Stormont

Life NI contribution to consultation on abortion in Northern Ireland

Question 1a: Should the gestational limit for early terminations of pregnancy be up to 12 weeks gestation (11 weeks + 6 days)?

No

Question 1b: Should the gestational limit for early terminations of pregnancy be up to 14 weeks gestation (13 weeks + 6 days)?

No

As a pro-life charity, Life NI cannot condone any law which accepts abortion as an appropriate solution to unwanted or difficult pregnancies. For Life NI, abortion is unacceptable in all circumstances, and as such we are extremely concerned about the wording used in this consultation, which suggests that an early termination of pregnancy should be allowed “without conditionality” in Northern Ireland. This opens the door for what many would consider extreme reasons for abortion, such as those based on gender or so-called disabilities such as cleft palate. It is also concerning to note that there is no mention of the women’s mental health with regards to a termination of pregnancy in the consultation, when there is mounting evidence to show that women are more likely to be emotionally and mentally affected by an abortion than after giving birth (Fergusson et al 2008). It is essential that women are presented with all the options available and do not feel that an abortion is the only solution to an unexpected pregnancy. It also must be considered that by 12 weeks, the lowest gestational limit put forward in this consultation, the fetus already has everything that is found in a new born baby. Its heart is beating (21 days), signs of brain activity can be detected (6 weeks), its fingerprints and fingernails have formed (10 weeks), and it’s moving and exercising in the womb. We can clearly see that there is a great deal of developmental evidence that attests to the humanity of the baby at 14 weeks and before. Indeed, the humanity of the pre-born child is recognised in the Convention on the Human Rights of the Child, where Article 24.2.d calls on states to “ensure appropriate pre-natal and post-natal healthcare for mothers”. This Article highlights the State’s responsibility to provide care and support for both mothers and their pre-born children, and as such directly undermines the premise of abortion at any stage as being against the innate rights of the child.

Question 2: Should a limited form of certification by a healthcare professional be required for early terminations of pregnancy?

No

If no, what alternative approach would you suggest?: Life NI strongly encourages that a robust and comprehensive form of certification is adopted for early termination of pregnancy. The removal or reduction of the certification process would pave the way for women to have multiple abortions, which is an extremely dangerous precedent that would put vulnerable women at risk. Given recent criminal cases as seen in Rochdale and Telford, where criminal gangs groomed and trafficked young girls and forced their victims into multiple abortions , the government should be seeking to strengthen certification measures in order to protect women, rather than limiting them. It is also concerning to note that no legal age limit for termination of pregnancy is noted within the consultation. Without a suitable certification process, there is a risk of young girls presenting for an abortion and there being no obligation for the practitioner to question their reason for being there, even at such a young age. It is also essential that comprehensive certification includes signposting to alternatives to abortion, such as counselling and practical support, in order to allow the women to make an informed decision regarding her pregnancy. We urge further consideration regarding this matter in order to determine if it really is in the best interests of the women to remove or limit the certification process.

Question 3a: Should the gestational time limit in circumstances where the continuance of the pregnancy would cause risk of injury to the physical or mental health of the pregnant woman or girl, or any existing children or her family, greater than the risk of terminating the pregnancy, be 21 weeks + 6 days gestation?

No

Question 3b: Should the gestational time limit in circumstances where the continuance of the pregnancy would cause risk of injury to the physical or mental health of the pregnant woman or girl, or any existing children or her family, greater than the risk of terminating the pregnancy, be 23 weeks + 6 days gestation?

