The NHS and prochoice

The NHS had existed for 19 years before it became possible for a woman who had had her children born in an NHS hospital to have an abortion in an NHS hospital.

In Northern Ireland, though the UK citizens there pay for the NHS just as they do in England, Scotland, and Wales, a woman who needs an abortion usually cannot get one: with the exception of molar and ectopic pregnancies, which are accepted even in the Republic of Ireland as needing to be aborted, any woman who needs an abortion must find the fare to England and a place to stay overnight before the abortion.

Until next Thursday. Marie Stopes International will open a clinic in Belfast on Thursday 18th October, and – acting within the ambiguous confines of the law – will be the first providers of legal abortion to women who would otherwise have to travel to London:

The main legislative restriction is the Offences Against the Person Act of 1861. Since 1967, the Abortion Act has governed abortion in England, Scotland and Wales but Northern Ireland was excluded, and the 1861 Act still applies there.

The 1945 Criminal Justice (Northern Ireland) Act also applies to abortion in Northern Ireland. It allows the abortion of a child ‘capable of being born alive’ only where the mother’s life would be otherwise at risk.

In 2009 the Department of Health published a document which, for the first time, provided guidance to health professionals in Northern Ireland on terminating pregnancy.

Because the clinic will only provide medical abortions, which are only possible up to nine weeks, a woman in need of a late-term abortion will still have to travel to hospitals in London or Liverpool.

Routine ante-natal care on the NHS includes the offer of an “anomaly scan” at 18 to 20 weeks:

If the woman chooses, an ultrasound scan should be performed between 18 weeks 0 days and 20 weeks 6 days to detect structural anomalies.
If an anomaly is detected during the anomaly scan, inform women to enable them to make an informed choice as to whether they wish to continue with the pregnancy or have a termination of pregnancy.
Fetal echocardiography involving the four-chamber view of the fetal heart and outflow tracts is recommended as part of the routine anomaly scan.

The three Health Ministers of England, Northern Ireland, and Scotland who all aim to oppose women getting to have abortions when needed:

Jeremy Hunt, Health Minister for England Jim Wells - Northern Ireland Health Minister Alex Neil, Health Secretary

The lone Health Minister in the UK who supports women:
Lesley Griffiths

“I do think there is a case to be had for a reduction from 24 weeks…” – Alex Neil

What Alex Neil was talking about – assuming that, as Health Secretary, he was expressing an informed view – was that the abortion limit should be lowered to 20 weeks so that when a woman had the anomaly scan, there would be little or no time for a woman to decide she needed to have an abortion. (The Royal College of Obstetricians and Gynaecologists disagrees with him.) Even as it is, the legal window for abortion is very short. Alex Neil apparently wants to be shorter, to increase the likelihood of getting to force women to endure a pregnancy which will end in death of the foetus and risk the woman’s own health and wellbeing.

I was challenged on this in the comments in an earlier post, as to why I thought Alex Neil was a misogynist, and I acknowledged that I didn’t: he could just be speaking out of ignorance – it could be that as Health Secretary, he does not think he needs to know about the healthcare needs of pregnant women.

But if it was ignorance, since he made the comments days ago, he’s had plenty of time to ask his civil servants to educate him and make him realise his informed position needs to be what human rights and the medical evidence say it should be. If he’s unwilling to do that, that unfits him to be Health Secretary, if the SNP hope to maintain any pretence that they are aiming for a progressive new nation.

Judging by Alex Neil’s silence, the SNP’s inaction and the comments both I and Kate Higgins have received, Alex Neil is, at best, not interested in having an informed view that upsets his ignorant little bubble, and neither the party nor their supporters are particularly interested in appearing progressive, even if appearing regressive costs them votes. Worse yet, perhaps they think they will get more votes by going against women’s rights: given three out of four Health Ministers in the UK are against women having full access to abortion when necessary, is the right-wing in the US winning here?

If so, it’s strange but good that in the middle of this tidal backwash, this should happen in Northern Ireland – a step forward, not a step back:

“We offer a safe place for women and men to find support, be provided with help and counselling, to feel that they are being listened to and not judged. It is a matter of choice, every step of the way. A woman may decide that she does not want to choose a termination. If she does, then offering early medical abortion cuts out the stress of having to travel outside Northern Ireland to access those services.”

Last year, 1007 women from Northern Ireland travelled to England or Wales for an abortion, as did 4149 women from the Republic. “When women are faced with a crisis pregnancy, it’s a time of great personal turmoil. Knowing that someone is here to help them come to a decision reduces the trauma and upset,” said Ms Purvis.

