Availability of abortion pill means the genie is out of the bottle

THERE are more than 1,000 abortions taking place in Ireland each year. Yes, they are happening every day, right under our noses, and as time goes on that figure is going to rise substantially, writes Alison O’Connor.

That increase will occur regardless of what the Oireachtas committee considering the Eighth Amendment decides, or what proposal the Government comes up with, or what does or does not pass through the Dáil, or how Irish people vote in a referendum. The reason is that each day an abortion pill package is delivered to at least three women around the country.

As awareness of this pill and its effectiveness and safety grows those numbers will climb, and correspondingly the numbers of women travelling to the UK for a termination will decrease. Of course, the women ordering and taking the pills are acting illegally.

But as Dr Peter Boylan, former Master of Holles St pointed out to the Eighth committee recently, An Post’s Addresspal, which give you a virtual address in the UK, is just one way of getting the pill through the post. This means that a semi-state organisation is facilitating the illegal importation of this medication. If this were not such a deadly serious topic it would be laughable.

As Dr Boylan pointed out, when the Eighth Amendment was enacted neither the world wide web nor the abortion pill had been invented, and its availability means “the genie is out of the bottle”.

However it also means there is potential for harm for women in the use of unregulated medicines.

The committee hearings have certainly put the spotlight on the role of the abortion pill, with TDs and senators not so aware of what a big role it now plays in pregnancy terminations, up to 10 weeks gestation. After that a woman would have to travel for a medical termination to the UK or elsewhere.

Very early on the members of the Citizen’s Assembly were told by Janice Donlon of the HSE sexual health and crisis pregnancy programmes that research had shown that, despite its illegality, between January 2010 and December 2015, 5,650 women from the island of Ireland consulted Women on Web (WoW) which supplies the abortion pill through the post, giving online consultations with a doctor, up to 10 weeks gestation.

It’s worth reminding ourselves that between 1980 and 2016 more than 170,000 Irish women and girls travelled from the Republic of Ireland to access abortions elsewhere.

There has been a slight fall in the number of women travelling from Ireland to Britain for an abortion, official figures have revealed. Records from the UK show 3,451 women gave addresses in Ireland — almost 10 a day — while attending clinics in England and Wales last year. But statistics also reveal a 48% decline in the numbers travelling since 2001, with a rapid decline between 2001 and 2007, and more gradually in recent years.

Earlier this year a report from the British Medical Journal found that more than 90% of Irish women who used abortion pills to end their pregnancy did not subsequently need any surgical intervention or any medical assistance.

In other words they took the pills as directed, the termination took place, and they were no longer pregnant. In the UK a woman takes the first pill at an abortion clinic, the subsequent one at home, and that is where the abortion occurs.

The data used was from a study conducted by the Netherlands-based WoW, which is a non-profit organisation that provides early medical abortion through online telemedicine in countries where access to safe abortion is restricted. The study found that taking abortion pills while being supervised online by a doctor in another jurisdiction “can offer an alternative to unsafe methods to end a pregnancy for women in countries where access to safe abortion is restricted”.

Of the remaining 10% of women, 31 needed either blood transfusions or antibiotics, 45 required some form of surgery to complete the abortion, and eight remained pregnant.

There were no deaths. The findings were based on reports from women living in the Republic of Ireland and Northern Ireland.

At present women who travel from Ireland for an abortion tend to do so later in their pregnancy for the obvious reason that they need to raise the money, book flights, and find somewhere to stay — 69% of women from the Republic doing so between three and nine weeks gestation, compared to 81% for women living in England and Wales.

Of course the purchase and importation of abortion medication is illegal in the Republic and Northern Ireland. Under the Protection of Life During Pregnancy Act 2013, anyone found to have taken such medication could face prosecution and a fine or up to 14 years in jail.

As things stand there have been no known prosecutions under the act. It is welcome to hear but also classic of our ridiculously two-faced approach to abortion that the Health Products Regulatory Authority has said it would not prosecute a woman who had illegally imported abortion medication for personal use.

Obviously it is far preferable to undergo a home abortion under direct rather than virtual medical supervision, and despite the reassurances there is always the fear for an Irish woman that if she needs to seek medical treatment in the event of something going wrong that she’ll be the exception to that prosecution rule.

Introduced in 1991 the abortion pill is now responsible for 55% of abortions in England and Wales and 81% in Scotland. Clearly to go down this route would be an answer of sorts to our problems, not all of them, in a particularly Irish way. It would avoid what we might call the squeamishness, for want of a better word, around abortion. Many prefer the idea of medical abortion as it does not involve surgical instrumentation or anaesthesia and is perceived as more natural, like a miscarriage.

Lots of the so-called middle ground want to help women but hate the thought of abortion clinics being built around the country and the thought of surgical abortions. Clearly though there would have to be the infrastructure and services to deal with women who have complications, such as the 10% identified in the study.

Availability of the abortion pill for terminating early pregnancy would also cover those who have been raped, but would not assist those who find themselves in the heartbreaking position of being told their baby has a fatal foetal abnormality, often diagnosed much later in pregnancy.

These situations would clearly have to be a central part of any proposals. Isn’t it worth considering though?