Official Report: Minutes of Evidence

Committee for Justice , meeting on Wednesday, 26 November 2014

Members present for all or part of the proceedings:

Mr Paul Givan (Chairperson)
Mr Stewart Dickson
Mr S Douglas
Mr Tom Elliott
Mr Paul Frew
Mr Seán Lynch
Mr Patsy McGlone
Mr A Maginness
Mr Edwin Poots


Mr Mark Baillie, CARE NI
Ms Philippa Taylor, Christian Medical Fellowship
Mr David Smyth, Evangelical Alliance Northern Ireland

Justice Bill: CARE NI, Evangelical Alliance Northern Ireland and Christian Medical Fellowship

The Chairperson (Mr Givan): I welcome Mark Baillie, the public affairs officer for CARE; David Smyth, the public policy officer for the Evangelical Alliance Northern Ireland; and Philippa Taylor, the head of public policy for the Christian Medical Fellowship (CMF). As was the case with the previous session, this session will be reported by Hansard and published in due course.

At this stage, I hand over to you. You can briefly take us through your submissions, after which members will have questions. I do not know who is leading off.

Ms Philippa Taylor (Christian Medical Fellowship): I am starting.

Ms Taylor: That is not actually how we decided it, but anyway.

The Chairperson (Mr Givan): The authoritative figure first. Is that better? The expert?

Ms Taylor: That is right. I have the last word.

I represent the Christian Medical Fellowship. We are an interdenominational registered charity that was founded in 1949 and represent about 4,000 British doctors in all branches of medicine. We are linked to about 70 similar bodies in other countries around the world. Approximately 350 of our members are in Northern Ireland: they are doctors, nurses and midwives. Our aim is to unite, equip and resource Christian doctors. In our public policy work, we make submissions to government and official bodies on bioethics and health-care issues.

CMF welcomes and fully supports the proposed amendment. I will give four reasons why. First, we believe that there is no evidence that private companies or charities are needed to meet existing levels of demand for the necessary abortion services in Northern Ireland. The National Health Service (NHS) here has sufficient capacity in Northern Ireland.

Secondly, we are concerned that private abortion providers are charities but are operating as businesses. I will take Marie Stopes as an example, although I could do the same for similar charities. They all have a clear — some might say aggressive — marketing strategy, and they operate with a business ethos. The ethos is to grow their business — abortions — and double their total income, much of which is from governments. Marie Stopes's plan for achieving its ambitious health goals include wanting to:

"forge enduring connections with governments and other institutions that influence policy, funding and practice for family planning, both at the country level and globally."

Its mission is:

"to work to transform policy environments globally and increase access to safe abortions and reduce policy restrictions [in countries]".

In its 2013 financial report, Marie Stopes clearly states that one of its goals is to make connections in order to demonstrate:

"reduction in restrictions on family planning and safe abortion service in at least 10 countries".

One of my questions is this: is Northern Ireland one of the 10 countries that it is targeting?

As I said, it is a business as well as a charity. As a business, it will inevitably have a vested interest in providing abortions and, as it does in the UK, rely heavily on taxpayer money to fund it through NHS contracts. I am concerned that this promotion of a more liberal policy on abortion is utterly at odds with the law, culture and values of people in Northern Ireland.

Thirdly, there are real concerns regarding the transparency and accountability of private abortion providers. As I am sure you well know, no figures have been published regarding how many abortions Marie Stopes has performed, not only here but in the countries it operates in, or on the breakdown of revenue generated from various charitable activities, whether abortion or family planning clinics. It is very difficult to find explicit published figures for all those countries, as well as for Northern Ireland. It is very difficult to find out exactly how many medical and surgical abortions have been performed in the Belfast clinic, how many referrals have been made to Marie Stopes International in the UK mainland primarily, or how much money that clinic makes from the procedure.

There are two major problems with that concern about accountability. The first is that we cannot be sure that the law, as it stands in Northern Ireland, is being upheld in a Marie Stopes clinic. The second problem is that we have no way of tracking women who have terminations in these clinics for health-care and research purposes. I will expand on that, because it is an important point. After a termination, the recording of a woman's administrative health and care number here, or the NHS number in England and Wales, is voluntary, so it is very rare for it to be routinely recorded in most private clinics in England and Wales, because there is no force. It is a voluntary recording. There is, therefore, no record of those terminations for future hospital stays if a woman goes back for another medical procedure or any other medical treatment or care. Neither is there any opportunity in the long term to carry out linkage research to follow up outcomes of abortion on the women. Recording the NHS number or the health and care number is fundamental to improving safety outcomes across all care settings. In Scotland, interestingly, abortions are largely undertaken in the NHS, so there is a good record linkage for women. Since 64% of abortions are carried out in private clinics in England and Wales, there is a very poor record linkage. I will briefly quote from a fact sheet for NHS staff. It states that the NHS number is:

"key to sharing patient information safely, efficiently and accurately between NHS organisations and its partners; including wrist bands, patient records, referrals, correspondence and results across GP, community, secondary and social care for every care episode and pathway for each patient.

