Only 2% of women seeking abortion did not progress beyond first consultation

The 2019 study of 475 women found that there is an “uneven geographic coverage” of service providers, which requires some women to travel, sometimes at significant cost, to access a termination.

The reasons for women not returning for their second GP visit are not ascertained, the report states, and says they may have chosen not to for various reasons including changing their minds, miscarriage, travelling abroad or presenting to another provider to start the process again. File picture

Just 2% of a study of women seeking an abortion did not proceed beyond the first consultation with their GP.

It comes as Cabinet is divided on a recommendation by Barrister Marie O’Shea following her review into Ireland’s abortion laws. Ms O’Shea has said a mandatory three-day waiting period to access termination medication should be made optional.

Social Protection Minister Heather Humphreys is understood to be among a number of ministers who have concerns around changing the waiting period. While Housing Minister Darragh O’Brien has said he would be in support of making the change.

Health Minister Stephen Donnelly published the review on Wednesday which makes 10 legislative recommendations and 60 operational measures.

A 2019 study of 475 women who were seeking an abortion revealed that just 11 women did not return for their second mandatory visit. The study was conducted over a six-month period in the first year that the abortion legislation was implemented since Ireland voted to Repeal the Eighth Amendment in 2018.

The reasons for women not returning for their second GP visit are not ascertained, the report states, and says they may have chosen not to for various reasons including changing their minds, miscarriage, travelling abroad or presenting to another provider to start the process again.

The report also stated that further research, preferably in the form of a national data collection framework, is required to obtain a better understanding as to why women didn’t return to their second appointment.

"I think that any changes that we do make, we'd have to give them very, very careful consideration,” Ms Humphreys said. 

I suppose to be fair it's not about personal opinions at this stage, it is a very sensitive issue.

"We had a referendum and people made their decision. There are some very sincerely held views on both sides.” 

Mr O’Brien, who voted against repealing the Eighth Amendment, said his “thinking” on the matter has evolved over time and the three-day waiting period can be “problematic” for people. “I haven’t read it all, but from what I’ve seen, I would be supportive of making those changes,” he said.

“There are some real issues with people not being able to access services that we’re legally bound to provide and I support that, so from looking at the changes that have been proposed I would broadly welcome them and I do, I’ll support them.” 

Untenable

The long-awaited report is critical of the access to services for women and said the provision of services is “untenable.” It states, based on the research findings, it would appear that the legal framework governing termination of pregnancy services is not in alignment with Ireland’s human rights obligations.

It found that there is an “uneven geographic coverage” of service providers, which requires some women to travel, sometimes at significant cost, to access a termination. Ms O’Shea recommends the HSE undertakes a mapping exercise to ascertain the precise number of medical practitioners providing abortion services nationwide.

The report states that there are around 422 providers of termination of pregnancy in primary care. Only 11 of 19 maternity units or hospitals provide full services which Health Minister Stephen Donnelly has said is “not acceptable.” 

The reason for non-participation by hospitals has been attributed by the HSE and the Department of Health to the prevalence of conscientious objection among medical practitioners. 

The report states to mitigate against the risk that a conscientious objector would not provide an abortion where there is a risk to the life or health of the pregnant woman in an emergency, it is recommended that a part of the Act be amended to include a provision obliging suitably qualified medical practitioners to perform a termination of pregnancy in emergency situations where there is an immediate risk to the pregnant woman’s life or health.

The report also recommends the department and HSE should consider supporting the establishment of local women’s health centers to enable GPs who want to provide the service to carry out sessions, but are unable to due to a lack of support from their practice colleagues. There is a “dearth of information” relating to GPs’ reasons for not providing termination of pregnancy services and the report states that research indicates that the main reason may be attributed to excessive workloads.

Since the legislation came into effect in January 2019, there were 17,820 abortions up to December 2022. Up to 17,510 of those did not exceed 12 weeks.

Lack of clarity

Data also indicates there has been a decline in the number of women who have travelled abroad for abortion care since January 2019. The review also identifies a lack of sufficient clarity in legislation on how certain sections of the Act should be applied and requests new ministerial guidelines regarding fatal foetal abnormalities.

Ms O’Shea also recommends the Department of Health consider amending the current legislation to expand the range of health professionals who may provide abortion services. Part of the legislation relating to the risk to life or health and the risk to life or health in an emergency lack clarity, the report finds.

It says medical practitioners find the wording of parts of the legislation “ambiguous”. “There is no guidance as to the threshold of 'risk', 'serious harm', or the extent to which the risk has to be averted,” it states.

“The subjective nature of interpretation, together with the prospect of criminal sanction and adverse media scrutiny, risks the practice of defensive medicine, which may lead to women being denied care in Ireland.” 

Not all staff in hospitals felt prepared to deliver termination of pregnancy in cases where the pregnancy could likely lead to the death of the foetus. “Some participants reported that they did not receive any additional training, education or supports prior to the commencement of services.” 

At present, doctors face up to 14 years in prison if they provide abortion care outside the specific circumstances laid out in the law. One of the recommendations includes the removal of the existing criminalisation measures against medical practitioners.