‘Somebody said to me, you’re just the face of mums and dads doing abortion’

Dr Paddy Moore is an abortion surgeon. During her 30-year career working as a consultant obstetrician-gynaecologist in reproductive healthcare, a lot has changed.

For one, she now finds it a lot easier to talk about what she does.

Earlier on in her career, she was more apprehensive about how people would react to hearing about what she did for work. “In my personal life, I protected my family members from it until my children had developed their own thoughts about it,” Dr Moore says.

Now in her 60s and the head of the abortion and contraception service at the Royal Women’s Hospital in Melbourne, Australia – the largest public provider of abortion services in Victoria – talking about and advocating for abortion is part of the day job. “It’s entirely consistent with my values and being a mum and all the rest of it. Somebody said to me today, you’re just the face of mums and dads doing abortion.”

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Dr Moore grew up near Coleraine in Co Derry. One of four children, her family emigrated to New Zealand in 1972 when she finished primary school.

Access to termination services in Australia has improved considerably over the course of Dr Moore’s career and is accessible between 20 and 24 weeks across Australia.

Abortion has also been decriminalised in every state except Western Australia, where a Bill to improve access and decriminalise abortion is currently going through parliament.

But recent rulings in the US and Poland remind her that the fight for reproductive rights is never over. Talking about abortion and engaging with it politically is as important as it has ever been. “I think that’s been part of my development. It’s something that you have to be prepared to talk about. And you can never take your eye off the ball.”

“We used to think that Roe v Wade was tight,” she says, referring to the US supreme court’s 1973 ruling that granted women in the United States the constitutional right to a legal abortion.

Last year, the US supreme court overturned Roe v Wade. Since then, multiple states have introduced an outright ban on abortion, with others heavily restricting access to services. In 2021, the Polish government legislated to ban abortion, except for cases of rape or incest, or if there is a threat to the life or health of the woman.

“You can’t take your eye off this issue. It’s always going to be a contentious issue and it’s always going to be used politically, so you have to engage politically,” Dr Moore says.

[ Leo Varadkar says he would like to see fewer abortions in Ireland ]

As a medical student, she assumed contraception and abortion care would be part of her training, but soon realised that not many of her contemporaries wanted to specialise in it. “I always thought it was something that we should be doing. It’s just part of our practice.”

During her career, Dr Moore has worked providing antenatal care for vulnerable groups, including patients struggling with alcohol and drug dependency, disabled women and patients who have been sexually assaulted. Her experience within the public health system and witnessing the varied and complex reasons women need access to abortion informed her as a practitioner. “Abortion was certainly a necessary and under-provided service,” she says.

Day to day, Dr Moore provides medical and surgical abortions for women and pregnant people in Victoria up to 24 weeks. In the rare cases, where people access abortion beyond 24 weeks, the agreement of two doctors is needed.

In making those decisions, Dr Moore says she considers everything from the economic, psychosocial and psychiatric implications of having the procedure and their effect on patients’ lives versus the implications of not getting the procedure.

Although the vast majority of abortions, about 80-90 per cent, happen before 12 weeks, Dr Moore says there are many reasons women access services beyond that point. In Ireland, following the 2018 referendum to repeal the Eighth Amendment and the subsequent legislation introduced on January 1st, 2019, abortion is legal up to 12 weeks. When asked about the 12-week gestation limit in Ireland, Dr Moore said it seemed like an “arbitrary cut-off”.

“It means a lot of people will still be going to Britain.”

Some Irish women are still travelling for abortions, although the numbers decreased considerably after the referendum and during the pandemic. Statistics released by the Department of Health and Social Care in the UK show that since Ireland’s abortion law came into effect in January 2019, up until June 2022, at least 861 women have travelled to England and Wales for an abortion. That’s almost five women a week.

Dr Moore cites several reasons for women needing to access abortion after 12 weeks, including that all reliable forms of contraception fail, meaning some people won’t realise they’re pregnant until further into their pregnancies.

Advances in antenatal diagnosis, better ultrasound and increased antenatal diagnoses for foetal abnormalities also mean that women have more information that could change how they view the risks and benefits of continuing a pregnancy, she added. “People make a global decision with regard to their family, and children they have, and the relationships they’re in. That’s my experience. They’re thinking protectively and globally about the children they already have.”

In cases of fatal foetal abnormalities, Dr Moore meets parents who are trying to make compassionate decisions, she says. Citing research from a senior social worker at the Royal Women’s Hospital, Dr Moore also says family violence, reproductive coercion, and non-consensual conception are all factors for prolonged delays in diagnosis.

A review of Ireland’s abortion system released in April this year made several recommendations, including a review into accessing abortion after 12 weeks in cases of fatal foetal abnormality, reviewed guidelines on conscientious objection, the decriminalisation of doctors and the removal of the mandatory three-day waiting period to access an abortion.

Following the publication of the report, the People Before Profit Party proposed a Bill that would remove the three-day wait period and decriminalise abortion fully. That Bill will now be further examined at committee stage. At the moment in Ireland, if you choose to have an abortion you must wait three days between requesting an abortion with your GP and receiving treatment.

[ Proposed changes to abortion law may not be made until new year ]

When asked about mandatory wait times, Dr Moore said accessing abortion services is already time-sensitive. Putting up more hurdles for women, a lot of whom still have to travel, organise childcare and take time off work, just causes more problems, she says. “I can be really categorical about this, there is no evidence that [three day wait time] makes any difference at all,” Dr Moore says. “In fact, there’s evidence that it just causes increased costs for patients and distress, real psychological distress. With my feminist lens on, it’s all about not trusting women, and having some kind of ownership over their sexuality, their reproductive rights.”

Another recommendation from the report’s authors was to review the guidelines on conscientious objection. The report found that, in some instances, conscientious objectors were impeding the rollout of abortion services across the country.

Not only is Dr Moore a consultant obstetrician-gynaecologist by training, she also trained as a teacher and sits on the Royal Women’s Hospital’s medical ethics committee. Although she thinks conscientious objection should be accommodated, she doesn’t care for the term itself as she says it assumes a moral superiority.

She thinks of herself as a “conscientious provider”.

“I have a conscientious obligation to provide the full suite of services for my fellow women-kind,” Dr Moore says.

There should be legislation obliging practitioners to be clear about the services they provide, before a patient is sitting in the chair in front of them, Dr Moore says. “You can have a conscientious objection, but we need to know your reasoning. So articulate your reasoning, and keep reflecting on your reasoning as you carry on.”

Assuming that conscience is static is not particularly helpful when establishing guidelines on conscientious objection, Dr Moore says. “I’ve seen my colleagues become exposed to stories and to change, to bear witness to the stories that they’ve heard and to realise they have an obligation.”