Incorporating: Margaret Wort & Co WB Gurney & Sons

ALL-PARTY PARLIAMENTARY GROUP ON POPULATION, DEVELOPMENT

AND REPRODUCTIVE HEALTH

MINUTES OF PROCEEDINGS

at a

PARLIAMENTARY HEARING

held in

Room 17, Houses of Parliament, London SW1A 0AA

on

Wednesday 29 November 2017

Before:

Baroness Tonge, in the Chair

Baroness Barker

Viscount Craigavon

Baroness Uddin

--------------

From the Shorthand Notes of:

AUSCRIPT LIMITED

Central Court, Suite 303, 25 Southampton Buildings, London WC2A 1AL

Tel No: 0330 100 5223 Email: uk.transcripts@auscript.com

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Witnesses: EMMA CAMPBELL, Alliance for Choice; POLLY BARKLEM and

BARBARA DAVIDSON, London-Irish Abortion Rights Campaign; RUAIRI ROWAN

and LAURA RUSSELL, UK Family Planning Association.

THE CHAIRMAN: Welcome to all of you. I am Jenny Tonge. This is Janric Craigavon.

VISCOUNT CRAIGAVON: I am an independent Cross-Bench Peer in the House of

Lords.

BARONESS BARKER: Liz Barker, Liberal Democrat Member of the House of Lords.

As the FPA knows, I am Chair of the All-Party Parliamentary Group on Sexual Health.

BARBARA DAVIDSON: My name is Barbara Davidson. This is Polly Barklem. We

are from the London-Irish Abortion Rights Campaign. We are a grass-roots organisation

founded about a year ago. We campaign for free and safe legal abortion across the island

of Ireland.

I am going to give you a brief outline of the law in Northern Ireland just to set our whole

discussion in context. The law governing abortion in Northern Ireland is one of the most

restrictive in both the European Union and the Council of Europe. The maximum

criminal penalty imposed - life imprisonment for both the woman undergoing the abortion

and any individual who assists her - is the harshest in Europe and among the harshest in

the world. Attempting to procure an abortion, having an abortion or performing an

abortion are criminal offences under the Offences Against the Person Act 1861, as is the

destruction of a child then capable of being born under the

Criminal Justice Act (Northern Ireland) 1945. The current law is that abortion is illegal in

Northern Ireland unless the continuance of a pregnancy threatens the life of the

pregnant woman or would adversely affect her mental or physical health. The adverse

effect on her mental or physical health must be “real and serious” and must also be

“permanent or long term”. The Abortion Act was never extended to Northern Ireland.

There is no exception to the general prohibition on abortion in cases of foetal abnormality

or where pregnancies are as a consequence of rape or incest. This was the subject of

a High Court claim in December 2015, when it was found that this was a breach of

Article 8 of the European Convention on Human Rights. That was appealed and

overturned in the Northern Ireland Court of Appeal in June 2017. An appeal to the

Supreme Court was heard in October of this year and judgment is expected soon.

Abortion policy was devolved to the Northern Ireland Assembly in 2010 and the reform of

abortion policy has been the subject of debate in the region ever since. Of the parties

represented in the Northern Ireland Assembly, the DUP, the SDLP and the TUV oppose

any change to the law in abortion whatsoever. Sinn Féin passed a motion at its most

recent ardfheis extending the party’s support for abortion to when a woman or girl’s

physical or mental health is at risk. The Alliance Party and the Ulster Unionist Party offer

their members a vote of conscience. Only the Green Party and the

People Before Profit Alliance are in favour of full decriminalisation, but those two parties

represent a tiny minority of the Northern Ireland Assembly.

Former politics do not tell the whole story. There is a young, post-conflict society in

Northern Ireland which remains deeply divided. This is reflected in voting patterns,

which tend to be along constitutional lines rather than along issues of social reform.

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There is strong evidence that the general public in Northern Ireland supports reform of

abortion laws. Most recently, the Northern Ireland Life and Times Survey of June 2017

reported that over 80 per cent of the people in Northern Ireland believe that abortion

should be legal when a woman has become pregnant as a result of rape or incest and that

73 per cent believe that abortion should be legal in local hospitals in cases of foetal

abnormalities. The Northern Ireland Assembly collapsed in January 2017 and there is no

immediate prospect of it reforming.

POLLY BARKLEM: I am just going to go on to the impact of the law. Ultimately, the

impact of the law is that the majority of women and girls who do not want to continue

with their pregnancies either travel to England for an abortion or they buy abortion pills

illegally over the internet. There were only 16 legal abortions in Northern Ireland in 2015

and 2016. That is the same figure as 2014 and 2015. It is generally understood that that is

as a result of the guidance that came out in Northern Ireland, which I think the FPA are

going to talk about a little bit more. That guidance had a really chilling effect and so there

are now fewer terminations carried out legally.

The official figures are that 724 women travelled to England for an abortion in 2016. That

figure is likely to be much smaller than the real figure because that is the number of

women that gave their address as being in Northern Ireland. There is likely to be - who

knows - a lot more than that travelling and not giving an address in Northern Ireland or

going to a country other than England.

The economic cost of travelling was for a long time extremely high. The Stella Creasy

amendment has recently changed that and is a great harm reduction measure. We will talk

a little bit about the funding - Barbara will come back to that later on - but basically

abortions are now free for Northern Irish women in England. Travel is means tested at

quite a low bar, but there is funding available for some of the poorest women, which is

really helpful.

Obviously the wider impact of travelling, now that the economic cost is alleviated, means

that it is marginalised communities that are worst affected by this law: women that cannot

travel because they do not have papers; women that are in abusive relationships and so

cannot get out, or even make an appointment to see their doctor. They might have

children and so they cannot leave them behind. Who is going to look after those children

for the number of days that they have to travel? It is obviously more worrying for those

women in the traveller communities. There are women as well who might not even know

they are pregnant for a long time, until it is later down the road, and then having to get all

of the information together to travel across is going to impact them in a worse manner. It

is not better just because it is now free. In particular, adolescent girls are at risk because

they would have to tell their parents; if they do not have a passport, they need to find some

other way to get to England; and that is extremely difficult. So it is those girls and girls in

care.

There is the effect of criminalisation as well. It is obviously a criminal offence to procure

an abortion, so to buy the pills online, which we know that a number of women do. We

obviously do not have statistics on exactly how many, but we know that Women on Web

has sent pills to 1,000 women over the last two-year period in Northern Ireland and 5,000

for Ireland and Northern Ireland. Between 2010 and 2017, there have been

nine prosecutions under the Offences Against the Person Act against women who have

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bought abortion pills or have been caught with them. There have been a few high-

profile cases:

- In 2016, a 21-year-old woman was given a three-month sentence, suspended for

12 months, after pleading guilty to purchasing abortion pills online to induce an abortion.

She said that she could not afford to travel. She bought the pills online, took them, and

then her flatmates took her to the police and she was ultimately arrested and prosecuted.

- A woman was charged for helping her teenage daughter access pills after her daughter

was raped and then became pregnant as a result. That is under judicial review at the

moment, which I think has been held up until the NIHRC trial. We are waiting to see

what will happen.

Obviously just the threat of criminal sanction has a horrible effect on women in

Northern Ireland. They either will not buy the pills or they will go down some other

route. The Abortion Support Network has countless horror stories of what women will do

if they do not have any other option. As well as simply the criminal effect it is

stigmatising, affecting employment opportunities, educational opportunities, travelling,

work permits, aside from just the situation of having a criminal record.

I think Barbara is going to quickly go into the funding.

