the medical staff in the hospital. You are really left thinking: “How on earth does this
happen in the South East of England in the circumstances that we are in today?” The
reason for it was that this young woman had tried on two occasions to access
NHS abortion services that had been commissioned, but each time she had been told that
she needed her NHS number to obtain free treatment. She did not know how to get her
NHS number. I cannot imagine going to a doctor for any other kind of medical treatment
where I am told that I cannot receive treatment unless I have my NHS number.
So really my plea with this - the take-home message - would be please can we look
forward and see that safe, good, abortion care is fully integrated into NHS provision in the
way that it is funded and in the way that it is signposted and delivered. Otherwise, women
who are hard to reach will be difficult for us to identify in this country.
LISA HALLGATEN: Thank you for inviting me here. Brook is a young people’s
sexual health charity. We deliver education work in 12 per cent of secondary schools in
England. We have 16 sexual health clinics around the country, including in Belfast.
I am not going to go over the situation in Northern Ireland, which has been really
beautifully set out for you, but just to say that, whilst we are really, really happy that the
Government has agreed to fund abortion for women coming from Northern Ireland, all the
difficulties faced by people coming over here are exacerbated for young people. They are
more difficult, especially if they do not have family support or if they do not have travel
documentation. The situation with education in Northern Ireland around abortion is
particularly difficult, as is the stigma. So all the things that I think have been mentioned
16
already are really exacerbated if you are a young person, especially if you do not have any
form of support.
I am going to focus on England, which is where Brook carries out most of its work, and
look at the issue in terms of four key headings: (i) cuts and commissioning;
(ii) crisis pregnancy centres; (iii) education; and (iv) the funding of anti-
abortion activities. I am going to be as brief as I can about those.
Just to say, I think we all know that all the evidence points to outcomes being best for
women who access abortion if they have had the opportunity to have the best possible
information and the best possible support with making a decision about abortion and they
have been able to access services as easily as possible.
In 2013, Brook and FPA jointly published guidance, endorsed by the
Faculty of Sexual and Reproductive Healthcare, on how to commission care pathways to
ensure that women are given sufficient support with pregnancy decision-making. Those
guidelines drew on reputable sources, like the Royal College of Obstetricians and
Gynaecologists, the Royal College of Psychiatrists, and many more. The guidelines were
drawn up to ensure that women who are feeling ambivalent about their decision or
expressing coercion or pressure receive the support that they need, as well as expediting
access to services. The guidance recognises that there is a very wide spectrum of need
from women, most of whom are very clear about their decision and simply want to benefit
from the easiest possible access to services, to, at the other extreme, those who need
additional information, support, time, conversation or counselling in order to make
a decision that they are really happy with.
Through various pieces of research, young people have been identified as one of the
groups that are more likely to need a bit of additional support, maybe because they have
less knowledge and understanding of their options, or they have a lack of partner support,
or they lack or perceive that they lack support from their family. So it is critical for us
that young people are given the support that they need when they present with an
unintended pregnancy. Services like Brook, and other specialist young people’s
sexual health services that in the past have been provided by the NHS but are increasingly
disappearing, have traditionally provided trained counsellors or other people with the right
skill set to identify those people who are in trouble, who have safeguarding needs, who are
feeling ambivalent, pressured, or need additional support around making a decision about
pregnancy. Those services are disappearing. Most contracts from commissioners now
preclude the possibility of employing a counsellor within those services, and increasingly
those young people’s services are disappearing altogether and young people are being
redirected into all-age integrated sexual health services or back to their GPs. These are
places that young people do not feel comfortable going to and do not want to go to.
I did a very small survey of staff in our own clinics. I am not saying that this is
representative, but it is a real snapshot. I just asked them if they wanted to measure or
represent the impact of cuts on various things relating to pregnancy, including
pregnancy testing, pregnancy decision-making support, providing access to
pregnancy services, and support following abortion with contraception and counselling.
