Northern Ireland’s Abortion Laws Have Negative Consequences for Women’s Health and Wellbeing

Abigail R.A. Aiken, Elisa Padron, Kathleen Broussard, and Dana Johnson

Introduction

Northern Irish abortion law is currently in the international spotlight, now that the Republic of Ireland recently repealed its constitutional amendment prohibiting abortion, and the Isle of Man passed a bill to legalize abortion.

The United Kingdom’s 1967 Abortion Act made legal abortion widely available in England, Scotland, and Wales. However, the Abortion Act was not adopted in Northern Ireland, where abortion is permitted only to preserve a pregnant woman’s life or to prevent permanent damage to physical or mental health. In addition, providing or having an abortion outside the law is a criminal offense in the UK and carries a maximum penalty of life imprisonment. However, healthcare professionals in Northern Ireland are not required to report women they suspect have self-managed an abortion.

Despite these laws, women who live in Northern Ireland have abortions. Unless they qualify for one of the few legal exceptions, women obtain a clinic-based abortion by traveling to a country where abortion is legal, most commonly England, or they use telemedicine to access medication abortion in the form of mifepristone and misoprostol, tablets which are mailed to women’s homes. This second pathway allows women to self-manage a safe and effective medication abortion at home with instructions and support provided by a telemedicine service. One such service, Women on Web, is a non-profit organization that since 2006 has provided medication abortion in settings worldwide where abortion is not available through the formal healthcare system

This research brief describes the abortion experiences of women living in Northern Ireland. Focusing on women’s decision-making around how to obtain an abortion and their experiences accessing care, 30 women were interviewed in-depth. Interviews were conducted before and after a policy change by the UK government in July 2017 that allowed women from Northern Ireland to access to free abortion services in Great Britain.

Key Findings

(see figure)

Despite free abortion care available to women traveling from Northern Ireland to clinics in Great Britain, Northern Irish women still experience multiple barriers to travel.
- The number of women who received abortion medications from Women on Web in the year after the policy change decreased by only 3% compared to the year before the policy change.
Many women find self-managed medication abortion using online telemedicine more acceptable than traveling overseas, but the experience is dominated by fear and isolation due to the risk of prosecution.
The documented obstruction of abortion medications by Northern Ireland Customs officials engenders fear and anxiety in women who are waiting for their shipment. Many fear that their package will be delayed or will never arrive. Some women try less effective methods (such as high doses of vitamin C or parsley pessaries) or unsafe methods (such as drinking large amounts of alcohol or engaging in physical harm) while waiting for their abortion medication.
Many women who have self-managed an abortion believe that healthcare professionals in Northern Ireland are required to report them to authorities. As a result of fears of being reported and potentially prosecuted, women feel forced to lie about having had a self-managed abortion or avoid seeing a healthcare professional altogether.

This caption describes the image above.

This figure shows the four key ways that Northern Ireland’s abortion laws affect women’s decision-making and experiences. Women experience barriers to clinic travel despite free abortion care – barriers include cost, limited experience with travel, confidentiality concerns, child care issues, and stigma surrounding abortion. Self-managed abortion is preferred because of perceived advantages of comfort, privacy, and autonomy but fear of criminalization exacts a price and prevents women from seeking support from friends and family. Northern Irish Customs officials obstruct and delay care – women experience fear and anxiety while waiting for abortion pills to arrive; some women try less effective or dangerous methods while waiting. Women are reluctant to seek care from Northern Irish healthcare providers – women are unclear what information and support healthcare providers can legally provide; many avoid contact altogether because of fear of prosecution. *Names are pseudonyms.

Policy Implications

Northern Ireland’s current restrictive abortion laws are not preventing all Northern Irish women from having abortions. Women living in Northern Ireland are accessing abortion either by traveling overseas or by self-managing using abortion medications at home. Policies to make abortion care free at clinics in Great Britain are not sufficient to ensure access. Self-management at home using abortion medications provided through online telemedicine is a safe and effective option, often preferred over travel. But the criminalization of these abortions harms and stigmatizes women by creating a climate of shame, fear, and isolation. The obstruction of abortion medications by Customs officials also puts women’s health at risk. Finally, the current abortion laws harm the doctor-patient relationship and isolate women from seeking care and support through the Northern Irish healthcare system. Decriminalizing abortion would allow women to access safe and effective abortion care without fear of prosecution and would pave the way for affordable, accessible, and acceptable clinic-based services in Northern Ireland.

Reference

Aiken, A.R.A, Padron, E., Broussard, K., Johnson, D. (2018). The impact of Northern Ireland’s abortion laws on women’s abortion decision-making and experiences. BMJ Sexual and Reproductive Health.

Suggested Citation

Aiken, A.R.A, Padron, E., Broussard, K., Johnson, D. (2018). Northern Ireland’s abortion laws have negative consequences for women’s health and wellbeing. PRC Research Brief3(15). DOI:10.15781/T2PR7ND17.

About the Authors

Abigail R.A. Aiken (araa2@utexas.edu) is an assistant professor in the LBJ School of Public Affairs and a faculty research associate in the Population Research Center at The University of Texas at Austin; Elisa Padron is an undergraduate student in UT Austin’s College of Natural Sciences; Kathleen Broussard is a PhD student in sociology and Dana Johnson is a PhD student in the LBJ School of Public Affairs; both are graduate student trainees in the PRC.

Acknowledgements

The study was supported by funding from a Junior Investigator grant from the Society of Family Planning, a grant from the European Society of Contraception and Reproductive Health, and a grant from the HRA Pharma Foundation. The study was also supported in part by infrastructure grant P2CHD042849, awarded to the Population Research Center at The University of Texas at Austin by the Eunice Kennedy Shriver National Institute of Child Health and Human Development. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health, the Society of Family Planning, the European Society of Contraception and Reproductive Health, or the HRA Pharma Foundation. None of the funders had any role in the conduct of the research or preparation of the manuscript.