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How to have an abortion when you’re in Ireland

(A Rough Guide to Ireland – Part 1)

So you’re pregnant and you don’t want to be. What next? First things first – commiserations on finding yourself in this situation. It’s shit and it might get a bit worse before it gets better, but there are people out there who are rooting for you and hopefully you find the information in here a little bit useful. This is basically a step by step guide to getting through this situation.

positive test

Are you definitely definitely definitely pregnant?

Take a test. You can buy them in every pharmacy and they cost between €10/€20. Sometimes they sell them really cheap in Dealz and sometimes other pound shops for around €1.50/€2. If you’re embarrassed about buying it or worried someone might see you, consider asking a trusted friend to go and buy it for you. If you’re worried about what the shop assistant might think, just try and look excited. The chances are the sales assistant is selling these every day and will not pay any heed to you anyway. If you’re not sure about the home test you took, the IFPA carry out testing for €20 but it’s free if you have a medical card. Cura and Sexual Health Centre in Cork offer free pregnancy testing. Having an early scan so you can figure out how far along you are might be useful if you aren’t sure. You can get a free scan at FemPlus in Dublin and there are places around the country offering scans at a variety of locations with an average cost of around €100. The Abortion Support Network can tell you where the best place to go for a scan is.  A scan will also confirm that the pregnancy isn’t ectopic. If you can’t get to a scan or afford a scan the most important thing when determining how far along you are is that you need to be counting from the first day of your last menstrual period, not from when you had sex.

Marie Stopes Reproductive Choices will provide you with a consultation and a scan but where they will charge €110 (or €90 for a phone consultation). It’s important to note that Marie Stopes’ clinics in Britain absolutely will not perform a procedure if you do not have the correct payment for it.

Decide if counselling is for you

Perhaps you’ve made a decision not to continue your pregnancy, or maybe you feel you want to chat confidentially about that decision with someone else. Here are a list of clinics that are legit crisis pregnancy clinics. The IFPA section about their counselling service has some useful links and shows the locations where they provide services around Ireland. When you go to these counselling services in those links, the counsellor is legally obliged to tell you about your options including parenting and adoption. Remember, whether or not you continue your pregnancy is your choice, and you need to do what’s right for you.  

Be aware that there are other unethical “crisis pregnancy” services out there that are designed not to assist women but to push their anti-choice agenda.

You might not want to go to counselling, but bear in mind that it’s free and if you go to counselling with either Irish/ Northern Irish FPA, Well Woman, Femplus Clinics, One Family, Cork Sexual Health or here2help, and subsequently attend BPAS for a termination, you won’t have to pay the €80/€90 counselling fee that BPAS charge. A letter from the IFPA to say you attended counselling will waive the counselling fee charged at *any* English clinic.

There are lots of women who make their decision the second they find out they’re pregnant. There are lots who take some time to decide on their own. There are others who go to counselling. Do what works for you – but as soon as you make your decision to have an abortion, start the ball rolling on making the appointment.

So you’ve made a decision to have an abortion, what now?

How you proceed in accessing an abortion from here on, really depends on how much access to money you have. If you have money you can travel overseas to access termination services, and I’ll go into the logistics of this later. If you don’t have money to travel, there are still options.

The Abortion Support Network are an organisation that offer practical, non-judgemental information and advice, financial help and, when needed, accommodation in volunteer homes. They provide guidance on what is the cheapest way for you to have your abortion, and which clinics will be the best choice for you. Ring them before you make any appointment and travel plans. If it is a particularly busy time of year for UK clinics it may be cheaper and quicker for you to travel to the Netherlands or Brussels for your treatment (although you will definitely need a passport to travel there from Ireland). ASN has a network of volunteers in UK cities that will provide accommodation and meals for those who need or want to stay overnight – most women are able to travel in and out in one day.

The Abortion Pill

Abortion is illegal in almost all cases here so many women who don’t have the money to travel (or it simply is not an option for them because of their immigration status or relationship status or age or childcare arrangements) will illegally order the abortion pill from Women Help Women. The abortion pill is a safe medicine.

Some women in the 26 Counties have found that when they ordered this online that it was confiscated by Customs but to our knowledge, nobody has been prosecuted for attempting to receive pills online. In the 6 Counties however, there have been prosecutions for attempting to procure a miscarriage (there are criminal penalties for this in both jurisdictions). There are difficulties in ordering online, but it isn’t impossible. The medication is usually supplied in exchange for an €80 donation. Need Abortion Ireland help women access medications from Women Help Women.

