THERE ARE 10 maternity units providing abortion services out of a total of 19 units across the country, over three months after Ireland’s abortion laws have been legalised.

The HSE has said that nine maternity units had provided abortion services from the start of this year, and that one additional maternity unit had since begun to offer the service.

After the Irish electorate voted to repeal the Eighth Amendment in May last year, Health Minister Simon Harris announced that abortion services would be available from 1 January 2019.

A number of healthcare professionals, including former Master of the National Maternity Hospital Dr Rhona Mahony, said that there was a concern about that implementation deadline, saying that it was “quite a big ask and quite a big challenge” to roll out the new service in that short timeframe.

It’s predicted that there will be 10,000 terminations in Ireland a year, according to a Rotunda Hospital board meeting document released to TheJournal.ie under a Freedom of Information request.

The document states that the National Women and Infants Health Programme has estimated that 80% of terminations will be under 9 weeks, meaning that they will be undertaken by GPs.

That means that around 20% would be in the 9-12 week bracket and would require hospital services. Termination of pregnancies that would require surgical intervention would mainly be carried out in the three main Dublin maternity hospitals and by Cork University Hospital, according to the Rotunda Hospital board meeting minutes.

Capacity and figures

The Department of Health will not be releasing exact figures on the number of people availing abortion services until the end of the year. It’s understood that this is to give hospitals and healthcare professionals a chance to implement the service fully.

In a statement to TheJournal.ie, the HSE did say, however, that “no capacity issues have been raised, and service demand remains within the predicted limits” in the first quarter of the year.

In response to previous issues raised by the hospital, the Rotunda said that three months into the new service, concerns about capacity were “not as significant a concern”.

A spokesperson for the hospital added:

Even though there are not overwhelming numbers, the patients presenting are resource intensive and require significant planning and management by hospital personnel. This does impact on theatre and gynaecology services.

In response to a question on whether the number of patients received by the Rotunda was in line with national projections, the spokesperson said:

“Numbers presenting at this hospital would indicate that a significant number of termination of pregnancies are less than 9 weeks and are presenting to GPs.”

The National Maternity Hospital and the Coombe did not comment, although the Coombe spokesperson referred to this statement released on 1 January date.

The statement notes that the hospital’s catchment area includes Kildare, West Wicklow, Dublin West, Dublin South City and Dublin South West.

“Appointment availability is limited and regrettably we may not be in a position to accommodate all referrals,” the statement also notes.

Concerns about 1 January

The Rotunda Hospital Dublin had raised concerns at board meetings prior to the 1 January deadline that the implementation of abortion services could “overwhelm current services”, as the hospital was tackling financial issues and long gynaecological waiting lists.

“The lack of communication, preparation, engagement and inclusion since the May Referendum with service providers has significantly added to the difficulty in planning for this service,” the Rotunda noted at a board meeting held on 2 November 2018, adding that it would team up with the two other Dublin maternity hospitals would “try to progress matters” with the Department of Health. 

There was a delay between the Eighth Amendment referendum vote, which was held on 25 May, and the passing of legislation to liberalise abortion laws outside situations where the mother’s life is at risk. This increased concerns among hospitals and GPs that not enough time was being given to prepare for the implementation of a new health service.

The National Maternity Hospital and the Coombe had raised similar concerns about the 1 January date, according to board meeting minutes released to TheJournal.ie under Freedom of Information requests.

On 28 October, the Coombe noted during its board meeting that “a particular challenge relates to how primary and secondary care will interface in terms of delivery of the service and support of the women, particularly in relation to access, choice, counselling, contraception, and follow up”.

“The lack of information/guidance and resources at a national level presented, and continues to present, challenges to providing a service,” the National Maternity Hospital board said on 23 January.

Primary care

The National Association of General Practitioners had hinted before that GPs registered to provide abortion services isn’t evenly spread around the country, and has led to some ‘black spots’ in providing the service in certain rural areas.

It’s understood that so far around 317 GPs have signed up to provide abortion services, while 169 are publically listed through MyOptions.

Around €12 million had been allocated for the provision of abortion services in Ireland in Budget 2019; around €7 million of this went towards acute services (hospitals) and €5 million towards primary care (GPs).

The funding for hospitals was divided out according to the number of females aged 15-44 who are in their catchment area, and goes towards providing equipment, as well as staff training. The Irish College of General Practitioners said that over 200 GPs have completed its training course on providing abortion services, while other GPs are still waiting to complete it.

Abortion services are free for women in Ireland; GPs are reimbursed €450 per pregnancy termination, which includes three appointments, and pre- and post-care.

It’s uncertain how many women would access abortion once it became legal; estimations were based on the women who travelled abroad for terminations, women who ordered abortion pills online, and the number of terminations in the UK.

Harris has also said that he’s looking at the possibility of allowing women in Northern Ireland to access abortions in Ireland for free. They currently have to pay the €450 fee.