Pregnancy after rape: The first step is to remove the Eighth

Sexual violence is a brutal act, regardless of where it happens and who it happens to – there is no typical victim or typical scenario. The one thing that victims will always have in common is the harrowing, and unforgettable, nature of their experience.

I am medical director of the sexual-assault treatment unit, or SATU, at the Rotunda Hospital, in Dublin, and of the national SATU services. In conjunction with my medical, nursing, midwifery, psychological-support and Garda colleagues, I meet survivors of sexual crime almost daily. When a man or woman enters any of our services across the country they have survived one of the most devastating experiences of their lives. No two patients are the same, but in general they are experiencing a whole range of complex and confusing emotions.

Disclosure of a sexually violent incident normally leads to two things. It enables a survivor to access appropriate medical, psychological and supportive care. It also facilitates commencement of a judicial investigation, if the person chooses to engage with the criminal-justice system.

What about people who are pregnant because they could not disclose the incident, and thus did not receive emergency contraception?

In response to these needs our network of SATUs is there to provide responsive care, free of charge, to men and women who disclose sexual crime. There are many facets to this care, but it always includes the offer of emergency contraception, where needed, and therefore pregnancy after rape is not frequently seen in the group of patients who attend SATU services.

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But telling someone you have been a victim of sexual crime, particularly in the immediate aftermath, can be really difficult – so what about people who are pregnant because they could not disclose the incident, and thus did not receive emergency contraception?

Or imagine being the person who countered a whole range of emotions in order to pluck up the courage to access emergency contraception after rape but for whom that medication failed, and she now finds herself pregnant.

At this moment, in this country, termination of pregnancy for a woman who is pregnant as a result of rape is available only if there is a substantial risk to her life (including risk of suicide), which can be averted only by termination of pregnancy.

However, the Citizens’ Assembly and numerous Irish surveys and opinion polls, as well as the joint Oireachtas Committee on the Eighth Amendment to the Constitution, have identified, by a significant majority, that pregnancy as a consequence of rape or sexual assault is a scenario where women should have the choice to terminate pregnancy. The reality is, however, that legislating and regulating for termination of pregnancy on these grounds alone is not possible.

Let’s look at two key reasons why this is the case.

First, it can be extremely difficult, and frequently impossible, for survivors of sexual violence to tell anyone about it at any time, let alone to have the concept of “mandatory disclosure” in order to “persuade” a person or panel that you “deserve” access to safe and legal termination of pregnancy.

As Noeline Blackwell of Dublin Rape Crisis Centre said in her submission to the Oireachtas committee, such a suggestion “disempowers the person who has suffered the rape while empowering those giving permission to access termination of pregnancy. Once more the consent of the victim is seen as irrelevant.”

Second, even in the context of intimate physical examination, there is no specific finding or type of vaginal injury that conclusively determines that unwanted sexual contact has occurred. Genital injury is not an inevitable consequence of sexual assault, and lack of genital injury neither implies consent by the victim nor lack of penetration by the assailant.

Therefore the only compassionate way to offer choice to women pregnant after rape is to provide safe and legal termination of pregnancy in this country without a requirement to disclose a reason, within a defined gestational limit.

This limit needs to be long enough to ensure that women have time to consider their options, including continuing the pregnancy, but short enough to ensure that most terminations of pregnancy are carried out as early as possible, when complications are lowest.

It is only after repeal of the Eighth Amendment that legislative change and patient-focused reform can happen

For these reasons the Oireachtas committee recommended legislation for and regulation of termination of pregnancy for up to 12 weeks, without forcing disclosure of a specific indication. Although some women will access termination significantly in advance of 12 weeks, other women will need a longer period of time (within that 12 weeks) to recognise the pregnancy, seek physical and emotional support and advice, and make an informed decision that is appropriate for them.

The first step towards introducing safe and accessible options for women who are pregnant following sexual violence is to remove the Eighth Amendment. It is only then that legislative change and patient-focused reform can happen.

As long as the Eighth Amendment exists, women who become pregnant as a consequence of rape will continue to number among the thousands of women who purchase and self-administer unregulated medications online with no medical support, or travel to Britain and elsewhere for termination of pregnancy.

Sexual violence occurs in every country and every culture. Ireland is no different in that regard. Where we are different, though, is in how we treat women and girls who become pregnant as a result of rape. It is not compassionate, it is not holistic and it is not caring.

It is time to remove the Eighth Amendment so we can support and care for victims when they are at their most vulnerable.

Maeve Eogan is a consultant obstetrician and gynaecologist as well as medical director of the sexual-assault treatment unit at the Rotunda Hospital and of national SATU services