Abortion Service Safe Access Zones (Scotland) Bill: equality impact assessment

Key Findings

Age

Abortion services can be accessed by people of all ages who were biologically sexed as female at birth and can become pregnant. There can be differences in how abortion services are delivered, due to age. For example, under 16s are generally unable to access early medical abortion at home (EMAH)^[14] which allows service users to administer both sets of abortion medications at home up to 12 weeks’ gestation, where clinically appropriate to do so, following on from a telephone or video consultation with a doctor or nurse. Therefore, whilst most service users will still attend a premise providing abortion services at some point, even if only to collect their medication, it is possible that service users under the age of 16 would be somewhat more likely to encounter anti-abortion activity as they generally have to attend appointments in person. This means that the positive impacts of the Bill may have a greater impact on those who are under the age of 16 who are seeking access to abortion services.

A recent study published by the Joseph Rowntree Foundation found that almost all young people felt there is stigma attached to having an abortion.^[15] Elsewhere, research has shown significant gaps in young people’s knowledge about abortion, which can act as a barrier to them making informed choices and accessing services.^[16] This gap in knowledge, alongside documented evidence of misinformation provided outside abortion clinics,^[17] may leave younger people more susceptible to anti-abortion activity, as detailed in testimony from the Scottish Youth Parliament.^[18]

Consultation responses also noted that younger service users may be more vulnerable to intimidation, and therefore may need additional privacy when accessing services. Professor Sharon Cameron noted in her consultation response:

“As a service, we are concerned about the negative impact of the presence of the protestors on patients attending our clinics not just for abortion but for wide range of health concerns, as well as other clinics in nearby hospital buildings. It can take a lot of motivation and courage to attend any clinic appointment, and the prospect of facing protestors on one’s way to attend a clinic may deter patients from accessing services that they need. Even on days when protestors are not present, patients may fear that protestors could be there. We are aware of patients contacting the service in advance of appointments worried about this. There is also concern that certain groups such as young people and vulnerable groups who may find it particularly difficult to navigate clinical appointments, may be most at risk.”^[19]

It is possible that anti-abortion activity which takes place outside premises providing abortion services may contribute to the stigmatisation of young people seeking abortions and that allowing it to continue unchecked would compound this. Given that under 16s cannot generally access EMAH within Scotland and must attend an in-person appointment, it is also possible that anti-abortion activity which takes place outside premises providing abortion services may disproportionately affect young people. As such, the provisions of the Bill may have a greater positive impact on this age group than others, although the great majority of patients will attend a premise which provides abortion services at some point, for example to collect medication and in many cases for an ultrasound scan.

More generally, implementing safe access zones will protect abortion care service users and providers of all ages from anti-abortion activity while accessing abortion services. The Bill will do so by preventing service users and providers from experiencing unwanted influence, harassment, and distress outside of premises which provide abortion services.

We know that those who take part in anti-abortion activity outside of premises that provide abortion services tend to be older in age, which was highlighted by Compassion Scotland in response to the consultation:

“Vigil groups often stand back from the clinics and are made up of older women who have had abortions themselves.“^[20]

Therefore, the Bill may have a negative impact on those people. However, as set out in greater detail in the Policy Memorandum, the aim of the Bill is not to prevent the expression of opposition to the provision of abortion services or restrict the expression of religious views on abortion. It limits the activity that can be carried out only in very limited circumstances and places, and only so far as is necessary to achieve the legislation’s overarching aims. Beyond these limitations, it does not remove the ability of those who oppose abortion to protest or make known views on abortion.

Race/ethnicity

Research suggests that service users from ethnic minorities are more likely to experience barriers when accessing healthcare^[21]. In addition, recent studies have shown that service users from ethnic minorities are less likely to engage with health services due to a number of factors, including poor past experience of health services, and cultural differences^[22]. This may be further compounded should service users encounter anti-abortion activity outside premises providing abortion services.

Preventing anti-abortion activities from occurring outside of premises where abortion services are located could, therefore, have a positive impact by ensuring that no additional barriers to accessing abortion services are created for service users from minority ethnic groups.

