Hello, it’s Órla Ryan here. Welcome to today’s liveblog of the Oireachtas Eighth Amendment Committee.
The agenda for the meeting is as follows:
You can watch proceedings below:
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While we wait for today’s proceedings to kick off, click here to read last week’s liveblog.
That hearing focused on mental health, and medical and international law.
We will be sending out an email round-up of what happened at the committee later today.
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Dr Caitriona Henchion, Medical Director of the Irish Family Planning Association (IFPA) is now delivering her opening statement.
“I am a medical doctor and have specialised in reproductive health for over 20 years. I am registered with the Irish College of General Practitioners as a contraceptive tutor and a tutor in the provision of long-acting reversible contraception. I am a member of the European Society of Contraception and Reproductive Health and the Irish Association of Sexual and Reproductive Healthcare Providers. I have been Medical Director of the Irish Family Planning Association (IFPA) since 2008.
“The IFPA is Ireland’s leading sexual health charity, and promotes the right of all people to sexual and reproductive health information and dedicated, confidential and affordable healthcare. We operate two not-for-profit medical clinics where we deliver services including contraception, post-abortion medical check-ups, cervical screenings and screenings for sexually transmitted infections. We also have ten centres nationwide where we provide free pregnancy counselling and post-abortion counselling services.
“My colleagues and I work in the context of an extremely restrictive legal framework – principally the Eighth amendment of the Constitution. We are also bound by two pieces of legislation that include criminal sanctions – the Protection of Life During Pregnancy Act and the Abortion Information Act. Navigating these complex legal barriers while trying to maintain a caring clinical relationship is an immense challenge for us as healthcare providers.
“This presentation will address the socio-economic dimensions of crisis pregnancy and the impacts of current Irish law on women who experience an unintended pregnancy or a pregnancy that has become a crisis for other reasons,” Dr Henchion states.
Dr Henchion continues: “Unintended pregnancy is a frequent occurrence among women of reproductive age. While for some women this is a joyful and welcomed situation, for many it is a traumatic and devastating life event. Conversely, a wanted or planned pregnancy can become a crisis. An unintended pregnancy can mean the difference between a woman determining her own future or seeing her plans derailed and her aspirations frustrated.
In 2016, more than 3,000 women and girls gave Irish addresses at UK abortion clinics. These women were from all walks of life and from every county in Ireland. In addition—as Dr Abigail Aiken explained—women are increasingly accessing the abortion pill online.
“IFPA doctors’ and pregnancy counsellors’ clients include women who have made a decision to have an abortion for a wide range of reasons related to their physical and mental health and well-being and their ability to cope with a pregnancy. The majority of our clients who consider abortion do so because to continue an unintended pregnancy would be intolerable burden at this time in their life. Any meaningful change from the current legal situation must include these women.
Each woman weighs up her particular circumstances very carefully before deciding that she is unable to cope with a pregnancy. The factors a woman considers include her family situation; her income; her social support networks; her plans for education; her working conditions; her social and physical environments in terms of housing, relationships and so on.
“Many women in this situation already have children. They know what it means to be a mother; for them, the need to care for their children is the primary reason they decide not to continue with another pregnancy. A woman may be trapped in an abusive relationship, or fear that continuing the pregnancy will trap her and her children into a lifelong relationship with an abuser.
“Pregnancy counselling services, such as the IFPA, can support women through their decision-making and give them information about abortion services. Increasingly, our clients are women who experience multiple forms of disadvantage, which in turn, restrict access to abortion. Indeed the term “socio-economic” masks the reality that an unintended pregnancy can have devastating impacts on a woman’s life and that of her family.”
“Once a woman in Ireland has made the decision to have an abortion, she is faced with a range of further obstacles and difficulties. Cost will be a significant factor in the decision of almost every woman. She will need to consider the practical supports available to her. Can she organise childcare? Can she get a sick cert from her doctor? Can her partner get time off to accompany her? As a migrant woman, is she legally able to leave the country? Will she be able to navigate the immigration procedures? If she has a disability, how will this impact on her ability to access care?
“Not everyone lives in Dublin or Cork. Women who live at a distance from the major cities, particularly if they’re dependent on public transport, may have a very lengthy journey to an airport if they decide to travel to the UK for safe and legal abortion. Clearly, this constitutes a further significant barrier.
“For minors, of course, all of the above is immensely more complicated.
“Non-judgemental, non-directive counselling by a trained professional can be a huge support to a woman at this time. But it is no substitute for access to services. And we cannot ignore the fact that socio-economic factors frequently determine whether a woman ultimately travels for a legal abortion or resigns herself to the reality that her only option is an illegal abortion. Of course, for some women, the obstacles are insurmountable, and they are forced to continue the pregnancy against their wishes.”
