Allowing English women to take the abortion pill at home is good news – and now we're coming for you, Northern Ireland

More than 50 years after the death of Gerri Santoro, it has still taken a woman’s pain made public, subjected to public dissection, for meaningful change to be made. So how long will it take for the women of Northern Ireland to be heard?

As landmark women’s health text Our Bodies, Ourselves put it in 1970, abortion is “our right ... as women to control our own bodies. The existence of any abortion laws (however ‘liberal’) denies this right.”

Those rights are advancing in some parts of the UK, and stalling in others. The latest development is that women in England will soon be able to take an abortion pill at home: a small but significant step forward that many welcome. Yet in Northern Ireland, women still face draconian laws and life in prison for daring to access their reproductive rights.

As it stands, a woman in England seeking an early medical abortion must take two pills – the first pill (mifepristone), and the second (misoprostol) up to 48 hours later – both at a hospital or clinic. Matt Hancock has decreed that, by the end of the year, women will be able to take the second pill at home.

It’s a huge win for English women, in particular for activist Claudia Craig, who five months ago published an open letter to then-health secretary Jeremy Hunt, highlighting the pain and indignity she and so many others have been forced to suffer as she travelled home after taking the second pill.

But it was also long overdue. All available medical advice, including the World Health Organisation (WHO), suggests that home use of the abortion pill is safe. Ann Furedi, chief executive of the British Pregnancy Advisory Service, said the decision represents “an outbreak of common sense”.

Not only does taking the second pill at home help prevent the risk of a miscarriage in public, as it can show effect within half an hour, but leading doctors argue that the current rule impedes working women and mothers who have to take time off or organise childcare, particularly in rural areas.

Although women in England may now be on equal footing with Scotland and Wales, this decision throws into sharper relief the appalling situation in Northern Ireland. Women are forced to travel to England for an NHS abortion (only a recent win, and a trip which is both inhumane and prohibitively expensive) – and even then, only with two doctors’ approval. Others risk prosecution by buying abortion pills online. The prime minister’s failure to act on this is almost unbearably galling.

And, while she remains propped up only by a deal with the devil and the DUP, it seems unlikely that this is where she’ll make her stand.

Even as the continued absence of devolved government in Northern Ireland has led to calls for abortion legislation reform, anti-abortion activists (including one Democratic Unionist assembly member) warned that any moves in this respect would “undermine the principle of devolution”.

The momentum of the #RepealtheEighth success in the Republic has yet to cross the border in any significant way, or challenge Northern Ireland Assembly’s 2016 vote against legalising abortion in cases of fatal foetal abnormality, incest or rape.

Just this summer, the Supreme Court ruled that those laws violate human rights, calling the current situation “untenable”. And yet, it remains tenable. The challenge was rejected on technical grounds and, despite the court’s urging to bring forward legislation, there seems little appetite to do so in Westminster, where May’s Brexit bargaining power hangs by a thread.

For far too long, considerations of abortion’s “morality” have muddied legislative decisions. Personal beliefs have been allowed to insidiously creep into, or ruthlessly ride roughshod over, issues of patient safety.

The truth is to be found in the facts: that wherever and whenever abortion is criminalised, illegal or restricted, women die – in pain, in fear and, more often than not, alone. Unsafe abortion is one of the leading causes of maternal mortality worldwide.

But the path to legalisation of abortion is littered with steps back and setbacks. Look at what’s happening in America, where landmark Roe v Wade is continuously threatened.

In the US, even where legalisation has been theoretically achieved, it is rendered meaningless when trumped by reality: when decreased funding for clinics, lack of providers or unnecessary restrictions all impede access. Planned Parenthood v Casey (1992), upheld Roe v Wade, but gave states the right to regulate abortion in the first trimester.

In the Republic of Ireland, where tough abortion laws will be relaxed following this year’s referendum, access – particularly in rural areas – will depend entirely on the whim of the providers.

And while Ealing Council has established the UK’s first “buffer” zone to protect women from protestors outside the Marie Stopes clinic, women accessing every other abortion clinic often have to confront those same placards and words of hate.

There’s also the question of abortion elitism: laws restricting access disproportionately affect women of poor or ethnic minority backgrounds. The WHO estimates that 25 million unsafe abortions take place each year, almost all in developing countries.

So how, in an England that prides itself on cutting edge healthcare and enshrined human rights, could this small step have taken so long? How long, in the UK where abortion is legal, can the situation in Northern Ireland stand?

In 1964, Gerri Santoro died by self-induced abortion, and the distressing photo taken of her body, surrounded by the blood that killed her, would become a catalyst for the pro-choice movement.

And the appalling thing is, more than 50 years later, it has still taken a woman’s pain made public, subjected to public dissection, for meaningful change to be made.