A REVIEW OF Ireland’s abortion legislation has recommended that the required three-day waiting period to access a termination should no longer be mandatory.
It also found that there is an “uneven geographic coverage” of service providers, which requires some women to travel, sometimes at significant cost, to access a termination.
The review of the Health (Regulation of Termination of Pregnancy Act) 2018 was led by barrister Marie O’Shea, who was appointed as the independent chairwoman last year.
A provision was included in the Act requiring a review of the legislation to be subsequently carried out.
Published today, it recommends that the mandatory three-day waiting period to access a termination be substituted with “a mandatory obligation on medical practitioners to advise the pregnant woman that she has a statutory right to a reflection period, which she may exercise, at her own discretion”.
The review states that the statutory requirement that informed consent may only be given after at least three days have elapsed from the date of the first consultation is a “contentious issue”.
It states that whilst there is “perceived benefit” to having a period of reflection to ensure that the decision is not made in haste and later regretted, “it is perceived by others as an infringement on their personal reproductive autonomy”.
It points out that termination of pregnancy services are not configured to run 365 days a year, meaning the three-day wait can extend to a four or five-day wait for treatment if the first visit takes place towards the end of the week, particularly if it coincides with public holidays.
“The mandatory waiting period can impose a physical and psychological burden on women,” the review states.
It says the waiting period may cause women to time out of eligibility for care in Ireland, especially if the three days is extended.
It states that this “disproportionately affects women” who may not realise that they are pregnant until later in the first trimester or who may have delayed in seeking care, or who may have timed out due to failure of previous treatment to terminate the pregnancy.
“In the case of the latter, there is a risk that the pregnancy could be affected by foetal anomalies occurring” due to the effects of the abortifacient medication.
Based on the research findings, it would appear that the legal framework governing termination of pregnancy is not aligned with Ireland’s human rights obligations, due to the barriers associated with implementation.
Speaking today, Minister for Health Stephen Donnelly said those who voted in the referendum campaign to reform the abortion legislation understood it would inlude a three-day wait for services.
Taoiseach Leo Varadkar also said today that he anticipates a free vote on the legislative proposals of the independent review into the abortion laws.
The review recommends 10 changes to current legislation and 60 operational changes in relation to termination services and laws.
Cabinet has agreed to refer the recommendations in relation to legislative change to the Joint Committee on Health for its consideration, while the HSE will establish an implementation group to deliver the operational recommendations.
Varadkar has previously been criticised after he expressed his reluctance to make any major changes to abortion legislation “so soon” after the referendum to repeal the Eight Amendment.
Speaking last week, he said: “When I went out and others went out to look for a yes vote, we said that there would be safeguards, and that included things like the waiting period.
“It included things like conscientious objections and I have to say I for one would be reluctant and uncomfortable to make any major legislative changes so soon after that referendum,” he said.
The review highlights the “uneven geographic coverage” of service providers, stating that fewer contracts between the HSE and primary care providers are recorded in the southeast, northwest, midlands and border counties.
It points out that there are an estimated 422 GPs providing termination services in Ireland, up 95 since 2019.
However, half of the counties in Ireland have fewer than 10 GPs providing termination services. Counties Leitrim and Laois have four GP contracts, while Mayo, Sligo, Roscommon and Offaly have three GP contracts. Carlow has two such contracts, while Longford only has one such contract.
It states that there is a “dearth of information” relating to GPs’ reasons for not providing termination services, adding that research indicates that the main reason may be attributed to excessive workloads.
A lack of hospital backup is also a relevant factor, as is having access to peer support, the review states.
It also highlights that only 11 of 19 maternity hospitals are providing abortion services in Ireland. It is expected that a further four hospitals will begin providing full services this year.
It states that this uneven coverage requires women in areas without enough services “to travel, sometimes long distances by public transport, at significant cost, to access a providing GP”.
It states that the mandatory three-day wait between the first and second appointment compounds this problem, adding that both issues also present logistical problems for women, particularly those who are time constrained.
It recommends that the HSE consider undertaking a mapping exercise to ascertain the precise number of medical practitioners providing abortion services in each county.
In areas where there is low coverage and where women must travel longer distances to
access care, it recommends that the Department of Health and the HSE should consider supporting the establishment of local women’s health centres.
“These could be led by an obstetrician/gynaecologist or a GP with special interest in women’s health,” it states.
It also recommends that the Department of Health should consider “expanding the range of health professionals who may provide termination of pregnancy services and should liaise with the professional bodies in relation to provision of training and education”.
It recommends that to address barriers associated with GPs’ responsibilities that impacts their capacity to provide termination services, the Department of Health “should support ICGP initiatives to achieve their target of increasing the number of GPs by 1,800 by 2028, to take the national target to 6,000, which would represent 4,000 GPs”.
