A heightened climate of fear has emerged around the topic of abortion in Northern Ireland following the prosecution of a woman whose flatmates reported her to police after she took two drugs to terminate her pregnancy at home.

News of the flatmates’ decision to call the police only intensified an already palpable atmosphere of unease and suspicion, other women affected by the issue have said. “People will feel like they can’t trust anybody now,” said Lisa, who is in her 20s and from Belfast. She described how she had bought abortion tablets online and taken them two weeks ago.

Sinéad (not her real name), 25, also from Belfast, said the case had made her wary of speaking to anyone but her partner about her decision to take abortion pills last September. “There is a culture of fear. It puts people in a dangerous situation, making them too frightened to go to the doctor, too afraid to tell anyone. You are never going to get over it if you feel you can’t tell anyone for fear of being shopped to the police.”

A clash between Northern Ireland’s Victorian-era abortion legislation and the availability of safe and cheap tablets online has once again put the country’s conservative attitude towards the issue under the spotlight.

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On Monday a 21-year-old woman was given a three-month jail sentence, suspended for 12 months, after pleading guilty at Belfast crown court to procuring her own abortion by using a poison, in the first known abortion pill-related prosecution in Northern Ireland. She was 19 when she took the tablets. Her barrister told the court that had his client lived anywhere else in the UK “she would not have found herself before the courts”.

The court case is hugely significant because self-administered abortions using pills – often procured over the internet – have rapidly become the cheapest, most accessible solution for women in Northern Ireland, where abortion remains illegal in all but the most extreme circumstances.

Medical staff said they were worried news of the prosecution would make women too frightened to come forward, even in an emergency, after taking abortion pills. “I don’t want to see women dying from septic haemorrhages because they’ve been too scared to get medical attention,” said Breedagh Hughes, director for Northern Ireland at the Royal College of Midwives. “This case is going to have a huge impact for women who are on their own and pregnant, particularly if they take these pills and want medical help.”

On Thursday night several hundred women gathered outside the office of the director of public prosecutions in central Belfast to protest against the decision to take the 21-year-old to court. “How many women were disgusted by [Donald] Trump’s comments about how women seeking abortions should be punished? Well this is actually happening right now in Northern Ireland,” the Alliance for Choice pro-choice organisation said. Protesters were urged to write to the Northern Ireland secretary, Theresa Villiers, asking her to “break the radio silence from Westminster”. More demonstrations are planned for Saturday in London, Dublin and Berlin.

There has been no comment on the case from the Westminster government because the areas of justice and health have both been devolved to Northern Ireland. None of the region’s three major parties have commented on the case.

But it has stayed on the front pages and dominated local radio news and chatshows all week. Pro-choice voices have described the case as a “witch-hunt” that has targeted a vulnerable young woman. Anti-abortion activists have criticised the sentence as unduly lenient and pointed out that life imprisonment is a possible alternative under legislation in Northern Ireland, which has the harshest criminal penalty for abortion anywhere in Europe.

Facebook Twitter Pinterest Anti-abortion activists picket the Marie Stopes Clinic in Belfast. Photograph: Charles McQuillan/Getty Images

The women who reported their flatmate to the police have spoken of their surprise at the widespread online condemnation of their actions, and described their own uncertainty about how best to react when the teenager told them she had taken the pills to terminate a 10-week pregnancy. Asked to justify why she had chosen to go to the police, one of them told BBC Radio Ulster’s Nolan Show that she was opposed abortion and had been upset by her flatmate’s lack of contrition. “She showed no remorse, she really didn’t. She was completely fine about it,” she said.

A few weeks earlier, the young woman had told them she was trying to raise enough money to go to another part of the UK for a termination, which would not have been illegal but would probably have cost her between £1,000 and £2,000. Northern Ireland residents are not eligible for the procedure on the NHS and have to pay private clinic fees, as well as the cost of flights, taxis and hotels. Despite the cost, each year about 4,500 women come to England from Ireland and Northern Ireland for terminations.

Because she did not have the money to travel, she went online and bought mifepristone and misoprostol pills, which are considered safe and reliable in the first 10 weeks of pregnancy, and cost no more than £100 if supplied through a Dutch charity such as Women on Web or Women Help Women. These two charities receive about 3,000 requests for advice and help from women in Ireland and Northern Ireland each year.

Activists have highlighted the discriminatory nature of the decision to prosecute, arguing that the woman was unfairly targeted for being poor as well as happening to live in a part of the UK where abortion is not allowed. The 1967 Abortion Act was never extended to Northern Ireland, where a termination is available only if there is “a risk of a real and serious adverse effect on a woman’s long-term physical or mental health”. Great uncertainty remains among medical staff about how to identify such a risk.

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“Northern Ireland’s Victorian-era abortion law dates from a time before the invention of the lightbulb,” said Amnesty International’s Northern Ireland director, Patrick Corrigan. “No woman in any other part of the UK would have been prosecuted and no woman in Northern Ireland with the money to travel to England would have been prosecuted. In Northern Ireland, it seems a woman can now be found criminally liable for being poor.”

Women who have recently taken abortion pills to terminate unwanted pregnancies told the Guardian that the prosecution made them feel more anxious about the possibility of being informed on by anyone, from acquaintances to medical staff or even the postman.

