Reproductive Rights in Ireland: Part 3

So we’ve gone through the struggle for contraception and the intricate legalities of abortion in Ireland. So where has that gotten us, exactly?

What do Irish people think of abortion?
If casual observers were solely going by the “pro-life” march in Dublin three weeks ago, they would probably think that pro-choice people are a minority and everyone else loves babies: about 5000 people (many bussed in from all over the country) marched through the city centre holding “pro-life” signs, while about 200 pro-choice counter-protestors were stationed at just one point along the route.

At least one of the pro-choice attendees found the anti-abortionists less positive than their happy face signs would suggest.

Last Saturday I was called a murderer….I was called a Nazi. I was told that I hate children, that I hate babies, that I hate life. I had people getting up in my face, screaming “LIFE LIFE LIFE LIFE,” before being told to move on by Gardaí.

The actual reality of Irish people’s attitudes towards abortion are more murky than this march suggests. The following statistics are taken from three recent opinion polls, conducted in January 2011 (RedC/Sunday Times), March 2010 (YouGov/Marie Stopes), and January 2010 (RedC/Irish Examiner):

  • The vast majority (86-87%) support legislation to codify the X-Case, and in cases like C v Ireland: termination of pregnancy to save the woman’s life.
  • Another large majority (79%) support termination where the pregnancy is the result of sexual assault, or the pregnancy threatens the woman’s health (situations which are not covered under the terms of the X-Case).
  • A slightly smaller majority support it when the fÅ“tus has a profound disability that makes survival unlikely (67%).
  • A substantial minority also support abortion “on demand” i.e.: when the woman feels it’s in her best interests: 38-41%, a substantial increase from a decade ago. This increases to 60% among 18 to 35 year olds.
  • Only 3% of Irish people oppose abortion under any circumstances.

The consistent message is that Irish people support liberalising the abortion laws, to the terms of the X-Case and C v Ireland at the very least. However, I couldn’t find any recent poll that had asked about gestational term limits, and when asked about special protection for embryos created as a result of IVF and other assisted reproductive technologies, most people supported that. Which makes me ask…

How much do Irish people actually know about abortion?
I.e.: what it involves; why it’s sometimes medically necessary or, at least, highly advisable; who gets abortions and why. The topic is not discussed in any sex education class that I know of – indeed, most young Irish people I’ve spoken to say that their secondary school teachers were discouraged from discussing the subject with them, and my own teachers strongly implied that they would face disciplinary action if they did. This may also have something to do with most Irish schools being owned by the Catholic Church. People may have their own opinions, but the 2000 Oireachtas Report on abortion makes clear that at least some anti-abortion people have their own facts, too. Among the top ten anti-abortion positions were:

4: There is no medical reason for abortion ““ no medical condition which would require abortion to save the mother’s life;
10: Abortion causes enormous physical and psychological damage.

I’ve restrained myself and only highlighted the two which are verifiably false.

So, how many Irish women get abortions?
In the last 30 years nearly 150,000 Irish women have travelled to England and Wales for abortions (about 7% of all women in Ireland); latest figures show just over 4,000 women per year. This is likely to be an underestimate, as it only counts women who give Irish addresses to the clinics. A much smaller number (fewer than 100 in 2010) travel to the Netherlands.

Between one in 10 or one in 15 Irish women of child-bearing age have had an abortion”¦ they are our friends, our sisters, our daughters, our mothers, but nobody talks about it.Dr. Mary Favier, Doctors for Choice

For women who can’t afford the time and the money it takes (over €2,000 in some cases, according to the Abortion Support Network) to travel for an abortion, or are not allowed to leave the country (asylum seekers, for instance), importing abortifacient drugs from overseas is also an option – though illegal. Abortion is also illegal in Northern Ireland, under a different set of laws, so you can’t just drive across the border.

Women on Web, the online branch of the Dutch organisation Women on Wave, will ship the drugs to Ireland after an online consultation. They can also be ordered at online pharmacies, with all the doubts about efficacy, safety, and dosage that implies: Choice Ireland say that customs have intercepted over a thousand packages containing the drugs (which may not be illegal here per se, but are illegal for use as abortifacients), and 1,216 packages were seized in 2009. Along with the slight decline in figures for women going abroad, this points to at-home illegal medical abortion becoming more popular.

Follow-up care after terminations is free of charge here, as is counselling. If a woman didn’t want to reveal she’d had a medical abortion herself, she could always claim miscarriage (of course she shouldn’t have to…).

