Abortion medications have served to improve the safety of self-managed and at-home abortions, but the associated legal risks make them significantly more unsafe in cases where people feel unable to access emergency medical care in the event of complications [6].

The ending of pregnancy done with the intent to obtain a miscarriage outside of the conditions of the AA 1967 is illegal, and the pregnant individual or any person who assists, can face life imprisonment.

Abortion-permissive legal frameworks enable the provision of abortion, bound by specific restrictions. An abortion-permissive regime such as that operating in Great Britain has made some headway in improving access to abortion over time, but the aspects of such a regime that label it permissive rather than supportive of abortion have highlighted the potential of limiting and endangering safe access to abortion [4]. Scholars of bioethics have emphasised the importance of access to abortion without legal risk, beyond a rudimentary legal right to abortion [4, 7, 8]. Here we can draw a key differentiation between access and rights, understanding that rights without access achieve fewer positive outcomes for people than access without rights. I differentiate between abortions rights and abortion access so as to highlight cases in which even within the context of abortion-permissive legal frameworks, barriers to access remain considerable and restrictive [4]. Such barriers can be legal (i.e. procedural requirements that delay care, extra-legal barriers that make it impossible to access abortion through formal channels). Barriers often have the most considerable impact on socioeconomically disadvantaged or disabled individuals [9].

Miani and Razum (2021) argue that the fragility of abortion legislation in Europe is a ‘public health crisis in the making’. Across many European countries including Great Britain, abortion is accessible, but in many cases still a crime [10].

On Monday 12th June 2023, Carla Foster was sentenced to 28 months in prison after using abortion pills to terminate her pregnancy, under the Offences Against the Person Act of 1861. The legal maximum sentence for offences under the Offences Against the Person Act remains life imprisonment. This is the harshest abortion penalty in the world [11]. The 44 year-old mother of three was prosecuted for the use of the ‘pills by post’ initiative outside of the legal period of 10 weeks’ gestation. Stoke on Trent crown court found that the individual had misled a British Pregnancy Advisory Service (BPAS) employee by claiming to be only seven weeks pregnant, when she was in fact between 32 and 24 weeks into her pregnancy [12].

The ‘crime’ committed occurred only a few months into the global pandemic when face-to-face support and medical advice was largely unavailable. Foster told the court that she had been unsure of the length of her pregnancy and had not consulted a doctor out of ‘embarrassment’, as she found herself pregnant and ‘in emotional turmoil’ as she tried to conceal the pregnancy [12].

While sentences like Foster’s are rare, the number of individuals being investigated by the police for the procurement of abortions have risen markedly over the last three years [13]. In the face of such trends, pro-life groups across the globe have become further emboldened, particularly following the US Supreme Court’s decision in June 2022 to overturn Roe v. Wade. The battle over individual’s bodies has become strikingly apparent beyond the American context.

Where does this leave us?

Legal experts such as Nazir Afzal have critically questioned whether it was in the public interest to prosecute Carla Foster. Prior to sentencing, multiple doctors and public health officials urged the judge not to impose prison time at risk of deterring other women from seeking appropriate and necessary medical care in the future. Foster, who poses no risk to society, is now being punished far more harshly than most rapists in the country. This case clearly demonstrates the fact that current British legislation is not fit for purpose [14].

Carla Foster’s original sentence stipulated that she be imprisoned for longer than the average prison sentence for violent assault in the UK. Her case has illustrated the archaic, draconian laws that are still governing women’s bodies, and the reform needed within British legislation to ensure that no individual facing pregnancy in difficult circumstances is criminalised. Foster’s case has prompted renewed calls to reform the legal framework governing women’s bodies that predates women’s right to vote [15].

Abortion is a common and essential health intervention. Studies estimate that around 73 million induced abortions take place across the world every year [16]. In 2022, the World Health Organisation (WHO) recommended against the use of legal and procedural barriers, including criminal law, to regulate access to abortion. Expansive evidence tells us that abortion is safer in jurisdictions where it is legally accessible, where individuals are significantly more likely to have access to higher quality care [17].

As a matter of health equity, expansive abortion rights must be guaranteed beyond merely permissive legislation. Legislative reform must happen soon to avoid a public health crisis through the control of individual’s bodies and restrictions to necessary medical procedures.