Buying abortion through the internet: exploring the social harm of criminalising abortion in Northern Ireland and the UK

Lead Research Organisation: University of Ulster
Department Name: Sch of Policy Studies

Abstract

Abortion is still a crime everywhere in the UK, even though it is legal in Scotland, England and Wales when two doctors say it is needed. In Northern Ireland, the law is still as it was in Britain before the 1967 Act. But Northern Irish women still have abortions; if they can afford it, they travel to England and pay privately for a legal abortion. But every year, hundreds of women who cannot afford to go to England buy pills over the internet to cause a miscarriage - what is known as a "medical abortion". These are the same pills that are used in about half the NHS abortions in Britain. This study will talk to women in Northern Ireland who have a medical abortion illegally, and women in Scotland who have it legally through the NHS.

The study will find out, through being part of the NI Life and Times Survey, about what public opinion really is on abortion in Northern Ireland, including whether they think women ought to be threatened with prison for taking pills which are available on the NHS in England, Scotland and Wales. We will look at where the "social harm" occurs because of these illegal abortions. Is the social harm caused by the women taking the pills or is it caused by the state that won't allow her to do it legally? As part of the research, a sexual health expert will look at the women's experiences and see what kind of aftercare, advice about contraception etc that the Northern Irish women get, compared with the women in Scotland who got the pills from the NHS.

The questions we hope the study will answer are:

What are the different experiences of women taking the abortion pill legally on the NHS (in Scotland) and illegally via the internet (in Northern Ireland)?
What impact does the illegal nature of such abortions in Northern Ireland have on the sexual and emotional health of the women concerned?
What do these different experiences tell us about the 'social harm' surrounding the UK's abortion laws?
What is the true state of social attitudes in Northern Ireland in relation to abortion?
What would decriminalisation mean for women (and abortion providers) in Northern Ireland and Britain?

It can be risky to do research on issues touching on illegality and the issue of abortion is a particularly controversial one but the research team has thought about how it will protect the women who have acted illegally, as well as our research.

The study hopes to cast new light on existing policy around abortion in the UK, especially Northern Ireland. It will seek to give policy makers new information on which to base their policies, and evidence which might open a debate about whether the UK, like Canada, should have no criminal laws associated with abortion.

The project team will produce more than just a final report. We will write policy briefs aimed at policy makers, the medical profession and women's and voluntary groups at local and national level. We will also send information about what we learn to the United Nations committee that oversees women's rights. Some of the summaries we write will be aimed at the general public and we will present papers at conferences and seminars, and any events to which we are invited.

Planned Impact

IMPACT SUMMARY

The comparative qualitative study of women in Northern Ireland who have a medical abortion illegally, and of women in Scotland who have it legally through the NHS and clear evidence about the true state of social attitudes in Northern Ireland in relation to abortion should be of significant interest to a range of non-academic research users, including:

Health Professionals
Currently, there is little knowledge about the impact of illegal abortions via the internet. This study will help make GPs, Accident and Emergency personnel, sexual and public health professionals generally aware of the issue, and provide evidence on which to base decisions, thereby improving the chances of proper aftercare for women who illegally self-induce.

Policy Makers
Policy makers in Northern Ireland and across the UK need more evidence on which to base policy developments. The research team have excellent links with civil servants and other policy makers in Northern Ireland and will work closely with Voice for Choice in London to ensure that policy makers at Westminster and Holyrood also make use of evidence produced by the study.

The Women's Sector
While the women's sector in Northern Ireland and Britain is aware that there are illegal abortions via the internet are happening in Northern Ireland, there is very little information on them, apart from the Open Letter published in the media in March 2013. This has an impact when civil society organisations re responding to Department of Health or Department of Justice consultations and submitting evidence to the UN Committee on the Elimination of Discrimination Against Women (CEDAW) and other International Treaty Bodies. For example, when the a number of women's organisations made a submission to the CEDAW committee asking for an inquiry, under the Optional Protocol, into reproductive rights in NI and cited the growing number of illegal abortions as a concern, the committee asked for more information on how this affected women's lives. However, no evidence was available, a situation that the study can redress.