The Scottish Government has not identified any negative impact for this group.

Disability

Research has shown that service users with disabilities are more likely to face difficulties when accessing health care^[23]. This is further compounded if service users also have another protected characteristic, such as being LGBTQ+ or from an ethnic minority^[24]. Therefore, preventing anti-abortion activities from occuring outside of premises that provide abortion services could ensure that disabled people do not have to face additional barriers such as feeling fear or harrassment when accessing those services, and thus could have a positive impact on disabled people who seek to access abortion services.

Some respondents to the consultation suggest that anti-abortion activities that take place outside of premises that provide abortion services offer an opportunity for service users to see the support that is available to them through the participating organisations. As one respondent to the consultation noted:

“For women in crisis pregnancies, and others who find themselves unsure that they are able to parent a child, removing access to information at the gates and to access to support groups they may not know how to find otherwise, will be damaging.”^[25]

The Royal College of General Practitioners highlighted in its consultation response that clinicians are trained to offer counselling and provide adequate safeguarding; other respondents made similar observations, in particular counselling which has not been asked for or sought outside premises by strangers whose qualifications cannot be known is inappropriate. This is further evidenced in a paper published by the Faculty of Sexual & Reproductive Health on safe access zones which states:

“Accessing an abortion is a personal healthcare decision that a woman should make based on her own wellbeing and health needs. During the process of accessing an abortion, trained abortion providers discuss options and offer counselling and other professional regulated services according to the patient’s wishes. It is inappropriate for any protestor to be offering these services or seeking to influence a woman’s decision outside of a clinic or hospital.” ^[26]

This Bill does not amend the current law on abortion; it does not make provision regarding the provision of counselling and guidance on support available for people considering an abortion, it seeks only to ensure safe access to abortion services.

The establishment of safe access zones outside of premises that provide abortion services will be well publicised in advance of the zones becoming operational so that the general public are aware of the existence of the zones and the offences that the legislation will create. In addition, the Bill itself places a duty on Scottish Ministers to publish both a list and maps of the safe access zones. This wil be an important step to ensure that service users and providers as well as those who participate in anti-abortion activity can access information about safe access zones. For service users and providers it will provide assurance that the premises they are accessing are protected, and for those participating in anti-abortion activities it will provide clarity about where engaging in these activities could be considered an offence.

The intention is that this information will be published online. It is recognised that ensuring this information is accessible to everyone will be important to ensure the Bill does not impact negatively on those with disabilities. The information will therefore be made available in different formats in order to adhere to accessibility requirements. Accessibility considerations will also be taken into account when public messaging is developed.

Sex

As all service users seeking to have abortions were born biologically female, the protection the Bill offers for those accessing abortion services will predominantly impact women. At this time, gender is not routinely captured as part of the data collected for abortion in Scotland. However, other research such as the 2023 evaluation of EMAH contained a patient survey which was completed by 327 service users, with over 99% reporting their gender as female^[27].

The Bill will ensure that people are able to access services free from unwanted influence, harassment or intimidation and so will have a positive impact on this protected characteristic. This may be especially true for abortion services that are located in premises which provide other services; some sexual health services provide both abortion and rape crisis services for example. As noted by MSI Reproductive Choices in their response to the consultation:

“Sex is protected characteristic. In our experience, women entering the premises were overwhelmingly targeted by the anti-choice groups, as they were presumed to be accessing abortion care at the clinic. In some instances, women and girls have been harassed outside MSI UK premises despite attending for another type of healthcare.

For some, abortion is required as a result of, or as a protection against gender-based violence. The activity we see outside our clinics can be distressing for anyone, but it is especially so for those who have already experienced trauma. For example, it can be a trigger for Post-Traumatic Stress Disorder for people who have been raped or abused.”^[28]

Further, the UN Committee on the Elimination of Discrimination against Women (CEDAW) recognises that the “abuse and mistreatment of women and girls seeking sexual and reproductive health information, goods and services, are forms of gender-based violence”^[29]. The UK is a signatory to the Convention on the Elimination of All Forms of Discrimination against Women.

