A year on from the abortion referendum concerns remain

A year ago today, on May 25th, 2018, more than two million men and women cast their vote in one of the most significant referendums in Irish history.

After weeks of intense campaigning, those on both the Yes and No sides had done all they could to convince voters why they should or should not repeal the Eighth Amendment to the Constitution. The Government had laid out its stall: if the vote passed, abortion would be legalised up to 12 weeks without restriction. The 12-week proposition came about because of the widespread unregulated use of abortion pills. Beyond this, terminations would be permitted in the case of fatal foetal abnormality or where the life or health of the woman was at risk.

Across the country that Friday, votes were cast as both sides of the campaign waited anxiously for the count the next day.

Ailbhe Smyth, the former co-director of the Together For Yes campaign recalls the atmosphere that evening in the campaign headquarters. Volunteers were eating pizza and trying to relax, when The Irish Times exit poll landed.

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It suggested the margin of victory for the Yes side in the referendum would be 68 per cent to 32 per cent – a landslide win for the Yes side.

“We didn’t know what was coming. When the poll came in, people were just stunned and overjoyed,” she says. “I just felt, and it is a feeling that has remained with me since, like it was a huge relief. I felt a huge weight had been lifted from the shoulders of women in this country. I felt it immediately, that there was a kind of freedom that we had not had before.”

The landslide victory was to be confirmed the next day with a final result of 66.4 per cent in favour of repeal to 33.6 per cent against.

Heartbroken

The No campaigners remember that time differently.

“People were heartbroken with regard to the results, and the scale of the results,” says Peadar Tóibín, an anti-abortion campaigner and former Sinn Féin TD who left the party over its stance on abortion. He subsequently became a founder of the Aontú political party.

Both camps knew that more testing times were yet to come in legislating for abortion in order to deliver on the result of the referendum.

“I wasn’t under any illusions, I knew it was a tremendous victory, but a victory that would be followed by hard work,” says Smyth.

The Regulation of Termination of Pregnancy Bill, which made provision for abortion, would go on to be debated in the Dáil for weeks, with more than 350 amendments tabled. The only amendments that passed were Government changes.

Tóibín said the legislative process was “strange”.

“It was the most aggressive I’ve seen the Dáil in my eight years there. It was interesting from the political perspective in that I have never seen such uniformity between the People Before Profit and Solidarity group and people like Simon Harris, Lisa Chambers and Micheál Martin.

“There was a monolith within the Dáil, unwilling to listen or to change the legislation in any way.”

On December 13th, just after 8pm, the Bill passed all stages in the Oireachtas.

“This is a genuinely historic moment,” Minister for Health Simon Harris said at the time.

“It paves the way for the implementation of the service for termination of pregnancy in January 2019.”

It was around this time that doctors started warning that this deadline was dangerously unrealistic.

Dr Peter Boylan, who assisted the Health Service Executive in the roll-out of abortion services, says that on reflection, Harris was right to set that deadline.

“I think Simon Harris deserves an awful lot of credit for leading this politically. He also deserves credit for setting the January 1st deadline. If he hadn’t set a date, we would still be talking about it and going around and around in circles talking about guidelines.”

Five months on from that January deadline, about 319 general practitioners have signed up to provide the service with 10 out of 19 maternity units providing full abortion care.

According to the HSE, all maternity services are providing some level of care including managing complications arising from terminations, care and supervision where there is a diagnosis of fatal foetal abnormality, referral to other tertiary units, and care and supervision where maternal life or health is at risk.

The master of the Rotunda Hospital, Professor Fergal Malone, says he believes some of the remaining hospitals have not signed up to provide full services because they see other hospitals are already doing this and feel they “might be able to get away with it [with not offering full services], without having to make difficult choices.”

He says this means some hospitals are exporting the issue to others.

From his perspective, however, the service has bedded down well and Ireland is in a very different place in comparison to this time last year.

“You can talk to patients and give them a full range of options and not watch as they crumble in front of your eyes as the horrible reality dawns on them that if they want to choose to terminate their pregnancy, they have to travel. Now, we can have simple discussions with patients in a completely different atmosphere.”

In terms of the past few months, he says GPs “have really stepped up to the plate” in looking after women.

“That has been a positive for the hospitals. The issue of conscientious objection was a difficult and complex one to solve, but we did solve it. We are respectful of staff who can participate and respectful of staff who have limitations. It is useful to understand that conscientious objection is not a black and white thing.”

Funding

The main issue, he says, is a lack of sufficient resources. He says that funding promised at the start of the year has not yet been released. “It is still waiting to find its way down to the frontline. We front all the cash ourselves which is, practically speaking, a difficult thing as we run a break-even budget.”

This pressure will intensify in the second half of the year if resources are not allocated, he says.

The issue of fatal foetal abnormalities, and the screening procedures for detecting them, entered the headlines again this month, when details emerged of a case where a termination was carried out, after test results, for reasons of fatal foetal abnormality, but a test later showed no abnormality was present. The National Maternity Hospital in Dublin has commissioned an independent review into the circumstances of an abortion carried out in the hospital last March.

Malone says this kind of case is exceptionally rare.

“I would hate for people to think that normal babies are being terminated frequently because of a misdiagnosis of a fatal foetal abnormality. No baby has been terminated in the Rotunda with the label of fatal foetal abnormality that has subsequently turned out to be healthy.”

Tóíbín has asked the Government to create new guidelines to state that an abortion cannot be carried out until the final diagnostic test has been issued.

“We indicated that the Government law would allow for a margin of error because the law says that if it is likely that the child is not going to survive more than 28 days outside the womb then it is permissible to have an abortion up until birth.

“That means a potentially large number of missed diagnoses and mistakes, and we said this in the [debate about the] Bill and that has come to pass. In many ways in the last weeks the Government has created its first hard case.”

For campaigners like Smyth, they are looking for changes to the law when a review of the legislation is carried out in 2½ years’ time. They have concerns that the three-day wait before a patient can access abortion medication is causing issues for women who live rurally and also for migrant women. “It is important for us to really ensure that abortion is genuinely available under the terms of the law to everyone who needs it and we are not there yet.” She is also concerned about criminalisation, and access to free contraception.

Under the new law, any woman who accesses an abortion in circumstances beyond the legal grounds will not face criminalisation, but doctors who perform illegal abortions or family and friends who help a woman access an illegal termination could still face 14 years in prison.

A spokeswoman for the Minister for Health said that a working group looking at how to provide free contraception will report back in September. Legislation to provide for “exclusion zones” against protesters outside healthcare centres that provide abortion is due before Cabinet next month.