The Abortion Reform Act 2019 is law, and here at CALM we are now turning our attention to how it will be enacted – on 24 May – and how abortion services will be provided.  So we were interested to see that Lawrie Hooper MHK tabled the following question for written reply to the Health Minister, David Ashford MHK at yesterday’s sitting of the House of Keys:

‘What provision has been included in the Department of Health and Social
Care budget for 2019/20 for the costs of implementation to the of the
Abortion Reform Act 2019; what staff, budget and resources have been
allocated in order to run the services required by the Act; what measures
have been put in place to ensure the counselling required by the Act is in
place; and what pathways are in place to support under 16s who may require
access to the services set out by the Act?’

An interesting question, and here is the (lengthy) answer, with our concerns in bold type:

In relation to budget and resources being allocated to the Abortion Reform
Act 2019 these will be contained within the relevant divisional budgets. DHSC
is a demand led operation where services are delivered based on day to day
demand and such individual procedures provided do not have individual ring
fenced budgets, the services are instead delivered out of the wider divisional
budgets under which they fall. As a new service it is impossible to predict
what the actual costs of the service will be as there is no previous service
provision upon which to base such predictions.

As the Honourable Member will be aware the services provided under the
Abortion Reform Act 2019 are statutory services and as such the department
has an obligation to provide the services as required. For absolute clarity no
one will be turned away or not treated due to budgetary restraints.
Should there be cost pressures discovered once the service is under way the
Honourable Member will be aware that Part 4 – Closing Provisions, Section 28
Expenditure of the Abortion Reform Act 2019 states, ‘Any expenses of the
Department which are attributable to this Act shall be paid out of monies
provided by Tynwald’. Once we have certainty and data around the cost of
provision of services in relation to the actual costs involved, then a specific
business case, should it be required, would be submitted to Treasury for
approval of additional funding for the Department in 2019/20.

The Department of Health and Social Care is working with the British
Pregnancy Advisory Service (BPAS) to establish an appropriate abortion
service pathway for women in the Isle of Man in accordance with the Abortion
Reform Act 2019.

The Department is developing an Integrated Sexual Health Service (ISHS) and
it is anticipated that medical abortion services will be a part of this service in
the future. As this project is in the development stage, in the interim, the
Department plan to deliver medical abortion services within Noble’s Hospital
with support from BPAS.

As per section 6 of the Act, the Department must issue guidelines for
counselling. Counselling guidelines are currently being drafted and will be
forwarded to the relevant Department meeting for approval. The Department
will ensure appropriate counselling services are in place for the
commencement of the Act.

Section 9 of the Act details the required consent of a parent or guardian or
another person acting in loco parentis in relation to a woman who is below
the age of 16. The relevant professional should be satisfied that the decision
to consent to the termination is taken in good faith and in the best interests of
the woman. The Department will ensure that as part of the service pathway,
appropriate support is in place for patients under the age of 16 and for those
women who are unable to give informed consent due to mental, medical or
physical incapacity.

As well as complying with the Abortion Reform Act 2018, all abortion services
commissioned or delivered by the department will comply with evidence based
best practice standards published by the Royal College of Obstetricians and
Gynaecologists. These require that the abortion provider ensures that all
women are given full information about their pregnancy options, the choice of
abortion methods, side effects, risks and complications, the range of emotions
commonly experienced after abortion, and information about other services
available (including sexually transmitted infection testing, contraceptive
services and support services for women experiencing sexual coercion or
domestic abuse), at their first appointment. The practitioner seeing the
woman for the first appointment (usually a specialist nurse) should discuss all
the above with the woman in a non-judgemental and supportive way and
provide written, objective, evidence-guided information for the woman to take
away before committing to the procedure. If a woman is uncertain about
continuing to abortion, she should be given the opportunity for further
discussion and decision support with the provider. Women who are certain of
their decision to have an abortion should not be subjected to compulsory
counselling. Where a woman requires additional support or information, the
practitioner would sign post or refer to the appropriate service. This could
include, for example, social services, social security or housing.
A referral to mental health services is not part of the standard pathway and
would only be indicated in exceptional circumstances.

In terms of post-abortion support, routine post procedure counselling is not
required. The abortion service provider will offer post-procedure counselling
for women who request it. Referral to mental health services will be available
to any woman whose mental health is perceived to be at risk (either by the
abortion service practitioner who has provided post-procedure counselling or
by referral from other sources, e.g. GP, if the woman presented there).

So what do we think?

Much of this reply is reassuring, particularly the sentence ‘As the Honourable Member will be aware the services provided under the
Abortion Reform Act 2019 are statutory services and as such the department
has an obligation to provide the services as required’

And what are our concerns?

1. What happened to easily accessible abortion services and trusting women to make their own decisions about their own reproductive health? Will women be able to take the second dose of medication at home (as in Scotland) or will they be cramping and bleeding in cars, taxis and on buses – the local and completely unnecessary equivalent of the experiences of those who fly or sail back to the Island after having abortions in clinics across?
2. It’s good to know that Abortion Services will come under the umbrella of the Integrated Sexual Health Service – but this doesn’t actually exist yet, and the association with BPAS is yet to be finalised (just 8 weeks before the service must be in place).
3. Why is the DHSC putting up hurdles – restricting abortion services to Noble’s Hospital, sending women home with leaflets to read before making a further appointment (at an already over-stretched family planning clinic) and, we understand, introducing pre-abortion ultra-sound dating scans – another appointment?  Of course women should have information about the alternatives to abortion, of course they should be given information about the procedure itself, but what makes the DHSC think that any person considering an abortion for whatever reason hasn’t already thought about all these things?  There is absolutely no evidence that people choose to have an abortion on a ‘whim’ and CALM sees these hurdles as completely unnecessary delays which could mean the difference between a safe, legal medical procedure and a more invasive surgical one.
4. Data about emotions following abortion – including data from BPAS itself – is that there is no ‘range of emotions’ and the most common emotion is relief.  Why is the DHSC even introducing this? To us, it smacks of the anti-choice, anti-abortion propoganda handed out by the likes of LIFE IOM, HEAR, rescue.im and Abort67 and which is designed to propogate the stigma around abortion that the Abortion Reform Act was supposed to lessen, even eliminate.

CALM always knew that getting the law changed was only the first part of the job: abortion services should be available to everyone who needs them, when they need them.

The Abortion Reform Act 2019 is being held up across the world as an example of how a progressive law should look, and how the services should be provided. The implementation of this law is being closely monitored, and not just by CALM.

The DHSC has a duty to provide the services which were debated at length in the House of Keys, Legislative Council and Tynwald and which are now part of the Abortion Reform Act 2019:

An Act with no Action is no Act at all.