The snapshot found that in all cases, in all these different areas of work, on average they
reported an impact of 7 or 8 on a scale where 1 was no impact and 10 was extreme impact.
What is actually happening is that services like ours are trying to make a decision all the
time about whether they streamline the offer to young people and offer them less time or
17
whether they see fewer young people. It is really an awful dilemma. One of the
receptionists who responded to my survey said: “I’m turning many people away from the
clinic on a daily basis as we don’t have room for them, as we don’t have enough members
of staff to manage the workload. This inevitably results in more unplanned pregnancies as
people cannot access contraception, longer waiting times for abortion and more strain on
services”.
I think it is a real issue. The actual funding constraints are a massive issue, but so too is
the way commissioning is going, which is trying to push everyone into monolithic
services and totally losing an understanding of specialist services. It is not only specialist
young people’s services. It is also just generally that specialist reproductive health
services are being put into huge integrated sexual health services or disappearing
altogether. Although I think most people put their premium on speed and availability of
abortion, we just really want to make sure that everybody can be picked up at the level
that they need to be.
Brook does not provide abortion services, but we are hearing increasingly that contracts
being offered by commissioners to independent providers are making it increasingly hard
for them to offer the level of service and good practice that they have developed over
years, which they themselves value, and which recognise and meet the very needs and
demands of women in relation to pregnancy decision-making. Those independent
services have always been really very adept at working out what people need and giving
them the level of support they need, which may be very little or may be a lot more. The
possibility for them doing that, I think, is under threat.
There is a problem in this country with crisis pregnancy centres run by anti-
abortion organisations giving misinformation to young people. We have reported on this
extensively in the past. It has not gone away. There is a problem with education in school
being inadequate, and we are making a massive plea for the new guidance to retain a
requirement on schools to address abortion in a way that is helpful in terms of helping
young people to know their rights and to access services. We are very disappointed that
Life received £250,000 of “tampon tax” funding when we know that a lot of the
information it provides and the services it provides fall very short of good, evidence-based
practice.
THE CHAIRMAN: It is outrageous.
LISA HALLGATEN: I know I have to wind up. I have more that I could say, but I am
very happy to answer questions.
THE CHAIRMAN: Thank you very much indeed, Lisa. Lord David Steel, the hero of the
hour - for 50 years, I mean!
LORD STEEL: I was asked if I could say a bit about what happened 50 years ago, but
I do not think I will dwell on it for too long because it is really well-known past history.
The fact is that, in the 1950s and 1960s, the Abortion Law Reform Association kept
pressing Parliament to change the law to make abortion available to women. Mine was
actually the seventh attempt from 1953 onwards to get a Private Member’s Bill through.
The others had all failed not through a lack of support - they all had good support in the
Commons - but through lack of time. The reason I was able to succeed was because
I drew the number 3 place in the Speaker’s annual ballot for bills and so it was possible
18
then to get the Bill through with a bit of help from the Government giving extra time
because of the opposition to it.
How did I get involved? Very simply, in the 1964 election, when I was an unsuccessful
candidate, the Abortion Law Reform Association had circulated to all candidates a leaflet
and a questionnaire. The leaflet set out the case for a change in the law and asked all
candidates to tick whether they would, if elected, support a change in the law. I had
ticked the “Yes” box, saying that I would support it, so once I had been chosen as number
3 in the ballot I could not very well dodge actually doing something about it other than
just ticking the box saying that I would support it. That is how I got involved in this
whole process. Of course it would not have got through but for help from a particular
Conservative MP and a Labour MP who acted as whips. To get people here on a Friday
was quite difficult. To get them through the night was quite difficult. But we did it.
Remember, up to the passing of the Bill, something between 30 and 50 women each year
died in this country as a result of criminal abortion, whether self-induced or botched back-
street abortions. When Dr John Marsh retired as secretary of the BMA some years ago, he
actually said in his resignation speech that the greatest contribution to public health in his
lifetime had been the Abortion Act. I had thought that that seemed a strange exaggeration,
but you then realise that what he was talking about was the fact that the public wards of
our hospitals were clogged with women admitted for what was called septic and
incomplete abortion. There were unknown hundreds of those each year.
