Back Off Chalmers: protect those accessing abortion services

Talking to the campaign Back Off Chalmers, Katie Pickup explores the impact of anti-choice protesters at abortion clinics and discusses some of the science behind abortion.

Back off Chalmers campaign logos. Image credit: beeillustrates

Imagine you have made a deeply personal decision and are seeking medical treatment. Now you are being heckled and shamed on the way to the medical centre, making the whole process so much more stressful and uncomfortable. This is the situation for over 100,000 people a year in the UK who visit abortion clinics targeted by protesters. 

Back Off Chalmers, an Edinburgh-based campaign, is advocating for a “buffer zone” to be implemented around Chalmers Sexual Health Clinic near the University of Edinburgh, preventing anti-choice groups from protesting against abortion within a 150 metre radius of the clinic. They also aim to expand their reach and make buffer zones a requirement around all clinics offering abortion in Scotland. I spoke to Ella Cheney from the campaign and asked her to explain the key issues they are trying to address.

“Chalmers is a clinic where there are currently, and have historically been, a significant amount of anti-choice protests outside. Some of this has been very peaceful and some of it has been less peaceful, but we are of the opinion that any anti-choice protest outside a clinic doesn’t create the right environment for someone who’s going in to access essential medical services.” 

These protests are by no means unique to Chalmers or Edinburgh, and Cheney explains that while the anti-choice protests are sometimes accompanied by pro-choice counter vigils supporting visitors to the clinic, this can still be incredibly disconcerting. “You can’t just focus on what you yourself are choosing to do that day. And if only anti-choice protesters are present, this creates an actively hostile environment outside of the clinic.” Clinics like Chalmers also offer a range of sexual health services other than abortion, so these protests impact people accessing contraception and STI checks as well. 

People’s experiences with protesters can differ a lot. Cheney points out that personal circumstances influencing someone’s confidence in their decision may affect the protests’ impact on them. She also stresses that certain groups may be particularly adversely affected. “You have vulnerable populations accessing abortion clinics: for example people with learning difficulties, people who have experienced domestic abuse, people who are trans and non-binary, people who already face barriers accessing these services, especially when there are hostile parties outside.” She notes that the protests sometimes involve transphobic commentary as well as anti-abortion sentiment. “I think situations can be very different depending on who you are and what you’ve experienced.”

As freedom to protest is an important right, I asked how the campaign differentiates these sorts of demonstrations from protests targeting political establishments or companies. “If you are protesting about governments and institutions then it’s not about individuals and their personal decisions. That’s the key difference. We also have a legal obligation to support essential access to medical services, including abortion. That is not coherent with having people harassing those trying to access essential services. The concept of it being a freedom to protest issue is misleading because it’s really an anti harassment issue.”

Progesterone, illustrated here, is one of the key hormones driving menstruation. Mifepristone, the first pill taken during a medical abortion, targets this hormone. Image credit: Karolina Zięba

In some ways, the pandemic has made it harder for those visiting abortion clinics targeted by protesters. Restrictions limit the number of family and friends able to accompany patients for medical procedures, making facing the protesters much more intimidating. However, Cheney explains that adaptations to the pandemic have spared some patients the ordeal of interacting with protesters. “There’s been an increased uptake in abortions where pills are taken at home, so for a lot of people the protests probably aren’t impacting them as much.” She does point out, however, that those who do still wish to have the procedure in the presence of medical staff may be even more disconcerted by groups of protesters at a time when we are not used to seeing gatherings of people.

The pills she mentions are the main method of abortion, known as a medical abortion. In 2018, 86.1% of abortions in Scotland were performed this way. There are two different drugs involved that have confusingly similar names: mifepristone and misoprostol. Usually the first is taken at the clinic and the second can often be administered at home. During the pandemic, both drugs have been allowed to be taken at home where possible, and pro-choice groups, including Back Off Chalmers, would like to see this extended even once the virus is less of a threat. 

The drugs interfere with key chemical messages that control a lot of the physical changes that occur during pregnancy. During normal menstruation, levels of the hormone progesterone build up to promote thickening of the endometrium, the lining of the uterus. When progesterone levels drop off again, this is when the lining would shed. However, if the egg released at ovulation is fertilised, then progesterone levels remain high in order to maintain a thick endometrium for the embryo to implant into. Progesterone makes these changes to the endometrial cells by binding to a progesterone-specific receptor inside the cells. The progesterone receptor can then switch certain genes on or off to change cell activities, in this case preparing the endometrium for pregnancy. 

