WKatie Boyd was a hen and decided that she wanted an abortion. Two years ago, Katie Boyd had been celebrating when Northern Ireland decriminalized abortion in October 2019. It seemed natural that now abortion care is readily available.
Boyd, 40, called a hotline intended to connect those seeking abortion with care, and was told she’d receive a call within five days from a clinic that could provide an early medication abortion. Five days passed without Boyd receiving a call. She kept trying to contact the clinic by phone, but no one called her back. Boyd started to panic as the days became weeks. The Northern Ireland government offers medication abortion. It involves two sets of pills and is only available up to the 10th week. A cutoff was fast approaching. Then, Boyd was forced to fly to England to access abortion more readily. Boyd called the international organization which had sent her the abortion pills several years before, but it was still illegal. Instead of offering assistance, Boyd was directed to the same hotline by the group because Northern Ireland now allows abortion. Legal—but not accessible.
“I was just hitting brick wall after brick wall after brick wall,” says Boyd. “And I got really upset.” She says she told her partner, “I feel like I’m in the 19th century. Something is happening to my body, and I’m not ok with it, and I feel like nobody’s listening to me.”
Boyd sent an email to Alliance for Choice (an abortion-rights group in Belfast) with very little time. Naomi Connor, the co-convener, replied in less than an hour and helped Boyd obtain abortion pills from another activist group. Boyd was able to take these at home, ending her pregnancy. The entire process was “brutal,” she says—and far more difficult than the abortion she had several years earlier, when it was still criminalized. “It was more compassionate, and more empathetic, and I had more autonomy over my body when the service was illegal.”
Naomi Connor is the co-convener for Alliance for Choice. She holds medications that help to induce a medical abortion in Belfast (Northern Ireland) on April 7, 2020.
Many people in Britain are upset at Roe v. Wade being overturned by the Supreme Court. But there are significant barriers in Northern Ireland to access abortion. This is a region of the U.K. where nearly 2,000,000 people live. It is frustrating that progress has not been made in the two years since decriminalization. That’s because the Department of Health has not commissioned abortion services, leaving already-stretched health care workers to provide care on an ad-hoc basis without funding or training. It means those who seek abortion have to navigate through a maze full of obstacles. Connor and other activists are more busy than ever trying to help people get abortions.
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To allow Northern Ireland’s representatives to decide how the country is run, many powers have been delegated by the U.K. government to Northern Ireland. This includes decisions regarding abortion policy. But now, the U.K. government is poised to bypass Northern Ireland’s officials to set up abortion services directly because of frustration over the delay. In May, the U.K.’s Secretary of State for Northern Ireland, Brandon Lewis, directed the Northern Ireland Department of Health to establish fully-funded abortion services “within days to weeks.” If it does not, “I will intervene further,” he said in a written statement to parliament.
It wouldn’t be the first time Westminster intervened in Northern Ireland to secure abortion rights. Even though abortion had been legalized elsewhere in the U.K. back in 1967, the legislation didn’t apply to Northern Ireland where it was illegal under almost every circumstance. For decades, most people needing abortion were forced to travel to England or obtain illegal pills—or continue their pregnancies. An investigation by the United Nations Committee on the Elimination Discrimination against Women in 2018 found that the U.K. had violated women’s human rights by restricting abortion access. The same year the U.K.’s Supreme Court said the restrictions in Northern Ireland were incompatible with human rights legislation. Following years of activism by civic groups and activists from Northern Ireland, Westminster finally took the necessary steps in 2019.
As with 2018’s Republic of Ireland referendum that resulted in limited legalization of abortion it was not passed by a judge. Instead, with Northern Ireland’s legislative assembly suspended due to political deadlock, the U.K. parliament passed a bill to maintain public services in Northern Ireland, and Labour MP Stella Creasy proposed an amendment decriminalizing abortion in Northern Ireland. In October, the law was passed and the criminalization of abortion was lifted despite some protestations by Northern Ireland politicians. The Northern Ireland abortion law is more permissive now than in the U.K. where there is still a law that criminalizes abortion, but it has been legalized under certain conditions by the 1967 law. Boyd found that the reality is quite different.