Women on Web are another organisation that can sometimes deliver to Ireland. The organisation ROSA have twice partnered with Women on Web to drive a bus around Ireland to do consultations for pills and then the pills will be posted to you a few days later. This is worth noting if you’re using resources to travel to a place where the bus is going to be because they will take around 3 days to get them to you. It may be quicker to just order them online in many cases as Women Help Women take around 5 days delivery. Both Women Help Women and Women on Web are reputable providers of early medical abortion pill. However we understand that Women Help Women is faster to respond to client emails. There is another reputable provider of pills, called Safe2Choose, but they are not currently sending pills to the Republic of Ireland.

Both Women Help Women and Women on Web will ask you for a Northern Irish address in addition to your home address, or the address of the place you will be receiving the pills. If you do not have a friend in Northern Ireland, fill out the medical consultation and WHW or WOW will follow up with you.

Please do not attempt an abortion with any other remedy, herbal or otherwise, as you could inflict serious injury on yourself. While Women on Web and Women Help Women are trusted providers of the abortion pill, there is always a risk when buying medicine online when it comes from a source that isn’t trusted. 

A safe place to have your abortion

Once you’ve got your pills, you’ll need a safe space to take them. Most people will do that at home but for some that won’t be an option so they might go to a trusted friend’s house. Need Abortion Ireland’s site provides useful advice and self-care tips for when you’re having your abortion. They also provide care packages and a text message support service 089 490 2517 available 6pm – 9pm, 7 days a week. You can email them at info@needabortionireland.org The British Pregnancy Advisory Service (BPAS) also provide a hotline for those living in Ireland with medical questions/concerns about medical abortion pills. BPAS can be reached at 1800 910 049 (ROI) and 0800 077 6049 (NI). Here are some tips on what to do if you think you’re in an emergency medical situation.

Increasingly, there appears to be a clampdown in the North on women taking the abortion pill, and a tendency towards prosecutions. Two prosecutions have been brought because someone touted on their housemate, and another two were reported by doctors. You are legally allowed to travel (if your immigration status is regularised) so telling your doctor you’re pregnant, or having them perform a pregnancy test should not be an issue. You do not have to tell them that you intend to have an abortion.

The Money

Figuring out how to pay for it, whether it’s the €80 donation for Women Help Women or €450 to a clinic and another €300 for flights, can be the most traumatic aspect of this experience for many women. If you are purchasing pills from Women Help Women or Women on Web and do not have the full requested donation, they may be willing to accept a smaller donation amount. If you’re later on in the pregnancy, or decide to travel to England, your procedure will cost more. The Abortion Support Network can help you with this but you may not wish to ask for that assistance. If you’re low on phone credit, you can request a call-back from the abortion clinics. Here is a list of clinics.

Many women take loans from their local Credit Union to fund their abortion. Generally speaking, they will let you borrow twice what you have in savings if a guarantor will sign for it. If you don’t have someone who can act as guarantor, you may need to get a student loan in a bank, or check if you can activate an overdraft facility on your account. Each credit union has different rules so it’s best to ask the branch you’re a member of. If you are in receipt of a social welfare payment you might be eligible to join and borrow from your local credit union through the Personal Microfinance Scheme. This was a government scheme introduced to try and stop people going to illegal money lenders. Try to avoid going to the illegal moneylenders at all costs. You could also go to the Community Welfare Officer to ask for an emergency payment. Keep in mind though that you will need to provide a reason why you need this payment, and if you say it is for a washing machine there is a chance you will need to either provide proof you purchased a washing machine or an inspector may call to check your purchase. You could take a chance and tell the CWO why you need the payment as they have a wide range of discretion but you do run the risk of going to a CWO who is antichoice and won’t give you the payment.

Other women have sold items on ebay to fund their terminations, or borrowed smaller amounts from various siblings or friends. You might have some coins in an old jar that you can put towards it. Maybe you have a fiver in an old coat. Or a €20 left in an old Post Office account. Withdraw it. Depending on your circumstances and ability to travel, you could be looking at paying anything between €450 and €2,500 to travel overseas to have a termination. Remember that the Abortion Support Network can give advice on the least expensive way to arrange your abortion and travel in addition to providing financial assistance to those who can’t afford to travel.

The medical abortion (abortion pill) costs less if you’re ordering it online, around €80, but you can only do this up to 10 weeks gestation. Surgical abortions will cost more but it will be cheaper if you do it without anaesthetic. Abortion is available in Britain on a broad range of grounds up until 24 weeks gestation. After 24 weeks, abortion is only permitted in Britain to save a woman’s life or prevent serious permanent harm to her physical and mental health; or where a child is likely to be born with a serious physical or mental disability. The later the gestation, the more expensive the procedure. Irish women usually have later abortions because it takes them longer to get the money together to travel.

