IRELAND – Three-year review of the Termination of Pregnancy Act to be initiated this year

The Department of Health has confirmed that the review is scheduled for 2021, overseen by them. Research to learn the perspectives of service users and service providers will be commissioned and carried out independently. The Department will manage the public consultation, which will “extend a public invitation to all interested groups, organisations and members of the public to provide their views to inform the review of the operation of the legislation”.

A range of NGOs who have been supporting access to safe and legal abortion in Ireland for years are beginning to make their own views public. The Irish Family Planning Association (IFPA) wrote a detailed assessment of the role of telemedicine, which has been an option for half the time abortion has been partially legal in Ireland. They argue based on the evidence that “permanent use of telemedicine in abortion care is a positive, patient-centred step… because it expands patient choices and supports reproductive autonomy”. Early in the Covid-19 pandemic, abortion services allowed doctors to provide care via phone or video consultations, both as a primary mode of care delivery and in combination with in-person care, which has helped to maintain an essential health service, while minimising the risk of Covid-19 exposure for both patients and staff.

However, IFPA say, the Department of Health stated in a letter dated 22 March to the Oireachtas (parliamentary) Health Committee, that telemedicine abortion will “lapse” when the pandemic is declared over. This is not only at odds with the evidence, they say, it contradicts previous assurances to the Oireachtas by the Minister for Health that a review of remote consultation for abortion care would be carried out. “To withdraw this innovative mode of service delivery without assessing its benefits would be short-sighted and contrary to international evidence. There is no health rationale for depriving women of this option.” They call for retention of telemedicine beyond the pandemic, within a blended approach to abortion provision, to expand patient choices and support reproductive autonomy.

IFPA also point out that abortion remains a criminal offence. Doctors providing abortion in cases of fatal fetal anomaly have highlighted the challenges of working under ‘ambiguous’ and ‘restrictive’ legislation with the risk of criminal sanctions. The criteria for accessing abortion for health reasons are extremely narrow, with only 21 women accessing care under this ground in 2019. They describe the stress and anxiety caused by the mandatory three-day waiting period, which sometimes even pushes women over the line and forces them to travel.

Research published by the National Women’s Council, entitled Accessing Abortion in Ireland: Meeting the Needs of Every Woman, has highlighted ongoing obstacles and legal barriers under the current law that are “forcing at least one person a day to travel abroad”. They found that only one in 10 GPs and just over half of maternity hospitals provide abortion services. Those who do are very committed, but coverage remains a significant barrier to accessing services, especially in rural areas and marginalised communities.

Black, Asian and Chinese women with Irish addresses are significantly represented (almost 9%) in the numbers travelling to Britain for abortions, the report states. Access also remains particularly difficult for women with a diagnosed fatal fetal anomaly, not only because they mostly require second trimester abortions by the time the anomalies are detected but also because the line between what is “fatal” and “severe” is not always 100% clear and providers fear being prosecuted.

In a journal article published in the IJGO in April 2021, the authors describe how and why telemedicine for abortion provision was initiated in Ireland, and outline the work undertaken to maintain access to abortion care in early pregnancy through the lens of a single community-level provider – the IFPA. They also explore what these developments may mean for abortion law, policy, and service delivery.

International Journal of Gynecology & Obstetrics, by Alison Spillane, Maeve Taylor, Caitriona Henchion, Róisín Venables, Catherine Conlon. Early abortion care during the COVID-19 public health emergency in Ireland: implications for law, policy, and service delivery, 24 April 2021.

NEWS SOURCES: RTȆ.IE, by Ailbhe Conneely, 25 May 2021 ; Irish Examiner, by Alison Spillane, 24 May 2021 ; Irish Times, by Sarah Burns. 24 May 2021  ; VISUAL