International Treaty Bodies
A number of International Treaty bodies have commented on the situation in relation to abortion in Northern Ireland. For example, the CEDAW committee has consistently asked the UK Government (in its 1999, 2008, 2013 recommendations to the UK) to undertake a process of public consultation on abortion in NI. This study will aid the committee by providing evidence on social attitudes in the region. Other International Treaty Bodies including the Committee on Economic, Social and Cultural Rights have also expressed concern at the lack of evidence in relation to reproductive rights in Northern Ireland.

The General Public
There is strong popular interest in discussion of any aspect of abortion and this interest should make it easy to gain popular media dissemination for this research. Given that abortion is increasingly a policy issue in Northern Ireland, the public needs more information on which to base its views. Relevant Radio 4 programmes will be approached with a view to securing interviews (e.g. Woman's Hour; Thinking Allowed) and, in the research team's experience, invitations to speak on local BBC radio and the world service should follow from these appearances. Further, in order to make the research more widely accessible, at least one article will be written for a broadsheet newspaper (e.g. Guardian news section, Society or Family supplement), as well as for a number of online forums, such as Opendemocracy and Mumsnet.

Publications

10 25 50
 
Title Decriminalise - a verbatim performance 
Description A 25 minute play using the verbatim words of women interviewed as part of the study, detailing some of the harm caused to women in Northern Ireland by the criminalisation of abortion in the region and the prosecutions of some women for self-managing abortions outside the health system. The play was initially devised, together with Alliance for Choice and Sole Purpose Theatre Company to be performed on Culture Night, October 2019 and was included in the Derry City and Strabane District Council programme for that night. The performance was later repeated and filmed for distribution and viewed over 4,000 times on Facebook. 
Type Of Art Performance (Music, Dance, Drama, etc) 
Year Produced 2019 
Impact In 2020, Alliance for Choice and Foyle Women's Information Network sponsored a community 'tour' of the play in working class communities across the North West of Northern Ireland as part of the Derry City and Strabane District Council's Social Justice Week. 
URL https://www.facebook.com/a4cderry/videos/2352847431647269/
 
Description That, as expected, ethical issues take considerable time to be cleared.
That attitudes to abortion in Northern Ireland are far more liberal than previously known. See http://www.ark.ac.uk/publications/updates/update115.pdf

The study has found that, despite free NHS abortions now being available in Britain to women from Northern Ireland and in spite of prosecutions of women who have been suspected of using pills to end pregnancies outside the law in NI, women who cannot or do not want to travel continue to use abortion pills. However, these women are fearful of seeking medical assistance because they know they are doing something that is outside the law; since the prosecutions started, they are even less likely to seek medical assistance - leading to fears that someone may die because from haemorrhaging. See https://www.ark.ac.uk/ARK/sites/default/files/2019-03/update127.pdf
Exploitation Route Women Help Women, one of the websites that provide pills via telemedicine has asked if it can share the findings World Health Organisation
Sectors Communities and Social Services/Policy,Healthcare,Government, Democracy and Justice

URL https://www.ark.ac.uk/ARK/projects/abortion
 
Description Findings from the NI Life and Times Survey module on public attitudes to abortion were used in a BBC Newsnight report about DUP influence in Westminster government on Friday 23rd February 2018 and cited on a number of occasions in the July 2019 House of Lords debate about Clause 9 of the NI (Executive Formation) Bill. Data from the study, in relation to women using abortion pills outside the formal health care system used by members of the Women and Equalities Committee to question witnesses at its Inquiry into abortion in NI. Data from the study used in the NGO Shadow Report to the CEDAW Committee 2018/19 A Sunday Times magazine feature article, July 2019, quoted data from the study. The research findings were disseminated to Sexual and Reproductive Health (SRH) professionals in collaboration with Doctors for Choice NI and dissemination activities used as a way to allow SRH professionals to share their views about an abortion service for Northern Ireland in a safe space.
First Year Of Impact 2018
Sector Creative Economy,Healthcare,Government, Democracy and Justice
Impact Types Cultural,Societal,Policy & public services

 
Description Data from the study cited in Westminster debates about abortion law in Northern Ireland
Geographic Reach National 
Policy Influence Type Citation in other policy documents
Impact The NI Executive Formation Act 2019 led to the decriminalisation of abortion in Northern Ireland, thus ending prosecutions of women seeking medical assistance after self-managing abortions using pills obtained over the internet and so protecting the health of women in the region.
URL https://hansard.parliament.uk/lords/2019-07-15/debates/19071517000206/HouseOfLords
 