If you’re reading this and not pregnant, start putting money away in a rainy day fund now. Open a credit union account if you can.

bpas

BPAS price list for those travelling from Ireland – April 2017

plane

Travelling for your abortion

Skyscanner is useful for checking for the cheapest flights. Make sure you liaise with your clinic first so that they have an appointment time available to suit you and with ASN beforehand if you’re getting financial assistance. If you have any serious medical conditions or are later along or have a particularly high BMI, that clinic may not be able to perform the exact procedure and may need you to go to a different clinic, so make sure you’re giving them accurate information so that you can have your procedure the day you travel. Also, book your appointment before your flights because it will be easier for them to adjust your appointment time if necessary than it will be for you to change your flights if needed.

If you fly over, you will need a passport for Ryanair so budget for that. Aer Lingus will take a number of different photo id’s including a work id with your photo on, a student id or a social welfare id if you’re travelling to Britain. If you can’t get an appointment in the UK and are travelling with Aer Lingus or another airline to somewhere else in Europe, you will need a passport. You can apply for a passport here and it costs €80.

Once you get there, if you’re travelling to a BPAS clinic, they have an excellent series of PDFs that show you the transport links to clinics from the airport nearest you. NUPAS also have a free courtesy taxi service. If you’re travelling to a Marie Stopes clinic, they have a free taxi pick up service for their clients coming from Ireland. When you make your appointment, the clinic will give you directions on how to get there via public transport anyway.  

 Outside the clinic

When you get to the clinic, there may be protesters outside. Protesters tend to stay at larger clinics but they aren’t allowed on premises so if there’s a car park outside and you arrive by taxi, you won’t have to deal with that. This can be distressing for women but this link provides useful information. Just remember, you aren’t doing anything wrong. Don’t engage with them. Just keep walking. If you’re very concerned about it, call the clinic and explain this to them and someone will escort you in.

Inside the abortion clinic

When you get inside, don’t be alarmed by the fact there are other Irish women there. They are all there for the same reason as you. You will never see them again.

Information on the abortion treatment and procedures is available here.

The length of time you’ll be at the clinic depends on the type of procedure you’re having but it will be anything from 3 hours to an overnight stay. For example, if you’re having a surgical abortion up to 14 weeks it takes around 15 minutes with an hour of recovery time. If you’re having the abortion pill and you’re under 9 weeks you can take both tablets in one go, but over 9 weeks and you’ll have to take one tablet and then come back in 1-3 days (this is why having an accurate knowledge of gestation is so important), and of course staying longer will increase the cost of your stay in Britain. 10-14 women travel to Britain every day from Ireland for abortions and most of these go over and back on the same day.

Consider when you’re paying if you want to do it by cash or debit card. Most clinics won’t have the name of the clinic show up on the card but you can check with them in advance in case you’re concerned. Depending on the exchange rate that day, it could be cheaper for you to pay in cash with sterling.

If you need accommodation, the clinic you attend can probably send a list of reasonably priced B&Bs if you ask them. If you can’t afford accommodation, contact Abortion Support Network. Abortion Support Network do not provide accommodation for women having Early Medical Abortions.

If you need to account for being away for a day or two, you can say you were just going on holiday or that you had a job interview. Try to keep things simple. Remember that there is no shame in your abortion, you have done nothing wrong – regardless of whether you choose to tell people or not. If you would usually bring your Aunty Pat a fridge magnet from your holiday, and you’ve told her you’ve gone on holiday, try and do the same this time.

Travelling for abortion after 24 weeks 

If you need an abortion after 24 weeks because of a serious foetal condition, you may have to go to a specialist clinic for this. There are a few hospitals England that will provide the necessary treatment but you may have to wait a few weeks for an appointment. Depending on the stage of pregnancy and your medical requirements, the procedure may differ so it is best to speak directly to the hospital about the costs. In some late term abortions, the procedure is that the foetal heart is stopped and then the foetus is subsequently delivered. What some women have found in Ireland is that it costs around €1,500 for the first part and another €1,500 for the delivery so they opt to travel the first part done in Britain, and then return home to deliver the foetus in an Irish hospital where they have the support of their family. This also removes the cost of transporting foetal remains home to Ireland for burial. Some women simply prefer this option. Please do not be alarmed by these figures. Liverpool Women’s charges around £1634 for the whole procedure including the stay at hospital with your partner and it really depends on your particular needs.

