Posts Tagged ‘Northern Ireland’

If you’ve been awake and living in Northern Ireland this week you’ll have done well to miss this story.

Marie Stopes is to open a private abortion clinic in Belfast this week. The clinic which will also provide advice and treatment for sexually transmitted disease and reproductive health will operate within the current framework of the law in Northern Ireland to provide abortions privately up to 9 weeks of gestation of pregnancy.

Understandably there has been much debate about this in the media and the usual polarised arguments of pro-choicers versus pro-lifers have been debated. I don’t really want to get into the usual debate about abortion but in the discussions I have heard and read since the announcement by Marie Stopes, it seems to me that the right questions have not been asked and important points have not been made. So that is what I hope to do now.

The Law

Our Health Minister Edwin Poots has been quoted as saying “I note that Marie Stopes International state very clearly that they will work within the law.” So what does that actually mean?

First of all lets look at the rest of the UK. Abortion is legal under certain circumstances in England, Scotland and Wales. The Abortion Act 1967 states:

Subject to the provisions of this section, a person shall not be guilty of an offence under

the law relating to abortion when a pregnancy is terminated by a registered medical

practitioner if two registered medical practitioners are of the opinion, formed in good faith –

(a) that the pregnancy has not exceeded its twenty-fourth week and that the continuance

of the pregnancy would involve risk, greater than if the pregnancy were terminated, of

injury to the physical or mental health of the pregnant woman or any existing children of

her family; or

(b) that the termination of the pregnancy is necessary to prevent grave permanent injury to

the physical or mental health of the pregnant woman; or

(c) that the continuance of the pregnancy would involve risk to the life of the pregnant

woman, greater than if the pregnancy were terminated

(d) that there is a substantial risk that if the child were born it would suffer from such

physical or mental abnormalities as to be seriously handicapped.

Now read a summary of the law in Northern Ireland:

The Infant Life (Preservation) Act 1929 allows abortion when necessary to protect the

mother’s physical and mental health. But, performing an abortion in Northern Ireland is an

offence except in specific cases. Abortion in Northern Ireland is only legal in

exceptional circumstances where the life of the pregnant woman is at immediate risk and if

there is a long term or permanent risk to her physical or mental health.

What strikes me about these two quotations is that on the face of it, apart from the clause relating to abortion being allowed for probable severe handicap and the requirement for abortions to be carried out before 24 weeks of gestation, there actually seems to be little difference.

Both laws allow for abortion where there is significant risk to the mother’s physical or mental health. So this being the case let’s look at the statistics for abortions performed.

  • The number of abortions carried out in England and Wales in 2011 was 196,082.
  • The number of abortions carried out in Northern Ireland between 2005 – 2010 was 394.

I think it’s worth pausing here. I find these statistics staggering and deeply upsetting, especially when you look at the birth statistics for England and Wales:

England and Wales 2009-2010 (12 month period)

  • 723,165 babies were born alive
  • 3,714 babies were stillborn
  • Around 35,253 babies were born preterm
  • Around 241,055 women lost a baby during pregnancy or birth

The abortion figures for 2009-2010 were similar to 2011. So basically this seems to suggest that approximately 1 in 6 pregnancies in England and Wales are aborted. So here’s my question:


Seriously, what is going on? How can this be? And when only 1% of abortions in England and Wales are performed because of the risk of serious disability of the child, this means the majority have been judged to be necessary to protect the mother’s physical or mental health or that of the other children in the family.

What is happening in England and Wales that is putting pregnant mums-to-be at such risk? Surely these risk factors will be similar in Northern Ireland. And yet I am not aware of any statistics that suggest higher rates of morbidity or mortality for women during or after pregnancy in Northern Ireland compared to England and Wales. Of course some women in Northern Ireland do travel to England and Wales to have abortions but these numbers are relatively low (approximately 1000 in 2011).

Getting to the point….

