Wednesday, 14 May 2014

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'Abortion is the one thing that unites us.' Stalemate in Northern Ireland since 1994

Last week, the High Court ruled that women from Northern Ireland are not entitled to free abortion care in England. The judgement put the spotlight back on the injustice that there are women living in the UK on 2014 who are not able to access abortion care when they need it. 

Pro-choice campaigners have been arguing for decades that all women in the UK should be entitled to free, legal abortion when they need it. Seems rather basic, really. Yet any drive for progress is blocked by anti-choice politicians using the same tried, tested, and quite frankly tired, excuses for years. The parallels in this article we found in our archive from the Independent on Sunday on 13th November 1994, for example, are astonishing.

Cartoon from Independent on Sunday, 13th November 1994 

The article below, by Kenan Malik, looked at the ‘implacable opposition to abortion [that] crosses the divide in Northern Ireland.’ Change the date in the top right hand corner of this  and despite being 20 years old the entire article could quite easily be taken from a paper over the weekend. You wouldn’t even need to go to the hassle of getting some new quotes from politicians – the excuses and, to put it politely, misleading statements about the lack of support for abortion among the general population are still trotted out. 

'Abortion as a unifying force in Irish politics' is sadly still very much a barrier to change. Steve Bell’s cartoon in the Guardian on Friday, below, was particularly on the money, and at a recent seminar the fact that abortion is one of the few issues both sides agree on was cited as a key factor in the continued stalemate.

Steve Bell cartoon published in the Guardian on Friday 9th May 2014 

Inconveniently for anti-choice politicians, surveys and polls have been showing for years that a significant proportion of Northern Ireland just don’t agree with their views. Malik’s 1994 article looks at a survey conducted that year by Ulster Marketing Surveys for the Birth Control Trust which showed just that

Belfast Telegraph, 11th November 1994 

Clearly politicians were out of step with public opinion in 1994 – and they still are today. FPA polling has shown that the majority support liberalising the abortion law, and this figure is still growing.  A Belfast Telegraph survey in 2012 also found that one in four in Northern Ireland support abortion on demand – a more liberal system than is currently in place in the rest of the UK. Despite these compelling statistics, politicians have continually ignored the mood for change. The then Secretary of State for Health, Virginia Bottomley, declared in 1994 that ‘there is no will in Northern Ireland for such change.’ In 2014 we have SDLP MLA Pat Ramsey taking over the reigns of blind denial stating that there is ‘no appetite for abortion.’

The experience of women facing unplanned pregnancies women of Northern Ireland in 1994 is also sadly similar to those facing unplanned pregnancies today. The personal stories in this piece of women feeling too ashamed to tell anyone about their pregnancy, of feeling isolation, and of struggling to meet the huge financial burden sadly echo those of the women of Northern Ireland today.

You get a sense of Groundhog Day when reading this article. Women in Northern Ireland are having abortions and they are paying a huge emotional and financial cost. This cost has been imposed by their own politicians, united in their ability to ignore both women’s experiences and the support for change. 

We were all very disappointed with last week’s ruling that women from Northern Ireland aren’t able to access free abortions on the NHS in England. But let's hope in another 20 years time these women will not only be able to access free NHS care, but most importantly able to do that at home. 

Independent on Sunday, 13th November 1994

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Tuesday, 13 May 2014

‘Repeat’ abortion and ‘late’ abortion: the reality behind the controversy

Two important new studies examine women’s reasons for having abortions, dispelling many the myths that surround abortions later in pregnancy, or women who have more than one abortion.

Access to later abortion in Scotland

Carrie Purcell of the University Edinburgh and colleagues conducted in-depth interviews with 23 women presenting for abortion at 16 or more weeks’ gestation in Scotland. Scottish women face a particular problem in accessing abortion, as abortion for reasons other than fetal anomaly is not usually provided in Scotland after 18-20 weeks.

The study found that some of the women did not realise they were pregnant until relatively late in pregnancy, sometimes because they were using contraception. Some of the women took ‘were ambivalent about both the pregnancy and the prospect of having an abortion’, which leading a delay in accessing services. A further group of women ‘had initially decided to carry their pregnancies to term experienced changes in life circumstances that were largely beyond their control, and the subsequent decision to have an abortion led to a later presentation for health services.’

These findings support those of other studies about British women’s reasons for seeking late abortion – notably, the work by Roger Ingham and colleagues, which revealed why, no matter how much access to abortion early in pregnancy is improved, a proportion of women will always need access to later abortions – because they don’t realise they are pregnant, or their circumstances change, or they need time to make their decision.

