Making Law Liveable? Bringing feminist knowledge of care into the curriculum

Note: These comments were originally written for a talk I gave at ‘Liberation through Law’, an event organized by SOAS Feminist Society and SOAS Law Society, on the 25th February. I am grateful to them, particularly Aleksandra Wolek and Sabeehah Motala, and to my co-panelists, Diamond Ashiagbor, Samia Bano and Linda Mulcahy, for generating such a great space to discuss the role of feminist legal theory in the university curriculum.

My comments arise from wanting to think more about how I draw on feminist activisms and organisations as sources of legal knowledge when I teach. This has been inspired in part by the recent successful campaign against Fiona Bruce’s efforts to outlaw sex selective abortion, which involved a wide range of feminist, health and pro-choice civil society organisations, including the End Violence Against Women Campaign, the Iranian and Kurdish Women’s Rights Organisation (IKWRO), Southall Black Sisters, the Royal College of Obstetricians and Gynaecologists (pdf), Antenatal Results and Choices (pdf), the British Pregnancy Advisory Service (pdf) and Voice for Choice.  As we consider and evaluate the ways in which law regulates reproductive lives, what can we learn from the experience and expertise of feminist civil society?

Typically a key feminist topic like abortion rights is taught in a medical or health law course. And the typical things we talk about are the fact that the Abortion Act, 1967, makes abortion a matter of medical discretion rather than a woman’s decision (Sheldon, 1997). Black letter medical law treats abortion differently from most other kinds of healthcare in that women’s views are not legally relevant. What matters according to the law is whether two doctors believe that a particular pregnancy is more likely to put a woman’s health at risk if continued rather than terminated. This takes abortion out of ordinary health care, which is governed by the doctrine of consent for those who are capacitated to make healthcare decisions, and the doctrine of best interests for those who are not so capacitated. Abortion becomes exceptional and women have to negotiate the discipling effects of that regulation when they need to access abortion care. So teaching about abortion law is a great way to consider how legal paternalism makes reproductive decisions on women’s behalf and uses medical authority to distance women from their own lives.

But abortion law also mobilises old-fashioned coercive power against women and their health professionals. Women who find themselves needing an abortion on terms which fall outside of the Abortion Act, 1967, are criminalized and stigmatized. Sarah Catt, who procured her own abortion by taking the abortion pill after the 24 week time limit, was sentenced to 3.5 years in prison, reduced on appeal from an original 8 year sentence by the trial judge (Prochaska, 2012). The full force of the criminal law was brought to bear on this woman as she tried to control her reproductive life. In criticizing and contextualizing that law I, in common with lots of other teachers of health law, use a variety of strategies. One such strategy is the familiar critical doctrinal strategy of flagging up the inconsistencies in black letter law, and looking to general principles of patient autonomy in other areas of health law. I look to critical engagement with human rights norms as a tool for tackling the inadequacies of abortion regulation. And I look to theoretical arguments about voluntary reproduction as an aspect of women’s equality.

But the point I want to focus on here is that often students are surprised to learn these two things about British abortion law: that doctors’ approval is necessary for non-criminal abortions and that some abortions are still criminal. And their surprise presents teachers like me with an opportunity to raise another important aspect of feminist approaches to law and that is the significance of the gap between law and practice. In practice, in the law of everyday life, the way people experience something like legal access to abortion care can be quite different from the way it’s represented on the books (Lee, 2004). And as scholars of legal consciousness have long argued, that everyday experience of law matters. It matters because actual access has immediate impact on people’s lives. But it also matters because those everyday understandings provide important resources for challenging official accounts in their violent, coercive forms and in their disciplining and governmental forms.

One important reason why there is a gap between law on the books and law in practice in the context of abortion in contemporary Britain is due to the presence and effect of pro-choice abortion providers. The presence of a pro-choice provider like BPAS, which has been providing woman-centred abortion care since 1968, makes a profound difference to women’s experience of abortion law. Their willingness to interpret and implement the Abortion Act in light of women’s life concerns has meant that sometimes at least women experience abortion care as if law is listening to them and taking their concerns seriously. But these vital aspects of women’s experience of law, the presence of feminist civil society organisations who work hard to make law a little more liveable, often don’t make it on to the legal curriculum. Or at least they make it on the curriculum in particular kinds of ways: as initiators of judicial review actions, collaborators in clinical education and providers of legal internships.