If your pregnancy has been diagnosed with a fatal foetal anomaly, you are not alone. You can contact AnteNatal Results and Choices (ARC), a UK charity helping people understand their diagnosis and providing information. You can also contact Termination For Medical Reasons, a group in the Republic of Ireland made of women and couples who have made the trip to England to terminate pregnancies for medical reasons. They have a support group called Leanbh Mo Chroi – 086 3745474 or leanbhmochroi@gmail.com.

If you are in care….

If you are in residential or foster care, you have the right to travel to access abortion services. Contact your social worker to make these arrangements for you. Be aware, that in many cases where young people in care have attempted to seek abortions overseas, they have had to go through psychiatric assessments with the HSE and there have been court hearings.

If you need a visa to travel…..

If you are an asylum seeker, there is provision for you to get travel documents to access abortion overseas but it is an arduous process. You solicitor can also seek funds from the HSE via court order to assist you with the cost of travelling.  You can contact the IFPA for more information on getting the assistance to travel from the HSE. As outlined here, you will need two visas, one to leave Ireland and one to make sure you get back in. If English is not your first language, let them know when you are booking your appointment, in many cases, a translator can be provided.

If you are a migrant or a refugee the best places to go if you need a visa to travel are:

MRCI Migrants Rights Centre Ireland http://www.mrci.ie (01) 889 7570

IRC Irish Refugee Council www.irishrefugeecouncil.ie  (01) 764 5854

The MRCI and IRC share a Dublin office.

Depending on what country you are from, it may be easier for you to get a visa for The Netherlands or Belgium.

A legal abortion in Ireland?

If there is a real and substantial risk to your life, including a risk of suicide, you may be entitled to an abortion in Ireland. This is not guaranteed. In the Ms. Y case, the young woman was suicidal but was ultimately coerced under threat of legal action to undergo a c-section at 24 weeks despite being deemed suicidal. We are aware of another case where a suicidal woman was granted an abortion though, but there are too few cases at the moment to predict how applications will be treated. If there is a risk to your life because you are suicidal as a result of your pregnancy and want to seek treatment in Ireland, speak to your GP. It may be best to make alternative plans to travel simultaneously in case your request for a termination is denied. If you are suicidal, there is a list of contacts that may be of assistance to you here.

After your abortion

When you return, you should attend for a post-abortion check up with your GP or with the IFPA or a Well Woman Clinic. Post-abortion check-ups are free as they are state funded. Post-abortion counselling is also free. A list of clinics where you can access non-judgmental counselling is here. From a doctor’s point of view, a medical abortion (an abortion using the pill) is indistinguishable from a miscarriage. You don’t have to tell your doctor about it, but there’s some useful information here and here that may help you make that decision. Be aware that if you tell your doctor you took the abortion pill illegally in Ireland, there is a chance they may report you to the authorities. Your doctor is not legally obliged to report you in the South, but doctors are legally obliged to report you in the north. It may be worthwhile travelling to access post-abortion care from a provider you know will not report you.

Take it easy. Consider your future contraceptive needs. Talk to a friend or a professional if you feel you need to but don’t feel you have to. It can be a big emotional deal even when you’re 100% confident you made the right decision. So most of all, be kind to yourself.

takecare

Budgeting for your abortion overseas – A Feminist Ire Cut Out & Keep Guide

Cost
Pregnancy tests
GP Visit
Phone credit for making calls to clinic / booking flights
Passport or ID Cost
Cost of travel documents or solicitor consultations to get them
Dating scan (optional)
Getting to ferry or airport (bus or taxi fare) or alternatively, airport parking plus petrol costs
Plane or ferry ticket cost
Plane or ferry cost for partner or friend accompanying
Phone credit for journey
Cost of printing documents (boarding pass, utility bill etc).
Accommodation
Fee for Abortion Treatment
Cost of Contraception
Food
Painkillers
Sanitary towels
Travel from clinic to airport
Travel from airport to home
Childcare fees
Miscellaneous
TOTAL

@stephie08

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All your wombs belong to us – The State, Ms. B and Forced C Sections

The High Court decision in HSE v B has been made public today (I’ll edit to add a link once it’s available). A month ago, a woman who wished to undergo a vaginal birth after three c-sections found herself in the High Court as the HSE attempted to have her compelled to undergo a fourth c-section against her consent. The HSE case was based on the notion that the Eighth Amendment rendered them more appropriate to decide what was best for her pregnancy than she was. This is a landmark decision, because for once, it’s a maternity rights case where the resulting decision hasn’t been completely terrible.

The judgment is long and make no mistake, there is no judicial feminism in here; the Court is at pains to point out throughout the judgment that they have no idea why this woman would possibly want a vaginal birth. But ultimately it goes on to state (at Paragraph 21):

“The court concludes that it is a step too far to order the forced caesarean section of a woman against her will even though not making that order increases the risk of injury and death to both Ms. B and her unborn child.”