Dr Henchion states: “When abortion is criminalised, as it is in Ireland, the burden of accessing care falls on the woman rather than the healthcare system. This is because whether a woman travels abroad for legal services or has an illegal abortion in Ireland, she must leave the mainstream healthcare service. Her experience will not meet international healthcare standards, such as those of the World Health Organization and the Royal College of Obstetricians and Gynaecologists.
If a woman decides to travel for abortion, the Information Act prohibits her doctor from making a referral to services in another state—even if she does not speak English, or has a poor educational level, or has an underlying medical condition. Unlike any other medical treatment situation, the continuum of care is broken.
“The onus shifts to the patient to make contact with a doctor outside Ireland and to provide her medical history. She must make her way to a private medical facility in another country without the supports that apply in other situations where people travel for healthcare.
“A woman who is unable to travel—or for other reasons opts for illegal abortion—is faced with the challenge of trying to find a reliable online provider without medical assistance. And she also risks prosecution under the Protection of Life During Pregnancy Act if she self-induces abortion, as does anyone who assists her. In either scenario, an underlying medical condition that is easily managed in the context of legal abortion may become more risky.”
“Yet another way in which care falls below acceptable standards is lack of contraceptive provision. As Professor Arulkumaran explained (at a previous committee hearing), best practice in contexts where abortion is legal is that contraception is offered as part of integrated abortion care, at the initial presentation and the post-abortion consultation.
“However, for women in Ireland, this is not the case. This may be because her first presentation is not with a doctor, and so she does not have immediate access to contraceptive information. Online abortion pill providers are not in a position to provide ongoing contraception.
“In my practice in the IFPA, I frequently see women, who, having paid all the costs of going to a private clinic for an abortion—perhaps €600 for an abortion at 10 weeks, plus travel costs—cannot afford to pay for post-abortion contraception, particularly their preferred option of a long acting reversible method.
All of these failures of care are related to the disruption and fragmentation of care in the context of restrictive criminal abortion laws. We see this also in relation to post-abortion care. Women who can access abortion in their own country have a clear post-abortion care pathway with the same provider. In the event of complications, there are robust and timely pathways for referral, as recommended by the RCOG.
“This is not the case for women who travel from Ireland. While free post-abortion care is funded by the HSE and available to women from providers such as the IFPA, our experience is that only a small number of women avail of this.
“And, of course, women who access illegal abortions receive a still lower standard of care. In addition to the fragmented care pathway, they risk inadvertently accessing medication from an unreliable online source, which could be inactive, inadequate or potentially harmful. In my clinical experience, women accessing medication online tend to report problems late – fear of prosecution is a real deterrent to accessing healthcare for some of these women.
“A substantial number of women are accessing abortion in this manner. As Dr Aiken made clear, most women experience relief at the availability of this option. But that is not to say that it is acceptable healthcare. It is an unregulated and unsafe practice, the harms of which are not being reviewed or measured by any public body. No one is being held accountable for this. And the government cannot continue to ignore it,” she states.
“In considering the very real health concerns associated with the criminalisation of abortion, we must not forget the impact of stigma on women. Research by the American Psychological Association has found that feelings of stigma, perceived need for secrecy, exposure to anti-abortion picketing, and low perceived or anticipated social support for the abortion decision negatively impact women’s post-abortion psychological experiences. Every day IFPA counsellors hear from women about exactly these experiences.
“Women’s privacy and informed consent are invaded in ways that do not happen when services are locally available. Some women must make multiple disclosures of a private and personal health situation to, for example, community welfare officers, officials in the Department of Justice, staff in direct provision centres, social workers. Decisions made at this level can turn obstacles into barriers.
Women’s dignity is violated at every step. Their right to confidentiality is taken from them so many times, right up to the moment when they find themselves in taxis from airports to abortion clinics with women they don’t know.
“In conclusion, our legal system imposes a significant burden on women at a time of crisis and stress in their lives.
“It criminalises women and healthcare providers. All women are disadvantaged and discriminated against when they are forced to travel to another state to access abortion services, and even more so if they access illegal abortion.
The requirement to travel for abortion forces a reduced quality of care on women. Again, this is even more the case with illegal abortion.
“We have an urgent need for safe and legal abortion care in this country. This means equitable access—regardless of socio-economic status—to high-quality, affordable, local services in Ireland that respect women’s autonomy and decision-making. As a society, we need to take responsibility for ensuring that this becomes a reality in law and in healthcare practice,” Dr Henchion states.
Responding to Sinn Féin TD Jonathan O’Brien, Dr Henchion says IFPA counsellors have helped a number of women who dealt with rogue pregnancy agencies and, as a result, delayed their abortion.
Discussing the Protection of Life During Pregnancy Act (PLDPA), she says it’s difficult for medical professionals to operate under current legislation.
Rather than have to deal with the “uncertainty” of the Irish system – such as a woman or girl having to be seen by a number of doctors before she is granted access to an abortion for mental health reasons - Dr Henchion says women who can afford it will travel to the UK.
