To this day, Dr Laura McLaughlin is still explaining to colleagues that abortion is no longer a crime in Northern Ireland.
It is exactly three years since the North’s strict abortion laws were liberalised by Westminster during a period of Stormont collapse – yet uncertainty and fear remain among some senior NHS staff about the outworking of the landmark legislation.
“A lot of people, even medical professionals, don’t understand what decriminalisation actually means,” says the consultant obstetrician and gynaecologist who co-founded Doctors for Choice NI.
“Even within my own department, I spent nearly the first four months just really trying to engage with medical, nursing and midwifery colleagues.
“There was a fear they would be forced into doing things they weren’t really comfortable with.
“With the Repeal campaign in the South, there was that engagement and you had time to bring people on board; so yes, as much as decriminalisation was a great step forward in empowering women… it really was just thrown upon us without any support, without any backup.”
Before October 2019, it was illegal for the North’s healthcare workers even to signpost patients seeking terminations to other organisations.
NHS staff were “absolutely terrified” to mention any interest in abortion care, according to Dr McLaughlin: “Decriminalisation means it is now legal for a woman who is up to 12 weeks’ pregnant to seek advice about an abortion, ask for an abortion and get an abortion in Northern Ireland.
“It’s as simple as that. But I am still doing that today – explaining that.”
Pro-choice campaigners say lack of awareness is directly linked to Stormont’s failure to roll out fully funded abortion services across the North’s five health trusts, with a recent Amnesty International UK poll revealing only one in 10 women know how to access terminations locally.
The result is that despite having the some of the most permissive legislation in Europe – on paper abortion is legal up to 24 weeks in Northern Ireland – access to care is fragmented, forcing many women to travel to England.
While all health trusts are currently offering early medical abortions (limited to nine weeks and six days of pregnancy), severe staffing shortages forced two clinics to close temporarily.
The Western Trust, where a quarter of the 300,000 population it serves live in poverty, only reinstated its service earlier this month after shutting last spring, and remains vulnerable.
Demand is high, with more than 4,000 terminations carried out in the North since the law came into force in March 2020.
Figures provided to The Irish Times by the British Pregnancy Advisory Service (BPAS), which acts a central access point for women in Northern Ireland seeking abortions, estimate that 15 to 20 women are travelling to England each month (where access to free NHS terminations has been available since 2017).
Last Monday, Northern Secretary Chris Heaton-Harris accused Stormont’s Department of Health of “continued inaction” on the issue and confirmed that the UK government will now step in to fully commission abortion services in Northern Ireland.
Health Minister Robin Swann has always insisted such a move required sign-off by the power-sharing executive – which could never transpire due to the DUP’s fierce opposition – but in May the UK government directed that Mr Swann’s department had the authority to act alone.
‘Requested legal advice’
Asked to respond to the criticism over its failure to commission abortion services, a Department of Health spokeswoman said Mr Swann had “requested legal advice” from the attorney general following developments in May.
“This [advice] was under consideration when the Secretary of State made the decision on Monday 24th October 2022 to invoke his statutory powers to commission abortion services. Department of Health officials continue to work closely with the Northern Ireland Office to support the implementation of abortion services, in line with legislative requirements.”
Amid the continuing Stormont deadlock and looming pre-Christmas election, is there confidence in the UK government’s ability to deliver on fully funded abortion care?
“There’s a small sense of joy but we’ve received similar statements in the past from the UK government that had no timeframe. We will believe it when we actually see it come through,” says Dr McLaughlin.
“Ultimately, every single one of us would much prefer the statement to come from our health minister and to have the backup from our chief medical officer.
“At the same time, it doesn’t really matter where the funding comes from, as long as it comes. This is essential healthcare. It’s not just the people that use our service who are affected. Like any pregnancy, it goes beyond the woman.”
BPAS also welcomed the UK government intervention while describing it as “woefully overdue”.
“Alongside women and abortion providers in Northern Ireland, we been waiting since 2019 for meaningful action to be taken to secure accessible, sustainable abortion services in Northern Ireland,” says BPAS chief of staff Rachael Clarke.
For a campaign group opposed to abortion, the Northern secretary’s announcement adds to the “sense of injustice” they feel at “undemocratic decisions” taken by Westminster.
‘People are entitled to protest, but last week a coffin was placed outside the Causeway clinic in Coleraine. It’s so traumatic’
Dawn McAvoy of Both Lives Matter NI said the law, led by Labour MP Stella Creasey and voted through by Westminster MPs in 2019, “would never have happened” had Stormont been in place.
“We continue to be angered and saddened by a law change that was undemocratically decided. Whether you like it or not, people in the South had at least had their say in a referendum.”
A co-founder of the pro-life organisation that helped mobilise a 20,000 strong “silent protest” at Stormont in September 2019 – former DUP first minister Arlene Foster was among the marchers – Ms McAvoy supports calls by those on the “opposing side” for more funding to be directed into counselling services.
“I think it’s so important to say that while we come from two different positions, we both recognise the reasons why women turn to abortion,” she explains.
Asked for her stance on the introduction of “buffer zones” outside the North’s abortion clinics to prevent harassment of staff and service users, Ms McAvoy says her group has never taken part in protests but defends the right to do so, “whether that’s through silent prayer or offering leaflets”.
“But when that tips into being aggressive, I just drop my head and think, what good is that doing to anyone? It’s not helping the voices that are saying both lives matter and that there are other choices for women. Neither is it helping the women going in to the clinics.”
Former Green Party leader Clare Bailey brought forward the private member’s Bill for the introduction of a “safe access zone” outside NHS clinics in the final days of the last Assembly mandate in March this year.
‘Called a murderer’
During her time volunteering with the Marie Stopes independent abortion clinic in Belfast (it closed in 2017) Ms Bailey says she was “spat at, splashed with holy water, called a murderer and watched a woman run into oncoming traffic to escape these people”.
“This needs to stop, this is not protest as I understand it,” she told MLAs before the passing of the bill prompted a round of applause in Stormont’s public gallery.
However, it is currently at the centre of a Supreme Court legal challenge by Northern Ireland’s attorney general, Brenda King.
She has asked the UK’s highest court to decide if the Bill is a “proportionate interference” with the rights of those who wish to express opposition to abortion services.
Emma Campbell, co-convener of reproductive rights group Alliance for Choice, argues protections are needed as she believes protests have become more “sinister” since the new laws were passed.
“People are entitled to protest, but last week a coffin was placed outside the Causeway clinic in Coleraine. It’s so traumatic,” she says.
“The other thing is, we’ve had GPs phoning us asking us for advice, because they are unsure about the legislation.
“The way the law stands at the minute, people should be protected from barriers but the culture takes so long to change. It’s not that people don’t want to help, they’re worried about their jobs.”
Dr McLaughlin agrees that increased training will raise awareness among her colleagues.
“Having seen it, there are people who said initially that they don’t want to be involved who are now in my team providing the care, seeing the women, handing the medication over. Three years ago, they would never have done that.
“So with time and education, they’re coming around to it. That’s what the South had, which the North never had.”