An anti-abortion protest in Belfast. The High Court in London has ruled that Northern Irish women are not entitled to free NHS abortions in England. Photo: Getty
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Northern Irish women denied NHS abortions are the scapegoats of men's colonial wranglings

The 1967 Abortion Act cannot be imposed on Northern Ireland by Westminster, but nor should penalising charges be imposed on Northern Irish women by the English NHS. 

There is no national health service for Northern Irish women. There is not, strictly, an NHS for Northern Ireland – instead, the region is covered by the body Health and Social Care, which provides social services as well as healthcare. But like the NHS in England, Scotland and Wales, the HSC was founded within the scope of the Beveridge report to provide medical treatment free at the point of use. Which it does, unless you are a woman who has use for an abortion, because the 1967 Abortion Act was never extended to Northern Ireland.

For Northern Irish women, terminations are only available in "highly exceptional circumstances". These "highly exceptional circumstances" are undefined, but they do not include: rape, incest, homelessness, poverty, fatal foetal abnormalities, or in fact almost any of the reasons a woman may have for needing to end a pregnancy. In 2013, only 51 abortions were performed in Northern Ireland; meanwhile, over 1,000 women travelled to other parts of the UK in order to have what should be a simple, safe and legal procedure.

And when Northern Irish women travel, they have to pay. They pay for the flights. They pay for the flights of someone to keep them company – or, if they cannot afford that, they come alone, so they pay in loneliness. They pay for accommodation if they need to stay overnight. They pay in secrecy or in social opprobrium. And they pay for the procedure, as reaffirmed yesterday by the High Court's decision that women from Northern Ireland are not entitled to free abortion on the NHS elsewhere in the UK.

In his ruling, Mr Justice King stated that devolutionary powers have to be taken into account. That means devolution to the home nation governing what a woman may or may not choose for her own body, of course: the idea that such a power could be devolved to the level of the pregnant individual is, apparently, quite unthinkable. This does not prevent Northern Irish women from having abortions. But, as Mara Clarke of the charity Abortion Support Network points out, "The fact that abortion is criminalised changes abortion from an issue of personal morality and choice to one of economy and class." Even for those who can afford it, this is a cruel situation. No woman facing the decision to have a termination should be forced to do so alone and in a strange place, hundreds of miles from home.

But if money is not readily available (and often it isn't, since financial restraint is one of the main reasons women choose abortion) the situation goes beyond cruelty and becomes savagely absurd. The less money you have, the longer you have to save, the further your pregnancy progresses, and the more you must ultimately spend. The consequences of this uterine catch-22 are directly observable in the statistics: in England and Wales, only 1.4 per cent of abortions are performed after 20 weeks’ gestation; but for Abortion Support Network's clients, the rate is 7 per cent. Money is time.

And, Clarke says, the girl in yesterday's test case found herself in exactly that pinch of escalating costs when she became pregnant in 2012:

A 15-year-old girl worked up the courage to tell her mother she was pregnant. Her mother fed the family beans on toast for a week to save an extra £50. The abortion cost £350, plus the charge for the mandated consultation, plus travel. By the time they had raised the money, the young girl was 15 weeks pregnant and the price had been pushed up to £600 for just the procedure. She also had to pay to get a photo ID in order to travel.

That is the tax that Northern Ireland's law places on a child who does not want to become a mother. Almost incredibly, it could have been worse: since Abortion Support Network was founded in October 2009, it has helped to arrange travel and treatment for six women who, by the time they reached England, were found to be over the legal limit for abortion. All six had to return, still pregnant, to have a baby they desperately wanted not to have. Anti-abortion zealots may try to celebrate the six lives they regard as saved; I mourn for six women whose lives have been blighted by compulsory maternity.

As far as I'm concerned, a woman's motives for seeking an abortion are of no relevance to her right to the procedure. Sustaining another life inside your body, at non-negligible risk to your own health and freedom, is an enormous thing to do – women should be answerable to no authority but themselves when deciding whether or not to continue a pregnancy. Abortion Support Network does not ask its clients for their reasons. Nevertheless, some have volunteered a little information about themselves, and what is known comprises a catalogue of distress.