Coming up to date, the fact is that in those days the only methods of abortion were
surgical of one kind or another. Although in the early years we had problems with women
coming in from Europe, taxis at Heathrow, and scandalous press stories and that sort of
thing, the fact is that since then our neighbours in Europe have advanced their legislation
so that most of them allow abortion on demand, on request, up to about the first trimester -
the twelfth or thirteenth week of pregnancy. So in fact our law already seems to be out of
date compared with what everybody else does.
Of course the big difference now is the availability of drugs. A little change in the law
was made and went through Parliament almost unnoticed. It was not even noticed by me.
A change was made to the Human Fertilisation and Embryology Act allowing ministers to
designate a home or anywhere they like as a place for medical abortion. I had a meeting
this week with the new Chief Medical Officer of Health in Scotland,
Dr Catherine Calderwood. With the Scottish Government, she has issued legal advice.
As abortion is devolved to the Scottish Parliament, they have issued guidance using that
Act allowing people to take the abortion pill at home. That does not happen here. The
Scottish Government has actually used that legislation. The UK Government still has to
do that. I hope that it will. I was a bit taken aback, because when it happened in Scotland
the anti-abortion people said they were going to take the case to court, and I thought they
were skating on thin ice until I realised that in fact they were using this new piece of
legislation, which I suspect the anti-abortion people had not even noticed - because I had
not noticed it either. It is a very interesting development that Scotland has now gone
ahead of the rest of the UK in making this provision.
Dr Calderwood had two concerns about the present Act. Apart from the fact of being able
to make that ministerial designation, it still requires two doctors. That is really out of date
now because it should be possible for a nurse or a midwife to be one of the two people
who prescribe the abortion pill. The other concern that Dr Calderwood had - and I was
19
interested in the case you were mentioning about the 20-week pregnancy - is that if there
is more legislation on this subject then there is a risk in Parliament that the upper time
limit could be reduced from 24 weeks to 20 weeks. I think that risk has receded myself
because there are more women in Parliament now and I think it would be more difficult,
but it is a risk, and therefore to be able to use an Order under the existing legislation is
probably the most immediate and useful thing that could be done. But the two-doctor
issue should be tackled, as well as the location at home being allowed, in my view.
THE CHAIRMAN: Thank you very much indeed. We have a nice bit of time for
questions. I have some. The first thing I want to ask really is whether people have seen
the report from the Advisory Group on Contraception. The Group has done a survey.
You will know that local authorities have to commission sexual health services and
family planning and advice centres. It is absolutely horrific that councils are refusing to
commission these services. The money that councils received was not ring fenced and so
they have no obligation to. They are just assuming, I guess, that the general practitioners
in their area will do the work. I just wondered, Ann and Lisa particularly, what your
organisations think about this, because it is going to affect abortion counselling, referrals
for abortion and everything if these clinics are not available - and they are closing hand
over fist all the time, all over the country.
LISA HALLGATEN: I attended a meeting of the Advisory Group on Contraception,
which we sit on. One of the things that was said was that the Department of Health is
looking at numbers of people accessing different forms of contraception and, until they
drop rapidly, the Department is saying that everything is fine. Of course epidemiologists
are saying, “Oh no, you have to wait to see the disaster”, but we know the disaster is
coming. You do not wait until you see more unintended pregnancies and more referrals
for abortion and fewer people getting fittings for effective methods of contraception
before you sit up.
THE CHAIRMAN: But the long-acting ones are not accessible. GPs are not doing it.
LISA HALLGATEN: Yes. There was a report from the Royal College of
General Practitioners as well expressing the difficulty with GPs being expected to fit
LARCs. So I think we are going to see more unintended pregnancies and the stuff that
I have talked about, which is a bit of a hidden thing - it is not something that is captured
statistically - which is the quality of support that people get in an abortion service. It is
going to go downhill and there is no way that is going to be captured. I think we all see it
as a looming crisis.
