Safe abortion is here to stay - but there remains much work to do, writes Dr Mike Thompson.
Today marks 100 days since the introduction of legal abortion in this country. Prior to this, abortions in Ireland were mostly exported, or furtive and unsupported.
A divisive referendum campaign resulted in two-thirds of voters supporting a woman’s “right to choose”.
The Eighth Amendment inserted into the Constitution in 1983, which gave the foetus equal rights to that of the mother, was repealed. A woman may now — for private reasons — decide not to continue with a pregnancy if this pregnancy is less than 12 weeks.
And if her pregnancy is less than 10 weeks (up to nine weeks and six days), that abortion can now be provided in the community (general practice or family planning clinics) by early medical abortion (EMA). Women who are more than 10 weeks pregnant will attend hospital for their care.
A woman with a wanted pregnancy, a crisis pregnancy, or an unwanted pregnancy — can all now access the care they need. I feel privileged that, as a GP, I can now provide holistic care to all these women.
We are now seeing a cohort of women who heretofore had been invisible to us as they were buying abortion pills online or travelling to another jurisdiction to have a termination. Figures show up to one in 10 Irish women may have had a termination of pregnancy (TOP).
I have found it rewarding to help these women at a very difficult time. It is a service I feel ethically and professionally obliged to provide. I understand not all of my colleagues will share this view.
This is not a service that every GP will want to provide. But luckily, the service is already functioning with just a fraction of GPs providing it. There remains much confusion about what, in reality, EMA entails.
A woman will make an appointment with her GP or a provider through the myOptions helpline (1800 828 010). The option for non-directive counselling may also be accessed through this number.
The process itself is medically straightforward — confirmation of her decision, assessing suitability, obtaining consent, dispensing of medication, and arranging follow-up. Indeed, it’s much like any other medical intervention.
The woman is given medication in the surgery to end her pregnancy and a different type of medication to take at home to expel the pregnancy.
Uncertainty, ambivalence, or confliction can be addressed. If needed, further counselling can be accessed. In my experience to date, however, a woman arrives certain of her decision.
Each woman can only make the right decision for themselves. Most women who make appointments are five to six weeks’ pregnant. Most of them already have children.
The concern of hospital services being overstretched has not occurred. Our hospital-based colleagues will continue to treat women who are more than 10 weeks into their gestation, with those who have presented with complications (rare), with those cases of fatal foetal abnormality, or where there is a risk to the mother. GPs could not offer a service without the support and expertise of our consultant gynaecological, midwifery, and radiological colleagues. Hospital-based services must be supported.
Yet, it is true to comment that the vast majority of abortion care is already being delivered in the community. Figures are not yet available, but I would estimate community EMA accounts for more than five in six cases.
Other countries are now looking to Ireland to see how a woman-centred, community based, safe, and evidence-based service can be adopted.
Targetable abortion clinics are not needed. There are local, safe, and anonymous clinics throughout Ireland with more than 300 GPs now signed up. “Othering” this cohort by some in the medical community has been unhelpful — that these women should go to some “other place” to be treated by “other doctors”.
However, it is not a time for complacency — there remains much work to do.
Some women still have to travel excessive distances to reach a provider. This affects marginalised women the most. The mandatory three-day delay before medication can be dispensed should be removed and replaced with a shorter, optional period. Exclusion zones are still required. The ideal of free at point-of-care contraception should be realised to reduce the number of crisis pregnancies.
Women from Northern Ireland should be allowed access care, free at point-of-care. Nine out of 19 hospitals that provide a maternity service currently provide EMAs — this could be increased. The ICGP has issued interim guidelines which need to be finalised.
Values clarification will need to continue for all healthcare staff. The HSE must appoint a clinical lead in TOP with responsibility for governance, audit, and reporting. Undergraduate and postgraduate education needs to be updated and taught.
The referendum convulsed the nation. The introduction of the service was fractured and uneven, some might suggest rushed. Large organisations have members with very disparate views. Individual GPs were always going to have the flexibility to respond quickly to need.
The HSE has been very proactive. The pathways for ultrasound or hospital care have been clarified. Clinical guidelines are in place. START (Southern Taskgroup on Abortion and Reproductive Topics), of which I am a member, has played a central role in peer support, education, and advocacy.
Normalisation of services may take time, even a generation, but EMA is now an accepted, available service from Irish doctors for their patients. It is here to stay.
Those women (or girls) who have chosen not to continue a pregnancy are relieved and grateful that their GP can now advise, help, and support their decision. As a GP, it is very rewarding to be able to address their physical, psychological, and social needs in a holistic way, as we do all our other patients who attend us.
The reality is that women can now access this service without fuss or fanfare, like much of general practice. Keeping the patient front and centre is what GPs do best, regardless of what stance we take on abortion.
A woman’s decision should remain between her and her doctor — where it belongs.
Dr Mike Thompson is an East Cork GP and founder member of START