The change in the law that Alex Neil wants to institute would bring Scotland closer to Ireland, where, as the campaigners Termination for Medical Reasons Ireland write:

The worst news that any expecting parent can receive, is that their unborn child will not survive outside of the womb. The law in Ireland does not allow mothers and fathers the personal choice to terminate a pregnancy under these very tragic circumstances. Instead, we are forced abroad, without care or advice, to undergo termination procedures. This website seeks to change this law and campaign for termination of pregnancy for medical reasons in Ireland. Help us make this possible.

In February this year two Glasgow midwives, Concepta Wood and Mary Doogan, neither of them old enough to remember the bad old prolife days when illegal abortion was one of the leading causes of death for women of childbearing age in the UK, complained to the courts that women who had had abortions were receiving care in their ward, and they were required to provide nursing care to those women, and they were also required to “delegate, supervise and support” other midwives and nurses who were more directly involved in providing the abortions. They claimed as a consequence of their religion that they shouldn’t have to care for women who had abortions even indirectly, instructing other nurses and midwives who were caring for them directly.

I’ve seen men argue that since women want access to abortion “tightened up”, advocate forcing women to give birth against their will, that means it can’t be a misogynist position. But Wood and Doogan exemplify misogny against other women, impelled, they claim, by religious faith that says that if a woman has done wrong according to the rules of Wood and Doogan’s faith, they don’t have to help her or care for her, or help and support others to care for her. That’s not Christianity: it’s misogyny.

The judge ruled

“Nothing they have to do as part of their duties terminates a woman’s pregnancy.

“They are sufficiently removed from direct involvement as, it seems to me, to afford appropriate respect for and accommodation of their beliefs.

The Nursing and Midwifery Council professional guidelines to nurses, quoted in the judgement, say that:

Nurses and midwives should give careful consideration when deciding whether or not to accept employment in an area that carries out treatment or procedures to which they object. If they raise a conscientious objection to being involved in certain aspects of care or treatment they must do so at the earliest possible time, in order for managers to arrange alternative arrangements……………
The NMC expects all nurses and midwives to be non-judgmental when providing care.”

Making abortion illegal only ever makes abortion more expensive and less accessible: a woman who has decided she needs to terminate the pregnancy will, if she medically can, travel to get her abortion, go into debt to get her abortion. The women who die in prolife jurisdictions are those too poor, too young, or too desperate to be able to find a safe, if illegal, practitioner. Restrictions on abortions are intended to put women in fear of breaking the law: they are not intended (and are never effective) as a means of preventing abortions.

In particular, attacks on the right of women to decide to have an abortion after 20 weeks are attacks on a particularly vulnerable set of people:

Just 1.4 per cent of British abortions take place between 20 and 24 weeks, though one in 12 of all abortions performed in Britain on women from the Republic of Ireland take place after 20 weeks, said Mara Clarke, director of the London-based Abortion Support Network.

Scans, she said, often did not take place until 20 weeks, so Irish women do not discover until then if the foetus is suffering from serious congenital problems: “So then they are faced with the situation of getting themselves organised within a matter of days.”

British research shows that the majority of all women who have abortions between 20 and 24 weeks are disproportionately young; older women who do not recognise that they are pregnant because they believe they are going through the menopause; or those in abusive relationships.

“However, the real reason why so many Irish women are late coming over is that they are trying to raise the money,” said Ms Clarke, who pointed out that abortions up to 14 weeks cost £400 approximately, between £600 and £700 after 14 weeks and £1,300 and over after 19 weeks, plus travel costs.

Aneurin Bevan devised the NHS to be a source of healthcare for all, free at point of access. It is good that at least some women in Ireland will no longer have to find the air fare to England or buy illegal abortion pills over the Internet. It is sad that, in Northern Ireland, a woman who needs an abortion cannot get it on the NHS.

‘The astonishing fact is that Bevan’s vision has stood both the test of time and the test of change unimaginable in his day. At the centre of his vision was a National Health Service, and sixty years on his NHS – by surviving, growing and adapting to technological and demographic change – remains at the centre of the life of our nation as a uniquely British creation, and still a uniquely powerful engine of social justice.’

While Jeremy Hunt stands out advocating for 12 weeks, Alex Neil’s proposal of reducing the limit just far enough to ensure that women could be forced against their will to continue a pregnancy after the 20-week scan revealed severe abnormalities, matches David Cameron’s expressed views on how to treat pregnant women. (SturdyAlex has noted the dangerous ambiguity of David Cameron’s references to his disabled son Ivan.) We have a Health Secretary in Scotland whose views on women are only as bad as the Tory Prime Minister’s, and it seems the SNP supporters are going all out for the “Calm down dear” response…

Gina Crosley-Corcoran writes

I am now a mother to a daughter who I will raise to believe in feminist goals, but I also believe that I may be doing the world an even greater service by raising feminist sons. It’s one thing for women to want to be equal, to try to be equal, and to even feel equal, but it is yet another for the men in our lives to step up to the equality plate and support our quest for equality.

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