No

As a pro-life charity, Life NI cannot condone any law which accepts abortion as an appropriate solution to unwanted or difficult pregnancies. We strongly believe that abortion is unacceptable in all circumstances, and as such we are extremely concerned with the consultation’s proposal for an upper gestational time limit of 23 weeks. For purposes of this legislation ‘risk of injury to the physical or mental health of the pregnant woman’ is too broad and undefined a term. 98% of abortions in England and Wales are performed under these subjective terms, with 9 out of 10 due to mental health risks. The definition of mental health risk itself is up for interpretation, which could lead to the stress often caused by pregnancy becoming a defining criterion for a late stage abortion. Indeed, in many circumstances social and practical issues are at play in a woman’s decision to have an abortion, issues that could be addressed through appropriate care, support and counselling. The consultation goes on to suggest that there is also the option to “leave the issue of term limit…to medical discretion”, which is extremely concerning as it leaves the way clear for abortion right up to birth, based on such a wide and undefined notion as ‘risk’. We also must take into consideration the fact that with the right medical care babies born at 24 weeks, the proposed upper limit for abortions, have a 50-70% chance of survival outside the womb. In fact, it was recently reported that due to medical advances babies born at 22 weeks have a greater chance of survival than ever before. We’re heading to a reality in Northern Ireland’s hospitals where in one ward a premature baby will be fighting for its life, whilst in another ward a baby the same age is being aborted.

Question 4a: Should abortion without time limit be available for fetal abnormality where there is a substantial risk that the fetus would die in utero (in the womb) or shortly after birth?

No

Question 4b: Should abortion without time limit be available for fetal abnormality where there is a substantial risk that the fetus if born would suffer a severe impairment, including a mental or physical disability which is likely to significantly limit either the length or quality of the child’s life?

No

Life NI is shocked by the blatant and lethal discrimination that is being shown regarding fetal abnormality and disability in this consultation, as it goes against the Equalities Act 2010. The terminology used, referring to ‘substantial risk’ and ‘profound impact’ on length or quality of life are wide open to interpretation. The term ‘quality of life’ is relative, and there are many people that would be happy with their own quality of life, where other people might view it as poor. This puts unborn babies with disabilities at risk and is therefore unacceptable. The term ‘impairment’ is vague and might also include abortions for a cleft palate; 15 abortions were performed for a cleft palate in England and Wales in 2018. Not only is the terminology used highly subjective and classifies a person’s quality of life before they have a chance to live it, they are also scaremongering for parents who receive a diagnosis of fetal abnormality. This puts pressure on parents to abort a baby with a disability, with the implication that it’s the more compassionate response. Terms such as ‘Fatal Fetal Abnormality’ and ‘incompatible with life’ can lead people to believe that the baby in utero is not worth saving. Many children who are deemed to have a FFA have not only survived birth but lived well beyond birth. One’s value cannot be determined by the length of their existence. As this story from the Belfast Telegraph shows, tiny human lives can have a massive impact on the people who have the opportunity to meet them. There are also many children who live longer than doctors thought and some who defy the odds of their diagnosis as stories from ‘Every Life Counts’ can attest. Unborn children with disabilities are the most vulnerable members of the human family and deserve the utmost protection. A disabled child has no less right to life than any other child. No pre-natal diagnosis can predict the joy that a child with a disability can bring. Whether a baby lives for months, days or even just hours continuing with the pregnancy gives parents the opportunity to meet and hold their child. Terminating the pregnancy on the other hand could lead to long term regret. The length of time a baby lives for beyond birth or his ‘quality of life’ afterwards, says absolutely nothing about his inherent worth, infinite value and inalienable human dignity. Life NI recognises that couples who face a pre-natal diagnosis may experience great confusion, fear, dread and even heartbreak. But fear should be allayed with accurate information, encouragement and support, not abortion. This is why we have recently launched our first peri-natal service in Belfast to offer parents the support they need.

Question 5a: Do you agree that provision should be made for abortion without gestational time limit where there is a risk to the life of the woman or girl greater than if the pregnancy were terminated?

No

Question 5b: Do you agree that provision should be made for abortion without gestational time limit where termination is necessary to prevent grave permanent injury to the physical or mental health of the pregnant woman or girl?