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In March 2020, the U.K. issued regulations describing the new legal framework that Northern Ireland has for abortion. It’s available for 12 weeks for all reasons and 24 weeks for those two doctors who certify that the continued pregnancy poses a greater threat to her mental or physical health than terminating it. Abortion is allowed after 24 weeks in severe fetal defects, when there are serious risks to the health of the mother or serious mental or permanent harm.
Robin Swann of the Democratic Unionist Party’s Health Minister declined to fund or set up abortion care. The public-funded system of universal healthcare in Northern Ireland is available. Swann claims he requires approval from the Northern Ireland Executive Committee, but this committee is currently inactive due to a political disagreement. Lewis passed regulations in May that eliminated the requirement for approval from the executive to order abortion services. A spokesperson for the Department of Health said the Minister is “currently awaiting legal advice on the implications” of the regulations “before considering the next steps regarding the commissioning of services.”
Without any government intervention, the clinicians offer what care they have to in addition to their normal duties. They do so without direction or resources. Four of Northern Ireland’s five local health care authorities are now offering medication abortions. Contrary to other parts of the U.K. that allow telemedicine to be used to give the pills at home to patients, Northern Ireland’s residents will need to travel to a clinic for the first pill. Connor said that although doctors perform some surgical abortions every year since 2020, they stopped doing so recently because the Health Department was not supportive. Therefore, those who can’t or won’t take the pills or are unable or unwilling to access them before the 10-week deadline must travel to England. This was especially true during the COVID-19 lockdown of 2020 when many modes of transport and hotels were closed and people were advised to remain at home. The government released figures on June 21 showing that 161 Northern Irish women traveled to England or Wales in 2021 to have abortions, compared to 371 in 2020.
Some areas have had their abortions suspended. This has left people with no access to local services. The Western Health and Social Care Trust, which covers a large, mostly rural area, stopped offering medication abortion in April 2021 due to “staff resourcing issues,” said a Trust spokesperson. Prior to the opening of neighboring trusts accepting Western Trust patients’ referrals, for one year they were left with no choice but to either travel to England or buy abortion pills online. The Trust is working to restart services “within the next number of months” and has recruited additional staff to “support the service going forward,” said the spokesperson.
According to activists, clinicians have been doing their best in spite of huge challenges. “The doctors and the healthcare professionals are operating in a vacuum,” says Connor. “There’s no governance for them, there’s no resources for them, there’s no funding for them. The circumstances in which they were required to provide this healthcare was difficult for them. So we can’t blame them” when they are not able to provide the care.
In the information void left by the health department’s inaction, many people don’t know where to go to access abortion or even whether it is legal. Even the phone number people from across Northern Ireland call to access an abortion referral—the number Boyd called—is run not by the health department but by a non-profit abortion provider in England, which stepped in back in October after Northern Ireland sexual health charity Informing Choices NI was forced to end the service for lack of funding. Connor says that some women and pregnant persons who use Google to search for information about abortion end up in anti-abortion centers. These facilities sometimes delay people until they reach the 10-week mark for medical abortion.
Many are now turning to activists in order to get the support they need. Connor is constantly receiving requests for assistance. A recent afternoon in Belfast saw her stop mid-conversation twice to receive calls or messages from woman seeking assistance accessing abortion. After being forced to go to England a decade back to get abortion, she got involved with the project. It took years to “unpack the stigma,” she says. She now tries to prevent others from having the same experience.
Naomi Connor, co-convener, Alliance for Choice Belfast (North Ireland), April 7, 2020.
When Connor initially spoke to Boyd and assured her she could help, “I felt like I exhaled for the first time in weeks,” says Boyd. Boyd, like 57% of U.K. women who had an unplanned pregnancy last year is already a mom. In the U.S. about 60% of those who have had an abortion have already had at least one baby. The couple, who have been together for seven years, are very cautious about contraception. She was stunned to learn that she had become pregnant when she discovered she was. The partner of seven years, who is also on the waiting list for vasectomy, supported her decision. (Waiting times for access to long-acting contraception is a connected issue—the Western Trust, where there are no abortion services, has a 16-week waiting list for patients seeking contraceptive coils and implants.) Boyd received her first call to the hotline in September. She then got a call about a month later from Belfast’s clinic. She says that she’d already had her own self-managed abortifaction. Because of the continued bleeding, she needed to see a doctor. At the hospital, doctors removed tissue that hadn’t been expelled in the abortion.