[It is] an efficient and effective tool used to integrate health records and help clinicians form a complete set of clinical
information for every patient."

That is in contrast to nearly every other procedure that is commissioned by the NHS: for nearly every private procedure, except abortion, the NHS number is required. It could be argued that the problem is that women need complete confidentiality and privacy protection in this area and might be identified if we collect all their data through the NHS number. However, a lot of research is confidential, including outcomes of abortion linkage with female health records. That linkage has been done in Finland and Denmark, and there have been no breaches of confidentiality.

My concern is that, by not keeping and recording the numbers for abortions in private clinics, providers are not held accountable for the health-care outcomes of their patients, linkage to future hospital stays or health-care needs is not enabled, and there is no chance of doing a follow-up from routine research. That is a real problem that arises from using private clinics and not NHS provision. I suggest that that is worth the Committee's consideration.

Fourthly and finally — this will not come as a surprise — I am a woman, so it seems that I have more right to speak about abortion than my colleagues. I have the right gender perspective, according to some people. That is a completely spurious argument. Do you have to have a self-interest in something to have a legitimate opinion on it? I am not black, for example, so does that mean that I cannot express my views on racism? Can I not argue for better provision for the homeless because I live in a home and have never been homeless? Do those who argue that men should have no voice think that David Steel had no right to introduce the Bill that led to the Abortion Act 1967? Can a female Member of the Assembly not argue for better resources for prostate cancer because she will never have it herself? This is clearly a spurious argument. We all have an equal right to make our views known, whether we are male or female.

I thank you for giving me the opportunity to express my views and doing the same for my male colleagues.

Mr Mark Baillie (CARE NI): CARE's position on the amendment can be set out quite simply: we support Jim Wells's amendment for three main reasons.

First, as Philippa indicated in her first point, we see no need for abortion to be provided by private charities or companies in Northern Ireland. As all members are fully aware, the number of abortions in Northern Ireland is low, and the legislation here allows only for abortion in rare circumstances. We have seen no evidence that the NHS in Northern Ireland does not have the capacity to provide for the requisite number of abortions that legally occur in Northern Ireland. In response, it may be argued that we allow patients to receive medical care privately for other conditions, such as a knee replacement. CARE has no objection to private medical care per se, but many in our society — indeed, probably a number of members around this table — accept that provision for abortion is very different from provision for a knee replacement.

As the law stands, abortion is allowed only in cases that involve the ending of the life of the unborn child to save the life of the mother, which all here will agree is a desperately tragic situation. It seems, therefore, entirely appropriate that abortions are restricted to National Health Service properties.

The second main reason why we support the amendment is on the grounds of transparency; Philippa mentioned that. The private provider at the centre of the Committee's attention is Marie Stopes International. The Assembly did not expressly pass legislation in this area to prevent private companies and charities providing abortion services, and Marie Stopes shrewdly exploited the vacuum. However, as I understand it, no one other than Marie Stopes International knows whether a single abortion has taken place in its clinic. That should be a major issue of concern, regardless of an individual's position on abortion in general.

Currently, there is some transparency in Northern Ireland with regard to the circumstances in which abortion occurs on the NHS. The number of abortions taking place can be considered by Members and the public. However, the public can have little or no confidence as to whether Marie Stopes International is operating within the law. I am not implying or suggesting that any illegal abortions have taken place at the clinic; I have no evidence on which to base such a claim. However, it seems significant to me that Members do not know precisely what is going on inside the clinic. The RQIA regulation referred to earlier, as I understand it — I am happy to be corrected — does not consider how many abortions are taking place, which is significant to our minds.

The third and final reason that we support the amendment relates to Marie Stopes International itself. I will not go over what Philippa, who knows a lot more about Marie Stopes than I do, said. It seems to me that if there was a capacity problem and Members decided to make express legal provision for private providers with appropriate regulation, those regulations would be very clear that it is not appropriate to permit a campaigning organisation such as Marie Stopes to perform the role.

Marie Stopes International does not hold a neutral view on abortion — neither does my organisation — I am not attacking them for that. However, they do not hold a neutral view on abortion; they want to see the law in Northern Ireland significantly liberalised. They are entirely entitled to that opinion, and they have a right to campaign for it. However, if a private provider was required to offer abortions in Northern Ireland, and at this point there does not seem to be any need for such an organisation, then it should not be one that openly campaigns for the law to be made more liberal.

I will close my presentation with one further remark. This amendment would not, as I read it — I am open to correction — shut down the Marie Stopes International clinic. They could, of course, continue to operate in Belfast and provide other services, as they currently do. Indeed, in a free society they are fully entitled to campaign for a change in the law, and my organisation opposes any harassment of their clients or staff. That said, we believe that they should not have the right to offer abortions in Northern Ireland. Thank you for listening.

Mr David Smyth (Evangelical Alliance Northern Ireland): Thank you, Chair and Committee members, for the opportunity to present to you today. I will start by outlining our basic approach to the issue. Then I will explain why we broadly support the amendment and make a few comments on the phrasing of it before I draw to a close.