BARBARA DAVIDSON: Just because of time reasons, I do not propose to go into the

details of the Stella Creasy/Justine Greening arrangements. I think they are well-known.

From our work with Justine Greening, we have some updates that are perhaps not so in the

public domain, which I am happy to answer questions on, but perhaps we will just move

on to the next topic.

THE CHAIRMAN: Can we hear from Alliance for Choice now?

EMMA CAMPBELL: Thank you for the invitation to give evidence. Alliance for Choice

is a civil society organisation based in Belfast. It campaigns for safe, free and legal

abortion in Northern Ireland. We would like to highlight the social discrimination

experienced by women in Northern Ireland with crisis pregnancies. It is important that the

APPG is aware of the strong anti-abortion socialisation process that manifests in

Northern Ireland through schools, churches, the media and political sphere. Being called

“murderers” by politicians and protesters inevitably leaves abortion-seekers with

additional emotional scars and further problematises an already complicated decision.

I will first talk about experiences of women after treatment, then changes due to funding

and then abortion medications and the societal changes in Northern Ireland.

The Marie Stopes clinic opened in 2010. Since then, there has been a steady and constant

presence of protestors outside calling themselves “pavement counsellors”. They

physically block access or pretend to be clinic workers. We face comments such as “We

have christened your dead baby Teresa”, or “You are now the mother of a dead baby”. If

they believe someone has accessed the pills, they will say, “If you’ve taken anything, we

will report you to the police” and “Don’t flush your baby down the toilet”. This is despite

the fact that women who do qualify for an abortion at Marie Stopes will have had

grave health conditions in order to have been accessing treatment there. I am a volunteer

escort, escorting women in and out of the clinic. As advised by the PSNI, we wear body-

worn CCTV to collect evidence and write a report for every single incident of abuse, yet,

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despite hundreds of logs and many interviews with police, as of yet no prosecutions have

been made. Two of our escorts have faced physical assault. We currently have an

ongoing case against one of the protestors, with a temporary injunction served. Jim Wells,

ex health minister of the DUP, has been known to call the clinic protestors “close personal

friends” and has recently been to visit the protestors outside the clinic during opening

hours to shake their hands, thus legitimising their abusive behaviour.

We welcome the recent Government announcement on funding, but this will not reach

everyone. In the week of the announcement, I personally took two calls from women who

could not travel. The first was from a support worker who was risking her job in even

speaking to me about her client needing to travel to England. Her client was fleeing

a violent relationship and had young children already. They had made an appointment in

England, but all of the woman’s personal documents and ID had been burned by her

ex partner in a controlling violent outburst. The second woman had an infant with

cystic fibrosis. She was pregnant again, but there was a 25 per cent chance the pregnancy

would result in another child with the same condition. Cross-contamination is dangerous

for such an illness and so her maternity care had offered her testing, yet they did not

advise her that she would not be eligible for treatment in Northern Ireland. We were

effectively the people breaking the news to her that she would have to travel, and so the

great news of being funded in England did not seem so great to her, with a young ill child,

when she had been left in the dark about the availability of treatment by

medical professionals.

As brought up by my colleagues here, we also know that women face other barriers to

travel: time off work from precarious employment, disability, immigration status,

mental health, abusive relationships and child care. Many of these women then go to

abortion pills as the answer. As noted by my colleagues, the use of telemedicine

abortion pills has been highlighted over the last few years due to multiple legal

proceedings. Women on Web offers reputable services, but there are other less reputable

services available. The pills are listed in the World Health Organisation’s list of essential

medicines. Between January 2010 and December 2015, 5,650 women in Northern Ireland

and Ireland requested at-home medical abortion through online provider Women on Web,

but we know this figure does not account for all providers and could conservatively be

double that. They examined the experiences of 1,023 women. Of those women,

97 per cent felt they had made the right choice and 98 per cent would recommend it to

others in a similar situation. They commonly reported serious mental stress caused by

their pregnancies and their inability to travel abroad to access abortion. The feeling most

women commonly reported after completing were “relieved” (70 per cent) and “satisfied”

(36 per cent). Women with financial hardship had twice the risk of lacking

emotional support.

However, police raids on homes, workplaces - my own and my colleagues’ included -

arrests and customs seizures have meant that women are now fearful of the repercussions

if they need to seek medical help after taking abortion pills. There is a direct danger to

women’s health - and lives - if treatment for rare, but possible, haemorrhage is not sought

in a timely manner from a professional. There is also a lack of willingness to engage in a

harm-reduction approach to the pills and instead we are faced with scaremongering by

local and UK media. Criminalising women who access these pills is in breach of the

recommendations of a number of UN committees, including CEDAW and the

Committee on the Rights of the Child, which the UK previously noted in 2014 and 2016.

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The UK Government has failed to respond to calls from CEDAW committees to have this

reformation of the law.

In the absence of Government consultation, public opinion polls have provided insight

into support for legal reform. Large-scale polls have been conducted in recent years, all of

which have demonstrated broad public support for reforming the law. In polls conducted

by Amnesty, BBC and RTE, respondents indicated support for abortion in cases where a

woman’s life was at risk.

THE CHAIRMAN: Emma, you need to wind up, I am afraid.

EMMA CAMPBELL: Eighty-seven per cent of people do not want to criminalise women

in Northern Ireland. These are my concluding points. Harassment and stigmatising

language are an unnecessary additional barrier to the difficult access to

reproductive healthcare with crisis pregnancies in Northern Ireland. New funding

measures are welcomed. However, this was introduced for political expediency. Funding

is a step forward for abortion-seekers who can travel, but it leaves so many behind.

Despite the changes, healthcare professionals still lack clear guidelines. In the absence of

easily accessible abortion healthcare, many turn to online providers. Criminal sanctions

are therefore directly endangering lives. We should not wait until the first woman bleeds

to death before we get the change we deserve.

THE CHAIRMAN: Sorry, you will have to stop there.

RUAIRI ROWAN: Thank you for having us here today. FPA is one of the UK’s leading

sexual health charities. It is a national affiliate of the International Planned Parenthood

Federation in the UK. For over 30 years we have provided the only non-directive

pregnancy choices counselling service in Northern Ireland. Other organisations will talk

about two options. We will give women information about abortion, as well as adoption

and continuing with the pregnancy. We also provide post-abortion counselling, although

we receive no Government funding currently for it.

Pregnancy choices is Government funded, but because our counsellors discuss abortion as

a choice for women, as Emma said, like Marie Stopes, our office is picketed on a

daily basis. The only day that we do not have a picket is on a Friday - and that is because

we do not hold counselling on Fridays. Individuals will gather outside. They will have

misleading leaflets. They will follow women down the street. We sometimes have

protestors waiting in the back alley in case women leave via the fire escape. Chalked

messages will be written on the ground, such as: “FPA, how many kids have you killed

today?” All these sorts of activities impact negatively on women. It means that they are

either fearful of coming in or they will not come to seek counselling at all.

We have a comments book in our waiting room where individuals can write down an

incident that has happened or their thoughts. I will read one comment from that book:

“Leaving the building with my sister, mother and uncle at approximately 12.30 pm. My

sister has been attending for counselling sessions for the previous few weeks which have

been really helping her. Accosted outside the door by a red-haired woman. I told her we

didn’t need her advice. She told me rudely that she wasn’t speaking to me; she wanted to

speak to my sister. I told her we’d phone her if we wanted her advice. She proceeded to

follow us down the street, trying to push leaflets on us. In the meantime, the man with her

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followed my uncle, shouting about how this would be his grandchild. Very intimidating,

pure harassment, and the first week it happened my sister didn’t want to come back.

