Regulations published for Northern Ireland Abortion provision amidst COVID-19

Alliance for Choice honour the monumental efforts of women and pregnant people, activist organisations, committed healthcare professionals, civic society and political allies that have brought about the new regulations in Northern Ireland for those who will need abortions. Though we welcome the news, it falls significantly short, especially in a time of a global pandemic. If the COVID19 crisis is to intensify as predicted, the Health Minister has a duty to sanction provision that does not jeopardise the health of women and pregnant people by forcing them to travel to clinics unnecessarily for abortions. 

Naomi Connor, Co Convenor said;

“We should not place women and pregnant people at risk of unsafe abortion when there is a scientific, safe and readily available alternative. At AFC we have heard directly that barriers and lack of access to abortion pills has led many to use dangerous alternatives. This is not a reality we wish to revisit when there is a body of scientific research that supports abortion telemedicine provision.”

Healthcare workers should not be put at risk by needlessly increasing footfall in healthcare premises when proven alternatives are readily available. Telemedicine is not only safe and effective for patients, but also serves to keep our healthcare staff safe and deployed where they are needed at such a critical time.

Emma Campbell Co-Convenor added, 

“We note the NIO has said that arrangements for funded treatment in England will still stand  “until we are confident that service provision in Northern Ireland is available to meet women’s needs”. However we are concerned they have not considered the impact on COVID-19 on both travel and the availability of abortion appointments in England as services shut down.”

The regulations make clear provision for the Health Minister to approve further places where medical abortion can be performed at any point in time. Now is that time and Minister Swann needs to ensure that this pandemic does not place women & healthcare providers at unnecessary risk. The Minister must act now, as is his charge, and as is provided for in the recent abortion guidelines to ensure this service is rolled out to women and pregnant people in NI seeking abortion healthcare

ENDS

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Contact:

Emma Campbell 07894063965  

Naomi Connor 07505096576

Alliance for Choice 

www.alliance4choice.com

@All4Choice

Further Information

‘Where procedures can take place - terminations to be carried out in General Practitioners premises, clinics provided by a Health and Social Care (HSC) trust, and HSC hospitals, operating under the overall Northern Ireland HSC framework and women’s homes where the second stage of early medical terminations may be carried out. The Regulations also provide a power for the Northern Ireland Health Minister to be able to approve further places where medical abortion can be performed, with the power being able to be exercised at any point in time.’

A summary of key points:

- Abortion on request up to 12 weeks, certification from 1 healthcare professional. For medical abortion, home use for second pill will be permitted.

- Abortion 12-24 weeks with ground specificied in the consultation doc and ground C of the Abortion Act 1967. This is expanded upon in the explanatory notes, and in the explanatory notes which state other factors, like well being, which 'may be taken into account'. Certification of 1 doctor and 1 HCP will be needed.

- There will be a criminal, non imprisonable sanction for those HCPs who act outside of the regs, this will carry a 5k fine.

- No time gestational limit where there is a severe or fatal anomaly

- Conscientious objection will mirror Section 4 of the Abortion Act 1967 and will include a duty to refer.

- No action on safe/buffer zones

- CBS funding will continue.

- the explanatory notes can be amendment by the assembly/depts

Please contact us for a copy of the regulations.

BELOW ARE A NUMBER OF POSSIBLE CASE STUDIES

• Someone who has tested positive and whose phase in isolation would push them over 12 weeks by the time they got to a provider. 

• Someone who is in a high risk vulnerable group and does not feel safe to leave the house.  

• Someone who has tried to make travel arrangements to get to England but as clinics are closing cannot get an appointment 

• Someone on a normally low income who has lost their job due the crisis and cannot afford the additional funds that would be needed to travel

• Someone who had an appointment in England whose flight has now been cancelled

• Someone caring for elderly relatives or immuno-suppresed relatives in their own home and cannot risk infection.

• A rise in intimate partner violence was recorded in China during the lockdown, this increases the likelihood of pregnancy as a result of rape and decreases the ability of an abused partner to leave the house safely.

• An Asylum Seeker, who would normally be unable to travel, may be further restricted in access to abortion care by movements of asylum seekers within Ireland being completely restricted going forward, and similarly with visitors not being allowed any access in. If/When asylum seekers are locked down in centres due to COVID-19 they may be hindered in accessing abortion support networks and/or abortion care.

• Someone who is in the country illegally and/ without papers; with tightening of border control internationally due to COVID-19 crisis, it may be structurally impossible for them to access abortion care within or without of Ireland, due to fear of deportation and/or imprisonment 

• Someone who is in a high risk vulnerable group medically and/ disabled, travel may normally be restricted due to physical and financial limitations; however being known to medical and state services as high risk and/ disabled may make a case for someone not being granted exceptional orders to travel for abortion care to delimit potential exposure to COVID-19 (ie ‘for your own good’)

• Someone who is in a high risk vulnerable group medically and/ disabled, particularly for cases over 12 weeks; if risk of threat to life of continuing pregnancy for pregnant person is already high without COVID-19 diagnosis, and if such same person were to be exposed to COVID-19, thus increasing risk to their own life, they then could be considered a major risk to their own health, and travel for abortion care denied  

• Someone in state care, a minor, travel may be restricted on guardianship grounds to be in the best interests of the health of the child going fwd, and the lack of agency of the child in such circumstances  

There's no such thing as a late term abortion - ARTICLE

Here's everything you need to know about abortion later in pregnancy according to doctors, not politicians, including how often it occurs and why it's necessary.

