The IFPA’s position on the abortion review
It is the IFPA’s view that the review should recommend the following changes to The Health (Regulation of Termination of Pregnancy) Act 2018:
- Extend the 12-week limit
Most women and pregnant people access abortion well before the gestation limit. But the 12-week cut-off excludes some people from access to abortion in Ireland and forces them to seek abortion services abroad. UK statistics show that at least 194 women travelled to the UK for abortion care in 2020. The 12-week gestation limit should be extended. No one should need to leave Ireland for abortion care.
- Remove the 3-day waiting period
Women are forced by law to wait for a period of 3 days between doctor appointments before they can access an abortion. Legally imposed waiting periods go against World Health Organisation guidance. Enforced waiting periods interfere with people’s ability to make decisions about their own healthcare, have no health benefits and prevent women and pregnant people from accessing healthcare when they need it. The waiting period should be removed from the law.
- Revise the definition of fetal anomaly
Many cases of foetal anomaly fall outside the law because abortion care is limited to cases of anomalies that are considered to be fatal within the definition of the law, and excludes other serious anomalies. This forces women/parents whose pregnancies are not deemed eligible to travel abroad for care at a very difficult time when they should be able to access care in Ireland. The definition of foetal anomaly in the law should be revised to allow for more inclusive, compassionate care for all who need it.
- Fully decriminalise abortion
Abortion is a criminal offence in all cases which fall outside the 2018 Act. While the criminal provisions do not apply to pregnant people, they create a climate of fear and uncertainty for healthcare providers and cause a ‘chilling effect’. The threat of criminal sanctions – including a possible 14-year prison sentence – can ‘hang over’ doctors and affect the care they provide. Some healthcare professionals may decide not to provide abortion care at all because of this. Criminalisation also leaves healthcare providers vulnerable to allegations by those who oppose abortion. WHO guidance recommends the full decriminalisation of abortion: “Criminalization of abortion can also have a “chilling effect” more broadly, as it can result in narrow interpretation of applicable law by health workers, including to avoid possible criminal liability (i.e. suppression of actions due to fear of reprisals or penalties). Abortion should be fully decriminalised.
- Ensure all 19 maternity hospitals provide full abortion care services
Only 10 out 19 maternity hospitals in Ireland provide full abortion services. If a person is between 9 and 12 weeks pregnant, they can only access abortion care in a hospital setting. Therefore many women and pregnant people do not have access to abortion care within a reasonable distance of their home and many GPs do not have a nearby hospital to refer people seeking abortion care to if it is needed. All 19 public maternity hospitals should provide the full range of abortion care services.
- Ensure better geographical spread of GPs providing abortion services
Only 1 in 10 GPs currently provide abortion services in Ireland. This means that many women and pregnant people do not have local access to abortion care. Some counties have very few GPs providing abortion care and County Sligo has no GP provider at all. This means that many people travel long distances to access essential healthcare. Geographical spread of GPs providing abortion care must be improved.
- Ensure choice of method
When offered a choice of method for early abortion, most women opt for medical abortion. But some women have a strong preference for surgical abortion. However, only medical abortion can be provided by GPs and women’s health clinics and women, girls, and pregnant people in Ireland are not generally offered the option of surgical abortion. Create access pathways to surgical abortion for pregnant people who need early abortion care
- Provide free post-abortion contraception
After an unintended pregnancy, many women strongly wish to begin using or switch to a more effective method of contraception. Yet, while, abortion is fully funded by the HSE and is free to women and people with a cervix, those who don’t have a medical card must pay the cost of contraception. The most effective methods include coils, patches, implant and injections. Some of these are expensive and when women can’t afford them, they are forced to continue using a method, such as the pill, that let them down in the first place. Include free contraception for people of all ages within the model of care for abortion.
- Telemedicine must be retained when the pandemic ends
Telemedicine has been integral to the model of care for early abortion since 2020. It was introduced as a pandemic public health measure. The IFPA’s experience of telemedicine is that it is highly acceptable to women. The major international reproductive health standard-setting bodies, including the WHO, recommend telemedicine within abortion care. Telemedicine should be retained as an option within early abortion care.
- Human rights and abortion
Abortion is now legal in Ireland and this has had a significant impact on reproductive and pregnancy healthcare. The IFPA believes that it is important to secure access to quality reproductive healthcare, including abortion, into the future. This means the ongoing development of policies and services towards the international human right standard of the highest attainable standard of reproductive healthcare, the provision of services that are available, accessible, acceptable to users and of high quality.
The IFPA is of the view that this requires policies on comprehensive sexuality education for all, measures to tackle stigma and provider bias, universal free access to contraception and the promotion of human rights values, including dignity.
In order to achieve this, the IFPA believes that Ireland must invest in excellence in reproductive healthcare including advanced training and education of doctors, nurses and midwives in all aspects of abortion care. Training for healthcare providers must include: the clinical aspects of abortion care; the human rights dimension (an understanding of the rights to health and reproductive autonomy); and best practice in holistic, person-centred reproductive healthcare at all stages of life.
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