Something needs to be done about these people.”

In 2015, one of those individuals was convicted for assault against one of our members of

staff - the only conviction there has been in Northern Ireland - yet that individual

continues to stand outside our office every day and harass other women. I think it is clear

that we need legislation either around safe access or buffer zones to prevent these sorts of

activities.

I am going to touch briefly on the guidelines that came about in Northern Ireland. FPA

took the Department of Health to court in 2001 over its failure to provide guidelines for

medical professionals. Following a successful appeal, a number of documents came and

then were retracted. A document called The Limited Circumstances for a

Lawful Termination of Pregnancy in Northern Ireland was released for consultation in

2013. The language used throughout the document was described as “intimidatory” and

“threatening”, both to healthcare professionals and to women themselves. The opening

sentence of the document stated: “The aim of the health and social care system must be

protection of both the life of the mother and her unborn child”. It then went on to say:

“The circumstances where termination of pregnancy is lawful in Northern Ireland are

highly exceptional. This document is intended to guide clinicians on the application of the

very strict and narrow criteria… consistent with the law. It details the very limited

circumstances under which a termination of pregnancy may be lawful in

Northern Ireland…”

The chilling effect of that document was clear. There were 51 abortions carried out in

Northern Ireland the year before. It dropped to 23, and now to 16. Commenting on the

mood within the medical profession at the time, Dr Carolyn Bailie, chair of the

Northern Ireland Committee of the Royal College of Obstetricians and Gynaecologists,

said: “There is a real sense of fear and concern that one of us could end up in prison”.

There was guidance then released in 2016 by the Northern Ireland Executive, but by that

stage the damage had been done, and, as other colleagues have mentioned, women are

now taking the matter into their own hands and ordering pills online.

The current guidance does deal briefly with abortion pills online, but I am going to read

this paragraph which mentions it. Bear in mind that this document was supposed to bring

clarity to the law. It states:

“If a health and social care professional knows or believes that a person has committed

certain offences, including an unlawful termination of pregnancy, he/she has a duty under

the Criminal Law Act (NI) 1967 to give [that information to the police]… However, the

health and social care professional[s] need not give that information if they have a

reasonable excuse for not doing so; the discharge of their professional duties in relation to

patient confidentiality may amount to… a reasonable excuse. Professionals should be

clear, however, that patient confidentiality is not a bar [on] reporting offences to the

police.”

So there is nothing clear about that statement. We feel that if admission is made to a

counsellor during a counselling session that our duties and obligations lie with the client

and their best interests and that dragging them through the court would certainly not be in

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their best interests. We also feel that the policy to prosecute in these circumstances is

having a wider effect in the fact that women who do acquire pills online are less likely to

seek medical support if they need to.

So in summary, the criminal law on abortion in Northern Ireland is unclear. The law on

when it is necessary to disclose personal information to prosecuting authorities is unclear

and unhelpful. The risk of criminal prosecution seems increasingly high. If that risk

continues any further, it will become difficult for charities such as FPA to provide

services.

LAURA RUSSELL: I know some of this has been covered already and so I will not go

into too much detail.

Abortion legislation in Northern Ireland is in contravention of human rights. The UK is

signatory to a number of conventions. The Committee on the Elimination of

Discrimination against Women, the UN Committee on Economic, Social and

Cultural Rights, the UN Committee on the Rights of the Child and the

UN Human Rights Committee have at various stages all issued statements saying that the

UK really needs to ensure safe access to abortion and post-abortion care services.

Along with Alliance for Choice and others, we recently made an intervention in the

Supreme Court in a case that was initially brought by the Northern Ireland

Human Rights Commission. The court heard that case on 24-26 October 2017 and is

currently considering whether the existing criminal law in Northern Ireland in relation to

abortion is lawful in three circumstances - where the pregnancy results from rape or

incest, or where there is a serious foetal abnormality - in relation to Article 3 (the

prohibition on torture), Article 8 (the right to respect for private and family life) and

Article 14 (the prohibition on discrimination), when read with Article 8 of the

European Convention on Human Rights.

With no Assembly in place, it is unclear who is going to be responsible when the

Supreme Court rules for making sure that whatever verdict is upheld is implemented. If

the Supreme Court rules in favour of the Human Rights Commission, it would probably

be the Northern Ireland Office. Even if it is the case that it does not, it is the responsibility

of the Northern Ireland Office to uphold human rights in Northern Ireland. It is not a

devolved issue. It is interesting to note that UK Government policy when it comes to

international development is that it should protect family planning and reproductive rights.

In a 2014 DFID document, the Department stated:

“In countries where it is highly restricted and maternal mortality and morbidity are high,

we can help make the consequences of unsafe abortion more widely understood, and can

consider supporting processes of legal and policy reform.”

So in cases of other countries they are in favour of supporting reform, whereas, when it

comes to Northern Ireland, even when she was making her statement about the new rules

which allow free access to services for women who are normally resident in

Northern Ireland and travelling, Justine Greening repeated, “None of this changes the

fundamental position that this is a devolved issue in Northern Ireland”, and that is

something that the Secretary of State for Northern Ireland has himself said in response to

various questions from MPs.

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But there is no Executive in place and so, if it is the responsibility of the Assembly, there

is no one who is going to implement it anyway. As I have mentioned previously,

human rights are still the responsibility of the Northern Ireland Office, and so it is really

clear that the Secretary of State cannot be absolved of any accountability. The

Northern Ireland Office has to take responsibility for human rights and take steps to

ensure that the law is performed.

It is the 50-year anniversary of the introduction of the Abortion Act in Great Britain. It

has never been extended to Northern Ireland. Women who face a crisis pregnancy suffer

the discrimination that we have heard about from my other colleagues here.

THE CHAIRMAN: As you know, we have a very short time for questioning. I do

apologise. I will kick off. Is there any chance at all that we can get this concept changed?

Abortion was deemed a health issue. To me, it is not a health issue. It can be a

health issue, but primarily it is a human rights issue - which is not devolved. I do not

know how we can get round this with the Government. It seems to me that it has got it

wrong.

LAURA RUSSELL: It is the case that the Supreme Court might also agree and rule that it

has got it wrong.

RUAIRI ROWAN: Yes.

LAURA RUSSELL: In that case, though, it is trying to ensure that the

Northern Ireland Office takes responsibility and does not say that it is actually a

responsibility of a devolved government that currently does not exist.

RUAIRI ROWAN: I think we have seen in the A and B case, which was defeated 3-2 in

the Supreme Court, the momentum that was built after that ruling. I think if the

Supreme Court decision came out early next year and stated that actually it was not a

breach of human rights, the momentum there would be, I think, even greater this time,

particularly without any Northern Ireland Executive in place. At the moment we do have

a Government in the UK that has quite a small majority and so it is quite possible to get

things through.

THE CHAIRMAN: Backed by the DUP.

RUAIRI ROWAN: Backed by the DUP. That does make it more difficult.

EMMA CAMPBELL: But there is also the point that devolution has been a flimsy barrier

when welfare changes were needed - and block grants were clearly a powerful motivator

in that case - so I do not see how it can be used as an excuse in this case for human rights.

THE CHAIRMAN: You do not see how it could be used?

EMMA CAMPBELL: No.

VISCOUNT CRAIGAVON: Thank you so much. I am sorry you are having to deal with

such an impossible situation. Well done for your work. I am slightly surprised at the

percentage figures which you have given. I think Barbara said 80 per cent were in favour

of legalising abortion, and I think you said 87 per cent were in favour of decriminalising

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abortion, which seem quite high percentages. Is it only in the very limited circumstances

that the 80 per cent are in favour? With that percentage, I am just wondering why the

people opposing you have so much power. Can you say something about the majority

percentages?

