By Jill McManus

Women’s health in Northern Ireland (NI) has made some astonishing legal progress but the services have been slow to catch up. Abortion was decriminalised in NI in October 2019, and after public consultation, regulations were laid down in March 2020. However, for the entirety of the Covid-19 global pandemic, during which the public was asked to stay at home, women and pregnant people in NI continued to face the injustice of travelling for abortion services. It has been 20 months since decriminalisation, yet for every day of those 20 months our government has been failing women.

When abortion is discussed by our politicians in NI, it is framed as an ethical and more often than not, religious, issue. This framing does not adequately express the experiences of the women and pregnant people who travel for that care or access it in NI.

When Alliance for Choice (AfC) discuss abortion, we consider it as a key aspect of human rights namely - bodily autonomy, dignity, the right to a personal and family life and mental well-being. As a final year medical student, and very soon to be doctor, I consider it to be a part of the broad spectrum of healthcare women access across their lives: contraception, fertility and pregnancy, menstrual health, menopause and for 1 in 3 women across their lifetime, abortion is a reality.

This year, on International Day of Action for Women’s Health, we at AfC are reflecting on the current lack of access to abortion services locally in Northern Ireland, the context in which women’s health is discussed in our education and healthcare systems, and the fight for justice in gender equality.

Northern Ireland was not included in the 1967 Abortion Act, which allowed for doctors to provide abortion care in England and Wales, and in Scotland up to 1991. For 50 years, abortion was more heavily restricted in Northern Ireland and that has yielded a society that is, in many ways, decades behind on women’s healthcare, pervading all aspects of health throughout the lives of women and girls.

This begins with our relationship and sex education (RSE) in schools. Roughly 70% of post-primary schools in NI use abstinence based RSE, provided from an evangelical Christian perspective. Many schools, during the ethics portion of religious studies, also teach only a “Christian” perspective on abortion, however we know from groups recently formed such as the Faith Voices for Reproductive Justice that there is no singular “Christian” perspective on abortion. Many of those who are of faith use contraception and sometimes, they require access to abortion care. Aspects of sexual pleasure, consent or LGBT+ relationships are not even touched upon, never mind integrated within RSE teaching.

The result is that young people are failed by our education system regarding RSE. According to a survey by Love to Know NI, 96.8% of respondents wanted change in how RSE is delivered island-wide, with those responding describing their RSE experience as “inadequate”, “terrible” and “useless”. (1)

The stigma perpetuated around sexuality for women, results in a difficulty for women in accessing contraception and abortion services. In January this year, over 700 women were contacted regarding poor placement of contraceptive implants between 2017 and 2020. (2) Some of these women became pregnant, and the for the vast majority of this period they would have been unable to access abortion services at home or would have been under threat of prosecution for seeking telemedicine services from providers such as Women Help Women or Women on Web.

This is an environment which leaves women with nowhere to go. There is currently a dearth of access to family planning clinics, and for those who can access contraception, long waiting lists for long-acting reversible contraception and the threat of this being inserted incorrectly, resulting in an unintended pregnancy at the end of it all.

For those trying to become pregnant, there is also a lack of funded access to fertility treatments in NI, with only one fresh and one frozen embryo transfer funded by the Health and Social Care Board (3), another inequity between NI and the rest of the UK. This is even less for those not in heterosexual relationships, and there are no sperm banks.

Many women report high levels of satisfaction with maternal care during pregnancy and childbirth, however NI has one of the lowest rates of breastfeeding in the world, with 24% of women wanting more support in breastfeeding according to the Birth NI survey. (4)

Until this year there was also no funding for perinatal mental health treatment and a mother and baby psychiatric care unit, however, thanks to brave campaigners like the Maternal Advocacy and Support Project and Linsday Robinson this has changed and funding for a unit for new mothers with post-natal mental illness will now be granted.

Lifelong issues for women, such as chronic menstrual pain are also, unsurprisingly, not treated well in Northern Ireland. With an 8 and a half year wait for women to be diagnosed with endometriosis, a condition that impacts on as many as 1 in 10 women, they are left in chronic monthly pain and no state-funded access to diagnosis or treatment. With only one specialist in surgery for endometriosis, it is not shocking that so many women experience delays in surgery for debilitating pain. (6)

This paints a picture of women’s healthcare not being prioritised, women’s pain disbelieved, and women’s experiences ignored. It took until 2021 for Stormont to develop a strategy for violence against women and girls, despite it being reported in August 2020, that reports of domestic violence being at an all-time high. (7) Even our now-legal abortion services are constantly under threat despite not even being implemented fully; women using services in hospitals are forced to see graphic anti-abortion imagery, one MLA is bringing a private member’s bill to restrict abortion from severe foetal anomaly to fatal foetal anomaly – an action that would force some of the most vulnerable women and families to travel to England for care, and Robin Swann, the Minister for Health at Stormont is still refusing to commission abortion care services across the HSC Board.

Despite what our Health Minister says, abortion is not a “contentious issue” that requires executive involvement. Abortion is no longer a criminal act in Northern Ireland, thereby making it the domain of healthcare and not criminal justice. Further, why should an executive minister in infrastructure or agriculture have vetoing power on a deeply intimate part of women’s health?

By refusing to commission these services, Robin Swann is allowing the DUP and the UK Government to use an important part of women’s healthcare as a political bargaining tool.

There is an assembly election next year, and it is important for all of us to ask difficult questions of those asking for our vote. Make it clear to candidates in your areas that our bodies are not up for debate and that this will be an issue you will be voting on. It’s likely at least one of the issues discussed in this article have impacted on you or the people you love. We make up half the population – its time women are seen for the significant decision makers in society that we are.

If you or someone you know needs an abortion, contact Informing Choices NI or Alliance for Choice for advice.

Here are some other important organisations to follow on these issues:

- The Homeless Period Belfast

- Abortion Support Network

- Here NI