The new study by Purcell and colleagues additionally found that in Scotland, access issues in later abortion present a major additional problem. While 13 out of the 23 participants were able to have an abortion locally, others had to deal with the financial, logistical, and emotional burden of travelling to England. The authors write:

‘Women who did travel to England had to mobilize a range of resources, including financial, practical and emotional support, and access to these varied. Travel costs – train tickets or flights and 2–3 nights’ accommodation, booked at short notice – were high. The women who travelled were in a range of socioeconomic positions, but none found it easy to obtain such funds, and none was clear on how to claim reimbursement from health services. Una – who was 24 and had an abortion at 21 weeks –had been able to fund a trip to England, but she was informed while en route that because of a health complication, she could not have the procedure at that time. This necessitated her returning home (a 17-hour round-trip) and rebooking travel and accommodation for the following week.’

The authors also note the contradiction that women having treatment for miscarriage, or abortions for fetal anomaly, did not have to go to England for these procedures, and the women in their study ‘felt there was judgment in this disparity’. The authors’ conclusions are worth quoting in full:

‘Many reasons for later presentation at health services could not have been foreseen by the women we interviewed. Our findings suggest that women need adequate time to consider the conflicting candidacies of motherhood and having an abortion, and that the additional work required to obtaina later abortion is a source of inequity. Indeed, women who have to travel for an abortion are aware of the differential service provision between themselves and others being treated locally for later miscarriage or fetal anomaly. The burden of traveling to England presents one of the most significant barriers to later abortion for women in Scotland, exacerbates an already potentially difficult experience, and contributes to abortion stigma and discrimination. This study highlights that it is not only in countries with restrictive abortion laws that women face barriers to service access. Future efforts to improve health care services should include a policy focus on reducing barriers to abortion access and improving provision of later abortion.’

Young women’s contraceptive use after abortion
Another study, conducted for the reproductive health charity Marie Stopes International, looked at the contraceptive use of women aged 16-24 having one or more abortions. Interviews were completed by 430 women aged 16 to 24 who booked an abortion at its centres, 121 of whom had previously had an abortion.
This study found, strikingly, that more than half (57%) of women were using contraception when they became pregnant. The majority were using short-term methods, such as the pill (54%) or condoms (40%); and 12% had used emergency contraception.
The study further found that uptake of contraception at four weeks post-abortion was high, at 86%, but 67% used their chosen method for less than a year. Reasons for stopping included menstrual irregularities for long-acting reversible contraception (LARCs) and not renewing supply in time for pills and injections.
The full report of the MSI study has yet to be released. However, an excellent commentary by Lisa Hallgarten on the Reproductive Health Matters website provides some context. Hallgarten writes:
‘When I and a colleague at Education For Choice undertook research into the phenomenon of repeat conceptions leading to repeat abortion amongst teenagers in 2007, it became clear very quickly that the term “repeat abortion” is a misnomer. It suggests that a woman is in some way thoughtlessly or compulsively repeating a negative action, whereas the truth is that each abortion is a separate and unique event in a woman’s life. Whether her abortions take place within a year, or twenty years apart, her circumstances, health, the status of her relationship and her emotional attachment to the pregnancy may all be very different. The way in which she got pregnant, her chosen method of contraception and consistent or inconsistent use of that method may also have changed from one unintended pregnancy to the next. Having a “repeat abortion” may engender feelings of guilt at ‘failing’ to prevent a second pregnancy, or it may feel safe, straightforward and familiar the second time round. When we talk about “repeat abortion” we make this complexity and the stories of women’s real lives invisible.’
Hallgarten goes on to talk about the way in which the stigma surrounding ‘repeat’ abortion can have an adverse effect on women’s contraceptive decision-making. ‘Feeling bad about a first or “repeat” abortion is not a good basis for making a positive choice about future contraception,’ she writes. ‘It can result in feelings of fatalism (which is very bad for decision-making); lack of trust in service providers or feeling untrusted by them; or agreeing to, rather than positively choosing, a recommended method of contraception. Likewise professional anxiety about preventing future unintended pregnancy may result in promoting, rather than offering, long acting reversible contraceptive methods.’
Hallgarten concludes:
‘I only wish that we could lose the idea that the most effective way to reduce stigma is by reducing the incidence of “repeat abortion”. This idea reinforces the messages from politicians, funders and the media that tell us “abortion just about ok, repeat abortion bad”. But what if we can’t eradicate “repeat abortion” simply by improving contraceptive services? What if, as our research found, women’s complex and sometimes chaotic lives and relationships play as much part in unintended conceptions as contraceptive provision or lack of it? What if, as is increasingly being articulated, there are women who simply cannot find a contraceptive method that works for them. Shouldn’t we focus on reducing the stigma of “repeat abortion” in and of itself?