So how might I address this when I teach about abortion and law? I’ve been thinking about this anew in light of the recent campaign by a wide range of feminist, health and pro-choice civil society organisations against Fiona Bruce’s effort to criminalise sex selective abortion.  The successful and collaborative nature of the campaign mark it out for attention in the first place; but I’m particularly curious about the ways in which it mobilised feminist knowledge of care practice.  Conservative MP Fiona Bruce, together with Jeena International, Stop Gendercide and Karma Nirvana, was initially relatively successful in mobilising concerns about abortion of female fetuses towards support for an amendment to the Abortion Act, 1967. On 4 November 2014, a majority of 181 to 1 voted in favour of debating an amendment to prohibit sex selective abortion at its first reading. But on Monday 23 February 2015, 292 MPs voted against Bruce’s amendment while 201 voted for, defeating the amendment by a 91 vote majority. Why did the momentum change and what does this change have to tell us about the role of feminist civil society in making law a little more liveable (Cruz 2013: 467 citing Butler, 2010: 31)?

In making the case for the amendment, Fiona Bruce made two arguments which looked like they addressed feminist concerns. The first was that sex selective abortion was harmful and worth prohibiting because it was discriminatory in suggesting that girl fetuses are less valuable. The second was that a prohibition of sex selective abortion would help pregnant women who were being abused and pressured into abortion for reasons of son preference. In response, a number of civil society organisations drew on their collective experience of working with women who seek access to abortion care and with women who have lived with violence. In one important intervention in a letter on 19th February, a wide range of people argued that the amendment would have the effect of criminalizing women and their doctors for sex selective abortion, that criminalisation does not help women who are experiencing sexist abuse and pressure, and that funding of support services would be a preferable alternative.

Their arguments reminded us that criminal law itself can be harmful, rather than a means of protecting people from harm, in stigmatising women and preventing them from seeking out help. Others such as Hashmat argued that taking reproductive choice away from a woman in a desperate situation does not tackle the causes of that situation and denies her options in responding to her actually existing reality. These interventions were really good examples of feminist critiques of the carceral state in action and of engagements with a critical harm reduction approach (see further Erdman, 2012; Todd-Gher, 2014; Lamble, 2013; Fletcher, 2014). These kinds of reforms can be dangerous even if they may look to have gendered concerns, because they encourage the punitive state to intervene in women’s sexual and reproductive lives, and are likely to expose women to more rather than less risk.

A second important point was that sex selective abortion is not that prevalent in the UK and is not necessarily a discriminatory decision if and when it does happen. The Department of Health has not identified any evidence of difference in sex ratios and the clinics tell us that women do not report sex of the fetus as a reason for abortion (BPAS, 2015). Fetal sex may be one part of a more complex story as when bringing a girl child into the world at a particular moment may be a threat to a woman’s mental health because she is under significant pressure to have a boy.  In making this kind of argument organisations like BPAS and Voice for Choice remind us of the important of evidence and personal stories in feminist evaluation of legal reform. Concerns about sex selective abortion practices sometimes mobilise a kind of feminist ‘common sense’ that selection must be sexist.  But any such ‘common sense’ needs to be challenged in light of contesting evidence and narrative. We can’t be in a position to decide whether a given practice is actually discriminatory and harmful until we have heard from those experiencing that practice themselves.

Feminist advocacy and care organisations are important legal actors and we could make more of them, with all their imperfections, in the legal curriculum. They provide great examples of legal ideas in practice, as they argue for sexual and reproductive autonomy in a way that is sensitive to diversity and vulnerability. They challenge the reason/affect dichotomy that permeates public debate as they mobilise affective knowledge of women’s experiences towards rational ends. And they show us how to make legal interventions by drawing on feminist experience and expertise while speaking to non-feminist audiences.

