Attitudes and Attitudes and practice of practice of

gynaecologists gynaecologists towards abortion in towards abortion in Northern IrelandNorthern IrelandColin Francome & Wendy Colin Francome & Wendy

SavageSavageMiddlesex UniversityMiddlesex University

Fiapac conference Fiapac conference 23.10.10 Seville23.10.10 Seville

Abortion law in the Abortion law in the British IslesBritish Isles

Until 1967 abortion was a crime under the Until 1967 abortion was a crime under the 1861 Offences Against the Person Act 1861 Offences Against the Person Act punishable by life imprisonment for the punishable by life imprisonment for the person doing the abortion and the woman person doing the abortion and the woman herself. In 1929 abortion to save the life of herself. In 1929 abortion to save the life of a woman was allowed. Following the a woman was allowed. Following the Bourne case in 1938 Justice MacNaughten Bourne case in 1938 Justice MacNaughten ruled that abortion was legal if ruled that abortion was legal if ‘continuance of the pregnancvy would ‘continuance of the pregnancvy would wreck the woman’s mental or physical wreck the woman’s mental or physical health’. health’.

The 1967 Abortion ActThe 1967 Abortion Act This allowed an abortion to be performed This allowed an abortion to be performed

in GB if two doctors certified in good faith in GB if two doctors certified in good faith that it was necessary on a number of that it was necessary on a number of grounds.grounds.

This law did not apply to Northern Ireland This law did not apply to Northern Ireland which still relies on the 1861 OAPA (which which still relies on the 1861 OAPA (which dates back to 1803) as amended in 1945.dates back to 1803) as amended in 1945.

Neither does the 1929 Infant Life Neither does the 1929 Infant Life Preservation Act apply in Northern Preservation Act apply in Northern Ireland but the 1945 Criminal Justice Act Ireland but the 1945 Criminal Justice Act (NI) made same exception(NI) made same exception

NI women travel to GB for NI women travel to GB for abortionsabortions

At least 50,000 women are At least 50,000 women are known to have travelled to UK known to have travelled to UK since 1968 since 1968

Prenatal screening is carried out Prenatal screening is carried out but if the woman has a fetal but if the woman has a fetal anomaly detected she cannot anomaly detected she cannot legally have an abortion in NI –legally have an abortion in NI –unless she threatens suicideunless she threatens suicide

The study methodologyThe study methodology

43 consultants identified by 43 consultants identified by contacting hospitals by phone. One contacting hospitals by phone. One retired by time Q sent out so retired by time Q sent out so sample size was 42sample size was 42

Questionnaires were sent three Questionnaires were sent three timestimes

2 refusals2 refusals 37 (88%) questionnaires received37 (88%) questionnaires received

Question 1Question 1

Research carried out by Marie Stopes International Research carried out by Marie Stopes International found that 95% of women from Northern Ireland found that 95% of women from Northern Ireland traveling abroad for their abortion would prefer traveling abroad for their abortion would prefer access in Northern Ireland. Do you think that the law access in Northern Ireland. Do you think that the law in Northern Ireland should be changed to permit in Northern Ireland should be changed to permit abortions to be carried out on a wider range of abortions to be carried out on a wider range of circumstances, be further restricted or remain the circumstances, be further restricted or remain the same?’same?’

Abortion law should be liberalised Abortion law should be liberalised 21 21 (57%)(57%)

Stay the same Stay the same 12 (32%)12 (32%)

Restricted Restricted 4 (11%) 4 (11%)

Question 2Question 2

Would you agree that abortion should be Would you agree that abortion should be legal in Northern Ireland in the legal in Northern Ireland in the following circumstancesfollowing circumstances

HIV positiveHIV positive Yes 41% No 49% Unsure 10% Yes 41% No 49% Unsure 10%

Fetal abnormality Yes 76% No 10% Unsure Fetal abnormality Yes 76% No 10% Unsure 13%13%

RapeRape Yes 68% No 22% Unsure 10% Yes 68% No 22% Unsure 10%

Question 4Question 4

If the law was changed would you personally agree If the law was changed would you personally agree to carry out a termination if the woman wanted to carry out a termination if the woman wanted an abortion in the following circumstances?an abortion in the following circumstances?