ANN FUREDI: I would really agree with that. We also sit on this Group. I think one of
the real difficulties is the absence of any real accountability about what has been
commissioned, whether it is through the council route, through the social care route, or
whether it is through the clinical commissioning groups within healthcare, about whether
they are actually commissioning services to meet people’s needs. For example, we are
seeing a new commissioning round on abortion taking place in London at the moment.
One of the arrangements that is being discussed, and it looks as though this is what will
happen in practice, is to basically have a situation where any organisation that meets a
baseline standard and agrees to provide services for a particular price will be able to
provide services. That sounds absolutely fair enough until you realise that what it does
not do is actually compel any of us to provide the service, so it could be, for example, that,
say, South West London could end up in a situation where no provider is prepared to
20
provide late abortion services, say beyond 16 weeks of pregnancy, simply because none of
us can do it for the price that is suggested.
THE CHAIRMAN: Presumably the commissioners are going for the cheapest option all
the time and will fish around.
ANN FUREDI: Yes, but the point is that what they will do is they will set a price and
they will say: “This is the price that we are offering”. In this particular instance the prices
are the prices that were set in 2013. They are looking for a five-year commitment with a
one per cent uplift. It may very well be the case that none of us will be prepared to say
that we can provide that. The outcome is that there is no safeguard that that community
has about what will happen in that particular case. I am one hundred per cent confident
that, when it all gets worked out, women will be served, but it is all too informal. It is too
squirreled away and non-transparent. That would not be the case, I think, with any other
area of healthcare.
THE CHAIRMAN: Thank you.
VISCOUNT CRAIGAVON: I have lots of questions for Ann, but can I take the
opportunity, with Lord Steel here, to say thank you very much and to thank you for your
work in the past? Just so that we can quote you in the future, are you saying that you
support in England the use of misoprostol where people want to use it?
LORD STEEL: Yes.
VISCOUNT CRAIGAVON: That is where we are heading.
LORD STEEL: It is quite interesting that, without going for decriminalisation, Scotland
has moved so far ahead. One thing I should just have mentioned is that Dr Calderwood
told me that before they came to that decision by ministers she had organised research in
the Highlands of Scotland, where, a bit like Northern Ireland, abortion was just not
available; not because of the legal situation but simply the lack of GPs willing to refer
women and so on. She said that that research was crucial in getting the change in the law.
Dr Calderwood is willing to make that research available to the Department down here, if
need be.
VISCOUNT CRAIGAVON: Can I follow up? You have identified the problem in this
building - the House of Commons - about having debates about the number of weeks
within which abortion is possible and you have said that that is not so much of a threat as
it has been in the past.
LORD STEEL: That is my view. But we do not know.
VISCOUNT CRAIGAVON: I was going to ask you. If we are talking about trying to
decriminalise abortion - I do not want you to give too much away on your evidence - do
you think the House of Commons is anywhere near accepting that particular line?
LORD STEEL: I had a meeting recently with Diana Johnson, who, as you know, is
promoting a Bill, and she is trying to get together an All-Party Group to back it up, which
I think is a better way of approaching it. Because this is now, as you know, a long session
of Parliament, the problem is that nothing will happen because she does not have a slot.
21
Nothing can happen until the next Parliament. My advice to her was to get together an
All-Party Group ready to use the next ballot that there is for Private Members’ Bills, as
I did in 1967, because I do not think any Government will touch this - although the
Government could, and should in my view, use the same powers that the
Scottish Government has done to issue ministerial --- What is the word? It is not a
statutory instrument, but it is guidance. Ministers are allowed to do that.
THE CHAIRMAN: With the availability of misoprostol now - and it is available on the
internet - do you not think that women are just going to take matters into their own hands
and that, in the end, ministers/governments are going to have to follow? We cannot
prosecute hundreds or thousands of women every year for using the abortion pill.
LISA HALLGATEN: There has actually been a really interesting piece of research.