‘Abortion is not the onerous journey it once was: the procedures can be provided very early and are extremely safe. If a woman feels happiest using a less reliable contraceptive method such as condoms and doesn’t see having one, two or three abortions across her 35 fertile years as a problem, why should we?’

This post was originally published on the bpas Reproductive Review

Thursday, 17 April 2014

A 'United' Kingdom? Disparity in abortion legislation between Great Britain and Northern Ireland

Last week, we attended a seminar by Jennifer Thomson, a PhD student at Queen Mary’s University London, looking at the continued disparity between abortion legislation in Great Britain and Northern Ireland. It was mainly students in attendance and we thought, why should they hog all the learning fun?’, so decided to write this short post.

The 1967 Abortion Act, which legalised abortion in England, Scotland and Wales, was never extended to Northern Ireland. In 2008, Diane Abbott MP’s amendment to the Human Fertilisation and Embryology Bill presented an opportunity to do just that, but it was sadly unsuccessful. A transfer of justice powers to Stormont in 2010 means that this was probably the last chance for Westminster to effect such a change in Northern Ireland. The power to end the inequality now firmly resides with Northern Irish politicians.

Abortion is, in theory, legal in Northern Ireland in ‘exceptional circumstances.’ However, a complete lack of clarity as to what actually counts as an ‘exceptional circumstance’ means that it is impossible for the vast majority of women to obtain an abortion in Northern Ireland when they need to.

Social attitudes are now out of step with the law, with a recent poll by the Belfast Telegraph finding that 46% support liberalisation. Thomson pointed out that the majority of polling suggests a greater acceptance for abortion on medical rather than social grounds: the Northern Ireland Life and Times survey found that only 25% thought that abortion was wrong in cases where there was a strong chance of “a serious defect in the baby” whereas a greater proportion, although still the minority, thought abortion on the grounds of a family’s financial difficulties was always wrong (43%). Currently, the government is only considering legislation for abortion in cases of fatal foetal abnormality which, while incredibly important, would only help a very small handful of women.

Why has there been so little movement on abortion rights in Northern Ireland? Thomson suggested that the continuing power of religious authority, much greater than that in the other nations, plays a crucial role, with abortion one of the few issues that bridges the strong religious divide. Thomson also argued that the idea of equality is largely seen in the context of creating parity between the two communities, rather than between men and women. Abortion rights campaigners are not alone in facing these difficulties and Thomson pointed to similarities with the LGBT rights movement. Northern Ireland refused to follow suit when the rest of the UK legalised same sex marriage and adoption, with the Northern Irish Attorney General stating at the time: "what happens in Scotland, England and Wales does not constitute a line into which Northern Ireland must be brought”, a phrase which could easily have been said in the context of a debate on abortion.

So after it was thoroughly - and depressingly - established that politicians are content to keep their heads firmly stuck in the sand, the discussion moved on to what pro-choice campaigners can do to help bring about the change Irish women so desperately need.

The government’s decision to act on abortion for fatal foetal anomaly only occurred because brave women were able to tell their stories, leading to a public outcry that couldn’t be ignored. But, as Thomson pointed out, it is very difficult to create a similar wave of public sympathy when a culture of silence and stigma still presides, in particular around terminations for social reasons.

Luckily, we were joined by Speaking of I.M.E.L.D.A., a group challenging the ongoing problem of Ireland making England the legal destination for abortion (hence the name.) One campaigner said it is very hard to get the public to support a cause that is barely spoken about, but there is a growing pro-choice movement working to raise the awareness that is needed for change.

It is unjust that women in Northern Ireland are denied the rights offered to women in other nations in the UK. Campaigners have been working to end this inequality for decades, and the polls are now showing that the public attitude to abortion is shifting. Try as they might (and they really are trying very hard), politicians can’t continue to ignore this issue, and they can’t continue to ignore the needs of the women of Northern Ireland. As one activist said as the event was closing, “we’ve have been campaigning for 20 years – and this time we’re not shutting up.”

Hear, hear. 