Essentially this means that the Court recognises the right of the HSE to pursue a case against a heavily pregnant woman on the basis of the Eighth Amendment, but the idea of legally compelling a woman to undergo a caesarean including the sedation, anaesthetic, the surgery, the pain, the recovery….and all that goes with it, was a little bit too much even by an Irish High Court’s standards.

Maternity rights activists in AIMS have been pointing out for years that the Eighth Amendment is not just a tool of coercion for women who want to access abortion services, but that it is used just as regularly against women who are continuing their pregnancies. They report that women are regularly told the guards will come to get them if they don’t turn up for their scheduled inductions. Being threatened with the guards coming to your door when you’re in the full of your health and not in a vulnerable pregnant state is one thing, but threatening a woman on the brink of her due date is quite another – it is beyond bullying, it is obstetric violence. And as AIMS have pointed out, it usually ensures that women will go along with whatever is being forced upon them by the HSE. The prospect of being brought to court, like Ms. B was, is too much for most.

The ruling is not completely terrible in that it finds that the risk to the “unborn” is not so great that it warrants overriding Ms. B’s rights to have a c-section forcibly performed on her, however as is the practice with Irish judgments there is no sense of what might constitute a *risk* to the unborn that is sufficient that a woman may have some other form of medical intervention performed on her against her will. We are not out of the woods yet. As long as the Eighth Amendment remains in the Constitution, this will not be the last Court case on the matter.

While this was a case concerning a woman who fully intended to carry her pregnancy to term, it has important implications for the tiny number of women who may find themselves before panels of doctors in an attempt to access abortions under the Protection of Life During Pregnancy Act. In the Ms. Y case a young asylum seeker, pregnant as a result of rape was deemed by a number of doctors to be suicidal. However, the HSE also felt that the way in which to avert the risk of suicide would be to perform a cesarean section on her at 24 weeks gestation instead of the abortion she requested as soon as she found out she was pregnant at 8 weeks. When Ms. Y went on hunger and thirst strike, the HSE sought and received a court order to forcibly hydrate her. The threats of court were uttered in relation to the c-section, and Ms. Y gave birth against her wishes by c-section as a result. We now wonder whether the Ms. B judgment had been delivered earlier and Ms. Y’s counsel fought the HSE at the outset of a c-section being mentioned, would the outcome have been different? Ms. B is yet another judgment to add to the mounting stacks of obstetric violence entering the courts that don’t really give us clarity one way or the other.

What is clear though is how the Eighth Amendment does not just impact those seeking abortions, but on the broader spectrum of reproductive justice. The Eighth Amendment along with a warped mentality of maternity care that infantilises women leads medical practitioners to coerce women into interventions out of a fear that they will be found to have not protected the “right to life of the unborn.” Criminalising those accessing abortions, threatening women who want natural births with garda interventions or dragging women like Ms. Y and Ms. B into the courts is obstetric violence. It demonstrates that regardless of the circumstance or your wishes in pregnancy, the State via the HSE will treat you as a vessel with no competence to make your own choice. There is no autonomy within maternity “care” and doulas are viewed with at best suspicion and at worst, contempt. There is a separate system of medical consent for pregnant women that mean effectively forced c-sections happen every day. They don’t enter the courts, but when the decision to agree to a c-section you don’t really want is made because you can’t take the bullying from medical practitioners or because you believe they will take you to court, is it really not forced?

Any kind of surgery against your will would be unpleasant to say the least. I can’t imagine getting a tooth out without having given full consent. But a forced c-section is a whole other level of violence. It is misogynist and it is degrading, and it is the State sponsored infliction of terror on pregnant women. There is no way you can undergo surgery you have been coerced into and not feel a profound blow to your sense of bodily autonomy and integrity, and those conditions are ripe for birth trauma and postpartum post-traumatic stress disorder. Women are gaslit and told their ideas about what should happen during birth are simply “baby brain” and the parallels with domestic violence are striking; indeed many women first experience violence in a relationship when they become pregnant. This is gender based violence, and if anyone objects to that analysis, then please, show me the judgment where the HSE attempted to compel a non-pregnant person undergo major invasive surgery, then colluded with the courts to make sure it happened.

What exactly will it take to ensure women are afforded autonomy over their pregnancies? Obstetric violence and coercion of pregnant women is abuse, and it is a major public healthcare problem in Ireland. Having an unwanted vaginal exam performed on you without consent is a form of violence against women that is no less real than violence against women in the home. We need to start addressing it as such so that the structural and systemic aspect of it can be picked apart and broken and so that no more Ms. Y’s or Ms. B’s find themselves before the Courts. We need to repeal the Eighth Amendment.