Women on Web have started looking at women from the British mainland who could
access legal abortion but are going to them to buy mifepristone and misoprostol. Their
policy is that they do not provide it in countries where it is legal and so they are having to
get back to those women. Dr Kate Guthrie has been part of a project of talking to the
women who have gone to them and asked them to supply abortion medication to find out
why they did not try to access a perfectly legal and free abortion. It has been really
interesting to find out the number of women who actually find access really difficult,
including women who have disabilities and find it hard to get out of the house, including
women who are in domestic violence situations and cannot confide in their partner and
cannot leave, do not have any access to any funding for travel, and those kinds of things.
However good we are making access, there are clearly women falling through the net and
looking to get safe abortion medication online. We do not want to be in a position where
women have to be prosecuted before we decide that that is not a good idea.
LORD STEEL: But of course in Northern Ireland there is anxiety that women who
acquire this online can still be prosecuted there because it is illegal.
LISA HALLGATEN: Yes, they are being prosecuted.
THE CHAIRMAN: But in Northern Ireland they are getting more and more women to
actually access it and say: “I’ve done it. I’ve accessed it. What are you going to do with
me?” I just think that that is going to happen. If I needed an abortion now, in the next
few weeks, I would not go to any doctor or anybody. I would just try to get the pills
online. There is no way.
ANN FUREDI: There speaks a former doctor! I think you really are right. The genie is
out of the bottle now.
THE CHAIRMAN: Yes.
ANN FUREDI: I think this is an issue with the world that we live in, where people expect
to be able to get things in a convenient, sensible and straightforward way.
THE CHAIRMAN: It is in developing countries, too, which this investigation is mainly
about.
ANN FUREDI: Exactly.
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THE CHAIRMAN: It has been massively used. In Pakistan they have even admitted that
it has become a form of birth control; that people access it rather than use birth control.
ANN FUREDI: One of the most frustrating examples that I think we have in the
developed world is in North America. Let us compare ours with the situation in Canada,
which has actually had mifepristone and misoprostol as a legal method for less than a
year, where already it is provided in a way that any other treatment in this country would
be: that you would go to your doctor, the pregnancy is confirmed, the gestation is
confirmed, the doctor gives you a prescription, you go to the pharmacist, you collect your
drugs and go home and take them. Very straightforward, in a very small period of time.
The ridiculousness about the situation in this country really speaks to Lord Steel’s
suggestion. I would really urge everyone to press the Minister at the moment to follow
the Scottish route. The ridiculousness is that if a woman comes in to a BPAS clinic and
she is having a spontaneous miscarriage - and we also offer services on the NHS for
miscarriage management - we can hand her a packet of misoprostol to take home with her
and use. If she comes in and we are carrying out a procedure regulated under the
Abortion Act, she has to take the same drugs home in her vagina. She has to place them
in her body whilst in the clinic and then go home. That is the only difference. It is
incredibly stupid - I do not think there is any other word for it. The sooner we can move
towards that situation the better.
Very briefly on decriminalisation, I think one of the things that we have all been really
surprised by is that the assumption was almost that people would see decriminalisation as
being very, very radical. I think what is really becoming clear is that even quite
conservative members of the population and Parliament do not want to see doctors or
women prosecuted for this. They may not like it and, as some of our colleagues from
Northern Ireland have said, they may think that abortion is morally wrong, or should be
really regulated, but they do not want to see it as part of the criminal law. I think that is
the thing that may really push things forward.
BARONESS BARKER: Can I just ask David a question? Having fairly eminent people
from the medical profession on your side was an incredibly important part of your success
in 1967. Given that for many of the younger generation of doctors and medical staff now
it is not an issue of the same importance, do you think that the medical professions would
swing behind some attempt either to decriminalise or to move to just
one medical professional, rather than two doctors, and some of the other reforms that we
have been talking about?
