146.We have heard that women and girls face a ‘postcode lottery’ when accessing lawful abortion provision in public hospitals in Northern Ireland. Dawn Purvis told us that; “There is a real inconsistency across healthcare professionals and I would say GPs in particular. With obstetricians and gynaecologists, it is based on who you know and not what you know. The pathway is not clear.”
147.We have also been told that this inconsistency extends to the provision of information about lawful abortion provision in other jurisdictions. One woman told us that she was initially told by her consultant that she would be able to access a legal abortion in Northern Ireland. When she was sent to a registrar at a different hospital in a different trust the next day, having spent the whole night discussing it with her husband:
the registrar [ … ] looked at me and she said, “That’s just not going to happen.” I said, “But the consultant we saw yesterday said she would sign off on it”. [ … ] To come to that decision, it is not a relief; it is what is the least worst option here, so that is what we had decided, but she said to me, “That is just not going to happen,” so flippantly.
148.Dr Fiona Bloomer of Ulster University told us that the work she has done with health professional bodies has shown a “chilling effect of the law and how that impacts on their practice, and also the unevenness of how polices are rolled out and how that impacts on them as professionals, and makes them very reluctant to even mention abortion.”
149.The Royal College of Midwives (RCM) told us in the oral evidence session in Belfast on 25 January that their members are very unsure about how to react when women who may have travelled to have an abortion present at a maternity unit bleeding. Karen Murray of the RCM told us; “If a woman presents and she is bleeding, they are very uncertain about asking questions because they are uncertain about the answers they are going to get and how they would deal with those situations.” Ms Murray said there needs to be a pathway following a termination outside of Northern Ireland that allows her to return with a package of care.
150.We also heard evidence that women who access abortion pills online fear prosecution and so are reluctant to seek medical care if needed. Grainne Teggart of Amnesty UK said in her view; “not only is the law not working, but it is extremely harmful to women who need this form of healthcare.” Dr Goretti Horgan of ARK agreed saying; “Even the very limited law that there is, is not working [ … ] that means that women either travel or they risk prosecution. Also, as our research is discovering, they are even risking not going to the hospital when they think maybe they ought to go to the hospital if they use the pills.”
151.The Chief Medical Officer for Northern Ireland outlined the regulatory framework for abortion in Northern Ireland in which health trusts are regulated by the Department of Health (NI). He said that there is a statutory duty on trusts to ensure that the services under their duty of quality are consistent. He went on to say that; “If those inconsistencies or differences were drawn to our attention, we would consider the most appropriate action to take.”
152.We took evidence from the General Medical Council (GMC), the regulator for doctors in the UK which sets the standards that doctors need to follow and decides whether doctors are qualified to practice. Despite concerns about a lower standard of care for women and girls seeking abortion provision in Northern Ireland, the GMC told us that their database going back to 2006 showed that there had been no complaints in relation to this in Northern Ireland.
153.The GMC told us that it contributed to the development of the 2016 guidance and that it is a source of “authoritative national guidance.” The GMC also said that there was a case for doing more to raise awareness of this guidance as a helpful resource. It said that GMC Liaison Advisers in Northern Ireland will make reference to the 2016 guidance in all relevant ‘GMC guidance workshops’ with doctors and its Northern Ireland team will explore patient awareness of the guidance during regular catch-ups with the Patient and Client Council.
154.Giving oral evidence to the inquiry, Minister for Women and Equalities, Penny Mordaunt, said that there is a question for the UK Government when faced with this kind of situation. She said:
If there were a situation where you had, in a devolved nation, a hospital failing or some other kind of poor care being provided to an individual, there would be systems, healthcare oversight, investigatory powers and all of that, which would kick in. This is exacerbated because it is not regulated as a healthcare issue—it is regulated as a criminal issue—so those things do not kick in.
155.Women and girls in Northern Ireland face a postcode lottery of provision when it comes to access to abortion even within the narrow scope of the existing law. This disparity of provision between hospital trusts, and even within the same hospital, is driven, in part, by the draft 2013 guidance consultation and the 2016 issued guidance. Women and girls on low incomes outside of Belfast are likely to be particularly disadvantaged.
156.Where women and girls in Northern Ireland purchase abortion pills online and subsequently present at hospital bleeding, medical professionals may not always seek full information from them for fear of prosecution. The GMC says that there can be a conflict between doctors’ duty of confidentiality and the law.
158.In the absence of a separate regulatory body overseeing the provision of abortion services, the Department of Health acting as a regulatory body should have a duty to regularly review consistency of services between trusts, training of the profession and facilities so that all women and girls have the same access to treatment within the law.
171 General Medical Council ()
Published: 25 April 2019