BARBARA DAVIDSON: I think the first thing to note is that when people think about

abortion they do not see it as a binary issue. It is unlike gay marriage, for example.

People are not “Yes” or “No”. They usually sit on a spectrum. That spectrum is usually

to do with the kinds of situations in which they feel that women ought to have an abortion

and what makes them feel comfortable. That is why you get people saying things like

they are happy in situations where a woman has become pregnant as a result of rape or

incest, or where there is a serious foetal abnormality. So the 80 per cent figure that

I quoted from the Life and Times Survey referred to abortion in cases of rape or incest,

which of course is still illegal, and 73 per cent - slightly fewer - in cases of foetal

abnormalities. Those three incidences were the subject of the Human Rights Commission

case, judgment for which we should get before Christmas. There is another point to be

made about that, which is that those exceptions are legally unworkable. How do you do

justice to the criminal justice system if you are having to prove to doctors that you have

been raped, for example?

My colleagues who work in Northern Ireland can speak more in terms of the power of the

opposition in Northern Ireland, but I think it goes back to what I was saying about voting

patterns, which we have in our evidence in our more detail, and that people simply do not

vote along social issues in Northern Ireland. They vote along what might be described as

the Green and Orange issues. People will not vote for Sinn Féin in circumstances where

they think that Sinn Féin might get in if they are normally DUP supporters, for example,

and vice versa. I do not know if Emma might want to say something about that.

EMMA CAMPBELL: I would agree with everything that Barbara has said. We also do

a lot of educational workshops on abortion throughout the country and so some of the

statistics seem anomalous, where we have 77 per cent believing that abortion should be

available when a woman’s life is at risk, yet 87 per cent believe a woman should not be

criminalised for having an abortion. This is because people answer these questions

initially as in “I don’t agree with it personally in circumstances of…”, yet when you

further push people they do not want to criminalise women. In fact what we did find was

that when a woman was criminalised for accessing the pills there was a huge public

outcry, and many of the MLAs as well were also talking about having to treat women with

mercy, yet being reluctant to change the law.

BARONESS BARKER: Is there any breakdown in terms of age? Can you tell us a bit

more about that?

EMMA CAMPBELL: So the demographics are actually rather surprising on age.

Young people are broadly pro choice. However, very young people, so between the ages

of 15 and 20, are pro life. This is exactly to do with sex education in schools. We find

that as people get older, unless they are extremely religious --- Only nine per cent of the

population disagrees with abortion in all circumstances. The older demographic have

actually experienced life. That is how we look at the details anyway. Amnesty did a poll

in 2016 and the support for abortion law reform across all political parties was exactly the

same. It is the same across the demographics, apart from that very young age, because we

do not have proper sex education in schools. It is given by religious organisations.

10

BARONESS BARKER: Does the unavailability of legal abortion have any bearing on the

availability of contraception?

RUAIRI ROWAN: We were talking about this earlier. In terms of availability, there

have been various cuts in recent years, which basically means maybe if you live in Belfast

you have slightly more access, because there might be a couple of centres that are open

every day, although, saying that, it is maybe only for a couple of hours every day. If you

live in a more rural area, you might have a clinic nearby that is open for two hours on a

Wednesday afternoon. So there are problems with that. We were speaking also about the

waiting list to have a coil fitted. I think Emma said it was 18 months in Northern Ireland.

EMMA CAMPBELL: Yes.

RUAIRI ROWAN: So the availability is that. In terms of GPs, there are not many GPs

offering contraceptive services. It does have an impact. On the societal issues, I was just

going to mention that this conversation has changed dramatically in the last number of

years, particularly now that more women are speaking about their experience of having to

travel, and that has changed public opinion dramatically. In previous years, most women

who would have come for a counselling session at FPA would have almost always begun

by saying: “I’ve always been against abortion until now”. They partly may not have felt

that but felt that that was what they were supposed to say because that is how they have

been brought up. It would be rare now that that conversation is brought up. I think most

people now will know someone who has had an abortion. They probably did in the past

but just did not speak to one another. So I think the conversations have moved on

dramatically and particularly now that women are speaking out.

THE CHAIRMAN: I do not know how many times in my life I have heard that phrase:

“I don’t believe in abortion but…”

BARONESS UDDIN: I just wanted to give my profound apologies for the delay. I have

been caught up in another Committee. As someone who is pro choice, I just want to say

to those of you who have been working in the Northern Ireland discussions that I have

been a real admirer of yours. So I just wanted to make apologies and to just add to a point

that you made about the demographic in terms of where young women are now much

more questioning the issue of abortion. Because I was going to do this Committee, I made

this point earlier in our Committee meeting here, with a group of women that I had spoken

to, and the feelings were very similar. I think it has a lot to do with the fact not only of the

education but that there is not a counter choice and that there is not very much about

women’s rights anyway in the education system, whether you are in Northern Ireland or

here, and the second point being that there are some implications about what is available

on the internet. So I just wanted to make that point. I am really sorry that I was not here

for your introductions.

THE CHAIRMAN: Can I come back and ask a question? Can you just clarify for me

two points? It is illegal to buy misoprostol abortion pills from the internet, but it is not

illegal to be a supplier of them?

EMMA CAMPBELL: Women on Web issue them via a registered doctor in the

Netherlands.

11

THE CHAIRMAN: Is that how they get around it?

RUAIRI ROWAN: Yes.

EMMA CAMPBELL: Yes. So it is not illegal to have the pills in your possession, but it

is illegal to take them with the intent to ---

BARBARA DAVIDSON: These suppliers are not based in Great Britain or in the UK.

THE CHAIRMAN: Can you not just say: “I thought they were Smarties”?

EMMA CAMPBELL: We do quite regularly have people’s addresses visited by

policemen or workshops raided.

THE CHAIRMAN: It is quite extraordinary, is it not?

EMMA CAMPBELL: Yes.

THE CHAIRMAN: It really is. It is so repressive. It makes me shudder. It is

Secret Service stuff really.

RUAIRI ROWAN: We have a specific law in Northern Ireland. Section 5 of the

Criminal Law Act (Northern Ireland) Act 1967 - which is specific to Northern Island and

nowhere else in the UK - makes it a criminal offence not to pass that information on to

police. If you are aware of a crime that has at least a sentence of

five years’ imprisonment, which abortion does, then you are legally obliged to pass that

information to police.

THE CHAIRMAN: But does the confidentiality of a doctor towards his or her patient not

override that?

RUAIRI ROWAN: It can do. I read you that statement from the guidance which says

that it may, but then the next statement says: “But there is no bar on reporting to police”.

THE CHAIRMAN: The BMA says that?

BARBARA DAVIDSON: That law originally was for national security reasons.

RUAIRI ROWAN: Yes.

BARBARA DAVIDSON: That law obviously originated in the Troubles, but it has now

just been appropriated.

THE CHAIRMAN: But foetuses were not involved in the Troubles.

BARBARA DAVIDSON: No. I know.

RUAIRI ROWAN: No one has ever been prosecuted under that law, but we used to

always say that no one would be prosecuted for having an abortion, and then last year we

started prosecuting women. So the fear is there. That one JR 76 court case, where the

mother is being prosecuted for procuring the pills for her 15-year-old daughter, came

12

about because the daughter was in an abusive relationship. They went to see her GP

a week later to kind of discuss that relationship and, somewhere between being referred on

to social services and child and adolescent mental health services, her GP records were

passed to the police, and that is how that prosecution has come to light. Women will not

go to GP on many issues and do not come to counselling because they fear it will be

passed on to the police - and that has happened.