Crisis Compounded? Legal Aid, Feminist Advocacy, and the Budget Cuts in British Columbia, Canada

By Agnieszka Doll

Since 2002, the successive governments of the Canadian province of British Columbia (BC) have enacted large-scale budget cuts to state-funded legal aid. The Canadian Centre for Policy Alternatives researchers reported that in 2002 provincial funding for legal aid has been cut by 40 percent (Brewin & Stephens, 2004; Govender & Milne, April 9, 2013) The most severe reductions were implemented in areas of family law, poverty law, and immigration legal aid. In fact, by the 2010 the legal aid representation in poverty and immigration cases was completely eliminated, while in family law, such representation has been limited to high risk cases (Brewin & Govender, 2010; Brewin & Stephens, 2004). In addition to difficulties in receiving legal representation, access to legal information has been also limited by changing eligibility threshold, substituting direct contact with lawyers with online and telephone service, and reducing the number of legal clinics. While legal aid in BC was considered insufficient even before the reductions, the cuts further deepened the crisis by limiting access to justice for the most marginalized populations (Morrow, Hankivsky, & Varcoe, 2004).

Feminist scholars (Morrow et al., 2004) have specifically argued that the cuts have a clear gender dimension. Firstly, prevalence of poverty among women, including those who experience intimate violence, renders women particularly disadvantaged by legal aid cuts as they often rely on state-resources for their access to justice (Sarophim, 2010). Secondly, the implemented cuts predominately targeted services related to family, civil or poverty law, which women tend to use more often that, for instance, services related to criminal law that received no similar cuts and that tend to be more frequently utilized by men. Third, concurrent implementation of changes limiting state funding for women’s organizations and subjecting funding to competitive distribution model, shattered existing infrastructure of research and advocacy-based organizations that are often unable to compete with for-profit organizations for service provision (Knight & Rodgers, 2012).

In the midst of those changes, I conducted (between 2008-2009) a qualitative study in one B.C women’s organization through which I explored how the organization’s staff experience delivering law-related services to women or helping these women access justice in the context of the budget cuts. I was also interested in learning about the extent to which existing legal services meet specific needs of immigrant women who experience intimate violence.

My interviews with the organization’s frontline staff and its administrators, as well as a focus group and hours of observations revealed three major findings regarding the consequences of government cuts on service offered by the organization:

1)      The organization went through severe employment shifts. For example, at the time of my research, the Victim Assistance Program – designed to assist women who experience abuse in navigating their criminal cases through the criminal justice system – lost all of its previous employees and was run by a new staff. Such shifts in the staff composition complicate the organization’s court presence; the previously established relations with the court personnel often need to be rebuilt, which takes significant amount of time and effort. Thus, the cuts contributed to shattering the organization’s credibility as legal advocates by affecting its ability to remain visible to justice and police administration.

2)      The organization became dependent on volunteer work. For example, the women’s center, which is often the first contact point for women seeking legal services, was forced to substitute the loss of three fourth of its professional staff with work of volunteers. This restructuring has consequences on the quality of information received by women who come for legal guidance. Since volunteers provide their help occasionally, their skills are mostly used to support the basic functioning of the center not to provide information about legal aid service to women in need. Often, they do not have the related professional training.

3)      Given changes in priority areas funded by the government, the organization adjusted their own services accordingly. Previous focus on feminist political awareness raising about the nature of gender inequalities or feminist advocacy gave way to emphasis on short-term relief services provided to the victims of gender violence. As organizations became forced to compete with each other for resources, they started to internalize the idea of self-sufficiency as their key for survival. Thus, instead of sharing resources such as translation services, etc. with other organizations, applying for own funding came to be regarded as a strategy of ensuing inflow of additional money to the organization.

