Amid COVID-19 pandemic, a landmark week for abortion care access in Northern Ireland

Belfast — After a chaotic week that saw outcry from pro-choice campaigners and abortion providers on both sides of the Irish Sea, Northern Ireland moved to ensure abortion services will be available during the pandemic. In a statement issued to the media on Thursday, April 9, the region’s Department of Health said medical professionals were now permitted to “terminate pregnancies lawfully.” The statement also claimed that the rollout of abortion services, which were meant to have been legally available beginning March 31, had been impacted by the pandemic and “the urgent need to focus resources on preparing the health and social care system for the surge in cases.”

The government’s decision comes after a tumultuous two weeks in which abortion services were supposed to be operational yet remained inaccessible through Northern Ireland’s health service.

Just a day before, on April 8, Human Rights Watch published a joint civil society statement urging European governments to “ensure safe and timely access to abortion care during the COVID-19 pandemic.” Among the specific contexts the letter identifies as particularly restrictive are those in which women “must travel to other countries to access legal care or must obtain abortion medication from outside their own jurisdiction.” Until this week, both these contexts applied in Northern Ireland.

The Department of Health’s statement came soon after BBC News Northern Ireland (NI) reported that health trusts had been instructed by the department not to roll out temporary plans they had devised for abortion care until full abortion provision was in place, claiming that it was “exploring options” and directing trusts to await more information.

On the same day, April 9, the British Pregnancy Advisory Service (BPAS), a leading abortion provider in the United Kingdom, said it would provide abortion pills by post to women in Northern Ireland who otherwise would face a journey to England to access the procedure there.

For the last two weeks, women were required to continue traveling to England to access abortion care — just as they had done prior to the legalization of abortion and during the interim consultation period that followed the change to the region’s abortion law in October 2019. With flights now being grounded and hotels closed due to the pandemic, travel is no longer a viable option.

After news broke at the start of April of an attempted suicide by a woman seeking abortion care, campaigners became increasingly concerned about the harm caused by lack of provision. When her appointment was canceled by a clinic in England due to lockdown restrictions, the woman attempted to access abortion through her local trust in Northern Ireland but was denied. She attempted suicide the next day.

Speaking last week, Naomi Connor, an abortion rights activist and co-convener of Alliance for Choice, described what women traveling from Northern Ireland to England for abortions faced: “When you get to England, a medical abortion requires you to take pills, so women are choosing a surgical abortion [instead],” she said. Connor explained that, though medical abortions are more preferable, women will opt for surgical abortions because “you can travel back on the same day.”

“If [those traveling from Northern Ireland] choose a medical abortion, they [then] have to endure all the pain and bleeding,” said Marie StopesUK’s Medical Director Jonathan Lord, speaking on Thursday before the announcement by the Department of Health.

This is an especially precarious risk considering that, in lieu of access to air travel, women were now taking the freight ferry across the Irish Sea to Liverpool, an emotionally and physically grueling eight-hour journey (each way). “One woman took a freight ferry to Liverpool,” Connor said. “She took [the pills] on the way back and she miscarried in the trunk of a lorry.”

“Women are being put at risk of exposure to COVID-19 by having to break isolation, when they could be in lockdown,” said Lord. “There is also a chilling effect on the staff caring for them on the [UK] mainland, who are being forced to put themselves at increased risk by having to see patients face-to-face when there is no clinical need. Their own government in England and Scotland has protected them from this by permitting remote consultation, but the Northern Irish government is forcing them to needlessly endanger themselves.”

Given the risks Lord outlined, campaigners in Northern Ireland put pressure this week on the region’s Health Minister, Robin Swann, to follow the lead of his contemporaries in the UK and the Republic of Ireland by introducing telemedicine, which would allow those requiring abortion care to speak to a doctor via a secure video link and take abortion pills safely at home — without visiting an already-stretched surgery or clinic.

“It’s safe, it’s effective, it has been researched to the nth degree,” said Connor of telemedicine. Given the threat of infection posed by the pandemic, telemedicine has been adopted by the other jurisdictions as a way of ensuring abortion access without endangering those seeking it or providing it.

However, instead of implementing telemedicine, Minister Swann referred the matter to Northern Ireland’s government who, in their deliberations on April 6, failed to reach a consensus.

The statement by Northern Ireland’s Department of Health does not mention telemedicine. While it marks a significant and welcome U-turn in the government’s approach to abortion provision at this critical time, the lack of telemedicine is a concern.

As Connor said before the new measures were announced: “Even if the abortion service provision rolls out, or if an abortion clinic opens tomorrow in Northern Ireland, women will still have to travel if they live somewhere rural — or even if they live in a city — unnecessarily putting themselves at risk, their families at risk, and health workers at risk. The solution to all this would be telemedicine.”

While BPAS will now provide abortion pills to women in Northern Ireland who need them, campaigners will continue to campaign for telemedicine provision locally. “We will still be pushing on that,” said Emma Campbell, Alliance for Choice’s co-convener with Connor.

While delighted to see abortion provision finally being rolled out, she, like Connor, sees telemedicine as a critical next step. “It’s great that women will get help now,” she said, “but we’re slightly worried they won’t introduce telemedicine here because, as usual, they’re just letting England sort it out.”

How effectively telemedicine for women in Northern Ireland can be delivered from England remains to be seen, particularly given the pressure abortion providers in the UK are already experiencing due to the pandemic.

For campaigners on the front lines of abortion care in Northern Ireland, while the announcement marks a landmark win, the battle continues.