THE CHAIRMAN: There is a bit of a movement, I believe, is there not, of women doing

it deliberately and announcing that they have done it?

EMMA CAMPBELL: Yes. That was our organisation. We got together over

200 signatures and said that we had either procured the abortion pills for other people to

take or we had taken them ourselves. We went to a police station in Belfast and handed in

a letter with our information on it. They are not willing to come and arrest any of the

activists.

THE CHAIRMAN: They have not arrested any of you yet?

EMMA CAMPBELL: No. But they have raided our premises before.

THE CHAIRMAN: But it potentially needs a critical number of people, does it not?

EMMA CAMPBELL: We have questioned the even application of justice in terms of the

Public Prosecution Service going after people in this particular situation yet refusing to go

after people where there are obvious incidents of assault and harassment or in a case

where somebody has been below the age of consent.

BARBARA DAVIDSON: There is a point to be made about how the democratic deficit

that we have described people in Northern Ireland experience is compounded by the fact

of the Troubles and the way in which legislation relevant to the Troubles has been

appropriated in ways that are oppressive to women in these circumstances. It is also true

with regard to the extension of the Abortion Act mooted in 2008, but a deal was done

effectively with the DUP in the interests of national security for 42-day detention, so

national security issues are things that people hide behind in this regard as well.

VISCOUNT CRAIGAVON: If somebody comes to search your home and there is no

prosecution, does something remain as a black mark on your record for the future? That is

a problem in this country.

POLLY BARKLEM: It would go on your CRIS report.

VISCOUNT CRAIGAVON: For the rest of time?

RUAIRI ROWAN: I am not 100 per cent. Thankfully, my home has never been raided

and so I am not sure on that point.

EMMA CAMPBELL: In my own experience, and in the experience of the other activists

whose homes were raided on International Women’s Day, when we were all out - so that

is interesting as well - they cannot get certain mail delivered to their house any more, and

we know that we will be on “watch lists” essentially.

13

POLLY BARKLEM: In this country it would go on the Police National Computer.

I imagine it is exactly the same in Northern Ireland.

THE CHAIRMAN: Thank you all very much for a really shocking session. It has

shocked me to hear it all over again. We had sort of known of this situation, but it is just

unbelievable to hear you actually enunciate it. It really is. I cannot believe that this is

happening in our country. I just cannot believe it. It is extraordinary. Thank you for

coming.

14

Witnesses: ANN FUREDI, British Pregnancy Advisory Service;

LISA HALLGARTEN, Brook; and LORD STEEL.

THE CHAIRMAN: I am so sorry for the slight disruption to our schedule. It is through

no fault of anybody’s except the room bookings department, which seems to have had a

really bad weekend, because we ended up with no room at all about 10 minutes before we

were due to start and then we had to wait half an hour for the room. So we are sorry, but

welcome to the three of you. Do we need any introductions? I am Jenny Tonge, chair of

the Group. This is Liz Barker, Lib Dem Peer; Janric Craigavon, independent Peer; and

Pola Uddin, who is a Labour Member. We are going to start with BPAS because you are

first in order.

ANN FUREDI: First, thank you very much for inviting us to provide evidence in this

session. I believe this session is really framed around the idea of hard-to-reach women.

I will say first of all that British Pregnancy Advisory Service is a charity. It is a not-for-

profit provider that operates around 60 clinics around England and Wales. We have one

centre in Scotland. We collaborate very closely with the National Health Service. We see

around 70,000 women a year for termination of pregnancy. Ninety-eight per cent of those

are paid for by the National Health Service and are commissioned under NHS contracts.

The outstanding number is normally women who have travelled from overseas,

specifically usually from either the North or South of Ireland.

I think Britain is perhaps an example to bear in mind when we think about how we can

have a law and a regulatory system and a system of provision that appears in many ways

to be quite liberal. Access to abortion in Britain is clearly way, way better than most of

the country situations that you would have been hearing about. I always find myself in a

difficult position when I am presenting overseas because people find it quite difficult to

imagine a situation that appears to be as good as ours, in the sense that you have a law that

more or less provides abortion on request, even though it requires some interpretation, but

specifically where abortion is paid for by the National Health Service and is not paid for

by women.

However, when we think about the difficulties that women have in accessing services at

the moment, I think it speaks to a point that Baroness Tonge was raising in relation to the

earlier panel, where you were talking about whether or not something is seen as a

health issue or a rights issue. For us, despite the integration in some ways of abortion care

with the National Health Service, in some ways I think it really relates to whether abortion

is seen as something that women should be entitled to receive in the way that they are

entitled to receive other health services, so the fact that my organisation is providing

abortion services - a charity outside of the NHS - is in some ways a special situation that

you do not expect to find with other healthcare areas.

I would suggest that one thing it would be very useful to flag up for perhaps looking at in

the future might be exactly how abortion services are indeed organised and the

collaboration that indeed should really occur with the National Health Service. At the

moment, we have a situation where there is competition for contracts between different

independent organisations - and, indeed, the National Health Service - whereas in fact,

when it comes to a service like this, it should not be the case that organisations are

competing. It should be the case that there is collaboration to make sure that the skills and

the facilities are best provided for the constituencies that should be needed.

15

That said, I would say that there has been huge progress with that in recent years. Women

who have complex underlying medical conditions may need to be cared for in services

that have a critical care facility. We now have much more effective pathways where

women who have previously found it quite difficult because their care cannot be provided

in standalone clinics of the kind that we run and Marie Stopes run can be dealt with within

the NHS. There is much more collaboration. It looks as though there will be more of that

going on.

We have a very robust regulatory framework in this country, which I think is right.

I think, though, going back to the point about competition, one of the things that we have

to be quite careful about is that in the environment at the moment, where everyone is

looking to make cost savings within the NHS, the cost of abortion services really does

have to be valued and seen, again, as being an integral part of what is required from

healthcare and not as an area where savings can be accrued by people trying to save

money on their commissioning.

Because I know that we are short of time and I would rather leave it for you to question,

I will finish with this example. You have to hold in mind an example like this because, as

I have said, we exist in a country where pathways are quite clear and where services can

be funded. I am not only chief executive of British Pregnancy Advisory Service. I am

also the chairman of the board of governors of MidKent College, a further education

college based in Gillingham, Kent. We were horrified earlier in the year when a young

woman was admitted to the local Medway Hospital Trust found to be severely bleeding.

She had been taken in as an emergency case. She was 20 weeks pregnant. She had tried

to induce her own abortion and had haemorrhaged. The foetus was delivered alive. It

took four hours to die, which was obviously an issue of great distress to the woman and to

the medical staff in the hospital. You are really left thinking: “How on earth does this

happen in the South East of England in the circumstances that we are in today?” The

reason for it was that this young woman had tried on two occasions to access

NHS abortion services that had been commissioned, but each time she had been told that

she needed her NHS number to obtain free treatment. She did not know how to get her

NHS number. I cannot imagine going to a doctor for any other kind of medical treatment

where I am told that I cannot receive treatment unless I have my NHS number.

So really my plea with this - the take-home message - would be please can we look

forward and see that safe, good, abortion care is fully integrated into NHS provision in the

way that it is funded and in the way that it is signposted and delivered. Otherwise, women

who are hard to reach will be difficult for us to identify in this country.

LISA HALLGATEN: Thank you for inviting me here. Brook is a young people’s

sexual health charity. We deliver education work in 12 per cent of secondary schools in

England. We have 16 sexual health clinics around the country, including in Belfast.