Evangelical Alliance seeks the life, health and well-being of both the mother and child in a pregnancy crisis. In fact, we seek the life, health and well-being of the wider family and community. We refuse to buy into the harmful dichotomy that pitches the rights of women against their unborn children. That is artificial, abstract and unnatural.

You will hear a lot of evidence about human rights, and these are vital, but our position is based primarily on the human dignity of both the mother and the child. "Inherent dignity" comes up in the first six words of the Universal Declaration on Human Rights before the word "rights" is even mentioned. The inherent dignity of each human being is what the very concept of human rights is based on. Attempts to progress human rights are completely undermined when in that process inherent human dignity is not accorded to the most vulnerable human members of our families and our communities.

One of the key arguments that you will hear from those opposing the clause is that women should have access to safe and legal abortion. Ironically, our first concern about abortions happening outside the health service is precisely that: they might be unsafe and illegal. As Mr Dickson states, there are other private health providers apart from Marie Stopes, and I do not want to focus on just one organisation. There is no regulation other than of basic standards of cleanliness; no way of knowing how and why abortions are carried out; no way of compelling information about the number of abortions; and no accountability. In England and Wales, where private organisations provide 64% of all abortions, this type of information is publicly available and publicised every year by the Department of Health.

These concerns about unsafe and illegal abortions, transparency, and accountability were highlighted and furthered when a private abortion provider appeared before this very Committee on 10 January 2013. They refused to give information to the Committee or to the Department of Health on the number of abortions that they had carried out or the reasons for them. Should this amendment fail, it is clear that there is an urgent need for the accurate, mandatory recording of every abortion in Northern Ireland, whether on health and social care trust property or elsewhere.

Generally, we are very cautious when it comes to the state restricting personal freedoms and choice; we are also hesitant about the state attempting to reserve certain activities within its control. However, in this case we certainly see an argument for limiting the provision of abortions to health and social care trusts. As my colleague Mark said, abortion, or the ending of human life, is a unique category of medicine and law. It does not belong to the same category as private cosmetic surgery or private-health care. Attempts to reduce the ending of a human life to a reproductive right, a good, a service, or just another medical procedure, should concern us all. Let us be clear: abortion is euthanasia — perhaps at a very early stage, but it is still the premature ending of the life of another human being. There are differences arising from bodily autonomy and consent, but the principle remains.

Granting a licence to a private clinic to end the life of another human being is the wrong decision. In England and Wales, where there is an open market for abortion providers, market forces apply. This is the ultimate consumer choice. In 1991, 10% of abortions in England and Wales were carried out by private clinics. Last year, it was 64%. Only 2% were paid for privately. With competition come ploys to increase demand and, ultimately, revenue.

As you steward the law that will shape generations of families and communities to come, I urge you never to forget that we are talking about the life, health and well-being of women and their unborn children. We make the simple point that this amendment is not proposed in a vacuum. Private specialist providers of abortion and their supporters are not seeking just to provide abortions under the existing law. In its submission Amnesty International supports the full decriminalisation of abortion, and Marie Stopes and others seek abortion on demand as the ultimate consumer choice. It is vital that this broader context is appreciated as we consider the amendment.

We welcome the provision in the clause that in urgent circumstances no fee will apply. Abortions are already provided in Northern Ireland where there is a medical necessity; they are provided free of charge and to the strictest levels of care and patient confidentiality, as throughout the health service. There is a glaring ethical conflict of interest when a private clinic provides abortion counselling and then receives revenue when they go on to provide an abortion to that same woman.

Chair, before I draw to a close, I will make a few comments on the language and phrasing connected with ending the life of a child at any stage of its development. There are potentially two issues with the wording that I want to raise. There was some debate in the Chamber the last time this clause was put forward about whether it would affect medication such as the morning-after pill or intrauterine devices (IUDs), which can prevent implantation after conception. It is still not clear enough whether a pharmacist or medical practitioner could fall foul of the law in prescribing medication that has a dual role as contraception or contragestion. I take the point, which was raised in the Chamber, that no prosecution could occur because at that stage of giving the medication it could not be proven whether conception had occurred and whether there was a human life. However, taking that application a stage further, what if someone purchases or supplies an online or over-the-counter abortifacient pill? Would prosecution in that case be possible only where it is proved that an unborn child exists, or is the supplying or taking of an abortifacient where there is a belief that there is an unborn child, whether proven or not, enough to constitute and offence?

We believe that the word "urgency" needs further clarity. We suggest "circumstance of urgency where the physical life of the woman is at immediate risk". Otherwise, there could be great ambiguity if the term is applied to cases outside a health trust's property.

Thirdly, we welcome the wording:

"If that person does any act, or causes or permits any act".

With the sale and distribution of online abortifacients, we need to enlarge our thinking of abortions outside trust and clinical properties to people's homes. We suggest a more detailed enquiry into the legality of the sale, distribution and taking of online abortifacients.