One important implication of my study I would like to highlight is the impact of budget cuts on feminist organizations’ potential to pursue advocacy for women in the courts, in the police, and in other law enforcing institutions. While the budget cuts to legal services evidently degenerated the position of women experiencing violence who need to represent themselves in courts and often surround their rights, truly successful legal representation amounts to more then just having a lawyer. It would not be novel to say that the gender stereotypes still prevail in the criminal justice system; the domestic violence cases are considered of a lower importance to other criminal cases, and the knowledge of intimate violence by court, police authorities, but also by lawyers is often not sufficient. Thus, survivors-centered advocacy shall be considered as complementary to prosecution or to other legal procedures resulting from or linked to gender violence so the needs of women are addressed by judicial decisions (Nichols, 2013). I would like to also suggest that individual-level advocacy pursued on the ground by feminist advocates is instrumental for fair and equal access to justice for women, similar, as it is to the needs-based access to legal aid. The structural –level feminist advocacy needs to continue to expose the link between the gendered socio-structural inequalities and gender violence. Those important dimensions of women’s and anti-violence movements have been seriously jeopardized by the discussed budget cuts. The quest for funding had the effect of pushing women’s organizations to depoliticize and subvert feminist ideas about the relationship between gender, violence, and structural inequalities and, instead, adopt “a Band-Aid” solution to gender violence and channel their advocacy efforts. This way, by undermining the potential for feminist advocacy through budgets cuts, the B.C. governments made effective steps towards reinforcing gender order through legal means and within legal system.

Bibliography:

Brewin, A., & Govender, K. (2010). Rights-Based Legal Aid: Rebuilding BC’s Broken System. Retrieved from Canadian Centre for Policy Alternatives website: http://www.policyalternatives.ca/sites/default/files/uploads/publications/BC Office/2010/11/CCPA_Legal_Aid_web.pdf

Brewin, A., & Stephens, L. (2004). Legal Aid Denied: Women and the Cuts to Legal Services in B.C. BC Office: Canadian Centre for Policy Alternatives and West Coast LEAF.

Govender, K., & Milne, K. (April 9, 2013). BC’s Publicly Funded Legal Aid is in Crisis. Retrieved from Canadian Centre for Policy Alternatives website: http://www.policyalternatives.ca/publications/commentary/bc%E2%80%99s-publicly-funded-legal-aid-crisis

Knight, M., & Rodgers, K. (2012). “The Government Is Operationalizing Neo-liberalism”: Women’s Organizations, Status of Women Canada, and the Struggle for Progressive Social Change in Canada. NORA – Nordic Journal of Feminist and Gender Research, 20(4), 266-282. doi: 10.1080/08038740.2012.747786

Morrow, M., Hankivsky, O., & Varcoe, C. (2004). Women and Violence: The Effects of Dismantling the Welfare State. Critical Social Policy, 24(3), 358-384. doi: 10.1177/0261018304044364

Nichols, A. J. (2013). Meaning-Making and Domestic Violence Victim Advocacy: An Examination of Feminist Identities, Ideologies, and Practices. Feminist Criminology, 8(3), 177-201. doi: 10.1177/1557085113482727

Sarophim, J. (2010). Access Barred: The Effects of the Cuts and Restructuring of Legal Aid in B.C. on Women Attempting to Navigate the Provincial Family Court System. Canadian Journal of Family Law, 26(2), 451-472.

Condemned as a ‘Typical’ Man?

By Robin Hadley

A few moths ago, I attended a seminar on infertility treatment. The audience included those involved in infertility treatment, academics, practitioners, and interested others. The complexities surrounding infertility treatment are vast and range from the very intimate and personal to legalities at national and international level. Conducting research in such a sensitive area is fraught with difficulties and the speakers were all very aware of the ethical implications of their research and practice. I was particularly interested in the researchers’ experience of accessing and interviewing men. The general view in infertility studies has been that men are not interested in participating in research, and many studies are heavily weighted with female respondents. As one researcher described her many efforts to interview the male partner of a couple, a ripple of sympathetic recognition of her struggle arose from the audience. ‘Typical man’ seemed to be the collective verdict, mine included. As I reflected back on the day I returned to that incident. The audience reaction was one of sympathy for the researcher and I wondered if that man did not also deserve some empathy. I know from my own research that many men assume that they will be fathers and that that knowledge is so embedded that it is not discussed. The assumption expressed has been that one would leave school, get a job/go to university/ get a job, find a partner, find accommodation, have children. That being the case I tried to put myself in that man’s position: the assumed ‘natural’ event had not happened. How would I feel? Shocked to the very core? I think so. Perhaps I had been brought up not to show feelings and instead, to show control – ‘mastery’ – through actions and/or rationality. In which case my reactions may include striving to balance things up by working and playing harder, or not becoming involved. Being raised in an environment where I am not expected to express emotions, I possibly, do not have the confidence or vocabulary to verbalise my emotional state. Here are my musings on what may have been ‘going on’ if I was that unwilling participant, “So, here I am, not fulfilling the role I expected to – and that others seem to achieve with ease – and I cannot make it right. There is only one person I can talk to and that is my partner but it is worse for her and the one thing I can be is strong for her. Then there is this University researcher who wants to have a talk. She’s talked to my partner, and wants to talk to us both. My partner thinks it will do me good. I don’t know how to express these feelings inside without bursting. I want to support my partner, part of me thinks it would be good to release the emotions but I can’t risk overwhelming her in the way I am sometimes overwhelmed. I’ll say I’ll do it and then see.”
If the participant’s thoughts and feelings were similar to the above then it is understandable why he was ambivalent about being interviewed.