@stephie08

Canadian court approves drug injection facility. Is sex work next?

The Canadian Supreme Court issued a landmark decision today in Canada v PHS Community Services, a case concerning the Vancouver supervised drug injection facility Insite.

Insite had been operating for several years, and there was both anecdotal and scientific evidence to demonstrate its effectiveness in keeping injecting drug users alive, improving their access to safe injection information and encouraging them into treatment – without leading to increased numbers of new or relapsed users. It operated under a discretionary exemption to federal drug laws, an exemption which the Conservative government eventually decided not to renew.

The Court had a few questions to answer, but the key one from my perspective was whether this decision breached Insite users’ rights under Section 7 of the Canadian Charter of Rights and Freedoms, which states:

Everyone has the right to life, liberty and security of the person and the right not to be deprived thereof except in accordance with the principles of fundamental justice.

The Court unanimously ruled that it did. It stated:

 The Minister made a decision not to extend the exemption from the application of the federal drug laws to Insite. The effect of that decision…would have been to prevent injection drug users from accessing the health services offered by Insite, threatening the health and indeed the lives of the potential clients.  The Minister’s decision thus engages the claimants’ s. 7 interests and constitutes a limit on their s. 7 rights…this limit is not in accordance with the principles of fundamental justice.  It is arbitrary, undermining the very purposes of the CDSA, which include public health and safety.  It is also grossly disproportionate: the potential denial of health services and the correlative increase in the risk of death and disease to injection drug users outweigh any benefit that might be derived from maintaining an absolute prohibition on possession of illegal drugs on Insite’s premises.

In response to Canada’s argument that it was a “policy question” whether or not to grant such exemptions – you can read this argument as saying “we know we haven’t got a leg to stand on as far as evidence is concerned, but we should be able to impose our moral and ideological view anyway” – the Court stated:

The issue of illegal drug use and addiction is a complex one which attracts a variety of social, political, scientific and moral reactions. There is room for disagreement between reasonable people concerning how addiction should be treated.  It is for the relevant governments, not the Court, to make criminal and health policy. However, when a policy is translated into law or state action, those laws and actions are subject to scrutiny under the Charter…The issue before the Court at this point is not whether harm reduction or abstinence-based programmes are the best approach to resolving illegal drug use.  It is simply whether Canada has limited the rights of the claimants in a manner that does not comply with Charter.

So strongly did the Court feel about the matter that it did not, as I had feared it might, take the easy way out and issue a mere declaratory order (essentially, one that acknowledges a right was violated without requiring any concrete action on the government’s part). Instead, it mandated the Minister for Health to grant the exemption. Although exemptions are discretionary, it stated, that discretion must be exercised in a manner compatible with the Charter – and

 On the trial judge’s findings of fact, the only constitutional response to the application for a s. 56 exemption was to grant it.

Clearly, this is a massive victory for the users of the Insite facility, for harm reduction principles, and for simple common sense. It’s also a welcome step along Canada’s slow path of developing a constitutional right to health (like Iarnród Éireann, they’re not there yet, but they’re getting there). And finally, it points in a favourable direction for the outcome of another landmark case, Bedford v Canada, a challenge to laws that criminalise various aspects of sex work.

To summarise Bedford briefly, it concerns provisions of the Canadian Criminal Code that outlaw keeping a “bawdy-house” (which basically means any place regularly used for commercial sex, even if by only one sex worker), living off the proceeds of another person’s sex work, or communicating in public for the purposes of engaging in paid sex. These provisions were struck down by an Ontario Court on the basis of absolutely mounds of evidence showing that they materially contributed to sex workers’ risk of violence – without having any demonstrable effect on the amount of paid sex actually taking place. Judge Susan Himel found that

there are ways of conducting prostitution that may reduce the risk of violence towards prostitutes, and that the impugned provisions make many of these “safety-enhancing” methods or techniques illegal.

The parallels to the Insite case should be obvious. Both concern behaviours that the government wishes to condemn on moral grounds, and the use of criminal laws as a tool of its condemnation. Though in both cases a deterrent effect was also alleged, this was not supported by the evidence before the court. To the contrary, the only effects demonstrated were threats to the lives and safety of vulnerable people affected by the laws – in violation of their Charter rights to life, liberty and security of the person.