But what if a pregnancy isn’t viable?
Apart from if the pregnancy is ectopic or molar, tough luck, Irish women. The Miss D case makes that clear. Ireland is widely cited as having one of the highest neural tube defect rates in the world (actual recent citations are surprisingly hard to come by), but terminations for fatal abnormalities are illegal here. Early pregnancy assessment for foetal problems are also not performed – women will get an antenatal screening including ultrasound at some point between 12 and 18 weeks, but are not offered the screening blood tests common in the U.S. (e.g.: the triple screen) and U.K.

Dr. Peter McKenna (Master of the Rotunda Maternity Hospital 1995-2001) stated that of the over 8,000 women a year at the Rotunda (the oldest continuously operating maternity hospital in the world), about 50 go to the U.K. to terminate pregnancies where the fÅ“tus has a lethal abnormality – which apart from the cost, trauma and stress involved for the woman and her family, presents terrible practical problems in terms of being able to autopsy the fÅ“tal remains, if that would be medically helpful, and/or bring them back to Ireland:

Should it [the fÅ“tus] be declared and then coffined and flown back as a dead corpse or should it be brought back, almost surreptitiously, as hand luggage? – Dr. Peter McKenna


So, seriously, when is abortion legal?
This is in theory determined by the X-Case, but the actual practice seems to vary. Ectopic and molar pregnancies are terminated with no fuss or fanfare – it’s understood that they are not viable. Other commonly accepted conditions which terminations are performed are for women with cancer of the cervix, and for uncontrollable pre-eclampsia, or eclampsia (remember way back in Part 1, this is what would likely have killed Mrs. McGee had she become pregnant again). Other conditions cited in the 2000 government report on abortion are HELLP syndrome and certain kinds of heart failure.

However, in the absence of any actual legislation protecting them, doctors are being super-cautious about when they will perform a termination, as in the C case and others – like Michelle Harte’s. This is despite the fact that the X-Case judgement itself says:

The danger [caused by pregnancy] has to represent a substantial risk to her [the woman’s] life though this does not necessarily have to be an imminent danger of instant death. The law does not require the doctors to wait until the mother is in peril of immediate death. [emphasis mine]

and the Irish Medical Council guidelines state that termination of pregnancy and other therapies can lead to the death of a baby (their term – item 21.4) and that doctors who object to certain treatments in non-emergency situations should (a) explain this to the patient and (b) refer to another doctor (item 10). Some doctors are on record as saying that they would act first and defend later, but this is by no means a universal position, even if (and this is no guarantee either) they regard the woman as their first priority:

There is no problem in my mind that the life of the mother is paramount and that we must do what we can to ensure that the mother survives.
– Dr. Seán Daly, Master of the Coombe Women’s Hospital 1998 – 2005

The X-Case judgement would seem to imply that a high risk of imminent death (as in the case of a ruptured ectopic pregnancy or uncontrollable eclampsia) is not a prerequisite for a legal abortion here – but doctors shouldn’t have to make this legal judgment. That is for government and the courts to decide, and no government in nearly 20 years – even governments involving the Labour party, the only major party that has even close to a pro-choice position – has dared to touch the issue.

The proximity of legal, safe abortion in England and Wales is a “safety valve” for governments to enable them to consistently ignore these issues. Women aren’t dying from illegal abortions here: we have mostly-free public healthcare, abortion after-care and counselling – we just don’t allow “the a-word” to occur within our borders.

This is not Rome… This is the Republic of Ireland 2011, a republic of laws… of proper civic order, where the delinquency and arrogance of a particular version of a particular kind of “morality” will no longer be tolerated or ignored. – Taoiseach Enda Kenny, 20th July 2011

Enda Kenny was speaking about the latest news about the covering-up of child abuse allegations by the Catholic Church (full text and video here: trigger warning for mention of sexual abuse). But will he listen to his own words, and to the opinions of most Irish people when it comes to legal abortion and other reproductive rights? My bet is on “no.” And even if we do legislate for some forms of legal abortion, this may put the laws in conflict with most major hospitals in Ireland which are run by Catholic boards.

This is not even close to a settled issue, and is one which I can see dragging out for decades to come.

I had intended to also cover other aspects of reproductive rights, such as Assisted Reproductive Technologies, pregnancy and birth options, but this ended up being a pretty long post as is. If you have questions or observations about any aspect of these topics, though, please join me in the comments.

3 replies on “Reproductive Rights in Ireland: Part 3”

The Daily Fail today has an article following an Irish woman to England for a medical abortion.

‘I know there are lots of people who can’t have children but that’s not my fault. I don’t want this baby and I have the right to make this decision. I couldn’t afford to take care of it anyway….I still can’t believe in this day and age women have to do this. I should have the right to decide what I can and can’t do.’

As usual, avoid the comments.

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