When a draft supreme court decision was leaked in May showing that judges intended to overturn Roe v Wade, many in the UK reacted with outrage. Rightly so: such a law change would leave abortion rules up to individual states. Rights groups estimate that abortion could become illegal in about half the states if this is successful. Americans would be forced to travel to states where it was still legal, or order costly abortion medicine online, risking severe legal consequences by doing so. Overturning Roe v Wade would probably also inspire anti-choice campaign groups to pursue legal action elsewhere in the world.
It can be easy, in the UK, to look to the US with horror, while overlooking the abortion access issues closer to home. We have a habit of importing American discourse into the UK. It’s understandable: the states are so huge and culturally influential that everything that happens there can feel weighted with great significance and the potential for a kind of butterfly effect. The issues with abortion in the UK are different, and less drastic than a full legal overhaul. But they are nonetheless significant. Practical difficulties with access have a major impact on the lives and choices of people in Scotland and Northern Ireland.
Earlier this month Lucy Grieve, the co-founder of Back Off Scotland, wrote an article for The Scotsman outlining the need to travel from Scotland to England for second-trimester abortions, since no health board in Scotland provides abortion care up to the longstanding legal limit of 24 weeks. This is not widely publicised (Grieve only found out by interviewing people for her work on buffer zones, the legally protected spaces implemented around abortion clinics to deter protesters from harassing clients). She was surprised at how many described journeying to England for an abortion.
Grieve found that people were having to travel as far as Bournemouth (around eight hours from Glasgow by train), and that 170 Scottish abortion clients had been referred by their doctors to travel to England for an abortion since 2019. The real number may be higher, since some women may organise their abortions by contacting English services directly.
“I was very surprised to find that in Scotland there is no health board that provides abortion care up to the legal limit of 24 weeks,” she told me. In some health board areas she found the service stopped significantly short of this too. In Fife, for example, it is 15 weeks and five days. Travelling a substantial distance for an abortion adds an unnecessary layer of practical complication to the procedure, from organising time off work to recovering away from home or while on the return trip. It can also create a psychological barrier, making the procedure seem more drastic than it otherwise would.
“Something that echoes across the experiences I’ve heard is that this care requires a real support network,” Grieve said. “Even having somebody that can travel with you and support you through the procedure.” The NHS pays for people to travel for abortions, although Grieve spoke to some who had not been aware of this at the time and so paid themselves. Any accompanying friends or family members must fund themselves. During the pandemic, which made travelling across the country or staying in a hotel far more difficult, the number of people travelling to England for abortions fell by about a half, she said.
In Northern Ireland abortion was decriminalised in October 2019. But abortion services have still not been commissioned, as the health minister, Robin Swann, has refused to comply. Last month the Northern Ireland secretary, Brandon Lewis, announced he would intervene if this continued. One DUP MP, Carla Lockhart, responded by saying Lewis wanted to “make Northern Ireland one of the most dangerous places in Europe to be a child in the womb, especially if that little baby has a disability”.
Naomi Connor of Alliance for Choice, a group that campaigns for abortion rights in Northern Ireland for women, trans men and non-binary people, explained that early medical abortion up to 10 weeks was the only thing available within Northern Ireland in the meantime. Even this service is provided on a patchy basis, dependent on healthcare districts and reliant on the dedication of medical professionals. The majority of those who need an abortion later than 10 weeks are still travelling to England. Again, their transport is paid for, but that of any accompanying person is not.
Connor said the Department of Health’s refusal to provide a central website with information about abortion services in Northern Ireland had left a void filled by anti-choice groups. The top Google result for “abortion NI” is an anti-choice group presenting itself as a medical advice provider. “Routinely we are seeing women who have been in contact with Stanton (an anti-choice group), for the first few weeks of their pregnancy, without realising they are an anti-choice group,” she said.
An abortion at 20 weeks is more medically complex than one at five, and recovery times are likely to be longer, making travel more arduous. Some fetal anomalies are only detected at the 20-week scan; Connor pointed out the irony that some of these emotive cases helped in the campaign for abortion access in Northern Ireland, but second-trimester abortion is still not available.
The “abortion hierarchy”, which deems only certain abortions (say for medical or financial reasons) morally acceptable is pervasive, even among liberals, but can be used to campaign for access. People who don’t believe that everyone has the right to bodily autonomy may be persuaded by cases where a medical condition effectively forces someone’s decision. “We do not believe in an abortion hierarchy, but later-stage abortions can be more complex,” Connor said. “The more complex pregnancies should really be travelling the least.”
Travel can have a huge psychological impact on people seeking abortions. A medical procedure becomes a multi-day, often clandestine and lonely event in an unfamiliar setting, and therefore becomes all the more memorable. The outcry in the UK over both of these access issues has been muted. Perhaps because practical difficulties such as these are not as headline-grabbing as a plan to overturn Roe v Wade. Perhaps because there is some latent discomfort with, or judgment of, those who seek second-trimester abortions. Even people who identify as pro-choice seem to frequently qualify this stance by, say, treating abortion as something primarily necessitated by dire financial circumstances or focusing on fringe cases involving extreme health risks. These are valid reasons, of course, but it is equally valid for a pregnant person to simply not want to have a baby. Access to medical care should not depend on a postcode lottery.