Some 90 per cent of Irish GPs do not offer abortion services, while the State's abortion legislation remains "restrictive", "exclusionary" and "flawed", an Oireachtas committee has heard.
Just one in 10 of the State’s GPs offer abortion services, while half of all counties have fewer than 10 GPs offering the service, the National Women’s Council (NWC) warned on Wednesday.
Meanwhile, just over half of the State’s publicly funded maternity units and hospitals (10 out of 19), provide full abortion care in line with the law, the council said.
Also speaking before the Oireachtas Joint Committee on Health regarding the review of the Termination of Pregnancy Act 2018, the Irish Family Planning Association (IFPA) warned of "glaring geographical disparities" in the provision of community and hospital abortion services between different counties.
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The NWC and IFPA both expressed alarm at the proportion of women still travelling to the UK for terminations because of remaining legal obstacles in this country.
According to the department of health for England and Wales, 375 women with Irish addresses accessed abortion services in 2019, while 194 travelled abroad during the pandemic in 2020 for these services.
“We cannot rely on other countries to provide this health care,” IFPA research officer Alison Spillane told the committee. “It must be provided within the Irish health system and we need to stop ostracising and stigmatising these women and families,” she said.
The trauma of travelling abroad was “one of the issues people felt would be solved by the referendum”, added NWC director Orla O’Connor. The current “rigid gestational limits” and “narrow foetal mortality clauses” are impeding Irish doctors’ ability to provide urgent care to women and pregnant people, she said.
The mandatory three-day waiting period before terminations has no medical basis and “implies a distrust” of a woman’s capacity to make rational decisions, said the IFPA.
In all other medical cases people rely on the clinical skills of their practitioner to explain the risks involved and are not legally required to take time to reflect on the procedure, said IFPA medical director Caitríona Henchion.
“In no other consultation do you talk so much about the law as abortion,” said Dr Henchion.
The 12-week limit is also hugely problematic for the 1-2 per cent of women whose termination fails, she added. If someone undergoes an abortion at nine weeks, they have to wait more than two weeks before taking another pregnancy test, she said. “We’ve given them medication that could cause harmful foetal anomalies but then saying you have to travel to get this treatment.”
Even if the gestational limit on abortion services was removed, evidence shows most women will continue to access abortions before 12 weeks, NWC women’s health co-ordinator Alana Ryan told the committee. Data shows 88 per cent of women access this service before 10 weeks and 6 per cent between 10 and 12 weeks.
Need to decriminalise
Maeve Taylor, IFPA director advocacy and communications, said the threat of "prosecution and criminalisation" within Irish legislation "creates a chill effect on healthcare providers" and "relegates abortion to the margins of healthcare". Abortion services must be decriminalised in all circumstances in line with World Health Organisation guidelines, she said.
Continuous State engagement is needed with doctors not offering the service, said the IFPA.
The legislation should also be amended to allow midwives and nurses to receive training in abortion services to make it more accessible to people in rural areas, said Dr Henchion. A peer support network might also convince more doctors in rural areas to offer these services.
“Safe access zones” are also urgently needed so practitioners feel secure they will be protected from harassment and abuse, said the NWC. All maternity hospitals must also be mandated to provide abortion services in line with the law, it added.
Both groups agreed the introduction of abortion services in the State had been “transformative” for women’s reproductive rights.
“We’ve had three years of understanding how the law is operating in practice,” added Ms Taylor. “The evidence is showing the law is getting in the way of the good operating of abortion services. The job isn’t done yet.”