The Scottish Government is aware that there are women who take part in anti-abortion activities outside of premises that provide abortion services and so those women may be negatively impacted by the legislation. However, the Bill will not impact on women who take part in anti-abortion activity outside of premises that provide abortion services differently; it will equally affect both men and women who engage in this activity. The aim of the Bill is not to prevent the expression of opposition to the provision of abortion services or restrict the expression of religious views on abortion. It is only to prevent their expression in limited areas to the extent necessary to achieve the overarching aims of the legislation. Those limitations will apply only within safe access zones (or in areas not within public areas in the zone that are visible or audible from the zone). Further detail on the size and design of zones can be found in the Policy memorandum.

Marriage and Civil partnership

We have not identified any positive or negative impacts for this protected characteristic.

Maternity and Pregnancy

In Scotland, abortion care is routinely offered through clinics and hospitals which provide other healthcare services, such as maternity, sexual health, gender clinics, and gynaecological services. Those accessing abortion care are pregnant, and the Scottish Government knows that having an abortion for any reason is a difficult, and often emotional, decision. As noted by one respondent to the consultation:

“My daughter chose to abort her much loved daughter and my much loved grandaughter This still loved child. She chose her daughter over herself. After scans showed fetal damage beyond repairing. We were devastated and heartbroken. It was the one decision in my daughters life she had to make alone because as the mother it was her right to protect her child from further pain at huge cost to herself. During these antenatal and scan visits we were intimated and harassed daily this continued both before and after the termination. At this most difficult time my daughter was called a sinner a murderess and more. Judge and jury anti abortionists chose daily to inform my daughter of her sins They broke her heart my placid sensible loving brave daughter whilst steadfast in her decision for her daughters sake took ptsd.”^[30]

Anti-abortion activity is often undertaken close to maternity services; for example at the Queen Elizabeth University Hospital (QEUH), Glasgow, anti-abortion activity takes place on the main road outside the entrance to the maternity hospital.

This means that anti-abortion activity can impact on those accessing maternity services and evidence gathered by the Scottish Government shows the negative impact on those seeking healthcare in buildings targeted by anti-abortion behaviour, even if those people are accessing services that are not related to abortion.

Testimonies provided by service users and providers accessing maternity buildings highlight the damaging effects of encountering anti-abortion activity. For instance, service users may attend maternity services for any number of reasons including giving birth, or to have additional diagnostic tests related to their pregnancy. For some service users who have had to attend services on multiple occasions encountering anti-abortion activity on a repeated basis has had a deeply profound impact on their psychological wellbeing. As one respondent to the consultation noted:

“Nobody should be harassed when seeking medical care. Pro-life protestors were present outside the Queen Elizabeth University Hospital Maternity Unit in Glasgow when a friend attended with a miscarriage. They were present also outside Glasgow's Sandyford Clinic for Sexual and Reproductive Health when another friend attended to have a coil fitted; she was filmed by a male protestor on her way in. In Glasgow pro-life protests are located outside premises that provide health services that include, but are not limited to, abortion. While it is women seeking terminations who require our immediate protection from these protests, they have a threatening effect on all service-users, some equally vulnerable. The professional bodies that cover all these services support buffer zones as a democratic solution. As a person who uses sexual health services, so do I.”^[31]

Gender Reassignment and Sexual Orientation

As noted above, a recent evaluation on EMAH conducted a patient survey which showed that the majority of service users having abortions identify as being female^[32]. However, the evaluation also showed a very small number of service users that identify as another gender. The Scottish Government acknowledges trans people are more likely to face barriers^[33] when accessing healthcare, and preventing anti-abortion activity outside of premises that provide abortion services could have a positive impact by ensuring that no additional barriers to accessing abortion services are created for trans service users. As noted by Zero Tolerance in their consultation response:

“Trans and non-binary people who want additional privacy and others such as younger, LGBTI, and those living in rural, and small communities are also more vulnerable (Engender 2021). This Bill will offer additional protection for those most vulnerable to harassment, intimidation and who may also need additional privacy due to characteristics protected by the Equality Act (2020)”^[34]

Some responses to the consultation note that lesbian and bisexual women are the most likely to access abortion services within the LGBTIQ+ community. They note that LGBTIQ+ people are more likely to have lived through traumatic experiences, and facing anti-abortion activity may be very distressing^[35]. Therefore, it is likely that the Bill will have a positive impact for lesbian and bisexual women, and trans men. This is because the Bill will make it offence to engage in harmful behaviours within a safe access zone.