Infertility has been seen as a form of complex bereavement consisting of multiple loses (Adler, 1991; Lechner et al., 2007) with levels of distress in women recorded as high as those suffering from serious medical conditions (Domar et al., 1992; Domar et al., 1993). However, recent research shows that, post infertility treatment, men who did not become fathers suffered poorer mental health than those who had become fathers (Fisher et al., 2010). In their conclusions Fisher et al (p.6) state ‘…that stereotypes that infertile men conflate fertility and masculinity, are less distressed than women about potential loss of parenthood, and adjust more readily to childlessness appear inaccurate.’ Men may or may not be ‘typical’ by choice but there are many social factors that influence their behavior and how their behavior is perceived. The belief that men are not interested in taking part in research, and their absence ‘condemned to be meaningful’ (Lloyd, 1996: p.451), reflects a lack of insight by the research community. I feel I must stress here these are my own reflections based on my research on involuntarily childless men and not a particular person or persons.

Useful websites
Infertility Network UK: http://www.infertilitynetworkuk.com
The Human Fertilisation & Embryology Authority: http://www.hfea.gov.uk/index.html
Mensfe: http://www.mensfe.net

References
Adler, N. E. (1991). Forward. In Stanton, A. L. & Dunkel-Schetter, C. (Eds.), Infertility: Perspectives from Stress and Coping Research (pp. vii-ix). Plenum Press: New York.
Domar, A., Broome, A., Zuttermeister, P. C., Seibel, M. & Friedman, R. (1992). The prevalence and predictability of depression in infertile women. Fertility and Sterility, 58, 1158-1163.
Domar, A. D., Zuttermeister, P. C. & Friedman, R. (1993). The psychological impact of infertility: a comparison with patients with other medical conditions. Journal of Psychosomatic Obstetrics and Gynaecology, 14(Special issue), 45-52.
Fisher, J. R. W., Baker, G. H. W. & Hammarberg, K. (2010). Long-term health, well-being, life satisfaction, and attitudes toward parenthood in men diagnosed as infertile: challenges to gender stereotypes and implications for practice. Fertility and Sterility, 94(2), 574-580.
Lechner, L., Bolman, C. & Van Dalen, A. (2007). Definite involuntary childlessness: associations between coping, social support and psychological distress. Hum. Reprod., 22(1), 288-294.
Lloyd, M. (1996). Condemned to be meaningful: Non-response in studies of men and infertility. Sociology of Health & Illness, 18(4), 433-454.

Sexual identity and care home provision: some reflections on the research process