Friday, 11 April 2014

Abortion: Ten Years On - articles from 1978

In the third post from the bpas archive we are sharing extracts from a publication called ‘Abortion: Ten Years On’. The Abortion Act received Royal Assent on 27th October 1967, and six months later on 27th April 1968 it came into force. This booklet was published by the Birth Control Trust in 1978 and features articles written by those closely involved in campaign for legal abortion in England, Scotland and Wales.

The first piece is from Alastair Service, the chairman of the Family Planning Association, and paints a fascinating picture of his time as a lobby organiser for the Abortion Law Reform Association  while the 1967 Abortion Act passed through Parliament.

He takes us through the initial repetitious days he spent scurrying across the Central Lobby approaching MP’s – some of them were “fiercely bearded”, a wonderful description I hope to hear more often. There were also mass lobbies, but unfortunately MPs didn’t really turn up. So they went to the Bar where funnily enough they found a large number of MPs to lobby. There were some barriers to cross: one MP told Service “send me all your stuff and I’ll talk it over with my wife”, while another declared “I don’t vote on things like that – I concentrate on the major issues”, presumably referencing the  Domestic and Appellate Proceedings (Restricting of Publicity Bill) which was competing for members attention at the time. Crucial stuff….

Service and his fellow campaigners ploughed on, rounding up MPs, nagging them during the late night sittings until they promised to stay to vote. Eventually while Service and Houghton were in a café and chatting about a campaign for free contraception, the final stage passed. The lesson: a watched Parliament never votes. Best to go and have a cup of tea.


One MP who Service definitely didn’t need to nag in the late hours of the evening to back the Bill was it’s architect David Steel. He is naturally pleased to celebrate the ten year anniversary of the abortion law reform in 1978. A parliamentary inquiry in to the Act found that it was responsible for “relieving a vast amount of individual suffering.” He took on those who said he wanted to kill babies, that he was going to hell, that he didn’t care about families, and he won. And yet he still speaks of the “respect” he has for his opponents. It seems more than fair that the authors of this booklet decided that he should be depicted as a knight (albeit at first glance a little confusing.)

While, as Lena Jager MP notes in another chapter in the book, “nobody will ever be able to prove statistically the impact of the 1967 Act” that Steel fought for, Madeleine Simms, the former press officer at Abortion Law Reform Association, quotes from an inherited scrapbook full of late 1930’s news clippings that prove in a much more powerful way than numbers ever could what the Abortion Law has meant for women.

These articles document the tragic conditions under which illegal abortion took place, and the risk women took with their lives and health when faced with an unwanted pregnancy. One case detailed is of a 36 year old woman who died from a “septic abortion followed by acute blood poisoning”, after deciding that 10 children in 17 years was enough. Even the Coroner expressed his sympathy, stating that he could “understand the desperate feeling that she must have had when she found herself once again pregnant.”

These also show how, despite the illegality, there was a community that worked together to provide abortions for these desperate women in a safer environment than those found down a back-alley. These “medical men” were breaking the law, but they were valued and supported, with defence funds raised when they faced prosecution. And when Dr Daniel Powell of Tooting , “the most watched medical man by Scotland Yard” died, “women from all parts of the country journeyed to London” to pay their respects.

Simms wrote that the scrapbook demonstrated the importance of free, legal abortion to those who in the late 1970s wanted the return of a restrictive abortion law, but the picture they paint serves as just a useful a reminder of life without legal abortion today.

For further updates from the bpas archive follow us on Twitter or search the hashtag #bpasarchive

Tuesday, 8 April 2014

Protecting pregnancies with a slice of bread – why we should back flour fortification

There are many circumstances that affect whether a woman decides to end a pregnancy which we simply can’t change.

We can’t conjure up the financial security she wants before she brings a child into the world, however important the campaign for secure maternity benefits and high quality, affordable childcare.

We can’t transform the man she’s accidentally conceived with into the man she wants to start a family with. We can’t eliminate the needs of her existing children whom she feels must come first. 

But every now and then, there are things we really can do to make a difference.

Everyday, women find themselves in the tragic situation of being told their pregnancy is affected by a neural tube defect (NTD) such as spina bifida or anencephaly. Spina bifida causes serious lifelong disability while anencephaly, where the baby’s skull and brain do not form properly, is always fatal. This country has one of the highest rates of these conditions in the European Union, resulting in an estimated 1,000 cases per year, not including those that end in miscarriage.

