The British Pregnancy Advisory Service (BPAS) said it was continuing to help women and, in some cases, girls, travel to England to undergo abortions – which are mainly surgical ones – but warned some were unable to end their pregnancies in light of pandemic restrictions and other pressures.
Throughout 2020 and last year, the charity treated 80 women who made the cross-border journey because they were unable to access care from Scottish health boards, where there are widespread and persistent inequalities in provision.
That two-year total is less than the 2019 figure, when 90 women travelled to England, but crucially, it has not been offset by an upturn in late stage terminations in Scotland.
On the contrary, that number dropped by eight per cent over the same period, with just 127 abortions carried out at 18 weeks’ gestation or over in 2021 - the second lowest figure since records began in 1968.
Several women forced to travel to England told Scotland on Sunday the traumatic trip was worsened by confrontations with anti-abortion protestors in London. Some were left thousands of pounds out of pocket.
One woman left with no option but to make a 700-mile round journey said she was left with the impression she had no legal right to an abortion in Scotland at 20 weeks. She said: “The thought of women having to go through what I went through is a disgrace to Scotland, a country which so outwardly proclaims to be a progressive nation.”
BPAS and other abortion campaigners said there was a lack of political will on the part of ministers to establish specialised care for later gestation abortions. It warned the “gaping hole” in provision was denying many women a fundamental human right enshrined in law.
Lucy Grieve, co-founder and director of Back off Scotland, which campaigns for the designation of buffer zones around abortion clinics, described the situation as “madness”, and said the position of Maree Todd, the women’s health minister, would be untenable unless change was forthcoming.
Five years ago, the Scottish Government said it was working with NHS boards to look at improvements around the “complex area” of later gestation abortions.
But correspondence obtained by Scotland on Sunday shows the government has not commissioned or undertaken any analysis of the issue since then, despite the fact multiple health boards raised concerns about women being sent to England during the pandemic.
Rachael Clarke, chief of staff at BPAS, said its statistics pointed to a growing number of women who had continued their pregnancies despite wanting an abortion.
“It’s not that those women are getting that care at home,” she said. “There are women who are continuing pregnancies who would otherwise not want to.”
Out of the 170 clients the charity treated between 2019 and 2021, five were under the age of 16. Some 18 were aged 17 or under.
“We’re talking about children that are being sent over the border in some cases,” Ms Clarke added.
“Women who need abortions at later gestations are disproportionately likely to have additional vulnerabilities. It could be due to drink and drug misuse or they may lead chaotic lives, for example.”
The trend of women from Scotland being forced to travel to England to terminate their pregnancies has been prevalent for years.
Between 2010 and 2020, 2,057 women resident in Scotland had abortions carried out in England or Wales. Since 1972, the total stands at 26,244. The 2020 figure was 123. The statistics for last year are due to be published later this month.
As long ago as 2014, a study commissioned and funded by the Scottish Government was explicit in how the lack of access to later abortions in Scotland had a detrimental financial and emotional impact on women.
“The burden of traveling to England presents one of the most significant barriers to later abortion for women, exacerbates an already potentially difficult experience, and contributes to abortion stigma and discrimination,” its authors concluded.
Eight years on, a multitude of systemic shortcomings remain, with gestational limits across Scotland effectively a postcode lottery.
Despite the fact the 1967 Abortion Act made it legal for women to have an abortion up until 24 weeks’ gestation, the reality is that most women presenting after 18 weeks have to head south.
Eight of Scotland’s health boards do not carry out the procedure beyond 18 weeks. Just four have a limit of 20 weeks. NHS Fife has a bar of 15 weeks and five days.
The latest Public Health Scotland statistics also reveal striking anomalies across health boards. While 4.2 per 1,000 women had abortions at NHS Lanarkshire at 14 weeks or over, the rate halves to just 2.1 at neighbouring NHS Greater Glasgow and Clyde.
Ms Clarke stressed: “There should be a centrally commissioned specialist service for surgical abortions up to 24 weeks’ gestation. We have pushed the government for this and absolutely nothing has been forthcoming.”
Scottish Labour MSP Monica Lennon, convener of the Holyrood cross-party group on women’s health, said it was “shameful” that women and girls were still having to travel to England.
“Abortion healthcare in Scotland has been the victim of complacency and neglect for too long. It’s worrying that the Scottish Government failed to act on its own evidence from as far back as 2014.
“The burden of travelling to England is a major barrier for women and girls who need a later stage abortion, yet nothing is being done to address this. Warm words from SNP ministers are no substitute for action.”
Questioned last month on the scandal of women having to travel to England, Ms Todd told LBC that “we are looking at that again”.
But Ms Grieve asked: “What does that even mean? What does she need to look at? This has been going on for decades.
“Those kind of comments represent the chronic lip service the Scottish Government provides whenever questioned or confronted with the bad decisions they have made around abortion policy.
“I think if it continues down this path, Maree Todd’s position is untenable, because she’s not standing up for women.”
Correspondence disclosed last week by the government under freedom of information legislation shows it has discussed options for increasing provision for later stage abortions on “a number of occasions” with health boards.
But in its response to the FoI request, the government added: “While we have gathered information on boards’ services and discussed with them some of the issues faced, we have not specifically undertaken or commissioned an analysis of this.”
The disclosure also reveals how several health boards raised concerns with the government about women being sent to England during Covid-19.
In March 2020, the government emailed health boards asking them to “look at contingency planning to be able to provide treatment more locally”, but it is unclear what services were put in place. That June, five health boards said they were dealing with the issue on a “case by case basis”.
The Scottish Government’s women’s health plan, published last August, promised to improve access to abortion services, specifying a “medium term” action of providing mid-trimester abortion care locally or regionally.
It comes as an emergency summit on buffer zones and abortion care in Scotland is expected to convene later this month. First Minister Nicola Sturgeon told Holyrood last month she would be “very happy” to chair the roundtable event.
Asked what it was doing to ensure Scottish health boards provide late stage abortion care, the Scottish Government said: “The Healthcare Improvement Scotland Sexual Health Standards make clear that all boards should be able to offer abortions up to at least 20 weeks’ gestation. Where an NHS board cannot offer abortion services above 20 weeks’ gestation locally, they must work to provide an appropriate and person-centred care pathway for all patients seeking abortions up to the legal limit.
“Should any women require to receive a late stage abortion outwith Scotland for clinical and safety reasons, their care is paid for by NHS Scotland. These represent a very small proportion of the number of abortions from Scotland as the vast majority are taken forward at an earlier stage.
“However, we are working with boards to try and ensure that late stage services are established here so that all women up to 24 weeks can be provided as locally as possible.”