Antenatal screening in Northern Ireland and Women’s Rights

Abortion was decriminalised in Northern Ireland (NI) in October 2019, following the introduction by the United Kingdom (UK) government of the Northern Ireland Executive Formation Act 2019 (Aiken and Bloomer, 2019). The NI Abortion Regulations introduced in March 2020, allowed abortion services to be provided under a broad set of conditions, including in cases of ‘severe fetal impairment or fatal fetal abnormality’ (Regulations, Section 7). Following a delay in the commissioning of services, interim services were eventually provided, but these were focused on early medical abortions (up to 10 weeks’ gestation), using medication. Some terminations due to diagnoses of severe or fatal fetal abnormality took place during that period, but monitoring data on gestations, and method of abortion have not been published. Beyond these criteria and parameters, abortion seekers were required to travel elsewhere to access services including some cases of severe or fatal fetal abnormality (Kirk et al., 2021). As of 24 October 2022, the Northern Ireland Office (NIO) has led commissioning, with full implementation of services enacted in late 2023. The adoption of the NI Abortion Regulations 2020, with its Section 7 allowing terminations on the ground of severe or fatal fetal abnormality, has brought into sharp focus access to antenatal screening, specifically during the first trimester. Unlike the rest of the UK, this screening is not routinely offered in NI and as a result, most fetal abnormalities are diagnosed following the anomaly scan which typically occurs at around 18-20 weeks’ gestation.

This policy briefing has been informed by two expert roundtables held in January 2024. The first roundtable was attended by families bereaved following diagnoses of severe or fatal fetal abnormalities and a representative from the Regulation and Quality Improvement Authority (RQIA), the regulator for health and social care in NI. The second roundtable was attended by health professionals involved in the delivery of maternity and fetal medicine services in NI, as well as academics and support organisations.