No

Life NI firmly believe that an abortion is not a life-saving procedure, and therefore provision should not be made for abortion without gestational limit in these circumstances. We refer to the Dublin Declaration, signed by over 1000 doctors, which states “as experienced practitioners and researchers in obstetrics and gynaecology, we affirm that direct abortion – the purposeful destruction of the unborn child – is not medically necessary to save the life of a woman”6. We acknowledge that in some cases medical intervention may be needed if the mother’s life is threatened. However, Life NI recognises the right to life of every human being, including the mother and her unborn baby. If she requires a life-saving treatment that may sadly result in the death of her baby, the principle of double-effect applies. If for example, she needed chemotherapy that might result in the loss of the baby, that should be permissible as the intention was to save the life of the mother, not to end the life of the unborn baby. Not being able to save a person because we lack the technology to do so is entirely different from directly ending their life. A baby that survived a treatment would be welcomed by both doctor and mother. A baby that survived an abortion, would not. It should also be noted that, after 24 weeks , and sometimes earlier, the baby is viable outside the womb and can be delivered via caesarean section or by inducing labour. From the point of viability the abortion to save the life of the mother argument becomes irrelevant and as such provision should not be made for it. The phrasing for both parts of the question is entirely ambiguous. For example ‘risk’ is far too vague and uncertain a term, especially since prognosis is not an exact science. Also, the phrase ‘to prevent grave permanent injury to the physical or mental health of the pregnant woman or girl’ also has the potential for loop holes, particularly since studies prove that women have a greater likelihood of being mentally affected by abortions, especially if there is a pre-existing mental health condition. (Fergusson et al 2008) We would point out that 7 out of 205,295 abortions were carried out under similar grounds mentioned in the question (i.e. F and G) in England and Wales in 2018. The subjective nature of the consultation’s wording could therefore put women more at risk of grave permanent injury through having an abortion, rather than providing them with alternative care and support.

Question 6: Do you agree that a medical practitioner or any other registered healthcare professional should be able to provide terminations provided they are appropriately trained and competent to provide the treatment in accordance with their professional body’s requirements and guidelines?

No

Life NI is concerned that the consultation’s suggestion that not only doctors, but ‘any other registered healthcare professional’ could be expected to perform an abortion would not only make it easier to procure a termination of pregnancy, but remove the care and support structures a consultation with a fully trained medical practitioner would offer to women. Given a qualified medical practitioner’s training and expertise it places them in a much better position to offer advice and care to a woman who experiences side effects or medical problems during an abortion. Would a registered healthcare professional such as a pharmacist or occupational therapist, no matter how well trained they are in the termination procedure, be able to deal with a botched abortion in the same manner as a medical practitioner? We also have concerns with the wording of the consultation, in referring to abortion as ‘treatment’. Pregnancy is not an illness to be cured, and this use of language further sanitises and normalises the physically and emotionally traumatic process of the abortion procedure. Yet again, women are being presented with abortion as being the only solution to a difficult or unplanned pregnancy. Women need to be informed of all the care and support options available to them, rather than rushed through a process by a questionably qualified healthcare professional.

Question 7: Do you agree that the model of service delivery for Northern Ireland should provide for flexibility on where abortion procedures can take place and be able to be developed within Northern Ireland?

No

Life NI does not agree that a flexible model of service delivery which would allow ‘women and girls to take the pills for the second stage of early medical abortion in their own homes’ is in the best interests of women. To encourage patients to take powerful drugs such as mifepristone and misoprostol in a non-clinical setting, such as their own home, is incredibly alarming. For these women and girls to self-administer such powerful medication without the supervision of a medical professional is concerning, as being alone in her home as they witness their pregnancy pass can have vast mental and emotional complications for the individual. Indeed, Fergusson et al (2008), in a study of the links between abortion and mental health, found that by age 25, 42% of the women who had an abortion in Ferguson’s cohort had experienced major depression in the last four years. At Life NI this is something we know all too well as our counsellors work with many individuals post abortion who are struggling, suffering or regretting their decision to terminate their pregnancy. There is also a duty of care for every single woman, which includes the right for that woman to have adequate time for reflection to ensure this is the right decision for her, by discussing all the options available to her, thoroughly checking the individual’s medical background and receiving emotional support if needed or requested. However, if the emphasis is on allowing for flexibility as to where an abortion can take place, how can we be certain that this full duty of care is being met? If we look at private abortion providers such as BPAS and Marie Stopes International, although they claim to offer emotional support, they cannot be impartial due to the financial incentives behind the woman choosing an abortion. For example, in 2017, the Care Quality Commission accused Marie Stopes of paying bonuses to staff who encouraged women to have abortions, a fact that was corroborated by Marie Stopes staff at Maidstone who told inspectors that the clinic was like a “cattle market” and described a “very target-driven culture”. We advocate that the model of service delivery for women in Northern Ireland be exclusively within a clinical setting, in the presence of a trained professional to care holistically for the woman and offer the follow up support that may be needed.