I am not going to go over the situation in Northern Ireland, which has been really

beautifully set out for you, but just to say that, whilst we are really, really happy that the

Government has agreed to fund abortion for women coming from Northern Ireland, all the

difficulties faced by people coming over here are exacerbated for young people. They are

more difficult, especially if they do not have family support or if they do not have travel

documentation. The situation with education in Northern Ireland around abortion is

particularly difficult, as is the stigma. So all the things that I think have been mentioned

16

already are really exacerbated if you are a young person, especially if you do not have any

form of support.

I am going to focus on England, which is where Brook carries out most of its work, and

look at the issue in terms of four key headings: (i) cuts and commissioning;

(ii) crisis pregnancy centres; (iii) education; and (iv) the funding of anti-

abortion activities. I am going to be as brief as I can about those.

Just to say, I think we all know that all the evidence points to outcomes being best for

women who access abortion if they have had the opportunity to have the best possible

information and the best possible support with making a decision about abortion and they

have been able to access services as easily as possible.

In 2013, Brook and FPA jointly published guidance, endorsed by the

Faculty of Sexual and Reproductive Healthcare, on how to commission care pathways to

ensure that women are given sufficient support with pregnancy decision-making. Those

guidelines drew on reputable sources, like the Royal College of Obstetricians and

Gynaecologists, the Royal College of Psychiatrists, and many more. The guidelines were

drawn up to ensure that women who are feeling ambivalent about their decision or

expressing coercion or pressure receive the support that they need, as well as expediting

access to services. The guidance recognises that there is a very wide spectrum of need

from women, most of whom are very clear about their decision and simply want to benefit

from the easiest possible access to services, to, at the other extreme, those who need

additional information, support, time, conversation or counselling in order to make

a decision that they are really happy with.

Through various pieces of research, young people have been identified as one of the

groups that are more likely to need a bit of additional support, maybe because they have

less knowledge and understanding of their options, or they have a lack of partner support,

or they lack or perceive that they lack support from their family. So it is critical for us

that young people are given the support that they need when they present with an

unintended pregnancy. Services like Brook, and other specialist young people’s

sexual health services that in the past have been provided by the NHS but are increasingly

disappearing, have traditionally provided trained counsellors or other people with the right

skill set to identify those people who are in trouble, who have safeguarding needs, who are

feeling ambivalent, pressured, or need additional support around making a decision about

pregnancy. Those services are disappearing. Most contracts from commissioners now

preclude the possibility of employing a counsellor within those services, and increasingly

those young people’s services are disappearing altogether and young people are being

redirected into all-age integrated sexual health services or back to their GPs. These are

places that young people do not feel comfortable going to and do not want to go to.

I did a very small survey of staff in our own clinics. I am not saying that this is

representative, but it is a real snapshot. I just asked them if they wanted to measure or

represent the impact of cuts on various things relating to pregnancy, including

pregnancy testing, pregnancy decision-making support, providing access to

pregnancy services, and support following abortion with contraception and counselling.

The snapshot found that in all cases, in all these different areas of work, on average they

reported an impact of 7 or 8 on a scale where 1 was no impact and 10 was extreme impact.

What is actually happening is that services like ours are trying to make a decision all the

time about whether they streamline the offer to young people and offer them less time or

17

whether they see fewer young people. It is really an awful dilemma. One of the

receptionists who responded to my survey said: “I’m turning many people away from the

clinic on a daily basis as we don’t have room for them, as we don’t have enough members

of staff to manage the workload. This inevitably results in more unplanned pregnancies as

people cannot access contraception, longer waiting times for abortion and more strain on

services”.

I think it is a real issue. The actual funding constraints are a massive issue, but so too is

the way commissioning is going, which is trying to push everyone into monolithic

services and totally losing an understanding of specialist services. It is not only specialist

young people’s services. It is also just generally that specialist reproductive health

services are being put into huge integrated sexual health services or disappearing

altogether. Although I think most people put their premium on speed and availability of

abortion, we just really want to make sure that everybody can be picked up at the level

that they need to be.

Brook does not provide abortion services, but we are hearing increasingly that contracts

being offered by commissioners to independent providers are making it increasingly hard

for them to offer the level of service and good practice that they have developed over

years, which they themselves value, and which recognise and meet the very needs and

demands of women in relation to pregnancy decision-making. Those independent

services have always been really very adept at working out what people need and giving

them the level of support they need, which may be very little or may be a lot more. The

possibility for them doing that, I think, is under threat.

There is a problem in this country with crisis pregnancy centres run by anti-

abortion organisations giving misinformation to young people. We have reported on this

extensively in the past. It has not gone away. There is a problem with education in school

being inadequate, and we are making a massive plea for the new guidance to retain a

requirement on schools to address abortion in a way that is helpful in terms of helping

young people to know their rights and to access services. We are very disappointed that

Life received £250,000 of “tampon tax” funding when we know that a lot of the

information it provides and the services it provides fall very short of good, evidence-based

practice.

THE CHAIRMAN: It is outrageous.

LISA HALLGATEN: I know I have to wind up. I have more that I could say, but I am

very happy to answer questions.

THE CHAIRMAN: Thank you very much indeed, Lisa. Lord David Steel, the hero of the

hour - for 50 years, I mean!

LORD STEEL: I was asked if I could say a bit about what happened 50 years ago, but

I do not think I will dwell on it for too long because it is really well-known past history.

The fact is that, in the 1950s and 1960s, the Abortion Law Reform Association kept

pressing Parliament to change the law to make abortion available to women. Mine was

actually the seventh attempt from 1953 onwards to get a Private Member’s Bill through.

The others had all failed not through a lack of support - they all had good support in the

Commons - but through lack of time. The reason I was able to succeed was because

I drew the number 3 place in the Speaker’s annual ballot for bills and so it was possible

18

then to get the Bill through with a bit of help from the Government giving extra time

because of the opposition to it.

How did I get involved? Very simply, in the 1964 election, when I was an unsuccessful

candidate, the Abortion Law Reform Association had circulated to all candidates a leaflet

and a questionnaire. The leaflet set out the case for a change in the law and asked all

candidates to tick whether they would, if elected, support a change in the law. I had

ticked the “Yes” box, saying that I would support it, so once I had been chosen as number

3 in the ballot I could not very well dodge actually doing something about it other than

just ticking the box saying that I would support it. That is how I got involved in this

whole process. Of course it would not have got through but for help from a particular

Conservative MP and a Labour MP who acted as whips. To get people here on a Friday

was quite difficult. To get them through the night was quite difficult. But we did it.

Remember, up to the passing of the Bill, something between 30 and 50 women each year

died in this country as a result of criminal abortion, whether self-induced or botched back-

street abortions. When Dr John Marsh retired as secretary of the BMA some years ago, he

actually said in his resignation speech that the greatest contribution to public health in his

lifetime had been the Abortion Act. I had thought that that seemed a strange exaggeration,

but you then realise that what he was talking about was the fact that the public wards of

our hospitals were clogged with women admitted for what was called septic and

incomplete abortion. There were unknown hundreds of those each year.

Coming up to date, the fact is that in those days the only methods of abortion were

surgical of one kind or another. Although in the early years we had problems with women

coming in from Europe, taxis at Heathrow, and scandalous press stories and that sort of

thing, the fact is that since then our neighbours in Europe have advanced their legislation

so that most of them allow abortion on demand, on request, up to about the first trimester -

the twelfth or thirteenth week of pregnancy. So in fact our law already seems to be out of

date compared with what everybody else does.