Finally, the unique law that we have in Northern Ireland strikes a very delicate balance between the life, health and well-being of the mother and her unborn child. We have a backstory here of death and violence; we aspire to a future of peace and good relationships. There is a real opportunity in the years ahead for this place to pursue a different narrative. Allowing a private enterprise to increase revenue from an activity that ends life rather than affirms it is not the sort of economy or culture that we wish to grow here. The amendment will not threaten the health, life or well-being of women who need an abortion for medical reasons under the existing law in Northern Ireland. However, if the amendment is coupled with tailored pathways of care for women in a crisis pregnancy, it could play an important part in the creation of a culture that truly cherishes the life, health and well-being of women, their unborn children, families and communities.

Mr Dickson: I have a comment rather than a question to start off with. We do not know the statistics and the safety levels of the Marie Stopes clinic because the Health Department will not regulate it. That issue needs to be addressed. It is there, and, presumably, whatever service we allow it to deliver, surely anyone who uses it has a reasonable expectation that it will be appropriately regulated. I encourage you to call on the Health Department urgently to ensure that it has that appropriate regulation.

I heard somebody say that this is such a niche area of medical ethics that it can be provided only by the National Health Service. Are you all opposed — particularly your medical organisation, Philippa — to private medicine services in the United Kingdom?

Ms Taylor: Not private medicine services per se; the focus here is purely on private abortion or termination provision. It is not about family planning services; it is about abortion provision.

Mr Dickson: To be absolutely clear, your objection does not include only Marie Stopes; it includes the other private clinics that have been practising within the law for many years in Northern Ireland. Has this issue arisen just because Marie Stopes came to Northern Ireland? Other clinics have been providing that service within the law for many years, and nobody has raised an issue about it before.

Mr Baillie: The difference is that Marie Stopes is a campaigning organisation, unlike, say, the Ulster Clinic, which is a private clinic.

Mr Dickson: It is primarily funded by insurance companies, which do lots of advertising, as far as I can see.

Mr Baillie: Yes, but they do not campaign specifically to —

Mr Dickson: I have looked at the BUPA website and have seen the description of the services that it provides. That is campaigning in my book.

Mr Baillie: Campaigning to liberalise the law on abortion?

Mr Dickson: No; campaigning for the services that it delivers.

Mr Baillie: That is what we mean. Marie Stopes has a particular view, which it is entitled to, to —

Mr Dickson: So, it is because it campaigns rather than because it delivers the service.

Mr Smyth: I also have an issue with its delivering the service, as there is no compulsion to provide figures for showing how and why abortions have been carried out.

Mr Dickson: Yes, and that is because the Department of Health will not require them to give that information, because the Department of Health, effectively, does not want to talk to them.

Mr Baillie: CARE would prefer if it was restricted to the NHS, but, if that fails, that is what we would like to happen.

Mr Dickson: So you would support equal regulation of their clinic with the NHS if that was the case?

Mr Baillie: Yes, if the Assembly refuses to take the path that is articulated in the amendment. A major concern of mine is the transparency issue. I think, regardless —

Mr Dickson: I wholeheartedly agree with you about transparency; the problem is attempting to get the regulator to provide it. In fact, I would be happy to go even further on transparency than one might require.

Mr Baillie: Which I completely respect. We feel that the NHS should provide it, but, if that fails, we absolutely agree that regulation should be brought in to check for transparency.

Mr Dickson: Although I made a comment, which I thought was a point well made, actually, in respect of those who can comment on various things, given that this room of full of pale, stale, grey-haired males — I am speaking for myself —

The Chairperson (Mr Givan): Stale and grey anyway.

Mr Frew: I think "blond" is the term.

Mr Dickson: Nevertheless, it is disappointing that we do not have the voices of all genders on this subject, which is, effectively, gender-specific, whatever way you want to deal with it: I cannot get pregnant.

Ms Taylor: I feel very strongly that, just because someone does not have a specific self-interest does not mean that they cannot speak out on an issue. Moreover, we are not just talking about a woman; we are talking about a baby and about a father as well.

Mr Dickson: Of course.

Ms Taylor: So there are actually three involved.

Mr Dickson: In that sense, you are allowing me to have my voice. There are others who are not terribly keen on me having my voice, even though I may take a different view from my colleagues.

Ms Taylor: I think that everyone has a right to speak. I am very concerned that people are shut down from speaking, but I suspect that the issue is not so much who is speaking as what they are saying, which is why I gave the example of David Steele.

Mr Dickson: Can we address the need to deliver it exclusively in the NHS? The very few people who, by law, can access that service in Northern Ireland come from a range of backgrounds. Amnesty and others made reference to those who cannot pay and who should rightly have that service delivered to them in the appropriate confidence of the NHS. However, there are others who can pay and who know, because they have made the comparison between the NHS and a private-sector provider, that they do not want to sit in a queue in a public clinic, and that they genuinely wish to have the service delivered privately, not to hide from the law in any respect — we have dealt with the issue of transparency — but simply because they wish to avail themselves of that service in a different way. I put the same question to you that I put to Amnesty: is it reasonable to suggest that the same clinician or doctor would be acting unlawfully in the Ulster Clinic and lawfully in the Royal Victoria Hospital?