Question 8: Do you agree that terminations after 22/24 weeks should only be undertaken by health and social care providers within acute sector hospitals?

Yes

Life NI does not agree with abortions at any stage in the pregnancy, and would argue that there are no grounds for late term abortions regardless of where they would take place. It must also be considered that unborn children at this stage of development are protected from abortion by Section 25 of the Criminal Justice (NI) Act 1945. However, if abortions are to be carried out, it goes without saying that the abortion should only be carried out by a health care professional in a hospital which can provide the optimum care for the individual.

Question 9a: Do you think that a process of certification by two healthcare professionals should be put in place for abortions after 12/14 weeks gestation in Northern Ireland?

No

Question 9b: Alternatively, do you think that a process of certification by only one healthcare professional is suitable in Northern Ireland for abortions after 12/14 weeks gestation?

No

Life NI fundamentally opposes abortion regardless of any certification process that’s put in place. We’re concerned that the consultation refers to certification by ‘healthcare professionals’ only, rather than registered medical practitioners. This shows that the certification process is nothing more than a symbolic gesture, something to be rushed through in order to give women access to abortion on demand at any stage in her pregnancy. Indeed, it is clear that the consultation’s purpose is to put an extreme abortion regime in place in Northern Ireland, and so it is hard to see any circumstance where an abortion would be denied. As a charity that offers care and support to women, we find it alarming that a registered medical practitioner’s involvement in an abortion through the certification process would be removed. Many of the women who come to us for support are extremely vulnerable, and this removal of care may result in patients missing out on vital care and support. Although the consultation describes the involvement of a second healthcare professional as “an administrative burden”, we at Life NI also believe “that all tightening of abortion legislation must occur in conjunction with greater support for women facing unplanned pregnancies” (Life Policy). Having less access to professional care is detrimental to the health and well being of women.

Question 10: Do you consider a notification process should be put in place in Northern Ireland to provide scrutiny of the services provided, as well as ensuring data is available to provide transparency around access to services?

Yes

Life NI believes it is essential that detailed data and records should be collected and published regarding abortion provision in Northern Ireland. Although it is hard to see how accurate records can be kept when the NIO’s guidance is pushing for an abortion regime where “the women or girl will not be required to explain or justify why she is seeking a termination”, such data and records would serve as a safeguard against coercive abortion, as well as giving evidence of the physical and emotional harm that can result from an abortion. Indeed, If a notification process is not put in place, not only can data not be gathered, which is essential to support those facing future unplanned pregnancies, there is also the risk of a lack of transparency around areas where intervention may be needed, including in the new framework itself.

Question 11: Do you agree that the proposed conscientious objection provision should reflect practice in the rest of the United Kingdom, covering participation in the whole course of treatment for the abortion, but not associated ancillary, administrative or managerial tasks?