By Emily Shiffer October 01, 2019

https://www.parents.com/pregnancy/my-body/pregnancy-health/theres-no-such-thing-as-late-term-abortion-here-are-the-facts/

What's the correct term for 'late-term abortion'?

"Generally people mean abortion performed after 12 weeks or 3 months, but it's better to specify exactly which period of gestation one is talking about," says  Daniel Grossman, M.D., director of Advancing New Standards in Reproductive Health (ANSIRH) at Bixby Center for Global Reproductive Health at the University of California, San Francisco.

Keeping abortion terminology by gestation period is the proper way to define it. "We talk about care as pregnancy progresses in weeks from a person's last menstrual period, or in trimesters (1st: 0-13 weeks, 2nd: 14-26 weeks, 3rd: 27-40 weeks)," says Chelsea Souder, MPH, director of Clinical Services and Communications Manager at AbortionClinics.org.

• RELATED: Types of Abortion Throughout Pregnancy

What about 'partial-birth abortion'?

This term originated from the Partial-Birth Abortion Ban Act of 2003. However, it's not a defined procedure recognized by leading medical groups, including American College of Gynecology (ACOG), according to the Guttmacher Institute.

"'Partial-birth abortion' refers to a procedure known as dilation and extraction, or D&X, which involves attempting to remove the fetus intact through the cervix," explains Dr. Grossman. "The procedure is no longer legal unless medication is used to stop the fetal heartbeat first."

• RELATED: The Abortion Pill: How Medication Abortions Work

When do most women have abortions?

Since 1973, when abortion was legalized nationally, around 11 percent of abortions have occurred at or after 13 weeks gestation. According to the Guttmacher Institute, here is when women have abortions percentage-wise:

• Earlier than 8 weeks: 66%

• 9-10 weeks: 14.5%

• 11-12 weeks: 8.3%

• 13-15 weeks: 6.2%

• 16-20 weeks: 3.8%

• After 21 weeks: 1.3%

When is second or third trimester abortion necessary?

While most abortions occur before 8 weeks, second or third trimester abortions are also options women may have. These are the most common reasons an abortion may occur during the second or third trimester:

Fetal anomalies

"The medical reasons for an abortion in the second trimester include a diagnosis of fetal malformation or genetic anomaly," says Dr. Grossman. These include: anencephaly, the absence of the brain and cranium above the base of the skull, or limb-body wall complex, when the organs develop outside of the body cavity, according to the ACOG.

Mother's medical complications

"Medical complications are the development of a condition in the pregnant woman that necessitates delivery," says Dr. Grossman. "Some examples of these conditions include severe preeclampsia, or high blood pressure of pregnancy, or bleeding from a placenta previa, when the placenta covers the cervical opening of the uterus."

Other medical complications include: premature rupture of membranes and infection, placental abruption, and placenta accreta, which may risk extensive blood loss, stroke, and septic shock that could lead to maternal death, according to the ACOG.

Less access to care

Second and third trimester abortions may also be more common in places with more strict abortion laws.

"Our research in Texas found that the restrictive laws there, which led to the closure of about half of the abortion clinics, were associated with an increase in second trimester abortion," says Dr. Grossman. "The obstacles that women face accessing care ends up pushing them later in pregnancy before they can obtain a wanted abortion."

Adds Souder, "These restrictions have forced many clinics to close, in turn creating waiting lists, sometimes two to three weeks out. Unnecessary waiting periods, gestational bans, and lack of providers in rural areas force people in some states to travel hundreds of miles to get care. Thirty-five states currently ban state Medicaid from covering abortion care, which affects the most marginalized people."

"Nearly 99 percent of abortions happen before a person is 21 weeks pregnant, and those that happen later almost all happen before 24 weeks. In rare and very complex circumstances, abortions may be necessary later on in a pregnancy—such as when there are severe fetal anomalies or serious risks to the pregnant person's health," says Dr. Dean. "These unexpected and potentially life-threatening complications are why it's critical that patients and doctors have the option of abortion later in pregnancy. Ultimately, the decision to end a pregnancy depends on a person's unique circumstances, and should be between them and their doctors."

• RELATED: What New Abortion Laws Mean for Moms, Pregnant Women, and Women Who Want to Get Pregnant

What is the procedure like for second trimester abortion?

In general, there are two options: "One option involves the use of medications to essentially induce labor to deliver the pregnancy. This may take a day or longer," says Dr. Grossman. "The second option is dilation and evacuation, or D&E, which involves opening the cervix and using instruments to remove the pregnancy. This usually takes less than 30 minutes and can be done under sedation or anesthesia."

Twenty states currently ban the D&E procedure, according to the Guttmacher Institute.

The Bottom Line

"The most precise way to talk about when in pregnancy an abortion takes place is to specify the number of weeks gestation or the range of weeks, like 'abortion at 20-24 weeks'," says Dr. Grossman. "Sometimes people say 'abortion after 12 weeks' or 'second trimester abortion'. It's important to be as specific as possible."

• RELATED: Understanding Abortion Methods and Procedures