Review of the Health (Regulation of Termination of Pregnancy) Act 2018
This is a landmark report, which draws on extensive public health evidence and expertise that was not available to lawmakers in 2018. It paints an extremely comprehensive picture of abortion care in Ireland. It shines a clear light on the flaws and weaknesses and, critically, highlights a range of actions that could greatly improve women’s experience of accessing abortion care.
The IFPA urges policy makers, services providers and Oireachtas members to study the report in detail, to engage with the information and analysis and, most importantly, to take forward its findings to ensure that abortion services are strengthened, and abortion care is secured into the future.
As a provider of early abortion care, the IFPA is very aware of the flaws in the law and the weaknesses in some aspects of service provision. The reality for many of our clients is that these flaws and weaknesses have real and harmful impacts on their experience of abortion care.
The IFPA’s comments this morning will focus on three key areas: (1) the mandatory waiting period; (2) the 12-week gestational limit; and (3) the criminal provisions.
All three areas require legal change.
On the mandatory three-day waiting period for early abortion care
The national and international evidence presented in this report is clear that the mandatory waiting period is a barrier to access. The report tells us that its imposition sets abortion apart from other areas of healthcare. This is stigmatising.
These findings are informed by the World Health Organization which holds that mandatory waiting periods have no benefits for women.
The report draws on the 2022 Unplanned Pregnancy and Abortion Care (UnPAC) study, which found that service users experience the waiting period as a patronising infringement on their reproductive autonomy.
It includes the views of healthcare providers that the mandatory waiting period is a material barrier to accessing care, and that a three-day wait in law can become a four- or five-day wait in practice. it has a disproportionate impact on marginalised groups and people living in rural areas. And, on some occasions, it has pushed women beyond the 12-week gestational limit, meaning they are no longer able to access care in Ireland.
This is entirely in line with the IFPA’s experience as a service provider. Waiting periods cause delay, they cause stress, they cause harm to people seeking healthcare.
It is ultimately inappropriate and paternalistic to impose this requirement on every person who seeks abortion care.
An analysis of our service data, released last week, demonstrates that the vast majority (97.5%) of our clients who attend for abortion care make their decision before they see a doctor. They then access abortion as early as possible after the waiting period. There is nothing in our data to indicate that the three-day wait influences the decisions of any of our clients. But it delays them all unnecessarily in accessing this particularly time-sensitive health service.
Based on the evidence and our direct experience as an abortion care provider, the IFPA’s firm view is that the mandatory waiting period should be removed in its entirety.
On the 12-week gestational limit for early abortion care
IFPA clinical data shows that the vast majority of women seeking abortion care do so early in pregnancy, generally between 6-8 weeks. But there are women who – for a range of reasons – present close to or just beyond the 12-week gestational limit. This rigid and arbitrary limit in the current legal framework makes these situations extremely challenging.
The report records the difficulty the gestational limit poses for some people seeking abortion care and documents the complex reasons why people ‘time out’ of the system. This includes:
- women who may not be aware they are pregnant because, for example, of an irregular menstrual cycle or the absence of typical pregnancy symptoms,
- women for whom the initial medical abortion is unsuccessful and
- women experiencing disadvantage, sometimes multiple forms of disadvantage.
The report demonstrates a clear need to re-examine Section 12 of the legislation in light of these situations. In the IFPA’s view, the Oireachtas Health Committee has a critical role to play in scrutinising this–along the other legislative recommendations—to ensure the law is facilitating rather than obstructing access to abortion care.
On criminalisation
The final issue I’d like to address relates to Section 23 of the abortion law. The criminal provisions of this section have clear consequential effects on women seeking abortion care.
The report provides strong evidence about these harmful impacts. Including abortion in a criminal statute stigmatises those who seek and provide abortion care. It creates a “chilling effect” on medical practice. This can lead to overly cautious, risk-averse decision-making about eligibility for care. It can deter other healthcare providers from becoming involved in service provision.
We very much welcome the report’s proposal to remove medical practitioners from the scope of Section 23. If implemented, this proposal has the potential to significantly reduce the harms outlined. But it’s important to note that the retention of criminal sanctions in any form is contrary to Ireland’s obligations under international human rights law.
The review clause was included in the 2018 legislation for good reasons: healthcare policy cannot be frozen in time by the law. It must be capable of evolving in line with emerging evidence and with best practice standards. In this respect, the IFPA is concerned by recent comments which suggest a reluctance on the part of some politicians to re-examine the abortion law in light of the review’s findings. Members of cabinet have a responsibility, along with the broader Oireachtas, to take public health evidence seriously and act accordingly.
Legislators acknowledged in 2018 that we had no domestic evidence to speak from in developing the legal framework – they therefore made the appropriate decision to include a review clause in the legislation. We now have that evidence base and political inertia cannot be allowed to stand in the way of best healthcare practice.
Thank you.
Press contact: Maeve Taylor +353 86 795 2167
For an email copy of these comments, contact maeve.taylor@ifpa.ie