No

Life NI believes that conscientious objection provision should cover participation in the whole course of treatment for abortion and that it should also cover participation in associated ancillary, administrative, or managerial tasks. The consultation document states that conscientious objection in the rest of the UK does not include ancillary, administrative, and managerial tasks associated with abortion, and that it is proposed that such a framework should be adopted for Northern Ireland. While we acknowledge the desire to “ensure consistency for professional bodies”, we believe it is inappropriate to adopt the proposed framework. The UK framework around conscientious objection is not robust, fair, or adequate. A 2016 parliamentary inquiry led by Fiona Bruce MP found that UK doctors are being refused promotion and can even face harassment by their managers if they object to taking part in abortions. The inquiry concluded that, although there were reports of good practice with regards to conscientious objection, in recent years there have been “[i]ncreasing legal and professional pressure to refer patients [for abortion], inadequate training at medical schools on the subject of conscientious objection, and limited career progression opportunities, both real and perceived, particularly in the field of Obstetrics and Gynaecology.” As an organisation with a policy upholding conscience rights regarding abortion, Life has heard many accounts throughout the years from healthcare professionals (especially midwives) who have held a conscientious objection to abortion. Their personal experiences highlight the practical difficulties of morally objecting to abortion under the UK’s current framework and demonstrate that said framework is inadequate. One of the most noticeable trends we have encountered is ‘compensation’ – i.e. midwives having to ‘make up’ for their conscientious objection by taking on a greater workload. Examples include taking additional night shifts or being allocated to more distressing cases, like stillbirths and difficult miscarriages. One midwife told us that she refused to participate in an abortion and as a result had to take on five additional women when she was already overstretched. Other, more harrowing accounts have come from midwives who have reluctantly had to help with the ‘after birth’ following an abortion. One midwife had to stand by and watch an aborted baby being born alive whilst the midwives stood around and “prayed for it to die.” Most accounts we have heard, therefore, demonstrate poor practice on the part of ward managers and a negative culture towards conscientious objectors from the hospital and the rest of the ward. The UK framework drives these results and it is therefore inappropriate to adopt this framework for Northern Ireland. Being involved in ancillary, administrative, or managerial tasks around abortion do make someone morally culpable in the act of abortion. It is grossly unfair and a wholly unreasonable burden to ask someone to participate – directly or via ancillary, administrative, or managerial tasks – in a procedure that they believe destroys an innocent human life with intrinsic dignity and worth. To refer a patient to another professional for an abortion only adds one degree of separation between the doctor and the act to which they are morally opposed, and completely contradicts their objection in the first place. To ask them to participate indirectly therefore demonstrates a lack of understanding of the nature of freedom of conscience and the reasons why someone may conscientiously object to abortion. This is wildly unreasonable and inappropriate in a supposedly progressive and liberal society.

Question 12: Do you think any further protections or clarification regarding conscientious objection is required in the regulations?

Yes

Life NI agrees that the new regulatory framework in Northern Ireland should provide a statutory right for healthcare professionals to conscientiously object to the provision of treatment relating to a termination of pregnancy, and that the new regulatory framework should provide a clear legal position. However, we also believe that the new regulatory framework should put in place the statutory right to conscientious objection in such a way so that, should the 1967 Abortion Act be repealed, the conscientious objection rights remain. At a bare minimum, Articles 9 and 14 of the European Convention of Human Rights, prohibiting discrimination on the grounds of religion and belief, should be recognised as underpinning the protection provided by the conscience clause of the Abortion Act. However, if conscientious objection is to be taken seriously, an amendment must be made to strengthen section 4 of the Abortion Act or, failing that, a new Freedom of Conscience piece of legislation should be introduced to address the current situation. With regards to an amendment to Section 4, the word ‘treatment’ could be changed to ‘activity’ as used in the Human Fertilisation and Embryology Act 1990. Section 38 of the HFE Act 1990 offers broader protection by using the word ‘activity’: “No person who has a conscientious objection to participating in any activity governed by this Act shall be under any duty, however arising, to do so.” We also maintain that the right to conscientious objection should extend to any and all ancillary, administrative, and managerial tasks that might be associated with abortion. See answer to Question 11. The right to conscientious objection also includes, more broadly, a right for medical professionals to conscientiously object without fear of repercussions to their career, good standing, or anything else. The new regulatory framework should make it so that such repercussions, which are more cultural and unspoken, do not proliferate. To do so could have a chilling effect upon recruitment to the medical profession. Life NI agree that healthcare professionals should be able to conscientiously object to abortion “to prevent grave permanent injury to the physical or mental health of a pregnant woman or girl.” We affirm, however, that should medical intervention be necessary to save the life of the mother, and if the mother consents, the healthcare professional should be required to participate.

Question 13: Do you agree that there should be provision for powers which allow for an exclusion or safe zone to be put in place?