Of course the big difference now is the availability of drugs. A little change in the law

was made and went through Parliament almost unnoticed. It was not even noticed by me.

A change was made to the Human Fertilisation and Embryology Act allowing ministers to

designate a home or anywhere they like as a place for medical abortion. I had a meeting

this week with the new Chief Medical Officer of Health in Scotland,

Dr Catherine Calderwood. With the Scottish Government, she has issued legal advice.

As abortion is devolved to the Scottish Parliament, they have issued guidance using that

Act allowing people to take the abortion pill at home. That does not happen here. The

Scottish Government has actually used that legislation. The UK Government still has to

do that. I hope that it will. I was a bit taken aback, because when it happened in Scotland

the anti-abortion people said they were going to take the case to court, and I thought they

were skating on thin ice until I realised that in fact they were using this new piece of

legislation, which I suspect the anti-abortion people had not even noticed - because I had

not noticed it either. It is a very interesting development that Scotland has now gone

ahead of the rest of the UK in making this provision.

Dr Calderwood had two concerns about the present Act. Apart from the fact of being able

to make that ministerial designation, it still requires two doctors. That is really out of date

now because it should be possible for a nurse or a midwife to be one of the two people

who prescribe the abortion pill. The other concern that Dr Calderwood had - and I was

19

interested in the case you were mentioning about the 20-week pregnancy - is that if there

is more legislation on this subject then there is a risk in Parliament that the upper time

limit could be reduced from 24 weeks to 20 weeks. I think that risk has receded myself

because there are more women in Parliament now and I think it would be more difficult,

but it is a risk, and therefore to be able to use an Order under the existing legislation is

probably the most immediate and useful thing that could be done. But the two-doctor

issue should be tackled, as well as the location at home being allowed, in my view.

THE CHAIRMAN: Thank you very much indeed. We have a nice bit of time for

questions. I have some. The first thing I want to ask really is whether people have seen

the report from the Advisory Group on Contraception. The Group has done a survey.

You will know that local authorities have to commission sexual health services and

family planning and advice centres. It is absolutely horrific that councils are refusing to

commission these services. The money that councils received was not ring fenced and so

they have no obligation to. They are just assuming, I guess, that the general practitioners

in their area will do the work. I just wondered, Ann and Lisa particularly, what your

organisations think about this, because it is going to affect abortion counselling, referrals

for abortion and everything if these clinics are not available - and they are closing hand

over fist all the time, all over the country.

LISA HALLGATEN: I attended a meeting of the Advisory Group on Contraception,

which we sit on. One of the things that was said was that the Department of Health is

looking at numbers of people accessing different forms of contraception and, until they

drop rapidly, the Department is saying that everything is fine. Of course epidemiologists

are saying, “Oh no, you have to wait to see the disaster”, but we know the disaster is

coming. You do not wait until you see more unintended pregnancies and more referrals

for abortion and fewer people getting fittings for effective methods of contraception

before you sit up.

THE CHAIRMAN: But the long-acting ones are not accessible. GPs are not doing it.

LISA HALLGATEN: Yes. There was a report from the Royal College of

General Practitioners as well expressing the difficulty with GPs being expected to fit

LARCs. So I think we are going to see more unintended pregnancies and the stuff that

I have talked about, which is a bit of a hidden thing - it is not something that is captured

statistically - which is the quality of support that people get in an abortion service. It is

going to go downhill and there is no way that is going to be captured. I think we all see it

as a looming crisis.

ANN FUREDI: I would really agree with that. We also sit on this Group. I think one of

the real difficulties is the absence of any real accountability about what has been

commissioned, whether it is through the council route, through the social care route, or

whether it is through the clinical commissioning groups within healthcare, about whether

they are actually commissioning services to meet people’s needs. For example, we are

seeing a new commissioning round on abortion taking place in London at the moment.

One of the arrangements that is being discussed, and it looks as though this is what will

happen in practice, is to basically have a situation where any organisation that meets a

baseline standard and agrees to provide services for a particular price will be able to

provide services. That sounds absolutely fair enough until you realise that what it does

not do is actually compel any of us to provide the service, so it could be, for example, that,

say, South West London could end up in a situation where no provider is prepared to

20

provide late abortion services, say beyond 16 weeks of pregnancy, simply because none of

us can do it for the price that is suggested.

THE CHAIRMAN: Presumably the commissioners are going for the cheapest option all

the time and will fish around.

ANN FUREDI: Yes, but the point is that what they will do is they will set a price and

they will say: “This is the price that we are offering”. In this particular instance the prices

are the prices that were set in 2013. They are looking for a five-year commitment with a

one per cent uplift. It may very well be the case that none of us will be prepared to say

that we can provide that. The outcome is that there is no safeguard that that community

has about what will happen in that particular case. I am one hundred per cent confident

that, when it all gets worked out, women will be served, but it is all too informal. It is too

squirreled away and non-transparent. That would not be the case, I think, with any other

area of healthcare.

THE CHAIRMAN: Thank you.

VISCOUNT CRAIGAVON: I have lots of questions for Ann, but can I take the

opportunity, with Lord Steel here, to say thank you very much and to thank you for your

work in the past? Just so that we can quote you in the future, are you saying that you

support in England the use of misoprostol where people want to use it?

LORD STEEL: Yes.

VISCOUNT CRAIGAVON: That is where we are heading.

LORD STEEL: It is quite interesting that, without going for decriminalisation, Scotland

has moved so far ahead. One thing I should just have mentioned is that Dr Calderwood

told me that before they came to that decision by ministers she had organised research in

the Highlands of Scotland, where, a bit like Northern Ireland, abortion was just not

available; not because of the legal situation but simply the lack of GPs willing to refer

women and so on. She said that that research was crucial in getting the change in the law.

Dr Calderwood is willing to make that research available to the Department down here, if

need be.

VISCOUNT CRAIGAVON: Can I follow up? You have identified the problem in this

building - the House of Commons - about having debates about the number of weeks

within which abortion is possible and you have said that that is not so much of a threat as

it has been in the past.

LORD STEEL: That is my view. But we do not know.

VISCOUNT CRAIGAVON: I was going to ask you. If we are talking about trying to

decriminalise abortion - I do not want you to give too much away on your evidence - do

you think the House of Commons is anywhere near accepting that particular line?

LORD STEEL: I had a meeting recently with Diana Johnson, who, as you know, is

promoting a Bill, and she is trying to get together an All-Party Group to back it up, which

I think is a better way of approaching it. Because this is now, as you know, a long session

of Parliament, the problem is that nothing will happen because she does not have a slot.

21

Nothing can happen until the next Parliament. My advice to her was to get together an

All-Party Group ready to use the next ballot that there is for Private Members’ Bills, as

I did in 1967, because I do not think any Government will touch this - although the

Government could, and should in my view, use the same powers that the

Scottish Government has done to issue ministerial --- What is the word? It is not a

statutory instrument, but it is guidance. Ministers are allowed to do that.

THE CHAIRMAN: With the availability of misoprostol now - and it is available on the

internet - do you not think that women are just going to take matters into their own hands

and that, in the end, ministers/governments are going to have to follow? We cannot

prosecute hundreds or thousands of women every year for using the abortion pill.

LISA HALLGATEN: There has actually been a really interesting piece of research.