So here are my concerns about Marie Stopes:

1. Subjectivity of the law

The above statistics suggest to me that abortion can be deemed legal because of the way in which the law can be interpreted. There seems to be a great degree of subjectivity in deciding what constitutes ‘grave permanent injury to the physical or mental health of the woman’. I have been a doctor for 12 years and I don’t remember seeing a single patient who I feel would have met these criteria (according to my interpretation of the law). I have however known patients who have travelled to England for an abortion. The main reasons expressed have usually been because of the inconvenience or disruption that a child (or another child) will bring to their life. These women have been able to make a case of there being significant risk to their mental health. But who am I, you might ask, to make a judgement about these women’s lives and the distress and burden that bringing a child into the world might bring? Well, I could be a doctor in the Marie Stopes clinic. Are the doctors in the Marie Stopes clinic going to apply the same subjectivity to interpreting the law in Northern Ireland as it would appear is done in England and Wales? If 2 doctors (as is required by law) decide that there is permanent risk to a mother’s mental health, how is anyone going to challenge that?

2. Can a private provider be truly objective?

This is my concern about private providers of healthcare and I think one of the great advantages of the NHS. In the NHS there is no incentive for me to perform unnecessary expensive procedures or tests on you unless I feel they are in your best interests. However I believe once you introduce money into the equation, this objectivity at least to a small degree is lost. Can we expect and trust a doctor whose salary is dependent on the way he interprets the law regarding abortion in Northern Ireland to be the same as one who has no financial gain in the matter?

3. Why 9 weeks?

Marie Stopes plan to offer abortions up to 9 weeks of gestation. This might seem a bit arbitrary, and actually I think it is. The reason for this is mainly due to the fact that in pregnancies up to 9 weeks of gestation they can offer ‘medical’ abortions. This avoids the need for a surgical procedure and a whole range of clinical governances and procedures. And to be fair it is therefore safer. But my question is that if Marie Stopes are going to operate under the law as it exists in Northern Ireland (and continue to interpret it in the way that it has been interpreted up to now), how many abortions do they expect to be performing? Which leads me on the my next question:

4. Why offer abortions at all?

Under Northern Irish law how many women at 9 weeks gestation can be judged to be at significant risk of physical or mental harm due to their pregnancy. For the vast majority of women who might be at physical risk due to pregnancy, this is rarely apparent in the early stages of pregnancy. In terms of the risk of harm to mental health, many women only discover they are pregnant between 6-8 weeks of gestation which hardly gives them much time to mentally process the implications of their pregnancy, let alone give time for a doctor (or two) to make a clinical judgement.

Furthermore if only approximately 80 abortions are performed legally on the NHS in Northern Ireland, why does Marie Stopes feel there is a need for this service. And why would any woman pay to go a private clinic when she can get treatment for free on the NHS? My only conclusion is that Marie Stopes expect to be doing more abortions in Northern Ireland than are currently done here and in order for this to happen they will be applying a different interpretation of the law.

And that in my opinion cannot be a good thing!

Final thoughts

I feel it necessary as I finish to point out that I do believe there are circumstances where abortion is acceptable and when it may even be the best available option. I’m not going to specify what those circumstances are because individual cases need to be evaluated according to the specific circumstances.

So I am not completely ‘anti-choice’. But I do worry that the debate around abortion is talked about in terms of being pro or anti choice as if that’s all there is to it. I worry that as a society we seem obsessed with choice generally. We expect and demand the right to make choices about anything that affects us. This to me seems unhealthy. Maybe sometimes in difficult situations having less choice might actually make things easier. And maybe sometimes the more choices you have, the more likely you are to make a wrong one.


So it’s been nearly two years since I’ve posted, so long in fact that I had forgotten my wordpress password. But the recent events in the developing country of NI has been a (metaphorical) bucket of cold water in the face and has awoken me from my cyberspace hibernation.

You will have found it hard to miss all the news as Northern Ireland has been splashed (pun intended) and flashed across the newspapers and TV due to the lack of running water, at one point, to over 50,000 homes. Some homes have been without running water for over 10 days resulting in the country being likened to the third world… but I’ll come back to that later. Of course the blame for this ‘scandal’ has been placed firmly with Northern Ireland Water, the company which as it’s name suggests is responsible for, well… Northern Ireland Water.

So here’s my question:  What is the real scandal? Northern Ireland Water (let’s call them NIW) obviously are accountable – they are responsible for ensuring a safe clean water supply to our homes. We pay for this service through our rates. Ministers from our wonderful power-sharing executive have been outspoken with helpful comments like, ‘Heads must roll’. Yeah, thanks, actually what most people want right now is water from their taps, not the promise of public executions. But I’ll come back to our politicians in a minute.

