Abortion in Northern Ireland

Marie-Claire Bradley, a Bristol-based medical student from Northern Ireland, discusses the ongoing issue of abortion in response to debate heard at the BMA’s Annual Representative Meeting 2019, subsequent court cases and imminent legislative change.

In June this year, I listened to discussion on the above motion at BMA ARM 2019 in Belfast for the pictured motion which clarifies and sets out a framework for the implementation of BMA’s 2016 policy that abortion should be treated in line with other forms of healthcare and decriminalized across UK and Northern Ireland and policy from 1984, 1985 and 2003 which specifically supports the reform of law in Northern Ireland. The air hung thick, humidity emanating from hot palms and from under stiff collared necks.

Since then, a number of momentous legal shifts towards the fulfilment of this motion have been achieved. In July, a majority of MPs backed the bill brought by MP for Walthamstow, Stella Creasy to repeal Sections 58 and 59 of the Offences Against the Person Act 1861 – which make abortion a criminal offence in Northern Ireland. As a result, the law governing abortion in Northern Ireland, the Offences Against the Person Act 186, is due to change three days from the time of writing (on 21st October), if the devolved assembly does not re-convene before then. Interim rules currently govern the care of those seeking abortions in the meantime – these rules allow doctors to finally at least allude to the possibility of treatment in England without fear of legal reprisal. (1)

On 3rd October 2019, Sarah Ewart, (who was denied abortion despite scans definitively showing that the foetus was in viable) brought her case before the High Court in Belfast. The court considered the archaic wording of the 1861 Act – a near-blanket ban on abortion, except in cases where continuing the pregnancy would cause ‘physical and mental wreak’, as highlighted by Dr Kerr- speaker for the motion and member of Medical Students for Choice- at ARM. The court ruled that such a ban breaches the UK’s human rights commitments.

Abortion will remain a criminal offence in England, Wales and Northern Ireland, although, Northern Ireland is the only place where women and pregnant people face lifetime imprisonment for terminating a pregnancy, even in cases of rape, incest and foetal abnormality, and doctors and medical professionals also face life imprisonment for assisting. The potential for such a win for human rights in Northern Ireland is, joyously, a result of local political stalemate and governmental disregard for the region.

This departure from current archaic rules to better represent the will and the needs of Northern Irish people is particularly welcome in a time of such paralysing political uncertainty – The writer notes that the Act came into force 20 years before it was legally possible for women to own property. (2) At ARM in Belfast, Dr Kerr explained the influence that the criminalisation of abortion has had upon medical education – while the procedure affects 1 in 3 women and pregnant people, education on the subject across the UK is poor and medical students in Northern Ireland receive “little to no” training in this regard. Dr Kerr commented that the unavailability of the procedure leads to “forced pregnancy” which is “an act of violence and assault” and indeed, as Dr John Chisholm, Ethics Committee Chair, later mentioned, the UN Convention on the Elimination of Discrimination Against Women Committee condemned the law on abortion in Northern Ireland as a “grave violation of rights under the Convention”. Dr Chisholm, also echoed the words of the proposer of the motion, Dr Anthony Lempert and Dr Noel Sharkey, speaking for the motion, in stipulating, “human rights are not a devolved issue”.

There was a common preoccupation amongst speakers against the motion who feared that any such legislative overreach may impact upon the peace in Northern Ireland:-

Speaking against, Dr Dominic Whitehouse opened with the phrase, “peace is precious and fragile” and subsequently brought to the attention of ARM; the lack of an active assembly at Stormont for two years, the murder of “female journalist reporting on riots in Creggan area of Derry” and “letter bombs being delivered by dissident republicans to London airports and Waterloo station” as evidence that peace in Northern Ireland is once again dwindling and implying that the enactment of the legislative changes laid out in the motion would amount to a return to “colonial rule” and thereby threaten the peace.

The unnamed “female journalist” to whom Dr Whitehouse refers is Lyra McKee, her tragic and untimely death highlighted the pertinence of her investigative work unpicking the stories of young people left behind by the Peace Process. Lyra McKee actively campaigned for LGBTQ+ rights, was pro-choice and in favour of the decriminalisation of abortion.

Dr Rachael Pickering, also speaking against the motion, emphasised that being “from Shropshire” meant that the legislative change suggested was “imperialist”. Dr Pickering told ARM that Northern Ireland is “politically conservative”. In fact, the writer notes that the fifth Northern Ireland Peace Monitoring Report, funded by the Joseph Rowntree Trust, lists the necessity of “reform of abortion law and equal marriage” alongside the potential impact of Brexit as issues that need to be solved in order to further secure peace in Northern Ireland, citing evidence from the Northern Ireland Life and Times survey and opinion polls which show that “the majority of the population in NI support liberalizing the law on these issues”. The odd notion that the backdrop of political instability in Northern Ireland which was originally caused by Direct Rule should be an excuse for further denial of human rights in Northern Ireland is somewhat absurd.

Dr Pickering, an English Representative, was correct in saying that English Representatives probably shouldn’t dictate the consensus of Northern Irish people. The fifth Northern Ireland Peace Monitoring Report notes that the views of socially conservative political parties in Northern Ireland “are at odds with” the view of Northern Irish people. (3) Indeed, as Dr Lempert notes, 59% of people in Northern Ireland have voted in favour of decriminalisation. The consensus of Northern Irish people is for the motion.