My colleagues and I at Swansea University have recently completed a mixed-methods study into the provision of inclusive care to older lesbian, gay and bisexual (LGB) people in residential and nursing care environments in Wales – an elongated title for saying, ‘how well are older LGB recognised and cared for in care homes?’ We know from the literature that heterosexism in residential care provision can mask the sexual health needs, diversity and desires of older LGB residents. Prior research from Australia and the United States has identified institutional and historical barriers that prevent older people ‘coming out’, or identifying as LGB to care providers (Barrett, 2008; Jackson, Johnson & Roberts, 2008; Knockel, Quam & Croghan, 2010; Tolley & Ranzijn, 2006). Our research was funded by the National Institute for Social Care and Health Research (NISCHR) and had a unique focus on Wales as a UK nation with devolved responsibility for providing health and social care to its citizens, including older people. Residential and nursing homes (private and local authority-owned) from across Wales took part. Two methods were used to gather staff perspectives on inclusive care —self-completed questionnaires (121 respondents), and focus groups with care staff and managers (5 groups) from 32 organisations. Other methods included: content analysis of Care and Social Services Inspectorate Wales (CSSIW) Inspection reports (383 reports) to identify content pertaining to sexuality, sexual health and LGB identities; and, semi-structured interviews with 29 older LGB-identifying adults about their hopes and expectations for future care. The final report is available online and provides an overview of the key findings and recommendations: http://www.swan.ac.uk/humanandhealthsciences/research/research-impact/lgb-residential-care-report/

What follows are some brief reflections on the process of involving care organisations in the research – reflective comments on the research process that do not always make the final edit of reports and papers but may help steer future research in this domain.

Willingness to participate and learn – We initially anticipated that seeking care home participation would be the biggest challenge in recruitment because of the politically-charged nature of the topic and our concern that staff and managers would interpret our research endeavours as a critical appraisal of their practice.  Instead, we were struck by the enthusiasm of staff and managers to participate. Using a random sampling method, we invited 51 organisations to participate with 19 declining. Most of these homes declined because of impeding closures that created logistical barriers to their involvement. For some staff groups, participation in a focus group was framed as an informal learning opportunity into an area that receives little time and attention, an unexpected but positive outcome. Across focus groups, there was general agreement of a ‘need to know more’ about sexual difference and LGB histories. Participating staff members conveyed an awareness of progressive shifts in legislation and social attitudes but in equal measures expressed a willingness to be more mindful of the sexual biographies of residents in their care.

Sexuality, dementia and everyday care – While our research focused on sexual identity and social inclusion, a connected and equally pertinent topic that frequently emerged in focus groups was the complexity of balancing issues of sexual expression, dementia and informed consent. Staff elaborated on the challenges of negotiating sexual relationships and intimate contact between residents with declining mental capacity alongside responding to the often divided opinions of family members. Listening to these accounts of complex care deepened our appreciation for staff members’ commitment to respecting the rights and choices of residents in their care and to continually ‘do the right thing’. It also brought home the ethical complexity of providing care in these settings for employees who were in receipt of a low financial reward just above the minimal wage with little professional recognition.

Missing voices from the research – Staff views and accounts conveyed through the research represent predominantly White perspectives. The majority of participating staff and mangers were white, heterosexual women born in Wales and of mainly Christian background. This clearly did not match our observations of staffing groups when entering homes – we noticed many participating homes employed staff from black and ethnically diverse groups, including individuals from African and Asian migrant communities. We were limited to the staff available to speak to us between rotating shifts and group membership was often facilitated by senior staff members operating as ‘gatekeepers’ for their organisations. It is difficult to pinpoint whether individual staff from migrant and ethnically diverse communities opted not to participate for personal or religious reasons or whether they were not approached to participate; we can only speculate about possible barriers to participation. Ethical requirements prevented us from actively approaching individual staff to participate. Finally, we did not anticipate the eagerness of ancillary staff members (such as cleaners, kitchen staff etc.) to have a say in the research. It became increasingly clear that their various duties involved regular contact with residents and their views were of equal importance in the provision of inclusive care. We confess to underestimating the validity and contribution of these staff members’ perspectives; food for thought for future research.

I hope the above reflections are of some benefit to other researchers and practitioners engaged in research in an area of increasing interest. Putting these observations to paper has been valuable for me in capturing the often sidelined messages about research into organisations providing care to others.

Barrett, C. (2008). My People: A project exploring the experiences of gay, lesbian, bisexual, transgender and intersex seniors in aged-care services Retrieved 16th October 2009, from http://www.matrixguildvic.org.au/MyPeopleReport2008.pdf

Jackson, N.C., Johnson, M.J. & Roberts, R. (2008). The potential impact of discrimination: fears of older gays, lesbians, bisexuals and transgender individuals living in small- to moderate-sized cities on long-term health care. Journal of Homosexuality, 54(3), 325-339.