Ms Taylor: It would be nice if we knew the answer to that. It comes back to the problem: we do not actually know for sure what is going on in the private clinic.

Mr Dickson: If you did know, would you then be opposed?

Ms Taylor: If we knew absolutely that a private abortion clinic was operating within the law, then, lawfully, we would agree that a woman — in effect what you are saying, — can choose where she goes for a termination.

Mr Dickson: Provided we are, to use that horrible term, "on a level playing field", with public information.

Ms Taylor: Yes. With all the caveats in place, yes, absolutely; but they would have to conform and uphold the law, and if the law were being upheld in a private abortion clinic —

Mr Dickson: In an open and transparent way so that we could check the facts and figures.

Ms Taylor: It is exactly the same as in England and Wales. We are not out to shut down all abortion clinics. We say: please make sure that there is transparency and accountability and that there is no conflict of interest where abortion clinics not only do termination but also try to offer counselling, advice and options when they clearly have other vested interests. As long as you can separate that out, and a private clinic is simply offering an abortion and not doing all the other pathway and care work that we talked about previously, then yes.

Mr Dickson: Bear in mind that the pathway to legal abortion in Northern Ireland is very restricted. You are not doing all that other counselling; that is not why you are there. You are there because you have a —

Ms Taylor: A specific need.

Mr Dickson: — very specific need. Just to make the comparison, much of what you said was very relevant to England, Scotland and Wales, but none of it is relevant in Northern Ireland.

Mr Smyth: I take a slightly different view on that, Mr Dickson. If someone is working for both the public sector and privately, there are two different contracts of employment; they may be entitled to do certain things under public contracts of employment that they cannot do privately. There are also other instances where certain acts are legal in some areas and illegal in others.

Mr Dickson: Urgency is an issue for people; I know that because I have had experience of it. I knew an individual who received a cancer diagnosis in the NHS and immediately said to the consultant: "Can I have that removed?" The consultant said, "Well, under NHS guidelines, I can do it within four or five weeks, but I can see you tomorrow at the clinic." And the person said "Yes" because they wanted whatever it was removed. So people act and react in that way.

Ms Taylor: And if the law permits it, they have every right to.

Mr Dickson: And should the law not permit that? A woman who has had a diagnosis in the NHS asks: "When can the abortion take place?" And the doctor says : "Well, it will be in a couple of days." And she says: "Can I have it done tomorrow?" And he says: "Yes, you can have it done in the private clinic tomorrow." Is that an unreasonable choice for an individual to make?

Ms Taylor: Technically, yes, she could be allowed that, legally.

Mr Dickson: This law would restrict that.

Ms Taylor: However, the problem that I see immediately with that example is that I do not see how you can fit in the prior care that she needs. Is that really giving her time to have all the sufficient information and resources?

Mr Dickson: I was shortening the period just to make the contrast. There is, I think, a perception that people can have those procedures, any procedure that is available and safe, in a private clinic and have it done in a shorter period.

Mr Smyth: Let me come back to a point. I do not see this as just a medical issue —

Mr Dickson: I understand that.

Mr Smyth: — or just an issue of a woman's reproductive right, to use that language. I also want to point to the figures. In 1991, 10% of abortions in England and Wales were carried out in private clinics; today the figure has jumped to 64%.

Mr Dickson: There is no suggestion that that can happen in Northern Ireland because the law does not permit it. I am not arguing, and I do not think that anyone has argued today, for an extension or a change in the law. This is about a further restriction in it.

Mr Smyth: The law has not changed substantively in that period in England and Wales, yet private providers now make up the bulk of the provision.

Ms Taylor: It brings in a broader issue: just because there is no change in the law does not necessarily mean that there will be no change in practice. That is an example. The fact is that, just 22 years ago, only 10% of abortions were carried out in private clinics, and now it is 64%. There has been no change in the law; there has simply been a change in practice. Much of that comes back to the campaigning tactics and policy of abortion clinics, which work really hard —

Mr Dickson: That would require Marie Stopes to enter into a contract with the NHS in Northern Ireland, and I cannot see that happening, to tell you the truth.

Ms Taylor: Yes, but it is not even just about whether the —

Mr Dickson: It may happen, but it is highly unlikely that there would ever be a contract for the delivery of any services between Marie Stopes and the NHS in Northern Ireland. So how can it expand for them?

Ms Taylor: Because they are very effective at campaigning.

Mr Dickson: So you predict that Marie Stopes will persuade the NHS in Northern Ireland to —

Ms Taylor: I think that you will have a fight on your hands because they are pushing very hard, both to remove public policy restrictions and for funding. They have a very clear goal of achieving as much funding as they can from public bodies internationally. They have been very successful. One of their policy goals is to double their income.

Mr Dickson: If Marie Stopes is that successful, what difference will this change make?

Mr Smyth: I think that, without the regulation and transparency that we are talking about, we do not know whether abortions are happening, what their numbers and reasons are, whether they are unsafe or illegal — all of that. What you could have developing — because we just do not know at this stage — is a dual market where, if you go legal, you will get an abortion on the NHS in certain circumstances but if you go to a clinic there may be practices which we just cannot know about. I do not mean to cast aspersions on any, but we just do not know. So, what I am saying is that, if a provision like this fails and does not pass, there should be some sort of transparency and a mandatory reporting of the numbers of abortions.

