Stories of women who travelled for abortion are ‘heartbreaking’, Donnelly says

The testimonies of women facing fatal foetal anomaly diagnoses, who travelled for abortions as they did not qualify for care in Ireland, were “heartbreaking” and would be “taken very, very seriously”, Minister for Health Stephen Donnelly has said.

He was responding to the “harrowing” accounts of the women’s experiences accessing abortion services since commencement of the Health (Regulation of Termination of Pregnancy) Act in January 2019, which were detailed in a HSE report published on Tuesday. Conducted by Trinity College Dublin, the research was commissioned by the executive as part of a legally required review of the operation of the Act.

The Unplanned Pregnancy and Abortion Care (UnPac) study found the Act “falls short” of women’s needs, creating anguish and shame, while causing a “chilling” effect on clinicians — particularly in the cases of women seeking termination of pregnancies with serious foetal anomalies.

The Act provides abortion without restriction up to 12 weeks’ gestation and after that where there is a risk to life or health of the mother, or in cases where it is judged that the foetus will die before or within 28 days of birth.

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Of the 12 women interviewed who experienced serious foetal anomaly diagnoses, just six qualified for abortion care in Ireland. Among the words used by them to describe their experiences were: awful, draining, anguish, arduous, harrowing, uncertain, protracted, cast out, shame, highly distressing, alone.

Under the Act, a woman qualifies for abortion only where two doctors certify “in good faith” that the baby “is likely” to die before or within 28 days of birth. Doctors face criminal sanction if they breach this. Where they cannot comply, the woman faces continuing the pregnancy to term or travelling abroad for a termination. Women found themselves hoping their diagnosis would be “fatal enough” for care in Ireland.

Speaking at a women’s health event, hosted by Fianna Fáil Senator Lisa Chambers, Mr Donnelly described the report as “very important”.

“My thoughts really go out to the women and their partners. This is exactly why we initiated a review of the legislation ... listening very carefully to service users and listening to service providers. All of that will be coming to me in a report with recommendations,” he said, adding that he would have the report before the end of the year.

“I can’t, it would not be proper of me, to pre-empt what I think should or should not be in that report ... but certainly I would be taking the kind of testimony that was published today very, very seriously. You couldn’t but feel for the women and the partners involved. So that is exactly why we did that report — to see what is and is not working in terms of operationalising the Act.”

The study found those seeking early medical abortions (EMAs) under 12 weeks faced “problematic” situations too — particularly around timely access to care. The mandatory three-day wait between asking for an EMA and accessing one was seen as “infantilising”, though most accepted it could be beneficial for some women.

The pro-life campaign described the report as “slanted” and “highly selective”. Eilís Mulroy, spokeswoman for the campaign, said: “Terms like ‘chilling effect’ are used again and again in the abortion debate to press for wider access to abortion.” She said Mr Donnelly was overseeing the three-year review in a “highly political and partisan way”.

Alana Ryan, health co-ordinator with the National Women’s Council, said the study made it “clear that significant systemic improvements are required”.

“Women shared the anguish and distress of being deemed ineligible for care on the grounds of fatal foetal anomalies, the disempowering impact of the three-day wait and expressed their ‘shock’ at the lack of GPs providing in rural communities.”

Speaking in the Dáil, Taoiseach Micheál Martin said the HSE report contained “significant and disturbing analysis” of the situation.

He said he was “not satisfied” that just 11 of the State’s 19 maternity hospitals were providing termination of pregnancy services.

“A number of other maternity hospitals are expected to introduce these services before the end of 2022,” he said.

Labour leader Ivana Bacik said the words expressed by women involved in the review, such as “draining”, “arduous” and “harrowing” showed how “inadequate” the current legislative structure was to meet the needs of women in cases of crisis or unplanned pregnancy.