No

We assume that this question relates to the implementation of buffer zones outside abortion clinics. We strongly disagree that there should be “exclusion”, or “safe” zones as the question puts it. Laws already exist in Northern Ireland to protect people from harassment. One such law is the Protection from Harassment Order (NI) 1997. This prohibits the act of harassment, stating that a person shall not pursue a course of conduct which amounts to harassment of another and which the perpetrator knows or ought to know will cause the victim harassment (which includes alarming the person or causing them distress). Therefore where people are being genuinely harassed, the police can intervene and arrest the perpetrators. No new law is needed. Where abortion buffer zones have been implemented in England and Wales it has sought to stop small groups of mainly elderly people praying and quietly offering support to women coming to the abortion clinics. Such activity can hardly be described as harassment or intimidation and would not breach the Protection from Harassment Order NI. In England and Wales, authorities have not been able to find evidence to arrest and prosecute people for harassment who are simply

standing outside abortion clinics and offering leaflets with support to anyone who wants to take them. The quiet offers of support which is offered by people outside abortion clinics helps to show women they do have a choice when it comes to abortion. There are women who have changed their mind and kept their baby because of support offered outside abortion clinics (https://www.thetablet.co.uk/news/8045/woman-describes-dramatic-change-of-mind-on-abortion). Erecting buffer zones outside clinics removes the ability of women to receive offers of support which may empower them to keep their baby. Of course we understand why this would be a good thing for abortion clinics. Every woman who changes her mind and keeps her baby denies the abortion clinic money. Freedom of Expression is a fundamental right. We support it where this freedom is exercised without harassment and intimidation. The absence of harassment and intimidation outside abortion clinics means that the implementation of buffer zones is an attempt to clamp down on freedom of expression of the pro-life movement.

Question 14: Do you consider there should also be a power to designate a separate zone where protest can take place under certain conditions?

No

We cannot see the justification for the implementation of any zones whether they be to allow protest or deny protest. As in the above answers they are unnecessary and represent a violation of the right to freedom of expression and impede the ability of people/organisations which want to reach out with help and support to vulnerable women.

Further Comments

Question 15: Have you any other comments you wish to make about the proposed new legal framework for abortion services in Northern Ireland?

Life NI are deeply concerned by the tone this consultation sets with regards to a proposed new legal framework for abortion services in Northern Ireland. As a charity which offers housing, support and counselling to hundreds of women facing unplanned or difficult pregnancies each year, we are well aware of the practical, social and emotional pressures facing women who find themselves considering an abortion. To propose a legal framework that streamlines a procedural pathway to abortion, offering it as the only viable solution to a diverse range of situations, demonstrates a complete disregard for a holistic and care-based approach which has the best interests of women at its centre. Throughout the consultation there is an obvious impetus that any new framework leads to as many abortions as possible with as much ease as possible. After many years of having good and right laws which protected not only the mother but her unborn child, it is unconscionable that Northern Ireland becomes a capital for abortion services, which is where the framework put forward in this consultation will no doubt lead us. There is no mention of any alternatives to abortion at any point in the consultation, which, as a leading provider of such alternatives in Northern Ireland, we know to be a glaring oversight. Proposing abortion provision without allowing a women access to all the options available to her is uncaring at best, and reckless at worst. Any new framework for abortion must allow for women to access any and all support she would need to continue with her pregnancy, be that through counselling or more practical support, rather than speeding her through a process geared towards one outcome – abortion. Indeed, one of our clients shared her experience of how she wished she had been listened to prior to her abortion and how she struggled with the consequences for many years afterwards: “Society doesn’t allow you to feel guilty or grieve for my lost babies, because when you do try to say to your partner or friends or relative how you are feeling all you get back is ‘it was your decision’ – no it was never my decision, all I kept hearing was ‘you are doing the right thing’, no one ever asked me how I was really feeling or told me how I would be totally consumed by the terrible grief and the loss of part of me. Over the years I have just bottled it all up, trying not to face the pain, speaking about it now is lifting an all-consuming weight from me”. This testimony goes to show that for some women, years of suffering could be avoided if they are given adequate space and access to alternatives before having an abortion to explore their feelings and determine whether this is something they really want, or is it something they feel they are expected to do. Any new abortion framework for Northern Ireland should reflect this reality and move towards offering women real choice when it comes to unplanned or difficult pregnancies, rather than offering abortion as the only solution to the situation.


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