Description Helping to identify training needs for Sexual & Reproductive Health Professionals in Northern Ireland
Geographic Reach Local/Municipal/Regional 
Policy Influence Type Influenced training of practitioners or researchers
Impact In collaboration with Doctors for Choice NI, the research team (as ARK - which is a partnership between Ulster University and Queen's University Belfast) held a roundtable with Sexual & Reproductive Health Professionals from across NI. The round table was held under the Chatham House rule and the discussion written up by the research team and disseminated by Doctors for Choice NI. One of the issues raised at the round table was the urgent need for training in Early Medical Abortion; this training was then provided by Doctors for Choice NI in conjunction with the Royal College of Obstetricians and Gynaecologists and the Faculty of Sexual and Reproductive Health.
URL https://www.ark.ac.uk/ARK/sites/default/files/2019-12/policybrief14.pdf
 
Description Written submission to the Westminster consultation on a new legal framework on abortion in Northern Ireland
Geographic Reach Local/Municipal/Regional 
Policy Influence Type Participation in a national consultation
URL https://www.gov.uk/government/consultations/a-new-legal-framework-for-abortion-services-in-northern-...
 
Description Written submission to the Women and Equalities Committee Inquiry on abortion in Northern Ireland which led to an invitation to give oral evidence. The study's findings were used on several occasions in questioning of other witnesses by the committee.
Geographic Reach National 
Policy Influence Type Gave evidence to a government review
Impact The written and oral evidence given to the Inquiry was cited in a number of places in the Inquiry report from the Women and Equalities Committee, both in relation to the public attitudes survey and to the impact of criminalisation of abortion on women in the region. Our written evidence is cited in the report as ARK (ANI0343) It recommended a change in the law on abortion in Northern Ireland and cited the evidence from this study as a reason why it needed to change urgently. Abortion has been decriminalised in Northern Ireland and a new regulatory framework is being developed to provide abortion services in the region. This research had a demonstrable influence on that change.
URL https://publications.parliament.uk/pa/cm201719/cmselect/cmwomeq/1584/158402.htm
 
Description Collaboration with Doctors for Choice NI 
Organisation Doctors for Choice UK
Sector Public 
PI Contribution Fill this
Collaborator Contribution As part of dissemination and impact strategy of the study, we wanted to inform doctors, particularly Sexual and Reproductive Health practitioners and Obstetrician/Gynaecologists. Due to the domination by of medical organisations here by more conservative doctors, this was proving difficult. However, once abortion was decriminalised at Westminster, there was an influx of doctors to Doctors for Choice.
Impact Links to policy briefs here
Start Year 2019
 
Description Event to present key findings in relation to the views and experiences of women using abortion pills obtained over the internet outside the law. 
Form Of Engagement Activity Participation in an activity, workshop or similar
Part Of Official Scheme? No
Geographic Reach Regional
Primary Audience Public/other audiences
Results and Impact 42 people attended the research conference in Belfast. Those in attendance included officials from the NI Dept of Health, the Equality Commission for NI, the NI Human Rights Commission, members of NGOs, post-graduate students and lawyers involved in judicial reviews around prosecutions for using abortion pills obtained over the internet.
Year(s) Of Engagement Activity 2019
URL https://www.eventbrite.co.uk/e/the-abortion-pill-womens-rights-policy-reform-in-northern-ireland-tic...
 
Description Evidence to the British Irish Parliamentary Association Inquiry into inter-jurisdictional aspects of abortion law 
Form Of Engagement Activity A formal working group, expert panel or dialogue
Part Of Official Scheme? No
Geographic Reach National
Primary Audience Policymakers/politicians
Results and Impact The Environmental and Social Committee of the British-Irish Parliamentary Assembly, which brings together parliamentarians from England, Wales, Scotland, N. Ireland and the Republic of Ireland, is holding an Inquiry into the inter-jurisdictional issues around abortion law reform across these islands. They asked for evidence and a written response was provided to them, using data obtained in the course of this study. The Inquiry then invited the PI to provide oral evidence when they sat in Stormont. The oral evidence session included questions about issues relating to the use of abortion pills obtained over the internet and lasted over an hour.
Year(s) Of Engagement Activity 2018
URL http://www.britishirish.org/committee-d-environment-and-social/
 
Description Keynote speaker at University of Kent conference on "Disrupting Technologies" 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Geographic Reach National
Primary Audience Other audiences
Results and Impact The conference explored the impact of fertility control technologies, from the contraceptive pill to LARCs and the abortion pill.
Year(s) Of Engagement Activity 2019
URL https://www.kent.ac.uk/events/event/37478/disruptive-technologies-fertility-control-pills-in-the-pas...
 