The most effective way to reduce NTDs is for women to take a supplement of folic acid in the months before they start trying for a baby, as the neural tube develops in the very early stages of pregnancy - before a woman often knows she’s expecting. But as we in our service know only too well, pregnancies happen when women are often least expecting them. Two thirds of the women we see with an unplanned pregnancy report using contraception when they conceived.

Many unplanned pregnancies end in abortion, but many others are greeted as welcome surprises. It's estimated that between one third and a half of babies are the product of these happy accidents.

But happy endings are not guaranteed.

We believe it's simply unrealistic to expect women who are not planning a pregnancy to be taking folic acid supplements on the basis that they might conceive. Fortifying our flour with folic acid would mean that this vital nutrient entered everyday foods widely consumed by women of childbearing age, whether they were trying for a baby or not, and prevent hundreds of cases of spina bifida and anencephaly a year.

It could spare a couple a day from the heartbreaking decision to end what was a much wanted pregnancy. These cases are among the saddest we see in our clinics.

It is now six years since the Scientific Advisory Committee on Nutrition (SACN) first recommended flour be fortified –  and the UK’s chief medical officers considered and approved that recommendation. The UK has been adding  calcium, thiamin, niacin and iron to wheat flour for more than 50 years so both the principles and the mechanics of fortification are already in place.  
The move is supported by disability organisations and those involved in women's pregnancy care like bpas. The decision now lies in the hands of UK health ministers.

They should follow the example of the US, Canada and Australia, which have all introduced fortification. There is now no evidence of any adverse impact on the rest of the population, but plenty to show this protects women and their babies.

It was scientists from the UK’s Medical Research Council who proved in the early 1990s that folic acid could prevent these defects. More than two decades have passed and it’s now high time that UK women and their babies were able to reap the full benefits of their work.

Thursday, 3 April 2014

Happy 40th Birthday, free contraception!

From 1 April 1974 all contraceptive advice and supplies became free on the NHS, and available to all women. 40 years on, we celebrate the anniversary of free contraception in the UK and call for the next step forward.
The contraceptive pill was first licensed in 1961, yet initially restricted to those deemed wise enough to use it, and worthy of its privileges – those bastions of moral responsibility who are older married women. So hoorah for the less celebrated year of 1974, when contraception became free of charge for all women, regardless of age or marital status.
It’s hard to think of a development which has brought about such a monumental change in women’s lives, their role in society, and their relationships with men as free access to contraception.
The Pill enabled women to take control of their biology. Family sizes shrunk, motherhood was delayed, and women began to occupy those spaces that had previously been the sole domain of their male counterparts. Alongside access to safe, legal abortion, women could start to make genuine reproductive choices.
Yet while we can celebrate the 40th anniversary of free access to this revolutionary pill, this birthday is also the occasion to reflect on what we want from contraception over the next four decades – and ideally before we reach the last half of the 21st Century.
We should be asking why we are not seeing the investment, effort or drive to develop new methods of contraception that actually meet women’s needs. There seems to be a prevailing sense of “job done” when it comes to contraception, and ongoing barriers to technological advances in this field. While we have seen a few new methods enter the market over the last decade of so, these are by and large variations on the dose and delivery of the same medication.
Hormonal contraception should be celebrated for the huge advances it has brought, but it’s not for everyone. While there are women who will swear by their contraceptive implant, there are others who find themselves begging the doctor to remove it. We need new methods without the side effects such as irregular bleeding, weight gain, nausea or lower libido. We need a greater choice of non-hormonal methods for those women who do not wish to use hormones or who cannot.
We need methods better suited to the reality of women’s lives and an acceptance that some women don’t want to use barrier methods like condoms or diaghrams but also don’t feel they are having sex regularly enough to warrant remembering a daily pill or having a long acting IUD or implant inserted. A pericoital pill, which could be taken at the time of sex, would represent a huge breakthrough for those women.
And we need to take politics out of pills. Researchers have noted that one of the major barriers to contraceptive development is the fear of controversy – so, for example, it would be possible to create a monthly pill that would either stop a fertilised egg implanting or detach it from the lining of the womb, yet concerns about the reactions from those who would see this as an abortion have put the kybosh on its development. Some women may well have their own personal position on whether this method is right for them – but shouldn’t that be their choice to make?
And lastly, we need methods for men. Men need something in between the two extremes of condoms and vasectomies, and the argument that most women wouldn’t trust men with their birth control is insulting to the many men who we know are keen to share the burden of contraception with their partner.
So hooray for free contraception. Thank you 1974. But it’s 2014 now – and women deserve more.
This piece was originally written for and published by Feminist Times