Mr Dickson: Those private-sector providers, as I understand it, have cried out for that regulation, but it has been denied them.

Mr Smyth: They could provide the information voluntarily at this stage, but they will not.

Mr Baillie: They refuse to do so.

Mr Dickson: I am not defending those people; I am just asking questions about how a service should be delivered.

Mr McGlone: Thank you for your presentation. I am just reading through your documentation. There has been quite a massive increase in the number of abortions in the UK. By my quick calculation, we are looking at an increase of up to 120,000, to judge from these figures, counting both the private and public sectors.

Mr Smyth: There were 189,000 last year in England and Wales.

Mr McGlone: These were the figures that I had in front of me. We heard earlier from Amnesty International. I would just like your commentary on that, because some of it annoyed me. First, I think that, obviously, a lot of these are lifestyle choices or social abortions; that is my clumsy way of describing them. There has been quite a huge growth in that. Can we have your commentary on that, please? What is your opinion on what we heard from Amnesty International — that they are pro-choice, for abortion on request or whatever they choose to call it? We got that from them eventually. What is your opinion on the view that human rights do not apply to the pre-birth child? What is your opinion, view or perspective on that, please?

Mr Smyth: I will put it into a local context through two very brief pieces of case law. I am a lawyer by background, and I cannot get away from the law at times. In R versus McDonald, it was said that if the fetus has:

"a real chance of being born and existing as a live child, breathing through its own lungs, whether unaided or with the assistance of a ventilator and whether for a short time or for a longer time"

it should then be considered "capable of being born alive".

Then, just last year, the Attorney General gave judgement in the case of Axel Desmond. That was a groundbreaking case because it gave personhood to the stillborn child and meant that an autopsy could be carried out on that child. It gave the child legal personhood. I wonder whether, in applying these cases, there is a particular situation in Northern Ireland, given our unique law, the way our case law has developed and the fact that it is different from the rest of the UK, whether there is a legal right for the unborn child. Ethically, morally and in all other ways, I would say that there is. I would also talk about human dignity and the right to life, which were not mentioned in Amnesty's thing. There is also the ruling in A, B and C v Ireland case, which stated that there is no right to an abortion, nor is there a consensus to when life begins. A wide margin of appreciation is given to member states, and I think that we are perfectly entitled to assume a right to life if we choose to take that path under a different narrative.

Mr McGlone: I am glad to have a person of legal bent here. I want to go back to that paragraph on page 5. I will read that out to you. You were over there and heard it when I put it to representatives of Amnesty International. It states:

"Human rights standards are clear that access to abortion should not be hindered, should be easily accessible and of good quality and that states should eliminate, not introduce, barriers which prejudice access to abortion services, such as conditioning access to hospital authorities."

What is your take on that? We very clearly heard a strong view from Amnesty International about what its perception of the law is. Do you have a particular perception or a particular informed view about those human rights standards?

Ms Taylor: Our organisation is very supportive of the law in Northern Ireland. We want to uphold the law, and fully support it from a legal perspective. From a moral perspective, we are very clear as an organisation that all humans have value, inherent dignity and worth from the moment of conception to the moment of death. The pre-born have equal rights to any human who is born. We strongly believe that.

We are also very concerned to make sure that we care for the welfare of women, and, in cases of abortion, there are often two patients to consider. However, morally, a human has rights from conception.

Mr McGlone: I am totally on the same message as you morally and ethically, and about the care and compassion that needs to be shown to the woman who finds herself in that situation, and her child. I was looking for a perspective. Morals or ethics really did not concern Amnesty International, and they cited international case law, and said that it was their view because of that case law. We heard that.

Do you have a perspective or an informed view on the legal aspects from where you are coming from?

Mr Baillie: I wholly agree with the line of reasoning that your colleague Alban McGuinness gave when he was here, particularly about the ECHR and the margin of appreciation of states. We firmly believe that Northern Ireland and the Northern Ireland Assembly has a right to have the law that it has, and we understand that a number of international rights bodies have taken a contrary view. As Alban noted, CEDAW is not justiciable in Northern Ireland, and there is no international treaty that will force the Northern Ireland Assembly to change its law. Westminster could of course legislate over the top of Northern Ireland, but that is unlikely to happen. From my organisation's understanding — I am sure that it will be the same for the CMF and EA — Northern Ireland is completely within its legal rights to hold the position it does.

Mr Smyth: The law in Northern Ireland strikes a very delicate balance, and it is actually an incredibly progressive law. It may seem a strange parallel, but the Wildlife and Countryside Act 1981 allows for the protection of wild bird eggs. Ironically, the pre-born hawk has more legal protection than the pre-born human in England and Wales. When you think about it in certain terms, it jars with you that there is something not right in the rest of the UK. I am very proud of the laws we have here.