Many struggle to get abortions within the 10 week limit. Boyd is one example. A pregnancy is detected at 4 weeks. Most women find out they are pregnant after this time, so that’s close to the limit. People can be over-exposed if they wait even one week to get referred to a clinic. And that’s if they can get to a clinic in the first place. This is not possible for those in abusive and coercive relationships. It is not always possible for people to leave work, arrange childcare or transport, which can be a problem in rural areas such as the Western Trust. It is more challenging to travel to England.
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Connor recently helped a woman who was a refugee from a country that had suffered female genital cut, rape and trafficking. She could not speak English well, had diabetes, and was scared to go to the doctor. Connor helped her get to a clinic. A translator wouldn’t allow the woman to speak after hearing that she needed abortive care. The clinicians found that the woman was 10 weeks and more pregnant. She would need to fly to England to get abortion care. Connor was angry. “This woman had encountered all that, she got to a place of safety here in Northern Ireland. And we were going to tell her she had to travel?”
Connor requested that the doctor call a nearby hospital to schedule a surgical abortion. The woman spent three days in the maternity unit’s labor and delivery suites, and eventually had a surgical abortion after multiple failed attempts at medication abortion. Her room was for stillbirths or miscarriages. Because of protocol, she signed forms. Doctors had to hand her pamphlets for miscarriage. The clinics described the setting and protocol as inappropriate because of the inability to commission abortion care. Connor said that they repeatedly apologized for this to her and the woman. However, she claims they tried to do the best they could. She had to inform another woman recently that she would need to travel to get an abortion. But the woman was already aware of her decision. Because of lack of local commissioning, she could not have a surgery performed by local doctors. “Those women who should be traveling the least, they’re the people who are being forced to travel,” she says. “And it’s inhumane.”
The need for assistance is so great that in 2020 Alliance for Choice organized an “abortion doula” training, where participants learned about abortion and how to support people through the process. Connor stresses that they are not healthcare professionals or counselors, and they do not interfere with people’s decisions. But once someone makes a decision, “we are there to support people throughout their abortion journey, whether that be practical, emotional, logistical, or any other type of support that we can realistically provide.”
Bethany Moore participated in training. Now, she is an abortion doula for Alliance for Choice Derry. That can be anything from dropping off meals, providing support during the process, or just listening. “It’s a radical act of community care, a radical act of love, helping someone get the care they need,” she says.
Many times, those looking for help are only able to confide in activists. Claire Hackett, an abortion doula with Alliance for Choice who lives in a rural area, says many of the women who come to her for help accessing abortion don’t feel comfortable sharing their situation with anyone else because of the stigma. When she talks with them, “they’re just so relieved to be able to unburden,” she says. When she tells them “look, we will get you sorted, you’re not on your own—you can really hear the relief and the relaxation in them.”
Around one third of U.K. women will have an abortion within the first 45 years. But the stigma is a barrier to access and isolates individuals. Many protesters gather in front of clinics. Northern Ireland is small and tightly knit, so many people fear that they will be recognized when visiting a clinic or talking with their doctor. “Your doctor might be a family friend,” says Moore. “There is that worry of who’s going to see me, what is my doctor going to say.”
Northern Ireland’s attitudes towards abortion are shifting. Surveys of public opinion show that most people support abortion access and decriminalization. But stigma is still “prevalent and multi-layered,” says Fiona Bloomer, a senior lecturer at Ulster University who studies abortion. “We’re not a society that is used to talking about sex, relationships, and sexual health. So abortion is on the far end of that scale,” she says. The stigma of abortion is allowed to endure because there’s no one to speak up. “As a society we’re on a pathway of feeling more relaxed about talking about abortion, but there’s a long way to go.”
The stigma is a reminder that activists will have to work even if they are allowed to provide abortion services tomorrow. But that’s the first step, and they say it must happen now. ”It’s beyond a joke that we still have no abortion services,” says Moore. “And that really comes from a lack of political will from the Health Minister to put his personal feelings aside and do his job.”
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