Research into protests and vigils that take place outside clinics and hospitals offering abortion care

Chapter one: Introduction

This research was conducted by Rocket Science on behalf of the Scottish Government. Rocket Science are an independent research and evaluation organisation who were commissioned to examine the prevalence, scale and impact of protests and vigils taking place outside of healthcare facilities that offer abortion care in Scotland. Specifically, the research was undertaken to:

• examine the prevalence, frequency and scale of vigils and protests which occur outside of healthcare facilities providing abortions.
• explore the impact of vigils and protests on patients’ ability to, and experiences of, accessing abortion services in Scotland.
• understand the perspectives and motivations of those involved in protests and/or vigils.

This research was completed prior to the Safe Access Zone legislation coming into effect. The research began in August 2022 and was completed in August 2024.

1.1. Language and terms used

It is acknowledged that given the emotive nature of this subject, and the often polarised views held, there is no definitively neutral language that can be used to discuss this topic. Whilst this report attempts to use objective and inclusive terminology as far as possible, we recognise that this is unlikely to be perfect.

The use of the term patient is also used as an inclusive, though imperfect, label to describe those who access abortion care. We do so in acknowledgement that for some this may be stigmatising or not accurately represent how they identify in relation to the service they are accessing.

According to Solon et al. (2022) the term ‘pro-life’ emerged in the late 1960s and the term ‘pro-choice’ followed soon after. There has, however, been a lack of examination of what these terms mean, and to whom, in either public or academic discourse. Solon et al. (2022) suggest that there is a prevailing notion that these are two polarised positions. They note that this gives the appearance of a false dichotomy that serves to over-simplify the complexity of perspectives that exist within these terms. In this report, we acknowledge the complexity of both terms, and so seek to use the terms sparingly. We use the terms ‘pro-life’ and ‘pro-choice’ only when relevant to the material being analysed and presented within the report. We do, out of necessity, rely on a somewhat over-simplified definition, where ‘pro- life’ is understood to mean organisations or individuals who believe that life begins at conception, and who are against the provision of abortion healthcare for this reason. We use a similarly over-simplified understanding of the term ‘pro-choice’, which is understood to mean organisations or individuals who believe that access to abortion healthcare is a right, and who campaign to protect this right.

Finally, throughout the report we use the terms protestor and/or vigil attendee, and protest and/or vigil. Although we recognise that these represent different activities to raise objections to the provision of abortion healthcare, we deliberately do not offer definitions or distinctions between these. Rather, we use the terms to describe all relevant activity which occurs outside of healthcare facilities.

1.2. Background to the research

The research was commissioned to provide an objective assessment of the prevalence and impact of protests and vigils in Scotland, after the Scottish Government became aware of concerns from healthcare providers indicating that protests and vigils were negatively impacting access to abortion care.

There has been discussion about the impact of protests and vigils outside healthcare facilities offering abortions in Scotland since as early as 1999, when the organisation Precious Life Scotland protested in Glasgow using what was described as “intimidating tactics and policy of personal harassment” by the Brook Advisory Organisation (BBC, 1999). More recently, there has been frequent media coverage of vigils and/or protests outside of healthcare services, predominately in Glasgow, which again have raised concerns within the media, with abortion providers, NHS staff, patients and campaign groups (Brooks, 2022; Nutt, 2022). At the same time, the United States Supreme Court’s decision to overturn the Roe v Wade (1973) ruling, which ended the constitutionally protected right to an abortion in the United States, has led to increased activity globally by organisations which oppose abortion healthcare (Dimsdale, 2022).

Abortion law was devolved to the Scottish Parliament on 23 May 2016 as part of the Scotland Act 2016. Whilst legislation imposes a set of conditions under which abortions can be provided^[1], the Scottish Government continues to work on improving access to abortion care. Public Health Scotland provides yearly statistics on the number of women terminating a pregnancy within Scotland. Figures show that in 2022, the termination rate was 16.1 per 1000 women aged between 15 and 44 years (Public Health Scotland, 2023). In total, there were 16,584 terminations for Scottish residents, which was an increase of 2,653 from the previous year. In 2023, 18,207 terminations took place in Scotland, representing a 10% increase in service demand compared to 2022 (Public Health Scotland, 2024). Increases were observed across all age groups and in all NHS board areas.

In 2023, almost all terminations (98.1%) were medical, rather than surgical procedures. In 2022, 98.8% of terminations were medical. In March 2020, the Scottish Government issued an updated approval under section 1(3A) of the Abortion Act 1967 (which was further revised in May 2022) to allow the drugs prostaglandin and antiprogesterone (mifepristone and misoprostol), which induce abortion, to be taken at home when deemed to be clinically appropriate for the patient involved. The term Early Medical Abortion at Home (EMAH) refers to situations where either or both the first and second drug used in a medical termination are taken at home. In 2023, 57.6% of terminations occurred fully at home, and 23.6% involved the second drug (only) being taken at home.

Terminations in a clinic or hospital setting accounted for 16.9% of terminations in Scotland in 2023. Despite this, protests and vigils continue to occur outside healthcare settings that provide abortion treatment.

There has been legislative activity in relation to the introduction of safe access zones around healthcare settings that provide abortion services. In summer 2022, Gillian Mackay MSP ran a public consultation on safe access zones which received almost 12,000 responses. Following this, the Scottish Government agreed to work with Gillian Mackay MSP to deliver her Member's Bill and in June 2023 the proposal for the Bill was lodged. Gillian Mackay MSP introduced the Abortion Services (Safe Access Zones) (Scotland) Bill to the Scottish Parliament in October 2023. The Bill was passed in June 2024 and became an Act of Parliament in July 2024. The commencement date was 24 September 2024.

1.3. Our approach to the research

A research framework was developed by Rocket Science and approved by the Scottish Government to ensure that the research questions were addressed. This can be found in Appendix one.

The methods employed for each element of the research are detailed in the relevant sections of this report. In summary, the methodology included a rapid evidence review to examine what the international literature can tell us about the impact of protests or vigils outside healthcare facilities that offer abortion care; a digital and social media content analysis, with a quantitative tracking of posts, and the qualitative analysis of the content of the posts; observations of protests/vigils to improve understanding of the nature and scale of vigils and protests; in-depth qualitative interviews with individuals currently involved in organising protests and vigils; online surveys and interviews and focus groups with NHS staff; and tracking social media posts and analysis of incident data reported to Police Scotland to understand the prevalence and scale of protest and vigil activity.

1.4. Limitations of the research

The research team was unable to engage anyone who has received abortion care to participate in the research. This limits us in drawing any conclusions in relation to whether protest and vigil activity outside of healthcare facilities impacts upon access to and/or experience of abortion care.

There was a low response to the survey designed to capture the prevalence, scale and nature of protests/vigils outside of health facilities within the five primary sites included in this study. This is due to a number of factors including a reported absence of protest/vigil activity in some areas, activity starting and finishing whilst staff are on shift (so they are not aware of any vigils/protests), and such activity taking place away from the main sites where abortion care is delivered.

There was also limited engagement from those who coordinate or participate in protest and vigil activity. The proposal of the Abortion Services (Safe Access Zones) (Scotland) Act was cited by those coordinating or participating in vigils and protests as a reason for not participating in this research.

Rocket Science attempted to gain access to appointment data from NHS sites, but this was not possible due to staffing constraints.