Three women examine how repealing or retaining the Eighth would affect culture of Irish healthcare

Three women each give their view on the potential impact of the upcoming referendum on Irish healthcare.

File photo.

Historian Lindsey Earner Byrne says the Eighth Amendment is indicative of a culture that does not trust women

The current cervical smear scandal is indicative of the history of how Irish women have been treated in relation to their own bodies, health, and lives.

It is in keeping with a society that introduced the Eighth Amendment to our Constitution only a few days after being informed a woman died because she was denied cancer treatment that was deemed harmful to her unborn child.

It is indicative of a culture where people continue to champion such an amendment after it resulted in the death of Savita Halappanavar, who had been denied an emergency termination to complete a partial miscarriage that ended up killing her. It is indicative of a culture that does not trust women.

Why am I surprised? After all, I have spent 20 years researching and writing the history of women in Ireland, in particular the treatment of mothers.

I know this distrust of women has a long history and it is a history that has prioritised an abstract morality over real women’s lives.

In 2007, I published a book unearthing the reality of the mother and baby homes that propped up our hypocritical moral culture. The logic that underpinned that system is not history.

Today, a woman, pregnant as a result of rape, who seeks an abortion in Ireland faces a longer sentence than her rapist. We don’t mind if she leaves the country, but then we were happy to export our unmarried mothers in the past too.

Throughout the first half of the 20th century, as many unmarried mothers left Ireland as stayed. Our priorities were and are clear, if frightening.

Distrust of women also underpinned the decision to suppress information relating to birth control in 1929, as one commentator, writing in The Dublin Review wondered: “What is there to induce women to go through the difficulties inseparable from maternity if they accept the principles of Birth Control?” The writer believed women would not endure repeated pregnancies out of patriotism, if, as he noted “the fear of God fails”.

In 1935, when the sale and/or use of contraception was criminalised, it was done so despite the knowledge that some women would pay for that decision with their lives. In fact, it was done so because of the knowledge that women’s health was being cited as grounds for access to birth control elsewhere.

For example, in the early 1930s, the League of Nations drew up a maternal welfare handbook which advised that women who suffered from heart disease, tuberculosis or nephritis should be provided with “anti-conception” advice.

When the Government objected to the notion of supplying birth control advice, the League explained it wished to ensure that women were not “called upon to sacrifice their lives”.

However, the Government, bolstered by the 1931 papal pronouncement that risks to the mother’s life offered no

pretext for abortion or birth control, persisted and succeeded in having the wording changed to read: “Steps to be taken to avoid [pregnancy] should be explained to the husband and wife by a doctor…due account being taken of the individual’s religious beliefs and moral principles, as well as of national legislation.”

At the time, medical opinion was that, after pregnancy, “death often ensues” for the woman with tuberculosis, a real and present danger in 1930s Ireland.

We need to remember too that when the Irish state banned birth control and all information about how to regulate fertility, women were marrying later than anywhere else in Western Europe and had the highest marital fertility.

The year after these negotiations with the League of Nations, the Master of the Rotunda hospital in Dublin noted the dangers facing mothers.

“From the fifth pregnancy the rate of mortality is over average by an amount which increases steadily and speedily until in women bearing their tenth child or more the mortality is five times as high as for all women bearing children,” he wrote.

At the heart of this history was a desire to control the flow of information to ensure that women were not fully aware of the health implications of repeated pregnancies and an acknowledgment that in prioritising morality some women would die.

I often hear people say they don’t “believe in abortion”. I wish that was an option, but abortion is not a religion; it is a medical intervention, a response to the trauma of unwanted, dangerous, or unviable pregnancies.

So, is this statement a declaration of a kind of moral geography that stops at the shores of Ireland?

I have asked people about the posters saying “in England 1 in 5 babies are aborted”, because I wanted to understand the logic of this argument.

Presumably, these figures (setting aside questions of accuracy) include Irish abortions? So when these posters tell us “Don’t bring this to Ireland”, are they referring to the roughly nine Irish women that travel to England everyday to terminate their pregnancies?

Shouldn’t it follow that people who are convinced by this logic would also like to restrict women’s right to travel?