“Now that people are aware prosecutions can happen, it will be more stressful. It is a hard thing to go through even with the support of friends, let alone without support,” Lisa said. When she bought the pills, she said, she did not know women were being actively prosecuted by the Irish courts, but she would have still made the same decision to go ahead – while taking even greater precautions to ensure no one found out. “I would have still gone through with it,” she said. “What other choice did I have?”

In another abortion pills case, due to be heard later this month, medical staff are understood to have called the police to report a mother accused of buying the tablets online for her underage daughter – highlighting for many women the potential risks involved in consulting healthcare professionals for advice. The news further underlined the need for secrecy and concealment, according to Lisa. “I would have been terrified to seek medical advice. I would have been too scared of them in case they reported me.”

Sinéad said she would have preferred to travel to a clinic in England but she could not afford to; she was not even able to pay the full price of the tablets, equivalent to about a week’s income, so she made a contribution to the charity of £30 instead. She was particularly anxious about receiving the parcel from the postman.

“You don’t know if someone has intercepted it. You think: ‘Have they seen what’s inside?’ It kept going around and around in my head: ‘Could I be reported? If I accept the package, and they know what’s inside, what will happen to me?’” she said. Customs officials in the Irish Republic routinely confiscate packages believed to contain these pills, and charities no longer ship them there because of the risk they will never arrive.

Facebook Twitter Pinterest Pro-choice activists in Belfast on Thursday. Photograph: Charles McQuillan/Getty Images

Sinéad felt similar worry when she went for a checkup two months later and told her GP she had had a miscarriage. “I left I was thinking: ‘Did she notice anything? Is she suspicious? Could she alert the authorities?’” she said.

The prosecution reminded her of the unfairness of the current situation. “It could have been me,” she said. “I feel am being punished for being poor. If I had had money, I would have gone to a clinic, met a nurse, heard from her that everything was going to be OK. I feel like we are treated like second-class citizens.”

Hughes said that although the guidance on abortion legislation in Northern Ireland had recently been clarified, midwives were still in a difficult position when confronted with women who had taken abortion pills at home and came to hospital feeling worried at a later stage. “We are required by law to balance the need for patient confidentiality with the need to report unlawful terminations of pregnancies to the police,” she said.

“What do I say to midwives? At the moment all they can do is stick their fingers in their ears and say ‘lalalala’ very loudly; or say to the woman who comes in: ‘You have been pregnant, you are no longer pregnant, and I don’t need to know anything else.’ That’s not helpful for the woman or the medical staff. There is no possibility for a relationship base on mutual trust because you are demanding that they tell you a lie.”

Mara Clarke, who runs the Abortion Support Network, a charity that provides advice and financial support for women in Northern Ireland who need to travel to the UK for a termination, said the numbers travelling to England had fallen in recent years because of the easy availability of these tablets.

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She anticipated the high-profile court case would reverse that trend, deterring women from taking the tablets and forcing more of them to make the expensive and stressful trip across the Irish Sea. The prosecution was in effect “telling women not to take pills that are so safe they are on the World Health Organisation’s essential medicines list. It’s telling women to have babies they don’t want, go to England or go to jail,” she said. On a more positive note, she said donations to the charity had soared in the days following the prosecution.

There is much uncertainty about whether this week’s prosecution marks a new aggressive approach to the use of abortion pills in Northern Ireland – which only began to be widely used two or three years ago – and whether many more cases will follow under the 1861 Offences Against the Person Act, as prosecutors catch up with the development.

Goretti Horgan, of the Alliance for Choice, said she was not sure there would be, because it was difficult for medical staff to identify a difference between a natural miscarriage and the consequence of these pills, so successful prosecutions could prove elusive.

Horgan and more than 200 other campaigners have signed an open letter to the Public Prosecution Service declaring that they have procured the tablets for themselves or other women, and say they are all willing to be arrested. But so far there has been a reluctance from the police to take any action against them. Three women in Derry have made repeated attempts to hand themselves in to police for the offence but officers have cancelled appointments.

Horgan was inclined to feel that the case could have an unexpectedly positive impact for Northern Ireland’s women in need of an abortion. “It spreads knowledge that these pills exist,” she said.

Grainne Boyle, a Queen’s University student and pro-choice activist, said she believed the prosecution had been designed to instil fear in women – but that it was having the reverse effect.

“People who wouldn’t describe themselves as pro-abortion are so angry at this criminalisation of a vulnerable and isolated woman, that their opinions are shifting,” Boyle said. “And the publicity about the pills has informed women that this is an option for them.”

Abortion pills

What are they? Pregnancy can be terminated by chemical means. The process involves taking two types of medication. The first is a synthetic steroid called mifepristone, which works by stopping the action of progesterone – a hormone that makes the lining of the womb an environment that can support a fertilised egg. The second is either swallowed as a pill or placed in the vagina 36 to 48 hours later and contains prostaglandin, which causes cramps and bleeding that trigger the loss of the pregnancy.

How long does it take to work? Four to six hours after the second medication is administered.

When can it be used? The NHS advises that medical abortion can be used up to nine weeks into the pregnancy.

Nicola Davis