Let’s Talk About: Bodily Autonomy, Trans Healthcare and the fight for Reproductive Justice

ARC logo in blue and pink

Here at the Abortion Rights Campaign, our primary aim is free, safe, legal and local abortion access for everyone on the island of Ireland. As an organisation that strives to be intersectional, we know that our campaign for abortion care is part of a broader fight for reproductive justice and bodily autonomy around the globe. Today, we’re going to take a look at a recent court ruling in the UK and what impact it may have on the battle for healthcare and bodily autonomy in the UK and in Ireland. 

On December 1st 2020, the UK High Court dealt a blow to the principle that young people can make medical decisions in relation to their own bodies, in a case known as Bell vs Tavistock NHS Trust. The case concerned the prescription of puberty blockers – reversible medications which can be used to delay the onset of puberty – to trans youth at Tavistock Clinic; specifically, whether or not minors are ‘competent’ to consent to such treatment. While it will take time for the full impact to become clear, for now it seems unlikely that anyone under the age of 16 will be deemed able to consent to puberty blocking medications, and it’s also unclear whether those aged 16-18 will be able to. 

The British legal principle that deals with medical consent for anyone under age 18 is known as “Gillick competence”. Originating from a case regarding access to contraception, the principle allows under-16s to consent to medical treatment, without parental involvement, providing they demonstrate the maturity to understand their decision. In the Bell case, discussed in detail here by Dr Sandra Duffy, the court decided that young people are “highly unlikely” to be capable of making decisions about gender-related medical care (even though puberty will resume if someone stops taking blockers). The court’s ruling has already had an impact on access to trans healthcare for young people, with several reporting that scheduled appointments have been cancelled against their wishes. The ruling has been widely condemned by human rights organisations as well as organisations that support trans youth (e.g. Mermaids). The High Court has recently granted an appeal.

So why does this UK ruling concern us here at ARC? It is part of that broader struggle for sexual health, reproductive justice and bodily autonomy. 

Firstly, there are no trans healthcare services for young people in Ireland – instead trans youth must travel overseas. We are well-versed in the denial of bodily autonomy in Ireland, by means of abortion care being exported abroad. Previously, there was an outreach clinic run by Tavistock through Crumlin hospital, which provided medical and psychological services. Since the Bell ruling, it has been revealed that this clinic is no longer accepting referrals. Instead, trans youth are being referred to a long-awaited ‘new’ Irish service that does not yet exist – leaving them wholly without support. 

Secondly, we are concerned about how the ruling’s weakening of Gillick competence may impact young people trying to access abortion or contraceptive care in the UK. Being ‘Gillick competent’ is the test for those under 16 to access these services without parental consent. Only time will tell whether this newly restrictive understanding of being competent to make medical decisions will affect minors’ access to abortion. It comes as no surprise to us that the lawyer trying to restrict access to trans healthcare, Paul Conrathe, is a prominent anti-abortion crusader who has already attempted to restrict abortion access for young people.

Although no longer constitutionally forbidden, abortion care is still highly restricted in Ireland.

Additionally, Ireland does not have specific legal provisions regarding medical consent for minors under 16. The HSE’s consent policy references the Gillick case as an example of how a ‘mature minor’ may consent to medical interventions without parental permission, as well as noting other rights that young people have, such as those flowing from the UN Convention on the Rights of the Child. Ultimately, we at ARC are concerned about whether the Bell vs Tavistock ruling could have a chilling effect on minors’ access to medical care.

Lastly, and perhaps most importantly, the Bell ruling is an attack on the right to bodily autonomy. Bodily autonomy is not just the right to decide to continue or end a pregnancy – it is the right to make our own decisions about what happens to our bodies. Of course, these decisions should be informed and consent freely given – and the best way to ensure informed decision making is to provide people with information and time. Limited services with long waiting lists restrict information and time for decision-making. Like pregnancy, puberty has its own timeline meaning that timely and appropriate healthcare is essential. This attack on healthcare services for marginalised young people must be challenged, as it is ultimately an attack on our collective right to bodily integrity and our freedom to decide what we want for our bodies and our lives.

As an organisation that strives to be intersectional, we campaign for reproductive justice for all. Our trans siblings fought alongside us during the campaign to Repeal the 8th. They continue to face medical gatekeeping, unnecessary barriers, and forced travel for healthcare. We stand with the trans community in this struggle for bodily autonomy.