Description Presentation at conference 
Form Of Engagement Activity A formal working group, expert panel or dialogue
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Professional Practitioners
Results and Impact Presented early findings about women who cannot travel for abortion at this two-day conference which took place in the week of the fiftieth anniversary of the 1967 Abortion Act, at the Royal College of Obstetricians and Gynaecologists )RCOG), London. The conference was attended by a range of health care professionals, including the President of the RCOG and several of the RCOG's Council and of the Faculty of Sexual Health and Reproductive Healthcare. The conference was also attended by academics, policy makers, politicians, campaigners and service providers from the UK and a small number of other jurisdictions influenced by the Abortion Act, including Canada, Nigeria and Australia.
Year(s) Of Engagement Activity 2017
URL http://www.bristol.ac.uk/law/abortion-act-conference/
 
Description Presentation to Scottish Abortion Care Providers Annual Conference 
Form Of Engagement Activity A formal working group, expert panel or dialogue
Part Of Official Scheme? No
Geographic Reach National
Primary Audience Professional Practitioners
Results and Impact About 80 doctors and midwives attended the annual Scottish Abortion Care Providers conference where the findings of the study in relation to the experiences of Scottish women self-managing abortion within the NHS were presented. There was a discussion afterwards about the study's findings about the importance to the women of self-referral to the sexual health service, which health professionals in Scotland have been arguing ought to be available across the country. It was indicated that the study's data would bolster that argument.
Year(s) Of Engagement Activity 2019
URL https://bsacp.org.uk/scottish-abortion-care-providers-sacp-conference-forth-valley-royal-hospital-la...
 
Description Round table with obstetricians and gynaecologists about developing an abortion service for Northern Ireland following decriminalisation 
Form Of Engagement Activity A formal working group, expert panel or dialogue
Part Of Official Scheme? No
Geographic Reach Regional
Primary Audience Professional Practitioners
Results and Impact 18 doctors including seven consultant O/Gs and five registrars attended a round table organised by the research team in collaboration with Doctors for Choice NI. The discussion was under the Chatham House rule and written up in a policy brief (URL below). The discussion focused on the challenges facing any abortion service in the region, given the strain under which the NHS already works; there was a huge level of support for such a service the lack of which to date the doctors deplored.
Year(s) Of Engagement Activity 2019
URL https://www.ark.ac.uk/ARK/sites/default/files/2019-10/policybrief12.pdf
 
Description Seminar presentation 
Form Of Engagement Activity A formal working group, expert panel or dialogue
Part Of Official Scheme? No
Geographic Reach Regional
Primary Audience Professional Practitioners
Results and Impact Seminar presentation for Medical Research Centre team of University of Glasgow's Institute of Health and Well-being. The seminar was attended by the consultant, several other doctors and medical professionals from the Sandyford Sexual Health Centre where the Scottish part of the study is being carried out. It allowed the medial personnel to ask questions about the value of the research for their own work.
Year(s) Of Engagement Activity 2018
 
Description Sunday Times Magazine feature 
Form Of Engagement Activity A magazine, newsletter or online publication
Part Of Official Scheme? No
Geographic Reach National
Primary Audience Media (as a channel to the public)
Results and Impact Five interviews from the study, with any personal information removed, were provided to the Sunday Times journalist, Laura Silver. The feature article was about the prosecutions of women in Northern Ireland and the journalist needed women's stories to illustrate it. Participants had agreed to have their anonymised words used in a range of media, so this was ethically fine. In fact, the journalist changed names again in the article but she acknowledged the study and the ESRC as funder.
Year(s) Of Engagement Activity 2019
URL https://www.thetimes.co.uk/article/the-northern-irish-women-taking-abortion-pills-in-their-bedrooms-...