Knockel, K.A., Quam, J.K. & Corghan, C.F. (2011). Are Old Lesbian and Gay People Well Served? Understanding the Perceptions, Preparation, and Experiences of Aging Services Providers. Journal of Applied Gerontology, 30(3), 370-389.

Tolley, C. & Ranzijn, R. (2006). Predictors of heteronormativity in residential aged care facilities. Australasian Journal on Ageing, 25(4), 209-214.

About the author: Paul Willis is Senior Lecturer in social work in the College of Human and Health Sciences at Swansea University. His research interests include ageing, sexuality and social care; wellbeing and identity construction of LGBT youth; and social inclusion in organisations. Email: P.B.Willis@swansea.ac.uk

‘A Stronger Voice for People with Dementia’ by the Dementia Advocacy Network (DAN)

What is advocacy?

The Advocacy Charter (produced by Action for Advocacy) defines advocacy as “taking action to help people say what they want, secure their rights, represent their interests and obtain services they need.  Advocates and advocacy schemes work in partnership with the people they support and take their side.  Advocacy promotes social inclusion, equality and social justice.”

Advocates are independent from other services and as such are able to focus on giving people a voice and empowering people in a unique way.

There is some statutory provision of advocacy (Independent Mental Health Advocates, Independent Mental Capacity Advocates and NHS Complaints Advocacy).  Statutory advocacy has the benefit of being protected by law (e.g. the Mental Health Act and the Mental Capacity Act) but these types of advocacy are only available in specific situations.  There is therefore a need for generic advocacy services that are able to work with a wider range of people on the issues with which they need support.

Dementia advocacy

The Dementia Advocacy Network (DAN) believes that every person with dementia should have access to a skilled and independent advocate who understands dementia and is equipped to advocate effectively.

People with dementia are among some of the most vulnerable members of our society.  With an illness that brings diminishing ability to cope independently, progressive changes in cognitive ability, fluctuating mental capacity and increasing difficulties in communication they are vulnerable to discrimination and abuse.  Increasing demand on services, austerity measures and reduced resources mean that sometimes the person with dementia has little involvement in decisions about their treatment and care, their rights disregarded, their voice not listened to or overpowered by others.

Advocates who work with people with dementia are able to ensure that their voice is heard and their rights protected.  Advocates can also work in a non-instructed capacity with people who are unable to tell the advocate what they want, which can be particularly valuable for some people with dementia.  DAN’s publication “Taking their side; fighting their corner” includes case studies that demonstrate the value of advocacy for sixteen different people with dementia.

Advocates can benefit other services by being able to spend time specifically focusing on finding out what the person with dementia wants and communicating this to service providers.  This means that service providers can have the assurance that their service is tailored to that particular service user, taking their individual views and preferences into account.

‘Mind the Gap’ – Advocacy provision in London

DAN has produced a report to promote the need for independent advocacy for people with dementia and highlight areas in London where there are gaps.  The findings of the report will be presented and discussed at DAN’s conference, ‘A Stronger Voice for People with Dementia’ which is being held in London on 18 September.  Anyone who is interested in attending can book a place here.

For further information please contact Jan Kendall, DAN Manager, or Heather Tyas, National Project Support, Dementia Advocacy Network (DAN): Tel: 020 8968 2614. Email: dan@advocacyplus.org.uk. Website: www.advocacyplus.org.uk/dan

Bringing abortion care home

What to say about Savita? What to say about the story of a woman who dies from septicaemia in Galway, after termination of a miscarrying pregnancy was refused?  The lawyer in me knows that we haven’t heard the full account yet.  But the critic in me thinks about the outpouring of emotion provoked by her husband’s story.  I batter the keyboard to try and stop my own frustrations from taking hold.  What use is yet another comment on yet another woman who has been failed by a health system which refuses to provide abortion care?  But I don’t want to be quiet either.  I want to try and make sense of the awful spectacle of Savita’s seemingly needless death.