LORD STEEL: My impression is that, yes, I think what you are saying is correct. It is
not just public opinion that has changed; I think medical opinion has changed. I think
there is a much greater readiness to accept the use of these drugs as an easier method of
abortion in the early weeks, but you still have to keep the safeguard for those women up to
20 weeks - and Dr Calderwood gave me the figures, which were actually quite
surprisingly large - who, for various good reasons, present late. You cannot use the drugs
in those cases. So I think the answer is that, yes, the medical profession is willing to see
the whole thing decriminalised. Regulated, yes, but not criminalised. My only slight
query with what Jenny Tonge said earlier is that I do not want to see these drugs used in
place of contraception. I think the importance of developing contraception and making it
available is absolutely paramount.
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LISA HALLGATEN: Can I just clarify on your question about medical professionals?
So the BMA, the RCOG, the RCM, and then last week the
Faculty of Sexual and Reproductive Healthcare, have all now passed motions to support
decriminalisation. These are, apart from the BMA, the specialist organisations and I think
they are going to pull other people behind them for sure.
BARONESS BARKER: Just on David’s point, I do not think we would do that either, not
least because, speaking as a member of the All-Party Parliamentary Group on HIV, which
I have been for a very long time, the whole issue of safe sexual health practices is never
more different than it was back in 1967. The whole thing has changed.
THE CHAIRMAN: Just between these four walls, can I ask another controversial
question? What do you think of the concept of menstrual regulation?
LISA HALLGATEN: I think it has been a life-saver in places like Bangladesh. It has
allowed people to provide safe abortion in a cultural context where it would not have been
allowed. I think without that kind of framing of it there would have been far more deaths
from unsafe abortion there.
THE CHAIRMAN: A professor I worked for 30 years or more ago - I do not how long
ago - was always advocating this. He could not see why there was all the fuss.
ANN FUREDI: It is a strange thing, is it not, that we have somehow come to attempt to
draw this incredibly sharp line between the prevention of pregnancy and contraception on
the one hand and ending a pregnancy - abortion - on the other? For a woman today who
does not want to have a child, I think the prevention of pregnancy is very, very high up on
their minds, as indeed I think the prevention of infection is high up on the minds of
younger people who are having sex. But if I am honest, and I have said this quite
a lot, I think there are women who come to our clinics looking for abortion as a means of
birth control, in the sense that prevention of pregnancy has not been possible through
one way or another, and so they are looking to end the pregnancy because they do not
want a child that they have not planned for and do not feel that they can. I think society
accepts that it would prefer women not to become pregnant but that, if they are pregnant,
it really does not want us to be forced to have children that we do not want. We have
a huge emphasis on responsible parenthood and it does not fit easily with that.
THE CHAIRMAN: But when we come to the methods used on the two sides, for the
contraception and for the abortion, we are splitting hairs -- when we talk about taking
emergency contraception or having a coil fitted to prevent the implantation of
a fertilised egg -- but saying that to take a medicine two days later that will actually throw
out the fertilised egg, which is just implanting or just about to implant, is wrong.
LISA HALLGATEN: I think it is very interesting. We had a really interesting session on
IUD fitting and for emergency contraception at the Current Choices Conference. This
issue was a kind of elephant in the room, because this person was saying “You can only
do it at this point, at this point, at this point”, but at no point did she say “for
legal reasons”, the implication being that it was for medical reasons, and it is absolutely
not for medical reasons.
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LORD STEEL: I think this is a particularly important issue in developing countries.
I have done quite a lot of travelling and lecturing on this subject. I remember going to
a conference about three years ago in Kenya, organised by the
Kenya Medical Association. They had in theory changed their law, but there was no
acceptance of legal abortion at all. That is what the medics were complaining about.
Of course this was in the time before the advent of the drugs, and I think the drugs
themselves will have made a big difference in countries like that.
THE CHAIRMAN: I think we will have to wind it up there. Once again, I am sorry
about the delays. You have all been magnificent. Thank you so much. The report will be
published and launched on International Women’s Day, 8 March 2018, somewhere in this
building - if it is still standing!
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