Of course, the two cases aren’t entirely analogous. Insite concerns the direct provision of a type of medical care, while Bedford is really about avoidance of harms caused by third parties (there is a significant body of evidence linking criminalisation of sex work with diminished access to health care, but the plaintiffs didn’t make that argument). And it was significant in Insite that addiction is viewed as a disease: the Court saw this as undermining Canada’s claim that it is not drug laws, but rather drug users’ behaviours, that give rise to the dangers they would face if the injecting facility was shut down. In the ongoing Bedford case, Canada is continuing to blame sex workers for their own risks, and “disease” is obviously not something the plaintiffs can (or would want to) come back with.

Nonetheless, it’s hard not to see the Insite judgment as a decisive victory for evidence over ideology, a rejection of the imposition of laws that have a demonstrably harmful effect on a particular population and no apparent beneficial effect apart from making some people feel good about the morally-derived “message” conveyed. And that has to bode well for the future of Bedford (currently awaiting an appellate decision, which itself is likely to be appealed to the federal Supreme Court). It’s still always possible that the courts will find the Criminal Code provisions against sex work so materially different to the withdrawal of Insite’s exemption that a different ruling must apply. But if I was Terri Jean Bedford, or any Canadian sex worker, I think I’d be wearing a hopeful smile today.

Sweden’s sex trade laws: not the answer

(Article by Stephanie Lord and Wendy Lyon)

There has been much debate recently around the introduction of the Swedish model of legislation to criminalise the purchase of sex. Championed by a group of well-meaning NGOs, and some with questionable origins, considerable column inches have been devoted to discussion of the benefits of criminalising the purchasers of sex workers’ services. For those who believe in women’s equality and oppose trafficking, it appears to be a safe enough endeavour to support. We are told by the “Turn Off the Red Light” campaign that all prostitution, regardless of consent, is a form of violence against women; that if demand for paid sex is eradicated, prostitution will end; that this is the best thing for women; that it has decreased prostitution in Sweden; that it reduces the numbers of women and girls trafficked and so on. It is unsurprising that people support this. Everybody is against trafficking, right?

But does it actually work? In short – no. In this debate, where you stand on the morality of a person commodifying their sexual services is irrelevant. If the goal of the Swedish legislative model is to eradicate prostitution and end the exploitation of women – it doesn’t work. To date, no evidence has been produced that the Swedish model has reduced the amount of prostitution. Not a single independent review has found this to be the case. Yes, the Swedish are correct when they say that street prostitution has decreased – but street prostitution in Sweden, as in every other country, is only a tiny percentage of total prostitution. As the Swedish Government’s 2010 Submission to UNAIDS stated, “Estimates of the number of people involved in commercial sex in Sweden vary widely and are very hard to estimate since it is mostly hidden and initiated primarily through the Internet or telephone. Although street prostitution does occur it is assumed to be only a fraction of total prostitution.”[1]

This is really not surprising, as criminalisation has never been successful in deterring prostitution in any country. Further to this, it hasn’t reduced trafficking to Sweden either. Consistent Swedish annual police reports confirm that sex trafficking is there and is even increasing. The law is seen as hindering traffickers from establishing operations in Sweden – but they are still easily able to operate from outside Sweden’s borders, which the police say makes it more difficult to apprehend traffickers.[2] It has also been reported[3] that clients are now less likely to report suspected trafficking cases since it may result in them being charged.

Proponents of the law believe that this model will work because many of them have looked to the Swedish government’s own evaluation of the law[4] – a bizarre approach, considering that most would never take it for granted that an Irish government evaluation of one of its own initiatives painted an accurate picture of reality. The Swedish government’s evaluation of the law has been widely criticised by many commentators – including Sweden’s Discrimination Ombudsman,[5] the Swedish Federation for Lesbian, Gay, Bisexual and Transgender Rights,[6] and the Swedish National Board of Health and Welfare[7] – for its bias, lack of research, unsupported conclusions, unclear methodology and exclusion of sex workers’ own voices. The evaluation said that police had no evidence of increases in off-street prostitution. However, it acknowledged that police do not normally investigate off-street prostitution unless it is linked to trafficking – so how do they know the extent of it?

We do know that in 2010 the number of prostitution reports increased five-fold over the previous year, but Swedish police say this was not due to an increase in prostitution but merely to greater resources being applied to tackle the issue.[8] This is absolute proof that there is a significant amount of sex work going on below the police radar.