If you are voting to stop Irish abortion, you must want to stop Irish people leaving Ireland to end Irish pregnancies.

The surprising thing is when I ask people this, not one person voting to retain the Eighth Amendment based on the rationale of these posters has agreed with the idea of restricting the right to travel. So again, I ask, is this about geography?

Don’t be fooled by disingenuous talk of not trusting politicians — that is a smoke screen, as urging people not to trust women would simply not wash.

This is the same rationale that talks of “abortion on demand” — that is code for “beware of giving women the final say on their own pregnancies”.

In essence, a no vote will retain the Eighth Amendment and ensure that individual women do not get to decide what happens to them in a moment of crisis after a rape, or in the case of their health being endangered by a pregnancy, or in how closely they are willing to flirt with death before medical intervention is justified to terminate their pregnancy.

Trust me.

Lindsey Earner Byrne is associate professor, School of History, University College Dublin

Trish Horgan says the Eighth means she must turn away some of her patients at their time of greatest need

I am a GP on the northside of Cork City and in my 16 years of practice I have met many women with difficulty in pregnancy.

This can include fatal fetal anomalies, miscarriages, and crisis pregnancies.

Crisis pregnancy is common, and can affect a woman of any age, class and background. Whether you are aware of it or not, you know someone who has experienced a crisis pregnancy.

The forthcoming referendum will ask us to repeal the Eighth Amendment so that “provision may be made by law for the regulation of termination of pregnancy”.

This will not change the laws on abortion immediately, but it will allow the Dáil to legislate for access to abortion care for women.

It will also not introduce abortion; it already exists. Thousands of Irish women access abortion services every year, but not at home.

So why is new legislation needed? What’s wrong with what we have in place right now?

As a doctor who has worked on the frontlines of this issue for 16 years, I believe the current legislation puts women — mothers, sisters, daughters, partners, friends, colleagues — at an unacceptable risk of harm.

That harm is caused, in part, by a break in the vital link between the patient and GP who usually navigates a healthcare pathway on the patient’s behalf.

At present, if my patient decides to terminate her pregnancy, the law will permit me, as her GP, to discuss that with her, but prohibits me from taking the next clinical step in her care, which would be to make a referral on her behalf.

This means my patient must navigate the next steps without medical guidance — sometimes with a partner, often as distressed and vulnerable as she is, sometimes not.

I don’t know what quality of care she will receive abroad, I won’t receive any information from the doctors treating her abroad, and I doubt she will come to me for any follow-up care, though she may desperately need it.

In 2016, 3,265 women gave Irish addresses (including 241 from Cork) at abortion clinics in Britain, bringing the number to 168,703 since 1980.

These are not just numbers; these are wives, mothers, daughters, forced to make a cruel and lonely journey at a time when they should be cared for at home. 

I am aware that some of those women may include my own patients and yet there is little I can do to help them. Just like there is little I can do to help patients who purchase abortion pills online.

Thousands of Irish women buy these pills which they take without medical supervision, spending hours or days afterwards bleeding or waiting to bleed, or wondering if they have infection or if they are still pregnant; and all the while terrified of prosecution because they have acted outside the law.

These women are even less likely than those who travel abroad for termination to present to me for medical care, because what they’re doing is illegal. 

From a medical point of view, these women are at risk of serious illness or death.

In any other circumstances, a woman with such complex physical and psychological needs would and should contact her doctor. But they don’t, and they won’t until we repeal the Eighth Amendment.

Women facing crisis pregnancies need the best healthcare possible at home in Ireland.

A yes vote recognises the reality that thousands of women in Ireland are having unsupported abortions every single year, and that we need to update our laws to reflect this reality.

A yes vote is about removing threats, and fear and shame from our healthcare. We urgently need to create an environment where patients who find themselves in crisis pregnancy can seek help from their doctors, not hide from them. 

This would allow for a compassionate, non-judgmental consultation where all options would be considered.

The Eighth Amendment means that I must turn away some of my patients at their time of greatest need.

I believe Ireland is a compassionate country. We cannot look the other way any longer. As a doctor I want to be able to support all of my patients.

I am voting yes so that I can deliver that support and care.