I talk to a pregnancy counsellor who works for a Irish pro-choice service.  She has worked for years supporting women with unplanned pregnancies, many of whom decide to travel for abortion.  She has been having a bad time recently in the wake of a sting on pregnancy counselling services, which accused counsellors of giving women poor advice.  She says: “I know why I do what I do, and why I say what I say”.  Everyday she negotiates the moral and legal complexity, which has baffled the politicians for 20 years since the X case.  She doesn’t have the luxury of getting overwhelmed and throwing her hands up in the air because ‘abortion is complex’.  While 6 governments have failed to implement the 1992 X case ruling, which allows abortion when there is a real and substantial risk to the life of the woman, she has listened to women’s assessment of their options.  She knows that women need abortions, even women who have anti-abortion views.  She knows that women make complicated moral judgments about the best course of action in their particular reproductive circumstances.  This public servant has found a way through the legal uncertainty to support women as they travel in search of abortion care.  Imagine if we valued her experience more.  Imagine how abortion law would benefit from understanding complexity as an element of, not an obstacle to, reproductive decision-making.

I listen to Mary Favier of Doctors for Choice on the Pat Kenny show on RTE radio.  Mary calls for the decriminalisation of abortion and the recognition of women’s right to control their own fertility.  She calls on doctors to act and to push up against the imagined boundaries of lawful abortion in Ireland.  It’s such a relief to hear Mary claim public space not just for women in life-threatening circumstances, but also for ordinary pregnant women.  One of the most distressing things has been hearing so many media commentators fixate on the narrowest of legitimations for abortion.  At times the scope of the argument has seemed limited to the meaning of life-saving abortion.  But we know thousands of Irish women end their pregnancies every year for all kinds of reasons.  Yet the mainstream public debate seems to proceed as if medical practice is never about tackling risks to health, or promoting patients’ well-being.  It’s as if women can’t be trusted with moral decisions, decisions whose consequences they will bear.  It’s as if a non-conscious, non-sentient, non-viable foetus has the same moral status as a conscious, sentient, viable woman.  It’s as if there is only an audience for the most distressing, blood curdling stories of abortion need.  But as Mary points out, Savita was also a woman whose request for a termination was refused.  Mary shows us what Irish abortion care could be like if it supported women’s moral agency.  Others like her – Clare Daly, Ivana Bacik, Susan McKay – allow us hope for a politics which addresses the ordinary everyday stories of pregnancy and abortion.

Hungry for information, I flick through my tweets and watch an older clip of Mara Clarke of the London-based Abortion Support Network tell the Dublin Pro-choice Rally, 28 September 2012, about the women they’ve helped over the last 3 years.  Mara talks about the vulnerability and resourcefulness of all kinds of women: rape victims, mothers with families, young asylum-seekers, students, women in gender transition.  She makes ordinary ingenuity come alive as she tells stories of the friends who raise funds and mind children so that women can travel.  Imagine having to ring a complete stranger for help, she says, when you’re under this pressure and need access to abortion.  These ‘strangers’ open their homes and their lives to women who need them for a day or two.  They take it on themselves to reduce the harmful effects of a healthcare system that ignores abortion-seeking women.   And before them ESCORT in Liverpool and the Irish Women’s Abortion Support Group in London (Rossiter, 2009) looked after women who travelled during the 1980s and the 1990s.  This hospitality of strangers makes caring across borders a reality as people connect over the simple act of wanting to help.

The reaction to Savita’s death has made the ‘distant suffering’ (Boltanski, 1999) of abortion-seeking women a little less distant.  Ordinary people keep apologising for not having taken action against Irish abortion law before now.  They’re taking moral responsibility for the legal and medical regime which produced Savita’s death and routinely sends abortion-seeking women abroad.  This failure in our public institutions – in law and in medicine – is at odds with a clear desire to care in other public spaces.  And perhaps that’s all I want to say at least for the moment: This is a terrible tragedy for Savita and her loved ones.  But the wave of revulsion is not just revulsion at what Enright has called the bloodthirsty nature of Irish abortion law.   It’s a wave of connection that’s bringing together these different challenges to an anti-abortion ethos.  We have to find a way to bring abortion care home: to take domestic abortion care beyond questions of life and death and into a respect for the ordinary moral messiness of people’s lives.