HIV HIV Would perform 32% would not 65% Would perform 32% would not 65%

Fetal anomalyWould perform 70% would not 27%Fetal anomalyWould perform 70% would not 27%

RapeRape Would perform 49% would not 51% Would perform 49% would not 51%

On request in first trimester Would perform 14%On request in first trimester Would perform 14%

Would not perform 85%Would not perform 85%

Question 3Question 3

Many countries in Europe including Italy, Many countries in Europe including Italy, France, Holland, Germany and Belgium France, Holland, Germany and Belgium allpw women the right to choose an abortion allpw women the right to choose an abortion in the first trimester( up to 12 weeks) Do you in the first trimester( up to 12 weeks) Do you think women in Northern Ireland should think women in Northern Ireland should have unrestricted access to abortion in the have unrestricted access to abortion in the first trimester?first trimester?

Yes 13 (35%) No 19 (51%) Don’t know 5 (14%)Yes 13 (35%) No 19 (51%) Don’t know 5 (14%)

Younger doctors split 50:50 older against 2:1Younger doctors split 50:50 older against 2:1

Question 5Question 5

Would you support the major abortion Would you support the major abortion charities being licensed to carry out charities being licensed to carry out abortions in Northern Ireland within abortions in Northern Ireland within the extent of the current law?the extent of the current law?

In favour In favour 19 (51%)19 (51%)

Against Against 14 (38%)14 (38%)

Don’t knowDon’t know 4 (11%) 4 (11%)

Question 6Question 6

If the law remains unchanged do you If the law remains unchanged do you agree that women should have parity agree that women should have parity with the rest of the UK and not have to with the rest of the UK and not have to pay for an abortion in England?pay for an abortion in England?

In favour In favour 29 (78%)29 (78%)

Opposed Opposed 3 (8%) 3 (8%)

Unsure Unsure 5 (14%) 5 (14%)

Question 7Question 7

If you were asked to treat a woman If you were asked to treat a woman experiencing post abortion complications experiencing post abortion complications following the use of abortion medication following the use of abortion medication online, would you report the woman to online, would you report the woman to the PSNI (Police Service of Northern the PSNI (Police Service of Northern Ireland)Ireland) ? ?

Yes Yes 2 (5%)2 (5%)

Depends Depends 1 (3%)1 (3%)

NoNo 34 (92%)34 (92%)

Policy implicationsPolicy implications

Law should be changed as UK is Law should be changed as UK is signatory to CEDAW statement but signatory to CEDAW statement but unlikely to happenunlikely to happen

NHS should agree to pay for abortions NHS should agree to pay for abortions for women from Northern Ireland who for women from Northern Ireland who have to travel to UK. We should lobby for have to travel to UK. We should lobby for thisthis

The charities bpas and MSI should set The charities bpas and MSI should set up a clinic jointly in NI to do legal up a clinic jointly in NI to do legal abortionsabortions

PublicationPublication

This paper Attitudes and practice of This paper Attitudes and practice of gynaecologists towards abortion in gynaecologists towards abortion in Northern Ireland has been accepted by Northern Ireland has been accepted by the Journal of Obstetrics and Gynaecology the Journal of Obstetrics and Gynaecology Colin Francome is Emeritus ProfessorColin Francome is Emeritus Professor

and and Wendy Savage Honorary Professor at Wendy Savage Honorary Professor at Middlesex University Dept of health and Middlesex University Dept of health and Socail Science. She is also coordinator of Socail Science. She is also coordinator of Doctors for a Woman’s Choice on Doctors for a Woman’s Choice on Abortion (DWCA)Abortion (DWCA)

www.dwca.org email www.dwca.org email wdsavage@doctors.org.ukwdsavage@doctors.org.uk