Disclaimer: The views expressed are that of the individual author. All rights are reserved to the original authors of the materials consulted, which are identified in the footnotes below.
By Pia Malla
Abortions are criminally regulated in the United Kingdom under the Offences Against the Person Act 1861, and can only be lawfully carried out in situations stipulated by Section 1 of the Abortion Act 1967. In a recent landmark development, the devolved government of Northern Ireland has also permitted abortions to be carried out lawfully up to 12 weeks of pregnancy.[1] However, there are still numerous socio-legal barriers which deter women from accessing reproductive healthcare. This article explores these barriers to access.
Financial barriers
According to the Department of Health and Social Care 2020, 99% of the abortions in the UK are funded by the NHS. [2][2] However, there are several associated financial costs which come with procuring an abortion, including transportation, losing out on wages when taking time off work, and childcare expenses. Transportation costs are especially relevant for those residing in Ireland, as they may still have to travel to England to access abortions on less restrictive grounds. Even those living within the UK sometimes have to travel a great distance to access care, as they are subject to a postcode lottery.[3] [3] Such associated costs have the potential to deter those in a lower socio-economic strata from accessing necessary care.
Social stigma of abortion
The social stigma surrounding abortion means that despite being able to access abortion by law, many women may find themselves facing barriers. In modern Britain, some may question whether abortion is still a source of stigma. But while it has lessened over the decades since the passing of the 1967 Act, patriarchal norms about women’s roles are still pervasive. This is evidenced by women’s preference for private and confidential ways of accessing care such as Telemedicine.[4] [4] One way this is perpetuated is through the criminal regulation of abortion.[5] [5] Women may feel threatened and ashamed whilst accessing care. They may fear being perceived as immoral or criminal, and want to avoid being identified at clinics.The intensity of abortion protests outside clinics exacerbates this feeling; the British Pregnancy Advisory Service found that abortion protests have the effect of deterring people from accessing clinic buildings.[6] [6]
Religious organisations that are against the lawful provision of abortion may also contribute towards the stigma of abortion. The recent case of R (on the application of Christian Concern) v Secretary of State for Health and Social Care demonstrates how many people continue to oppose the evolution of the law on abortion.[7] [7] Here, Christian Concern filed a case against the home use of Mifepristone without the process being overseen by medical practitioners.
Lastly, stigma also plays a role in how those with limited education may not be privy to essential information about healthy menstrual cycles and potential signs of pregnancy. This especially applies to younger women and girls. One possibility is that even if a woman finds out that they are pregnant, her pregnancy may fall outside the gestational limit within which it can be legally aborted.
Marginalised groups of women
Vulnerable or marginalised groups of women may be more likely to be deterred from accessing care. This includes women who are in abusive situations who do not have complete control over when they can leave their homes, disabled women who have mobility issues, migrant women who are unaware of the regulatory framework, and BAME women who may face a different form of stigma within their own communities. An intersectional approach must be taken to empower these women and help them access abortions.
Legal barriers
One legal barrier in the UK is the requirement for women to provide justifiable grounds for abortion to their doctors. This reflects the existence of a paternalistic streak, which is largely inconsistent with the principle of autonomy upheld in medical ethics.[8] [8] Another barrier is that two doctors are needed to approve of a person’s decision to abort. Although medical professionals should exercise control over the performance of an abortion, it is questionable whether they are qualified to ultimately determine whether an abortion is permissible. On the other hand, one could argue that these provisions ensure that care service is of high quality, and that in practice, most doctors are likely to rubber-stamp women’s requests. Other provisions which constitute legal barriers include section 4 of the Abortion Act 1967 on conscientious objection. This concerns the ability of medical staff to refuse to participate in the abortion procedure. This can give doctors opposed to abortion for religious or moral reasons a platform to reject the woman’s wishes.[9] [9]
Conclusion
While the provision of lawful abortion is an important first step towards abortion access, it is by no means sufficient to address all issues of access to abortion in the UK. A more holistic approach needs to be taken towards empowering women to access abortion, which looks at the current law and beyond to social, economic and cultural issues. Moreover, there is a need to acknowledge such obstacles, and encourage transparency about potential barriers so women are better able to overcome them.
[1] The Abortion (Northern Ireland) Regulations 2020. [2] Department of Health & Social Care, Abortion Statistics, England and Wales: 2019. (2020), 9. [3] Elizabeth Chloe Romanis, Jordan A Parsons and Nathan Hodson, ‘COVID-19 and reproductive justice in Great Britain and the United States: ensuring access to abortion care during a global pandemic’ (2020) 7(1) Journal of Law and the Biosciences 1, 3. [4] Patricia Lohr, Jonathan Lord and Sam Rowlands, ‘How would decriminalisation affect women’s health?’ in Sally Sheldon and Kaye Wellings (eds), Decriminalising Abortion in the UK: What Would it Mean? (Policy Press 2020), 49. [5] Rebecca Cook, Joanna Erdman and Bernard Dickens (eds.), Abortion Law in Transnational Perspective, (University of Pennsylvania Press 2014), 369. [6] Mary Oppenheim, ‘Anti-abortion protesters deter women from going 'into clinics as well as entering services to find staff’’ The Independent (30 September 2020). [7] [2020] EWCA Civ 1239. [8] (n 4), 44. [9] ibid, 74.
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