Mr Douglas: Thank you for your presentation. Will you define from your point of view at what stage life begins in a womb? I said earlier that I was talking to some people this week who said that it is at conception, while others said that it is when the heart starts to beat. Do you have a view on that?

Mr Baillie: As Philippa said, my organisation takes the view that life begins at the moment of conception.

Ms Taylor: Yes, I am absolutely very clear that conception is the start. As an organisation made up of a lot of members, our main line is conception, and the majority of our members hold to that view. However, I acknowledge that some Christian doctors and health care professionals might argue for implantation, perhaps, although there would not be any who would argue beyond implantation. I reiterate, as I am sure many of you will be aware, that our belief is that conception is the least arbitrary point and, scientifically and medically, the point that is certainly most credible.

Mr Smyth: That would be our organisation's position as well.

Mr Douglas: Obviously, this is a very delicate situation, and it is very difficult for many people. This has been referred to before, but in light of someone being raped or where there is incest in a family, what is your view on that in terms of abortion?

Ms Taylor: That is incredibly difficult. We have a terrible crime, and a lot of trauma will result from the terrible crime of rape. However, I believe that abortion, as a consequence of that, is just going to simply add another trauma on to an already traumatic situation. It is important to separate out the two issues. The crime is the rape, and what the woman does and the choice that she makes after that should be separate to that decision. It is an incredibly difficult situation. When you look at the research, you see that a lot of women who have had an abortion after rape regret that decision. They have not had a chance to come to any sense of healing after the rape, and that is compounded by the abortion.

It is rare that much research is done on interviewing women who have been raped and kept the child. However, research was done in the US on about 120 women, and nearly all of those who kept their child were very grateful, and it actually helped the sense of healing and recovery from the trauma of the rape itself. Obviously, any kind of research is going to be very difficult to carry out, and a lot of it is anecdotal; therefore, I cannot say for definite to women that it is best to do one or the other. Certainly, anecdotally, it appears that the best alternative is to help and support women through a pregnancy and whether she requires adoption or keeps the baby afterwards. There is a problem of assuming that abortion is the easy answer after a rape. There is an assumption that, "OK, let us just get rid of the problem," but actually that is not the easy answer. That causes another problem. It is very difficult, but I would not support abortion after rape. I would throw everything at the woman to really support and help her.

Mr Smyth: There are some figures from the Rape Crisis Network Ireland that you may find interesting. A very recent and very local study in 2013 found that in 90 cases of pregnancy through rape, only 17 women and girls chose to have a termination, which is 15%. I think the perception is that most people choose a termination as "the right thing to do", but we challenge that assumption. We believe in redemption, and that out of something horrendous — one of the most grave human rights abuses, to use that language — something good, positive and life-affirming can result. Again, we want to see pathways of support for the women in that situation.

Mr Baillie: I would rather wait until the consultation response to outline my organisation's view, if that is all right. We will make it clear at that point.

Mr Douglas: Mark, you mentioned Marie Stopes. One of the problems that you have is that it campaigns, as such. Would there be any circumstances where, if Marie Stopes changed, you would support its work?

Mr Baillie: I imagine that there are aspects of what Marie Stopes does that would not be objectionable — not in terms of carrying out abortions, obviously. As I understand that it offers a number of other areas of care, although I could be completely wrong about that. However, I do not think that everything that it does is wrong per se. I made the point earlier about it being a campaigning organisation, and it is entitled to be. We have no complaint with that. My organisation is a campaigning organisation, and Marie Stopes respects our right to campaign as well, and that is right in a free and democratic society. We support the amendment because we simply do not see the need. The one concern I have is this: is it a simple matter of the Health Department just regulating this, or would new legislation have to be brought through? That would take a lot more Assembly time. To be honest, we do not even know whether Marie Stopes has conducted a single abortion. Why should the Assembly spend all this time creating a new regulatory framework when perhaps it is not necessary? It is up to MLAs to come to their own view on that. I do not imagine that we would support Marie Stopes's right to conduct abortions unless it changes its position dramatically.

Mr Poots: I am sorry that Mr Dickson is not in the room right now. I was absolutely appalled that he made the comparison between extinguishing the life of an unborn child and removing a piece of cancer that is likely to take someone's life. One is governed by the law, and the other is governed by good practice and protocols as established by medical consultants over and again. The comparison is wholly wrong; it should never have been raised in the first instance.

Marie Stopes is operating a very secretive organisation in Belfast city centre. It does not want the Health Department to be involved. The Department does not have the legal authority to do it. RQIA can go in and look at issues around cleanliness, but nobody outside Marie Stopes knows how many abortions, if any, have taken place in Belfast. The problem is that nobody knows precisely whether Marie Stopes is abiding by the law. We have the potential for unregulated abortion outside the law taking place in Northern Ireland. That is why the amendment is useful and helpful.

You said that 64% of abortions in England have been carried out by groups outside the National Health Service. Is it your view that, if you want a consistency of service, the best means of providing that while operating within the law is to have it carried out by the National Health Service? Do we enable a greater degree of inconsistency and perhaps deviation from the law by allowing private practices to engage in that legally regulated procedure?