Religion

In developing the Bill the Scottish Government recognises that the protected characteristic which is most likely to be impacted is religion. Abortion is a deeply polarising issue, and people who take part in anti-abortion activity outside of premises that provide abortion services are often affiliated with religious organisations and often see that as an expression of their beliefs.^[36] Whilst it should be noted that not all respondents to the consultation who identified as having religious beliefs were opposed to the introduction of safe access zones, the Bill may impact negatively on people who choose to engage in anti-abortion activity for reasons related to their religion by restricting their ability to express their religious beliefs within a specified area. As noted by one respondent to the consultation:

“im prolife, and i have been praying outside my local abortion provider (aberdeen royal infirmary/ari) for about 9 years. as a practising catholic i believe i have the right (and duty) to try to prevent unborn children from being murdered in their mothers wombs. i have been part of '40 days for life' for about 5 years. its better organised and led than any other pro life activity i know of but is a peaceful, prayerfull protest. buffer zones will ultimately mean more children are killed and mothers and families will be permanently scared.”^[37]

The above response reflects the view of many respondents to the consultation and the evidence which the Scottish Government has collected throughout the development of the Bill. Many individuals who participate in anti-abortion activity outside premises providing abortion services view these activities as a part of their faith, and feel that they are compelled to bear witness to abortions and/or try to prevent them.

As noted by one respondent to the consultation:

“…banning individuals from seeking to express their view that abortion is morally questionable infringes on their human rights in terms of freedom of speech, expression and religion…” ^[38]

It is acknowledged that the Bill may interfere with individuals’ rights to express their religious beliefs, however this will only be the case within specified safe access zones. In order to minimise infringement on religious expression, detailed mapping exercises have been conducted to ensure that zones are of an adequate size to protect service users and providers but are not overly restrictive on the rights of those who choose to participate in anti-abortion activity. Importantly, individuals who participate in anti-abortion activities can still express their opposition in other ways such as writing articles for the media, attending vigils in other locations, and using social media platforms. Further detail of the work which was undertaken to determine the zone size can be found within the Policy Memorandum on the Scottish Parliament website.

Evidence collected by the Scottish Government during the development of the Bill shows some abortion care service users who have had abortions and are religious have felt intimidated by anti-abortion activity. There are two reasons given for this; firstly, service users may be religious and have felt that they may be identified by individuals choosing to engage in anti-abortion activity which may result in negative consequences for them. Secondly, service users have felt an increased level of distress based on the perceived judgment they feel from individuals engaging in anti-abortion activities who are of the same faith group. As one respondent to the consultation noted:

“In Edinburgh I was accompanying a then 17 year old from Dublin - a cousin. She was terrified. She told her parents she was coming to see me to think about university options in the UK, and so chose a clinic in Edinburgh so we could also get some photos of her around uni buildings etc as ‘proof’ this is what we’d been doing. We arrived at the clinic and there were 5 middle aged men outside. All 5 of them had disgusting placards supposedly depicting foetuses and were attempting to hand out flyers to passersby - which, sadly, included us. I was able to shield her from them but she could still hear them shouting that she was a murder, telling her she’d regret it for the rest of her life, that the baby would haunt her and she’d go to hell. She didn’t want to have an abortion. Part of her did believe that abortion is murder because this is how her parents brought her up. It was a huge, huge thing for her to contact me, ask me to pay for a flight and a hotel, and accompany her. But she did it, because she knew it was the right choice for her.”^[39]

Finally, for those considering abortion and whose own faith or religion can make the impact of anti-abortion activity more significant, the Bill will have a positive impact by preventing behaviours from occurring within safe access zones.