Women on Web have started looking at women from the British mainland who could

access legal abortion but are going to them to buy mifepristone and misoprostol. Their

policy is that they do not provide it in countries where it is legal and so they are having to

get back to those women. Dr Kate Guthrie has been part of a project of talking to the

women who have gone to them and asked them to supply abortion medication to find out

why they did not try to access a perfectly legal and free abortion. It has been really

interesting to find out the number of women who actually find access really difficult,

including women who have disabilities and find it hard to get out of the house, including

women who are in domestic violence situations and cannot confide in their partner and

cannot leave, do not have any access to any funding for travel, and those kinds of things.

However good we are making access, there are clearly women falling through the net and

looking to get safe abortion medication online. We do not want to be in a position where

women have to be prosecuted before we decide that that is not a good idea.

LORD STEEL: But of course in Northern Ireland there is anxiety that women who

acquire this online can still be prosecuted there because it is illegal.

LISA HALLGATEN: Yes, they are being prosecuted.

THE CHAIRMAN: But in Northern Ireland they are getting more and more women to

actually access it and say: “I’ve done it. I’ve accessed it. What are you going to do with

me?” I just think that that is going to happen. If I needed an abortion now, in the next

few weeks, I would not go to any doctor or anybody. I would just try to get the pills

online. There is no way.

ANN FUREDI: There speaks a former doctor! I think you really are right. The genie is

out of the bottle now.

THE CHAIRMAN: Yes.

ANN FUREDI: I think this is an issue with the world that we live in, where people expect

to be able to get things in a convenient, sensible and straightforward way.

THE CHAIRMAN: It is in developing countries, too, which this investigation is mainly

about.

ANN FUREDI: Exactly.

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THE CHAIRMAN: It has been massively used. In Pakistan they have even admitted that

it has become a form of birth control; that people access it rather than use birth control.

ANN FUREDI: One of the most frustrating examples that I think we have in the

developed world is in North America. Let us compare ours with the situation in Canada,

which has actually had mifepristone and misoprostol as a legal method for less than a

year, where already it is provided in a way that any other treatment in this country would

be: that you would go to your doctor, the pregnancy is confirmed, the gestation is

confirmed, the doctor gives you a prescription, you go to the pharmacist, you collect your

drugs and go home and take them. Very straightforward, in a very small period of time.

The ridiculousness about the situation in this country really speaks to Lord Steel’s

suggestion. I would really urge everyone to press the Minister at the moment to follow

the Scottish route. The ridiculousness is that if a woman comes in to a BPAS clinic and

she is having a spontaneous miscarriage - and we also offer services on the NHS for

miscarriage management - we can hand her a packet of misoprostol to take home with her

and use. If she comes in and we are carrying out a procedure regulated under the

Abortion Act, she has to take the same drugs home in her vagina. She has to place them

in her body whilst in the clinic and then go home. That is the only difference. It is

incredibly stupid - I do not think there is any other word for it. The sooner we can move

towards that situation the better.

Very briefly on decriminalisation, I think one of the things that we have all been really

surprised by is that the assumption was almost that people would see decriminalisation as

being very, very radical. I think what is really becoming clear is that even quite

conservative members of the population and Parliament do not want to see doctors or

women prosecuted for this. They may not like it and, as some of our colleagues from

Northern Ireland have said, they may think that abortion is morally wrong, or should be

really regulated, but they do not want to see it as part of the criminal law. I think that is

the thing that may really push things forward.

BARONESS BARKER: Can I just ask David a question? Having fairly eminent people

from the medical profession on your side was an incredibly important part of your success

in 1967. Given that for many of the younger generation of doctors and medical staff now

it is not an issue of the same importance, do you think that the medical professions would

swing behind some attempt either to decriminalise or to move to just

one medical professional, rather than two doctors, and some of the other reforms that we

have been talking about?

LORD STEEL: My impression is that, yes, I think what you are saying is correct. It is

not just public opinion that has changed; I think medical opinion has changed. I think

there is a much greater readiness to accept the use of these drugs as an easier method of

abortion in the early weeks, but you still have to keep the safeguard for those women up to

20 weeks - and Dr Calderwood gave me the figures, which were actually quite

surprisingly large - who, for various good reasons, present late. You cannot use the drugs

in those cases. So I think the answer is that, yes, the medical profession is willing to see

the whole thing decriminalised. Regulated, yes, but not criminalised. My only slight

query with what Jenny Tonge said earlier is that I do not want to see these drugs used in

place of contraception. I think the importance of developing contraception and making it

available is absolutely paramount.

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LISA HALLGATEN: Can I just clarify on your question about medical professionals?

So the BMA, the RCOG, the RCM, and then last week the

Faculty of Sexual and Reproductive Healthcare, have all now passed motions to support

decriminalisation. These are, apart from the BMA, the specialist organisations and I think

they are going to pull other people behind them for sure.

BARONESS BARKER: Just on David’s point, I do not think we would do that either, not

least because, speaking as a member of the All-Party Parliamentary Group on HIV, which

I have been for a very long time, the whole issue of safe sexual health practices is never

more different than it was back in 1967. The whole thing has changed.

THE CHAIRMAN: Just between these four walls, can I ask another controversial

question? What do you think of the concept of menstrual regulation?

LISA HALLGATEN: I think it has been a life-saver in places like Bangladesh. It has

allowed people to provide safe abortion in a cultural context where it would not have been

allowed. I think without that kind of framing of it there would have been far more deaths

from unsafe abortion there.

THE CHAIRMAN: A professor I worked for 30 years or more ago - I do not how long

ago - was always advocating this. He could not see why there was all the fuss.

ANN FUREDI: It is a strange thing, is it not, that we have somehow come to attempt to

draw this incredibly sharp line between the prevention of pregnancy and contraception on

the one hand and ending a pregnancy - abortion - on the other? For a woman today who

does not want to have a child, I think the prevention of pregnancy is very, very high up on

their minds, as indeed I think the prevention of infection is high up on the minds of

younger people who are having sex. But if I am honest, and I have said this quite

a lot, I think there are women who come to our clinics looking for abortion as a means of

birth control, in the sense that prevention of pregnancy has not been possible through

one way or another, and so they are looking to end the pregnancy because they do not

want a child that they have not planned for and do not feel that they can. I think society

accepts that it would prefer women not to become pregnant but that, if they are pregnant,

it really does not want us to be forced to have children that we do not want. We have

a huge emphasis on responsible parenthood and it does not fit easily with that.

THE CHAIRMAN: But when we come to the methods used on the two sides, for the

contraception and for the abortion, we are splitting hairs -- when we talk about taking

emergency contraception or having a coil fitted to prevent the implantation of

a fertilised egg -- but saying that to take a medicine two days later that will actually throw

out the fertilised egg, which is just implanting or just about to implant, is wrong.

LISA HALLGATEN: I think it is very interesting. We had a really interesting session on

IUD fitting and for emergency contraception at the Current Choices Conference. This

issue was a kind of elephant in the room, because this person was saying “You can only

do it at this point, at this point, at this point”, but at no point did she say “for

legal reasons”, the implication being that it was for medical reasons, and it is absolutely

not for medical reasons.

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LORD STEEL: I think this is a particularly important issue in developing countries.

I have done quite a lot of travelling and lecturing on this subject. I remember going to

a conference about three years ago in Kenya, organised by the

Kenya Medical Association. They had in theory changed their law, but there was no

acceptance of legal abortion at all. That is what the medics were complaining about.

Of course this was in the time before the advent of the drugs, and I think the drugs

themselves will have made a big difference in countries like that.

THE CHAIRMAN: I think we will have to wind it up there. Once again, I am sorry

about the delays. You have all been magnificent. Thank you so much. The report will be

published and launched on International Women’s Day, 8 March 2018, somewhere in this

building - if it is still standing!

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