Trish Horgan is a GP in Cork city

We need to take care of our vulnerable, not export them for the UK to receive help, says Louise Kenny

I’m an obstetrician and gynaecologist specialising in the management of high-risk pregnancies.

I have more than 25 years of clinical experience and I spent the last 12 years working in Ireland as a consultant obstetrician at Cork University Maternity Hospital.

Over two unseasonably warm and sunny days earlier this month, 400 or so of Britain and Ireland’s doctors who, like me, specialise in the management of high-risk pregnancies attended a conference in Brighton.

The British Maternal and Fetal Medicine Society (BMFMS) meeting is an annual opportunity to meet with colleagues and friends, to share medical and scientific research progress, discuss complicated medical dilemmas and to advance the care of maternal and fetal medicine.

Obstetrics, and the management of high-risk pregnancies in particular, has long been regarded as the ‘Cinderella discipline’ of medical research.

Here in Ireland, we punch above our weight, sporting the world-class Infant centre at UCC and the newly launched Perinatal Research Centre at UCD.

The Irish contingent is always well represented at BMFMS.

And yet, each year as Team Ireland board the plane to meet with our European colleagues, our pride is always tinged with a sense of shame.

As consultant obstetricians at the sharp end of clinical practice, we know what it is to diagnose a life limiting fetal abnormality and to tell the grief-stricken parents — your options are limited, all we can do is wait.

At the darkest hours of any mother’s life, we are unable to offer what our colleagues in Britain and elsewhere can.

We provide information, the contact details of the hospitals where many of us trained and where we know our patients will be met with compassion and care.

But under the Eight Amendment, we cannot fulfil the most basic requirement of good clinical practice. We cannot pick up the phone or send a letter to provide even the most basic of clinical details — as this would constitute procurement of an abortion and we would face a custodial sentence.

We are gagged and bound. Our British colleagues understand this. Week in and week out, for the last 34 years, they have opened their underfunded and understaffed hospitals and clinics to Irish women shunned by their own country.

Colleagues and friends to us, but strangers to our patients, they nevertheless care for them as if they were their own.

Last year, of the 3,265 Irish women who attended hospitals and clinics in the UK seeking termination of pregnancy, 61 women attended Liverpool Women’s Hospital, where I trained, with pregnancies complicated by either significant maternal medical illness or life-limiting fetal abnormalities.

Some 61 Irish citizens, at a time of critical need, travelled to a foreign country for basic healthcare, approved by the World Health Organisation (WHO), the International Federation of Gynaecology and Obstetrics (FIGO), and the Royal College of Obstetricians and Gynaecologists (RCOG), but denied to Irish women because of the Eighth Amendment.

The ultimate English solution to a problem Ireland has refused to acknowledge.

Several of those 61 women were patients of mine. Since moving back to Ireland 12 years ago, I have cared for many women whose lives have been damaged, sometimes irreparably, by the Eighth Amendment.

I remember each and every one of them. I remember the sudden, sick, hollow feeling in my stomach when I turned on the ultrasound during a routine appointment and saw something that would change a woman’s life forever.

Obstetrics is the best job in the world. It can also be the worst.

There are no words to describe the feeling that accompanies the words “I’m so sorry, I have something to tell you”, but I’m certain that it is nothing to the utter despair felt by the mothers and fathers who hear those words spoken.

In the evening sunshine in Brighton, I meet a colleague, an old friend from Liverpool who I trained with and who has been there for countless Irish women over the last three decades.

He follows me on Twitter and he understands the irony. When we first met, I was a very junior doctor from an Irish Catholic family, I was reticent about abortion and had everything to learn.

For the last 12 years, he and his colleagues have been there for the women, the babies and the families that have been exported, on my watch, from Ireland because of the Eighth Amendment.

I cannot express my gratitude and I cannot hide my shame. But this year, as we part, Team Ireland toast our

colleagues with a renewed sense of purpose and hope.

We will vote yes on May 25 and hope that this year will be the last year we export our most vulnerable citizens. Next year we will be able to take care of our own.

Louise Kenny is consultant obstetrician at Cork University Maternity Hospital

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