Certainly NIW have a lot to answer for but surely they deserve a bit of slack. The recent mini Ice Age we experienced was unprecendented, with no-one predicting the extent of the deep freeze. Much of initial water shortage (those who were without water over Christmas) was due to frozen supply pipes. Temperatures during this period dipped to as low as minus 18 degrees celsius. There was clearly nothing NIW could have done about this. The main problem to supply occurred after the thaw. It was only then that the extent of burst pipes became apparent. Until then NIW could not have repaired these pipes. In addition, one of the main reasons that reservoirs ran so low was that the thaw occurred when many businesses were closed. This meant burst pipes remained undiscovered -again there was little that NIW could have done about this. I also think  NIW deserve some credit for the work carried out in the past 3 days. In this time they have restored water supply to over 40,000 homes (the majority of those affected). Given the scale of the problem, this is no mean feat.

Despite all this it is fair to say that key people in NIW should have better anticipated the problems that were likely to occur. But in my opinion, the main failing of NIW was in communication. They didn’t have the infrastructure to deal with volume of calls they received and their website was a shambles. For example while the BBC were reporting that Coleraine was one of the worse affected areas, the NIW website didn’t have any mention of Coleraine supplies being cut off. When they did finally mention Coleraine in update it was to inform customers that their supply had been turned off the night before! This lack of information and misinformation resulted in panic and I think is what angered most people. Rumours spread, with every man and his dog fearing they would be without water in the coming hours. Baths, pots, buckets and all sorts of receptacles were filled (mostly unnecessarily) in anticipation of the taps running dry. This of course further confounded the depleted supply in reservoirs. Some of course stepped up offering to help. One friend of mine offered to turn his garden sprinkler system off for a couple of hours. Another began selling his water on Ebay. And most embarrassingly, Scotland sent us billions of litres of water in aid.

So back my question: What is the real scandal? Is it how NIW have underperformed? Is it perhaps the fact that our polititicians took so long to knock their heads together to try and sort out the mess before jumping on the bandwagon of blaming someone else? Does no-one else think that perhaps our elected government could have acted quicker? Instead they decided to meet only yesterday, by which time most of the water supply problem had been sorted. And have they presented the people they serve with a constructive solution to the problem? Eh, no. All they have promised is retribution for the failings of NIW and maybe a bit of money for anyone who has been upset at being dirty for a few days. Certainly there is a case for some scandal here but this I believe is not the real scandal.

What is the real scandal? Well, you’ve waited long enough wading through enough of my ranting and rambling, so I’ll tell you; The real scandal is how shocked the world has been seeing pictures of white people in the developed world having to queue for bottles of water.

Which of the pictures above is really more troubling? The fact is we’re quite used and dare I say it all too content to see pictures of African children queuing to get water from a well or a puddle they’ve walked maybe tens of miles to reach. Can you imagine what the politicians (and the rest of us) would be saying if our experience was as in the 2nd picture? Well here’s some facts to sober us all up a bit (it’s worth reading the next bit slowly & allowing the horrible reality to sink in):

  • Today 4,000 children will die from drinking dirty water. (Source:
  • One in eight people in the world do not have access to clean water. (Source:
  • 2.5 billion people live without appropriate sanitation (defined as safe and clean disposal of human urine and faeces). (Source:
  • A lack of clean water kills more people every day than anything. And here’s the thing, the estimated cost to make clean water available to everyone is $10 Billion.’ (Americans spend $450 billion EVERY year on Christmas alone). (Source: The advent conspiracy. It’s worth checking out this video!)

Our house was without a full water supply for maybe 36 hours, obviously not as bad as many. But let’s face it, the worst that resulted for the majority of us affected was a bit of inconvenience. I actually in some way enjoyed the adventure of it -having to be resourceful and thoughtful about how to use the water we had left. It certainly made me appreciative of the basic things we enjoy in this country which we totally take for granted. And it made me think of our brothers and sisters around the world who suffer and die on a daily basis because of a simple lack of water. So I actually think the water crisis in Northern Ireland has been a good thing. I would even go so far as to suggest that Northern Ireland Water should think about turning off the supply regularly one day a year – just to cause us to think and be thankful!

Here’s some links to how you can contribute to helping the real water crisis worldwide: (Worldvision)