Of the 1,175 women from Northern Ireland and the Republic of Ireland helped by Abortion Support Network since 2009, 62 had serious mental health issues; 56 had serious medical issues; a further nine had been warned against conceiving again after health problems in a previous pregnancy; 48 were in or escaping abusive relationships; 49 were pregnant as a result of rape; three were refugees; seven were homeless; 16 had tried to self-harm or self-abort (one woman, Clarke tells me, was desperate enough to plan a car crash that she hoped would induce miscarriage); 25 were suicidal; 83 said that the man involved had disowned responsibility; and 29 were carrying pregnancies with fatal foetal anomalies such as conjoined twins or anencephaly.

Because these figures are based only on what women have chosen to reveal, they are minimums. The depth and breadth of the miseries compounded by Northern Ireland's absurd law are certainly much, much greater. The 1967 Abortion Act cannot be imposed on Northern Ireland by Westminster, but nor should penalising charges be imposed on Northern Irish women by the English NHS. When women are forced from their own home to get medical treatment, the scapegoats of men's colonial wrangling, the least we might do is give them that treatment as we'd give them any other – free at the point of use.

You can donate to Abortion Support Network at its website.

Sarah Ditum is a journalist who writes regularly for the Guardian, New Statesman and others. Her website is here.

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A swimming pool and a bleeding toe put my medical competency in doubt

Doctors are used to contending with Google. Sometimes the search engine wins. 

The brutal heatwave affecting southern Europe this summer has become known among locals as “Lucifer”. Having just returned from Italy, I fully understand the nickname. An early excursion caused the beginnings of sunstroke, so we abandoned plans to explore the cultural heritage of the Amalfi region and strayed no further than five metres from the hotel pool for the rest of the week.

The children were delighted, particularly my 12-year-old stepdaughter, Gracie, who proceeded to spend hours at a time playing in the water. Towelling herself after one long session, she noticed something odd.

“What’s happened there?” she asked, holding her foot aloft in front of my face.

I inspected the proffered appendage: on the underside of her big toe was an oblong area of glistening red flesh that looked like a chunk of raw steak.

“Did you injure it?”

She shook her head. “It doesn’t hurt at all.”

I shrugged and said she must have grazed it. She wasn’t convinced, pointing out that she would remember if she had done that. She has great faith in plasters, though, and once it was dressed she forgot all about it. I dismissed it, too, assuming it was one of those things.

By the end of the next day, the pulp on the underside of all of her toes looked the same. As the doctor in the family, I felt under some pressure to come up with an explanation. I made up something about burns from the hot paving slabs around the pool. Gracie didn’t say as much, but her look suggested a dawning scepticism over my claims to hold a medical degree.

The next day, Gracie and her new-found holiday playmate, Eve, abruptly terminated a marathon piggy-in-the-middle session in the pool with Eve’s dad. “Our feet are bleeding,” they announced, somewhat incredulously. Sure enough, bright-red blood was flowing, apparently painlessly, from the bottoms of their big toes.

Doctors are used to contending with Google. Often, what patients discover on the internet causes them undue alarm, and our role is to provide context and reassurance. But not infrequently, people come across information that outstrips our knowledge. On my return from our room with fresh supplies of plasters, my wife looked up from her sun lounger with an air of quiet amusement.

“It’s called ‘pool toe’,” she said, handing me her iPhone. The page she had tracked down described the girls’ situation exactly: friction burns, most commonly seen in children, caused by repetitive hopping about on the abrasive floors of swimming pools. Doctors practising in hot countries must see it all the time. I doubt it presents often to British GPs.

I remained puzzled about the lack of pain. The injuries looked bad, but neither Gracie nor Eve was particularly bothered. Here the internet drew a blank, but I suspect it has to do with the “pruning” of our skin that we’re all familiar with after a soak in the bath. This only occurs over the pulps of our fingers and toes. It was once thought to be caused by water diffusing into skin cells, making them swell, but the truth is far more fascinating.

The wrinkling is an active process, triggered by immersion, in which the blood supply to the pulp regions is switched off, causing the skin there to shrink and pucker. This creates the biological equivalent of tyre treads on our fingers and toes and markedly improves our grip – of great evolutionary advantage when grasping slippery fish in a river, or if trying to maintain balance on slick wet rocks.

The flip side of this is much greater friction, leading to abrasion of the skin through repeated micro-trauma. And the lack of blood flow causes nerves to shut down, depriving us of the pain that would otherwise alert us to the ongoing tissue damage. An adaptation that helped our ancestors hunt in rivers proves considerably less use on a modern summer holiday.

I may not have seen much of the local heritage, but the trip to Italy taught me something new all the same. 

This article first appeared in the 17 August 2017 issue of the New Statesman, Trump goes nuclear