Ms Taylor: It absolutely does. If they are all carried out under the NHS, we have the opportunity for much better regulation, accountability and transparency, and for the proper follow-up of women. Coming back to one of the points I made in my first statement, my concern is that, once you start going outside the NHS, we lose the ability to keep track of women undergoing terminations through its health care numbers. That is a very important point. In the NHS, we have a proper tracking of women, and we can follow up if there are any future health care concerns or if she presents for another issue that may, in the long term, be related to a prior termination. If you cannot link women, we will never be able to work out what the long-term effects of abortion are. It is absolutely essential for the care of individual women that we have not just proper regulation of the clinics but proper follow-up of women after the abortion. We cannot guarantee that in the private sector because there is no proper follow-up and regulation in care, whereas, in the NHS, that is much more likely to happen, and there is much more consistency in provision. In England and Wales, it is incredibly concerning that so many terminations are carried out in the private sector. In addition, 98% of those are funded by the Government.

Mr Poots: Is it also the case that abortions that are carried out in Northern Ireland seek to remove the baby whole? Many of the clinics in England inject the baby with a poison and vacuum it out, and the baby is, more often than not, dismembered when it comes out.

Ms Taylor: Bit by bit.

Mr Smyth: There was a very, very strange scenario in England and Wales where there was an outcry over the remains of 15,000 aborted and miscarried babies being used as fuel for a hospital incinerator. The irony is that there is outrage over how the body of a dead baby is used, when the law does not accord dignity in life to that child. There is an uproar about how the body is treated after death, which shows a strange cultural problem.

The Chairperson (Mr Givan): I want to try to bottom out the view about the reasonableness of restricting abortion to the state. When this was debated in the Assembly when I tabled the amendment previously, I cited examples across Europe where the state has restricted the provision of services on a range of issues because it was deemed to be in the interests of wider society. It was an important issue, so they did that. This is where I come to on the issue for Northern Ireland. Is it right that this issue should only be under state control, or is it something that the private sector should be allowed to engage in? Some will have the view, which I share, that you should never allow a financial incentive to be involved in decision-making on the ending of a life. Where are the three organisations in respect of the reasonableness of the state restricting abortion to the NHS and not allowing private clinics to carry out that type of service?

Mr Baillie: As I said in my opening remarks, it is entirely reasonable for the state to do that. Our position is that the Assembly should pass the amendment. If it does not, and only if it does not, the Department of Health should enter and regulate, because our major concern is about transparency, as was mentioned earlier.

Ms Taylor: I fully support that view.

Mr Smyth: I am generally very cautious when the state tries to restrict the personal freedoms and choices of its citizens, but this is an exceptional circumstance. We are talking about the ending of a human life, so I have no problem with the state reserving unto itself in such reasonable circumstances certain functions.

The Chairperson (Mr Givan): Is there a concern that the private industry involvement in abortion could be the Trojan Horse when it comes to abortion in Northern Ireland? Is that a real concern? Philippa, you touched on that earlier when you said there are organisations that have a very clear objective and stated view on what the law should be on the issue. You alluded to how changes have happened through practice. Is there a concern that that could happen in Northern Ireland?

Ms Taylor: I spent some time looking at a lot of the papers and publications of abortion providers, and it is clear that they have a twofold agenda. First, they want to increase the number of abortions and abortion provision; they call it "safe abortion provision". That is understandable as they are abortion providers and it is their job. My concern, when I was looking through their literature, is that they state too many times that they also want to reduce or remove restrictions on any abortion provision in countries. So they actually want to change policy, and it is quite clear that they want to do that internationally, which will therefore include Northern Ireland. They want to remove restrictions to abortion, so they have an agenda to change policy. That is where I have real concerns.

Mr Baillie: On the Marie Stopes International website, there is mention of a policy and partnerships team, the aim of which is to work to:

"transform policy environments and increase access to safe abortion and family planning services globally. As a team they do this through developing and strengthening relationships with key high profile and relevant stakeholders and support our programmes to develop their own strategic partnerships, reduce policy restrictions and maximise in-country donors."

That is a very clear view, and Marie Stopes are open about wanting to reduce policy restrictions. Coming back to the clinic in Belfast, we have no evidence that they are breaking the law. The problem is that nobody can go in and find out. Until that is solved, there is going to be a significant concern there. I am not accusing them of anything: I am simply saying that that is not a tenable situation. Something must be done, either through this amendment or another road.

Ms Taylor: It is only fair that, if a clinic is operating in this country, we ask questions of that clinic and its agenda. It is important that we start looking at those clinics. Some of their staff are paid far more than government Ministers; they are paid huge amounts of money. There is an awful lot of money involved in running these clinics, and they get a lot of money. It is quite a lucrative trade, and it would seem, certainly in England and Wales, that, despite operating within a shrinking health budget, they are being paid huge amounts of money while operating under charitable status. We can start asking questions about non-democratic decision-making, vested financial interests, good governance and priorities in government spending and their right to speak out on issues other than abortion provision — for instance, in terms of changing policy.

The Chairperson (Mr Givan): Thank you very much. I appreciate your time.

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