In 2012 a 15-year-old UK citizen found herself unwillingly pregnant. Had she lived in England, Scotland, or Wales she could have contacted her GP or local sexual health clinic to arrange a termination. But restrictions on abortion in Northern Ireland means she and her mother were forced to scrimp to cover the costs of travel to England for the abortion. And since women resident in Northern Ireland are not entitled to NHS-funded abortions in England, they also had to pay for the procedure.
The Abortion Act 1967 does not extend to Northern Ireland where abortion is still primarily regulated by an 1861 statute. This has been interpreted to permit abortions only in cases where continuance of pregnancy threatens the life of the pregnant woman or poses a “real and serious” risk of “permanent or long-term” harm to her physical or mental health. In 2013, only 51 cases met this threshold. These restrictive laws don’t prevent women from having abortions; rather, as the case of the 15-year-old shows, it just makes it harder for them to access the care they need.
Like many in their situation they found themselves in a financial spiral. The longer it took to save money for the procedure, the further the pregnancy progressed; the further the pregnancy progressed, the higher the cost of the procedure. The 15-year-old’s mother described the situation as “harrowing”. Finally, with the assistance of the Abortion Support Network – a charity established in 2009 to provide Irish women (from both the north and south of the country) with financial, logistical, and emotional support to access abortion care in England – they travelled to have the abortion at an independent sector clinic.
Hurdles and obstacles
Regional variation in access to UK abortion services is nothing new. When the 1967 Act was first introduced, women faced obstacles that were both institutional (bureaucracy) and personal (obstruction by medical personnel). This was described by social policy analyst Francois Lafitte and others as “the abortion hurdle race”. To overcome these hurdles, independent sector clinics like the Birmingham Pregnancy Advisory Service (now British Pregnancy Advisory Service) were established to plug gaps in NHS abortion care.
Unfortunately, for many women in the UK these obstacles continue. For example, women in Scotland are, due to lack of willing providers, unable to access abortions once they have reached 18-20 weeks gestation under Ground C: “the continuance of the pregnancy would involve risk, greater than if the pregnancy were terminated, of injury to the physical or mental health of the pregnant woman”. This is despite the fact that the legal cut-off for abortions is 24 weeks. These women also have to travel to independent sector clinics in England (usually as far as London) in order to access this care. But unlike women in Northern Ireland, the local NHS board in Scotland will cover the cost of the procedure (though not necessarily travel and accommodation for which “after the fact” applications for expenses can be made).
The teenager’s mother challenged the legality of the policy that precluded her daughter from accessing an NHS-funded abortion in England because she believed it to be to be discriminatory. The details of the case are technical and beyond our scope here, but the High Court in London affirmed the position that Northern Irish women are not entitled to NHS-funded abortion care in England.
The Secretary of State for Health has the power to make an exception to general funding arrangements which stipulate that only those ordinarily resident in a particular region are entitled to NHS funded non-urgent treatment there. However, the judge found that the reasons for his refusal to do so were neither “irrational” nor “unreasonable” (the threshold needed for the challenge in this case to succeed). Abortion is categorised as non-urgent care and the fact that the teenager could not access this care where she was ordinarily resident didn’t change this. The ruling was criticised by Amnesty for treating Northern Irish women as “second-class citizens of the UK in terms of their right to access healthcare”.
About 1,000 women travel from Northern Ireland to England annually to access abortion services. The total average cost for travel, accommodation, and the procedure is £900. The financial burden to these women is compounded by the emotional burden, as they enter what Yale anthropologist Marcia Inhorn described as “reproductive exile”. While abortion also remains a safe and routine procedure, inevitably risks increase when it is performed later and with less access to follow-up care. Naturally, these burdens mean that socially or economically disadvantaged women and girls are most vulnerable.
The death of Savita Halappanavar in the Republic of Ireland in October 2012 rightly attracted widespread international condemnation of restricted abortion in that jurisdiction. Within the UK, it is also too often overlooked that women in the north are similarly denied the right to make decisions about their reproductive futures available to their counterparts elsewhere in the country.