Abortion law in the British Isles: progress needs to become the rule not the exception

Field: Social Sciences (Social Sciences)

Although elective abortion remains unacceptable to many around the world, others regard 2018 as having seen improvements in the sexual and reproductive rights of girls and women across the British Isles. The Republic of Ireland delivered a decisive majority in favour of repealing the 1983 eighth amendment to the Irish constitution, which recognised an equal right to life for mothers and their unborn children, effectively prohibiting any induced abortion in almost all cases. The Isle of Man decriminalised abortion and started the journey towards providing abortion services. Scotland, England and Wales now recognise a woman's home as a safe and acceptable place to take misoprostol, the second drug used to effect an early medical abortion. Enabling women to choose whether to administer misoprostol at home – rather than at a clinic – is a simple and practical measure that will provide women with significantly more choice. It will allow them to avoid the distress and embarrassment of bleeding and pain during their journey home from an unnecessary additional clinic visit. Importantly, it will improve access to safe and regulated care after abortion for women in rural communities, women who cannot take time off work and women in coercive relationships. Despite the progress that has been made, reforming British law and the way that care is delivered remains unfinished business. The 1967 Abortion Act removed the horrors of illegal ‘backstreet abortions’, but legally abortion remains a criminal offence and is only permitted on ‘medical grounds’ certified by two doctors. This is out of step and needs reforming. Although change is needed across the UK, it is needed most in Northern Ireland, where the 1967 Abortion Act was not implemented. Women living there should have the same access to abortion as in the rest of the UK; local public and medical opinion both support this. Currently, healthcare professionals struggle to provide care for women requesting a abortion or with post-abortion complications. This is unacceptable and leaves doctors, nurses, and midwives working in a precarious legal vacuum. Whereas the decision by the English, Welsh and Scottish governments to fund abortion on the National Health Service for women from Northern Ireland is an important step forwards, it remains unacceptable that they have to arrange and self-fund travel and accommodation, which can be extremely stressful and can result in delays. The barriers to obtaining an abortion in Northern Ireland mean increasing numbers of women are purchasing ‘abortion pills’ online, taking them with no medical support, delaying seeking care if there are complications, and putting themselves at risk of life in prison. The UK government has international obligations to reform abortion law in Northern Ireland. Decriminalisation through repeal or reform of sections 58 and 59 of the Offences against the Person Act offers the most effective way to meet those obligations, removing the criminal penalties for abortion and enabling Northern Ireland to develop its own framework for the provision of services. If abortion is decriminalised and recognised as a healthcare rather than a criminal matter, it would still be subject to all the laws and regulations that govern every clinical procedure. None declared. Completed disclosure of interests form available to view online as supporting information. Please note: The publisher is not responsible for the content or functionality of any supporting information supplied by the authors. Any queries (other than missing content) should be directed to the corresponding author for the article.