Patient died travelling home after abortion, Rotunda master says

The master of the Rotunda Hospital Dublin, Prof Fergal Malone has said one woman had died in recent years while travelling home from the United Kingdom due to complications following a pregnancy termination. *

Speaking to the Oireachtas Committee on the Eighth Amendment he said: "We are aware of at least one of our patients from Ireland who died following a complication from a surgical termination of pregnancy while travelling between Ireland and a centre abroad."

“Forcing patients to travel between two jurisdictions, particularly when dealing with travel between islands, will inevitably increase the risks to mothers’ physical health and wellbeing” he said.

Dr Rhona Mahony, master of the National Maternity Hospital, has said the Eighth Amendment "makes no clinical sense" before the foetus is viable.

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Dr Mahony said the Constitutional provision “creates unacceptable clinical risk and should be removed”.

“Prior to foetal viability, we do not have the option of delivering a foetus because the foetus cannot survive and if a pregnant mother dies her baby dies too.

“Therefore, prior to foetal viability this constitutional provision makes no clinical sense. However, its presence facilitates a real possibility that clinical decision-making may be delayed and distorted as clinicians ponder the law rather than medicine.”

On the issue of foetal anomalies during pregnancy, Dr Mahony said 60 women who attended the maternity hospital service in 2016 travelled to the UK for a termination of pregnancy. Her statement also outlined that 43 women who attended the maternity hospital service had travelled for a termination of pregnancy so far this year.

In her statement, she noted “the diagnosis of a major foetal anomaly and particular a foetal anomaly in which survival is unlikely after birth is a really difficult part of my job”.

The Eighth Amendment of the Constitution of Ireland recognises the equal right to life of the mother and the unborn child. A referendum on the matter is expected to take place next summer.

* Speaking to the committee earlier on Wednesday, Dr Abigail Aiken, assistant Professor from the LBJ school of public affairs, University of Texas, said through in-depth interviews, Irish women had described the methods they would have had to resort to or which others sometimes would have made them resort to through coercion, had online telemedicine or travel not been accessible.

Research and interviews she conducted with women who had used the Women on Web website service to order abortion pills online outlined several ways Irish women would attempt to induce miscarriages.

“Very unfortunately, these include coat hangers, starvation, high doses of vitamin C, strenuous exercise, large quantities of alcohol, scalding water, drinking bleach, throwing themselves downstairs or running into traffic.”

A case study was read out to the committee about one of the women interviewed in this process, Rebecca (39) a mother of two.

In it Rebecca said she was "walking up to 20 km every day. I was doing sit ups, I was doing squats. I was doing anything I could possibly do to make this happen…"  
 "I was actually reading pregnancy sites that warn you not to do things and everything they were warning you not to do was exactly what I was doing"

Fine Gael TD Kate O’Connell questioned Dr Aiken on whether she identified the presence of “abortion regret” among women who undergo a pregnancy termination, and Dr Aiken said she had not, but there was a lack of research into the issue.

Senator Ronan Mullen was critical of the “imbalance in those invited to address the committee” on the topic of healthcare and the Eighth Amendment.

Representatives from the World Health Organisation (WHO) also addressed the committee on Wednesday.

They recommeneded the Government ensure that abortion services were available all over the country and should be integrated into the national health system if the Dáil and the electorate decided to overturn the current general prohibition.

Dr Bela Ganatra of the WHO said the restriction on abortion led to women ordering abortion pills online, which “does not meet the criteria as what WHO would regard as safe”.

"Abortion services," the WHO recommends, "should be integrated into the health system to acknowledge their status as legitimate health services and to protect against stigmatization and discrimination of women and health-care providers."

The WHO also says that if there are to be charges for the procedure, women who cannot pay should be able to access abortion services without charge.”

Values-clarification exercises

In the event of abortion being legalised in all or most circumstances, the health authorities will have to train health care providers in order to ensure provision of the procedure, and should also provide “values-clarification exercises”, the body says.

“In addition to skills training, participating in values-clarification exercises can help all health-care personnel differentiate their personal beliefs and attitudes from the needs of women seeking abortion services.

“Values clarification is an exercise in articulating how personal values influence the way in which health-care personnel interact with women seeking abortion. Despite health workers’ attempts at objectivity, negative and predefined beliefs about abortion and the women who have them often influence professional judgement and quality of care,” the WHO says.

Potential barriers

The WHO officials also warned that even where abortion is legal, there are potential barriers to accessing safe services. They can include:

–“Restrictive interpretation of legal grounds, including the conditions that fall under health;

–Failure to provide public information on the legal status and availability of abortion;

–Excluding coverage for abortion services under health insurance, or failing to eliminate or reduce service fees for poor women and adolescents;

–Requirements for third-party authorisations from one or more health-care providers, or from a hospital committee, from a court or police, from a parent or guardian, or from a woman’s partner or spouse;

–Restricting the range of health-care providers and facilities, which may result in poor availability of services, especially in rural areas;

–Conscientious objection, by health-care facilities and by health-care personnel;

–Requiring mandatory waiting periods;

–Censoring, withholding or intentionally misrepresenting health-related information, in the context of abortion;

–Failure to guarantee confidentiality and privacy; and

–Requirements for medically unnecessary screening tests (such as requirements for women to view ultrasound images or listen to the fetal heartbeat).”

* This article was amended on October 14th, 2017. The original version  incorrectly referred to flying rather than travelling.