The review also identifies a lack of sufficient clarity in legislation on how certain sections of the Act should be applied and requests new ministerial guidelines regarding fatal foetal abnormalities.
Under the current legislation, a person is permitted to terminate their pregnancy for up to 12 weeks, and a GP or doctor must first certify that they are no more than 12 weeks pregnant.
Terminations can also be carried out where there is a risk to the life, or of serious harm, of the pregnant woman, or where there is a condition present that is likely to lead to the death of the foetus either before or within 28 days of birth.
While the woman is decriminalised under the Act, it criminalises anyone who assists a pregnant person to obtain an abortion outside of the provisions of the Act, with a prison sentence of up to 14 years.
The review recommends that legislation be enacted to provide for safe access zones and protection of service users and providers by criminalisation of conduct which intentionally or would reasonably be regarded as having the effect of influencing a person’s decision to have a termination of pregnancy or provide the service.
The review found that between 2019 and 2022, nearly 18,000 terminations took place in the Republic of Ireland, with the vast majority of these being under 12 weeks.
The review states the number of abortions being carried out because there is a risk to the health or life of the mother “have remained relatively low and static”.
It also found that there has been a decline in the number of women who have travelled abroad for abortion care since January 2019, when services commenced in Ireland.
It states that most of those who are travelling to the UK are in the later stages of gestation and abortions are being provided where the pregnancy has not exceeded its 24th week and the continuance of pregnancy “would involve risk, greater than if the pregnancy were terminated, of injury to the physical and mental health of pregnant person”.
They are also being provided where there is substantial risk that if the child were born it would suffer from physical or mental abnormalities. “These figures indicate that not all needs are being met,” the review states.
The full report can be read here.
In a statement today, Minister Donnelly thanked O’Shea “for her dedication and hard work in preparing this comprehensive report”.
“I would also like to acknowledge and thank the stakeholders, service providers, those who avail of these services as well as members of the public for their input into the report,” he said.
“Furthermore, the efforts and contributions made by those at the forefront of getting this service up and running should be acknowledged, having worked so tirelessly throughout the pandemic and beyond to ensure its establishment was finalised”.
Speaking to RTÉ’s News at One, Donnelly said that he has “a very clear priority to make sure that these healthcare services are as accessible and as safe and as good for women in Ireland as possible, whilst critically being very cognisant that when we voted to repeal – something I campaigned strongly for – there were criteria that people understood, including these three days”.
The minister said the recommendation and other legislative proposals would be referred to the Oireachtas health committee.
However, he said there has already been an operational adjustment to the three-day wait period such that the first consultation should be done by phone.
Asked if the period of reflection should be left in place, Donnelly said while he had his own personal view he did not want to “unduly influence” the committee.
Donnelly noted that only 11 of the country’s maternity units are currently providing services and characterised this as “not acceptable”.
He said it was aimed they would all be providing services by early next year.
Speaking in the Dáil, Taoiseach Leo Varadkar said he anticipates a free vote on the legislative proposals of the independent review into the abortion laws.
“Certainly for my party and I think it’d be the same for Fianna Fáil and perhaps Sinn Féin and other parties as well, this will be a free vote and a vote of conscience for people.”
Aontu leader Peadar Toibin said people were persuaded to vote in the referendum on the basis that there would be “some safeguards for children”.
“Five years later, it looks like Government are going to wash away remaining safeguards,” he said.
Toibin said there had been an “enormous jump” in the number of abortions, which he described as “catastrophic”.
He said the mandatory three-day wait and the ability of doctors to conscientiously object are both under threat.
The Taoiseach said Toibin was “jumping the gun” as the proposed legislative aspects of the review will be referred to the Oireachtas committee on health.
He said the operational aspects have been referred to the HSE for implementation.
“We’ve made no decision whatsoever on any of those legislative proposals,” he said.
Ahead of its publication, the National Women’s Council (NWC) welcomed the review, adding that it is “crucial we see a timeline for this to progress in this Dáil term”.
“The referendum to repeal the 8th amendment was a watershed moment for the women of Ireland. But we know many barriers to access remain,” Orla O’Connor, director of the NWC, said.
This review, guaranteed by law, was an essential piece of the legislation when it was introduced and it’s very welcome to see it now.
The Pro Life Campaign has said abortion is now certain to be an election issue given what it says are the “extreme nature of the recommendations” contained in the review.
“The Government should be focussing on reducing Ireland’s soaring abortion rate rather than making yet more concessions to the pro-abortion lobby – concessions that would inevitably result in even more abortions taking place each year,” spokesperson Eilís Mulroy said.
With reporting by Hayley Halpin
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