Irish Medical Times – 12 February 2010
By Brian Herron
A new report puts Ireland's abortion laws under international scrutiny and is very critical of the Government's lack of action on the issue, writes Brian Herron
An international human rights watchdog has launched a scathing attack on the Government's inaction on the abortion issue in Ireland.
Human Rights Watch, an international, independent organisation that aims to defend and protect human rights, has published a report that calls for the implementation of guidelines to clearly outline when an abortion in Ireland may or may not take place.
In its report, entitled A State of Isolation: Access to Abortion for Women in Ire/and, the organisation also claimed that Ireland, by not allowing access to abortion, is in contravention of international human rights laws.
Marianne Mollmann, Advocacy Director for Human Rights Watch's Women's Division and one of the authors of the report, said that the Government was like 'an ostrich putting its head in the sand' and condemned its 'abdication of responsibility'.
This abdication extended to the report itself – in what Mollmann described as a 'surprising strategy', neither the HSE nor the Department of Health agreed to participate in the research.
The report also describes the 'climate of fear and shame experienced by many Irishwomen who have to travel abroad to terminate a pregnancy. According to estimates, at least 138,000 women have accessed abortion services abroad since 1980.
Groups opposed to abortion access, including Youth Defence and the Pro-Life Campaign, roundly criticised both the assertions of the publication and Human RightsWatch.
"It's ridiculous to claim that Ireland is in breach of its international human rights obligations because it respects the right to life of unborn children," said Dr Ruth Cullen of the Pro-Life Campaign. "It's embarrassingly obvious from[this] publication that Human Rights Watch has little or no knowledge of the situation in reland.
"Human Rights Watch may see a political value in using over-the-top terms to describe Ireland's abortion laws, but this approach does nothing to serve the cause of informed and reasoned debate." Other Irish organisations, including the Irish Family Planning Association (IFPA),have welcomed the report.
Abortion is illegal in Ireland except in cases where there is a direct risk to the mother's life, including risk of suicide. To date, there is no evidence that legal abortions ever take place in Ireland.
No legislation has been introduced to give any clarification under what specific circumstances a mother's life is deemed 'at risk', and there are heavy penalties, including lengthy jail sentences, should a doctor be deemed to have acted inappropriately.
"What's the percentage risk to the woman's life before a physician can recommend a termination of pregnancy?" asked Mollmann, speaking to IMT.
"Is it 20 per cent? Is it 80 percent? At that point, it becomes a lottery on the life of a woman.
It's completely arbitrary. How are doctors to make that distinction without further legislation? "At the very least, there needs to be clear guidance about when it's appropriate to terminate a pregnancy. This would avoid a woman having to seek an abortion abroad when there's a threat to her life." The current Government has stated that it does not in-tend to introduce legislation on this issue.
"Individual doctors may not like to provide the intervention themselves, but the service should be available if there's a severe need for it," said Mollmann.
Human Rights Watch's report also highlighted concerns that some women have regarding how they might be treated if they told a medical professional that they were considering an abortion.
"It's a big problem that women won't go to their GP for ad-vice on the termination of a pregnancy," said Mollmann.
"There are taboos around the subject, and the feeling exists that the GP either can't pro- vide the service, or won't be willing to help. The GP could well be the family doctor, too.
Women experiencing a crisis pregnancy may not be comfortable talking to the family physician." The publication also suggests that there is a low up- take of post-abortion care in Ireland, despite the fact that it is both free and available.
According to Irish service provider Well Woman, only an estimated one in seven clients returns for a medical check-up following a pregnancy termination abroad. The numbers availing of counselling are even lower. A much better situation, according to Mollmann, would be for a woman to be able to call a maternity hospital and get clear, impartial information and advice from professionals.
"But that's simply not the case at the moment. Doctors are restricted in the kind of information that they can provide – and in many cases, doctors don't know what they're legally allowed to tell patients." During the course of her re- search, Mollmann spoke to a number of Irish GPs and consultants.
"There's an understanding among physicians that the lack of legal clarity is ludicrous. When we talked to GPs around the country, we heard concerns like, 'I can't do my job. I'm thinking about the criminal responsibility, not the patient's health'."
Niall Behan, CEO of the IFPA, broadly welcomed the report. "It captures the 'chilling' effect that the absence of legislation has on those who work with women experiencing cri- sis pregnancies." Echoing the phrase used in the report, Behan noted: "There is a climate of fear for women who have a crisis pregnancy – but there's fear in the medical community, too. GPs and OBGYNs don't want to be stuck with the label 'abortion doctors'.
"There has been a huge shift among Irish people on the abortion issue. There is very strong support for a woman to be able to terminate a pregnancy under certain circumstances. I think that the medical com-munity reflects this wider societal view." However, the lack of guide-lines could inhibit a GP doing his or her job to the best of his or her ability.
"At the moment, any GP who considers helping a patient to make arrangements to have an abortion outside of Ireland puts themselves in an extremely awkward position." He said that the lack of pro-vision of abortion services in Ireland could have a big impact in the medium- and long-term health of the patient. "A woman may not wish to avail of post-abortion care or counselling because of the taboo that criminalisation brings -she may not be comfortable seeking the support of family, friends or her regular GP be-cause of the stigma surrounding it.
"The Government is being hypocritical. They've introduced a range of guidelines to make it easier for women to travel with the intention of having an abortion abroad, but they've failed to bring in proper guidelines that would allow women to access services in Ireland – despite there being provision in law.
"There's always some dissent, but there is broad support on the ground – even from GPs who disagree with the practice of abortion – for greater clarity on current legislation.
The IFPA has concerns that the vacuum created by the lack of clear guidelines has resulted in worrying trends, like the potential to access medical abortion drugs over the internet, which could be taken without medical supervision.
Recently, the UK introduced legislation that prohibits British companies from sup-plying Irish women with ac-cess to abortifacients, but they are still available from furthera field.
The drugs themselves are not the problem, according to the IFPA – it is the lack of access to them through legitimate channels.
"We all agree that it would be better if crisis pregnancies didn't happen and women didn't need to have an abortion," said Mollmann.
"So we should look at strategies that could reduce crisis pregnancies. Then, if a crisis pregnancy should occur, look for solutions that create the least amount of stress for women, but provide them with a full range of options."