Mifepristone, the first pill taken during a medical abortion, is an anti-progesterone, which does what you might expect and blocks the progesterone receptor. This stops the cell receiving any more progesterone-dependent instructions, preventing further development of the endometrium. When taken during pregnancy, this means the uterus is no longer being encouraged to maintain a suitable environment for the fertilised egg. Mifepristone can also be used as an emergency contraceptive, though in this case it is thought to work by preventing ovulation. 

Interestingly, similar types of drugs are used in cancer therapy. Progesterone is in the same class of hormone as estrogen and androgens (such as testosterone), which target similar receptors to the progesterone receptor and bring about their own sets of changes. Hormone therapy is a common treatment for cancers such as breast and prostate, commonly using anti-estrogens and anti-androgens respectively. These drugs work in a very similar way to mifepristone’s anti-progesterone properties: blocking the receptor and preventing the hormone-induced changes, which in this case can prevent tumour growth. 

During a medical abortion, after mifepristone comes drug number two, misoprostol, usually 48 hours later. The initial treatment with mifepristone has already started making the uterus less suited to pregnancy, so now misoprostol is used to help shed the endometrium. Misoprostol mimics molecules called prostaglandins which have a role in blood vessel dilation, inflammation and muscle contraction, among other things. Prostaglandins are involved in normal menstruation when the endometrial lining starts shedding, and cause muscle contractions in the uterus walls. This helps expel the endometrial tissue from the body, though can also trigger menstrual cramps. In a medical abortion, misoprostol is used to the same effect as natural prostaglandins to generate similar uterine contractions which help pass endometrial lining, preventing further development of the pregnancy. The drug also softens the cervix which makes it useful in other situations including surgical abortions, contraceptive IUD insertions and inducing labour. Outside of gynaecology, misoprostol is approved for treating gastric ulcers as it can also protect the stomach from damage caused by painkillers such as aspirin. 

Medical abortions can be performed up to 20 weeks into the pregnancy, although other factors may call for surgery to be used instead, particularly at the later end of that window. In Scotland, 98% of all abortions happen before 20 weeks, 90% before 13 weeks and 70% before 9 weeks. Abortions requiring surgery, including any after 20 weeks, have to be performed in England as this is currently not available in Scotland. Cheney warns of complacency in the abortion debate when so much of it is centred round the USA. She admits that the situation here is considerably better, but still describes Scottish abortion rights as “precarious”. 

“We still have criminalized abortion, you still have to see two doctors, we’re arguing over whether you should be able to take perfectly safe medical abortions at home and you have to travel to England for a surgical abortion. We don’t have perfect abortion access here in any way, shape or form.” 

Cheney hopes to build momentum for the campaign’s newly released petition to implement the buffer zones outside clinics providing abortion in Edinburgh, as well as future aims to extend this across Scotland. She stresses that it is a grassroots campaign with inclusivity at its heart, and welcomes anyone with any level of experience to get involved. 

Beyond the topic of buffer zones, Back Off Chalmers aims raise awareness around abortion more generally. “We’re really hoping that it starts conversations about other elements of abortion and abortion education”, Cheney emphasises. Against a backdrop of threatened abortion rights across the globe, these conversations are incredibly important. There is power in movements like this that protect our right to make our own personal choices.

Written by Katie Pickup and edited by Ailie McWhinnie.

To support the campaign you can follow Back Off Chalmers on Instagram @backoffchalmers, Facebook Back Off Chalmers and Twitter @backoffchalmers

You can sign their petition to Edinburgh City Council here.

There are opportunities to help out with social media content creation, relationship management, online events organisation, graphic design and animation. They are also looking for local groups in Edinburgh keen to collaborate and raise awareness – sports teams, businesses, any areas welcome. If you would like to get involved please register your interest here or get in touch via social media.

You can also donate to their fundraiser to cover the costs of posters and a paid social media campaign to spread awareness beyond the student community. 

Katie is a first year PhD Student in Genetics and Molecular Medicine focusing on stem cells. Find her on Twitter @_KatiePickup and LinkedIn @Katie Pickup

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