The voice of this much needed Northern Irish perspective, came when Dr Noel Sharkey spoke in favour for the motion stressing the need for legislative change to ensure that Northern Irish people have the same human rights as people in the rest of the UK, emphatically stating that, “As a gay man I cannot marry my partner.” He explained that the lack of devolved government was not a reason to stall reform of legislation as the underlying health issues are “becoming more toxic and dangerous” as a result. Closing the debate, he powerfully stated that, the “Criminal framework is not preventative, it simply exports the problem […] it is time to trust women. Human rights is not a devolved issue. Instead of giving women in Northern Ireland air-fares, it is time to give them healthcare.”

Threatening uncertainty surrounding the border in Ireland casts a heavy shadow over economic well-being and the maintenance of the hard-won peace in the region and the right to choose hangs in the balance until Monday when Secretary of State, Julian Smith, will be forced to legalise abortion and same-sex marriage before 13 January 2020. Smith’s video tweet on 14th October urged the devolved executive to sit and discuss the law on abortion before the 21st October deadline immediately followed sit down talks between the DUP and Cabinet. Accusations ensued from MP Stella Creasy that the right to abortion is being used as a “bargaining chip” by the Government in the scramble to bend the DUP over to accept their Brexit deal. Indeed, the next day a subsequent statement from the DUP called for Stormont to sit once again to “oppose the extreme liberalisation” of the law.

UK Medical Licensing Assessment

On Tuesday, Broad Left student activists from all over the country attended the General Medical Council-Medical Schools Council meeting about the UK Medical Licensing Assessment (UKMLA), in order to hear an update on and ask questions about the important issues and concerns we have about the upcoming changes.

The day was aiming to demystify the exam and allow students a chance to speak. There was some more transparency around the assessment, but unfortunately, we are still a long way from total understanding and are hopeful for more open, transparent and informative communication. The mood of the room became progressively more anxious, confused and dissatisfied with the answers that the GMC were giving. As the Q&A session continued, students in the audience appeared increasingly aware that the plans in their current format are full of inconsistencies- the aim of certifying a minimum common standard is moot if exam conditions, resit opportunities and their integration into local finals are all carried out differently. The GMC seems happy to implement the exam but keen to wash its hands of the logistics of implementation and the impact it may have on medical students’ wellbeing.

The BMA has been feeding back to the GMC for the past few years on the development of the exam from a position of opposition; our union is against the imposition of the UKMLA. We believe the exam is unnecessary, adds extra burden to our members and have concerns over the resit policy, the impact on equality groups, and the financial disadvantage the exam and preparation for it will put on some students, particularly those who have to travel.

Despite these concerns, we have already won significant concessions: the exam will not be paid for by medical students, we made the GMC scrap their plans to centralise the exam regionally and we believe that we have recently secured the guarantee of free revision materials and practice software.

We in the BMA have the option of taking action to boycott or disrupt implementation if our concerns aren’t addressed and our members agree. This position was advocated for and won at Medical Student Conference by many students including the Broad Left. In the first instance, however, we have decided to engage with the GMC and Medical Schools Council initially to ensure the voices of medical students are considered and the exam’s negative impacts are as small as possible.

The Student Left and our colleagues in the BMA Medical Student Committee will continue to push for the best possible outcome for our members, and we will not shy away from action if necessary to achieve that.

 

UKMLA Main Points:

  • The UKMLA will be a requirement for students graduating from 2023 onwards
  • The UKMLA will come in two parts:
    1. An Applied Knowledge Test (AKT)
    2. Clinical and Professional Skills Assessment
  • Dates:
    • 2021 – Pilot Exam
    • 2022 – First sitting of the examination (unsure if this will count)
    • 2023 – Full UKMLA implementation
  • AKT:
    • Will only have SBA’s (short answer questions) initially
    • 150-200 questions long
    • Between 1-2 Papers
    • Will be PASS/FAIL
    • Will be 4 dates to sit this exam per year (will be up to the medical school)
  • Clinical and Professional Skills Assessment:
    • This will involve adjustments to clinical exams that are already running

Uncertainties:

  • Resit policy will be determined via the university
  • GMC would discourage ranking – unsure how universities would use the data
  • Will be alongside normal medical finals (for now)
  • Reasonable adjustments
  • Appeals Process

See the BMA blog on the UKMLA here

Council Discussion on Pay Strategy

The BMA member survey (criticised in a previous post) came back with predictable results – the profession in England is angry at continued pay cuts. Perhaps due to the lack of campaigning on the long-term impacts of pay cuts, our original pay demand (RPI+2%) or the context of the DDRB recommendation; or perhaps because it was better than the government attempt, members considered the DDRB recommendation to be a more acceptable option.

Whilst we have used the survey results to express our anger, we are now concerned that it will now be used to justify asking for only backdating of the government offer, or that, even worse, the BMA will use the delay to justify doing nothing.

The responses of the Branch of Practice committees are very important, along with the responses of the devolved nations, who have had different offers, or lack an offer yet. However, these have largely focused on the question of the DDRB itself, and whether to engage with the process of ‘independent’ pay review in the future.

At Council today, we will argue for an indicative ballot of our members, preceded and accompanied by a strong communication campaign to engage and inform members on pay.