Photo: All Ireland Rally for Choice Belfast 10/06/12 by Tyler McNally (all rights reserved)

Over the past couple of weeks or so the abortion debate has once again flared into life. Newly appointed Secretary of State for Health Jeremy Hunt announced his support for halving the legal limit on abortions to 12 weeks. Then, last week, the journalist and political commentator Mehdi Hasan published a piece claiming that ‘Being Pro-Life Doesn’t Make Me Any Less of a Lefty’ prompting many to spend the next few days demonstrating that actually ‘Yes, Being Pro-Life Does Make You Less of a Lefty.’ This week the British Pregnancy Advisory Service (BPAS) launched a campaign titled ‘No More Names’, aimed at reducing the stigma and indeed harassment that many women experience around abortion.

Clearly, abortion is an issue that commands widespread social, and political comment. But it is not simply an issue of pro-choice verses pro-life or left versus right. For example, it is commonly assumed that the UK’s 1967 Abortion Act was the result of the nascent feminist movement. Certainly some feminist campaigners were involved but not all feminists, then or now, agree with abortion. The act resulted from the work of a diverse range of individuals and groups whose interests and concerns generated a complex and sometimes conflicting set of aims and objectives. This included many individuals and organizations that were morally opposed to abortion but could no longer ignore the consequences of prohibition: unsafe backstreet abortions. 45 years later the issues remain just as complex.

In the midst of these debates comes an announcement from Marie Stopes that it will be opening a clinic in Belfast offering termination of pregnancies of up to 9 weeks gestation*. This is a landmark event given the political, social and religious context of Northern Ireland and it is one that merits further consideration. The majority of women living in Northern Ireland who want a termination have to access abortion services elsewhere in the UK and, in some cases, elsewhere in Europe.  The associated financial as well as emotional and physical costs involved in seeking an abortion in England, Scotland, Wales and beyond has a direct impact on determining who can (and who cannot) pursue this course of action. Thus, for Northern Irish women abortion appears to be an economic privilege, rather than the political right it is for women in other parts of the UK. The opening of the Marie Stopes Clinic might go some way to redressing this inequality, (but this does not mean that the clinic is being welcomed with open arms).

In this context, the costs associated with seeking a termination are of paramount importance. The NHS does not provide for those who travel from Northern Ireland for a termination and so the women (who are UK citizens) must pay for private treatment. On top of this there is the cost of travel, overnight accommodation, possibly time off work and perhaps childcare – the total bill can easily be upward of £1,000. Many cannot afford this and it is in this context that we see stories of women buying abortificant drugs through online providers as a cheaper alternative to visiting a UK clinic.

The specifics of the Northern Irish situation create a number of paradoxes. Those in Northern Ireland who advocate for the continued restriction of abortion are able to maintain this position precisely because they do not have to fully face the consequences of this position. In the pro-life/pro-choice debate the issue of unregulated abortions does not have a significant bearing, precisely because women can pay to travel elsewhere for a termination. The paradox is that whilst access to abortion is officially severely restricted, in practice, it is widely available to those who can afford it. Northern Ireland’s particular religious characteristics are, of course, also important in this debate. Religious observance is widespread and many of the local politicians are self-avowed Christians, of various denominations, with most parties being avowedly anti-abortion. Nevertheless Northern Irish politicians are charged with representing the views of all their citizens and there is a great diversity of opinion. The current political situation is failing to meet the needs of those women who travel to access abortion services and it is disenfranchising those who cannot afford to do so. The opening of the Marie Stopes Clinic in Belfast provides a legal service some women clearly wish to access, whilst also challenging the Northern Irish government to clarify the legal position on abortion.  Whilst the Marie Stopes clinic does not remove all the financial barriers to abortion, it brings the issue of abortion provision in Northern Ireland to wider attention in an unprecedented way. This can only serve to move the social and political debate forward, and for this it is to be welcomed.

* The legal position on abortion in Northern Ireland remains unclear and there have been demands for the devolved government to clarify the issue for some time. In 2004 the Family Planning Association NI (FPANI) successfully challenged the Northern Irish Department of Health and Social Services’ refusal to issue guidelines on abortion. These finally emerged in 2009 but, on the basis of their provisions for conscientious objection and counselling, they were successfully challenged by a group of pro-life organisations. No further guidelines have been issued since although the Family Planning Association of Northern Ireland have recently been awarded a further legal hearing now scheduled for Jan 2013.

UPDATE Following tragic death of Savita Halappanavar in Galway, Republic of Ireland:

The tragic case of Savita Halappanavar does not precisely reflect the concerns expressed above.  But it does illustrate something about the consequences of reducing debates about abortion to simplistic moral arguments that stifle legitimate debate. It seems evident that even in a country with restrictive abortion legislation that women whose pregnancy places their life at severe risk should receive lifesaving treatment. In this respect the tragic events in Galway make it difficult to come to any other conclusion than that Savita Halappanavar’s care was, at best, mismanaged. Two investigations have now been launched to find out where things went wrong.

However that this tragic event occurred is not simply a matter of legislative or professional incompetence but a broader political failure of those in positions of power – whether they are legislators, professionals or clergy. Only last year, a group of Irish medical professionals declared that ‘abortion was not medically necessary to save the life of a pregnant mother.’ Consider this statement (from trained medical professionals) in light of the the clinical parameters of Savita Halappanavar’s case. It is evident that both North and South of the border clinicians need further guidance. The intransigence of the powerful belies the increasingly organized grassroots pressure on the Irish and Northern Irish governments to tackle the issue of abortion legislation. Their continued failure to do so maintains the status quo where women travel to other countries to get the services they need whilst moralist rhetoric monopolises public, political and professional discourse.

The power of these moralists extends, it seems, all the way to the clinic where it needlessly cost Savita Halappanavar’s her life. This state of affairs cannot continue. Both political and professional actors need to accept their responsibility to create proper legislation and clinical guidelines for abortion before any more women die needlessly.

About the author: Nathan Emmerich is a Visiting Research Fellow in the School of Politics, International Studies and Philosophy, Queen’s University Belfast. He tweets from @bioethicsuk.