More importantly, Swedish sex workers have reported significant adverse consequences as a result of the law – including that it has deterred some of the “ordinary” clients who only want regular sex, but has not deterred the dangerous ones.[9] In short, criminalising the purchase of sex in Sweden has meant for Swedish sex workers that the odds of any particular client turning out to be dangerous are much higher. According to the sex workers – as opposed to their self-appointed spokespersons – since the clients are more nervous about being caught, the decision about whether to accept them has to be made much more quickly and without adequate time to assess whether they are dangerous.[10] For them, the loss of “ordinary” clients now means they have to accept clients they would not otherwise accept, including those who demand sex without a condom.[11] By making direct contact between buyer and seller more difficult, the law is also said to have increased the power of intermediaries (or in common language, pimps).[12]

It has been widely recognised in the HIV/AIDS sector that sex workers who are not able to control their working conditions, most importantly condom negotiation, are at a higher risk of infection.  This is the reason why virtually the entire global health sector supports the decriminalisation of sex work and granting sex workers occupational health and safety rights. The World Health Organization,[13] UNAIDS,[14] the Office of the High Commissioner on Human Rights,[15] the UN Secretary General,[16] the UN Special Rapporteur on the Right to Health[17] – all of these have called for the removal of laws criminalising commercial sex between consenting adults, primarily because criminalisation is a recognised risk factor for HIV/AIDS.

It is a mistake to assume that criminalising only the clients removes this risk factor. In Sweden’s UNAIDS Submission, only 18.5% of sex workers reported using a condom with their most recent client.[18] The health and safety complaints raised by Swedish sex workers since implementation of the law are virtually identical to those raised by sex workers in jurisdictions where sex-sellers can also be prosecuted.

The Swedish evaluation acknowledged that sex workers feel stigmatised, hunted and stripped of capacity under the new law – but said this was a good thing since the aim of the law is to combat prostitution. [19] To sell this to the Irish public as something that will stop exploitation of women is a lie. It is, in fact, comparable to saying that drug addicts should have to use dirty needles because it might stop them injecting! Although, while we’re on the subject, this is similar to the approach Sweden takes to drug addiction – it has largely rejected harm reduction[20] in favour of penalisation and abstinence-based treatment – which doesn’t work.

Sex workers have been consistently denied a voice in the Swedish debate. So far, they have also been denied a voice in the Irish debate. Last year, the Irish Department of Justice went to Sweden to learn about its policies and did not meet with a single sex worker or representative organisation.[21] It is a major violation of their human rights to adopt a law that affects their lives without giving them a primary role in shaping the debate.

It is important to understand that the alternative to the Swedish or Irish models is not “legalisation” as found in places like the Netherlands, Nevada, and parts of Australia. Those schemes are aimed at controlling the public order aspects of prostitution, rather than safeguarding sex workers’ rights. A truly rights-based approach would look more like the model in New Zealand, in which most sex work is not “legalised” but decriminalised. New Zealand sex workers made a significant contribution to the scheme’s design, and while the law that was ultimately passed is not perfect, it does give sex workers more rights than any other jurisdiction in the world – including an absolute right to refuse a client or service, protection under occupational health and safety legislation, and the important safety mechanism of being allowed to work together, in pairs or small groups.[22] It is hardly surprising that New Zealand sex workers overwhelmingly respond positively to questions about their rights under the law.[23] The same cannot be said about the Swedish law. Not even the Swedish government makes such a claim.

Everybody wants to see an end to forced prostitution and trafficking. Sex workers themselves are very well placed to assist in this campaign, and their contribution should be welcomed and encouraged. The Swedish law does the opposite: it encourages them to avoid police and social services rather than engage with them. Coercion and abuse can never be addressed by making an industry more hidden and denying labour rights to the people working in it. Just as they would in any other sector, it is the exploiters who benefit when we decide that the sex trade is “different” and so basic standards of labour law should not apply.


[1] Government of Sweden, ‘UNGASS Country Progress Report 2010’ p.63

[2] National Criminal Police of Sweden, ‘Trafficking of Human Beings for Sexual and Other Purposes: Situation Report 9’ (2006) p.18

[3] Ministry of Justice and the Police of Norway, ‘Purchasing Sexual Services in Sweden and the Netherlands: Legal Regulation and Experiences’ (2004) p.19

[6] Federation for Lesbian, Gay, Bisexual and Transgender Rights, ‘Prohibition of the Purchases of Sexual Services: An Evaluation 1999-2008

[8] The Local, ‘Big Increase in Prostitution Reports’ (2010)

[9] Ministry of Justice and the Police of Norway (n3), p.13

[10] Johannes Eriksson (Rose Alliance), ‘What’s Wrong with the Swedish Model’ (2006) p.4

[11] Ibid.

[12] National Board of Health and Welfare of Sweden, ‘Prostitution in Sweden 2007’ pp.47-48

[18] Government of Sweden (n1) p.25

[21] Freedom of Information request obtained from Department of Justice (2011).