Responding to Independents 4 Change TD Clare Daly, Dr Henchion says there is “a vast number of different situations” in which women and girls may need an abortion.
She says trying to ”set out a list of conditions” or get women to meet a list of criteria before allowing them access to an abortion “does not recognise the complexity of the issue in the first place”.
Dr Henchion says barriers to contraception include its cost and the lack of good quality sexual health education. “Prevention is definitely the best way to go,” she tells the committee.
Discussing current legislation, Dr Henchion asks why it includes a 14-year prison sentence connected to abortion if the goal isn’t to have a chilling effect on doctors.
“Overall, abortion is a very safe procedure,” she says, adding that “very few people” need further medical intervention afterwards.
Fianna Fáil TD Anne Rabbitte says there is a “vacuum” due to the lack of pro-life speakers coming before the committee, noting she would like to hear from more.
Chair Senator Catherine Noone tells her she hopes speakers from One Day More (a group suggested by Independent TD Mattie McGrath) will address the committee.
Rabbitte welcomes this, saying of pro-life groups and individuals who have refused to come before the committee: “They’re doing their own community a disservice.”
Noone welcomes her comments.
Replying to Deputy Rabbitte, Dr Henchion says there is a fear that some women aren’t presenting for medical help after having an abortion or taking abortion pills for fear of being reported to authorities.
Responding to Fine Gael TD Peter Fitzpatrick, IFPA CEO Niall Behan confirms that the organisation is a member of the International Planned Parenthood Federation, is connected to the Center for Reproductive Rights, and supports the Repeal the Eighth campaign.
“We’re very upfront about that, we’re very clear. I don’t see what the problem is,” Behan says.
He says women who attend IFPA clinics due to crisis pregnancy are told about all their options – including abortion and adoption.
Behan says he’s only aware of about two women who came to the IFPA seeking advice about a crisis pregnancy who decided to put their babies up for adoption.
Fitzpatrick is now raising concerns about IFPA counsellors previously telling women they could lie to their doctor about having an abortion, saying they had a miscarriage instead.
Dr Henchion says counsellors were led into giving specific answers while being secretly recorded, something she describes as “unethical”. She says the comments were taken out of context.
She says the Director of Public Prosecutions looked into the issue and found “no evidence of wrongdoing”. She says the law is the issue here, again citing the chilling effect of the Eighth Amendment.
Fitzpatrick says it’s “disgraceful” that women were told to lie to doctors, saying it could put their health at risk.
Senator Rónán Mullen says he understands why pro-life groups don’t want to come before the committee, accusing it and the chair Senator Catherine Noone of being biased.
Noone is not happy with this, criticising his “constant attack” on her role as chair. She asks him to be reasonable.
Mullen is also raising what Fitzpatrick did – that some IFPA counsellors told women they could lie to their doctor about having an abortion. He says counsellors also told women how to get abortion pills.
Behan says he’s not aware of a more committed groups than the IFPA in terms of women’s reproductive health.
“I really welcome this opportunity to set the record straight,” he states.
Behan says he worked with the HSE (which carried out an audit into the situation) and gardaí as part of the investigation and it was found “there was no wrongdoing whatsoever” on the part of the IFPA.
“Quite frankly the guards were embarrassed to be investigating this nonsense,” Behan says, claiming that “anti-abortion campaigners” were trying to smear the IFPA.
Mullen isn’t happy with this, saying Behan can’t speak on behalf of gardaí. Mattie McGrath echoes this sentiment.
“This is the type of stuff that the IFPA has been putting up with since the 1970s,” Behan says, telling Mullen: “It doesn’t really get you anywhere.”
Mullen says he didn’t get an answer to any of his questions.
When Behan again reiterates that no wrongdoing was found after the gardaí and the HSE both looked into the situation, Mullen says his response is “appalling” and like something Richard Nixon would say.
Social Democrat TD Catherine Murphy, in her own words “playing Devil’s advocate”, notes that some people claim women use abortion as a method of family planning. She says she herself does not believe this.
Dr Henchion says women – very often with their partners – give a lot of thought to whether or not they should have an abortion. She cites one case where a woman “very regretfully” decided to have an abortion as she already had two children with special needs and felt she would be unable to care for them properly if she had a third child.
In terms of ordering abortion pills online, she says there are “a number of risks”, including that the medication “is not what it is supposed to be” and doesn’t actually work.
She says some women need medical help after taking abortion pills but often delay or completely avoid going to a doctor because “they’re fearful of getting into trouble”.
Responding to Fine Gael TD Hildegarde Naughton, Dr Henchion says sexual health education varies widely depending on the school, adding that many vulnerable people don’t receive any if they leave school early.
Behan says the IFPA has also helped some women or girls who had a concealed pregnancy – that is where they hid their pregnancy for a prolonged period.
Fine Gael TD Kate O’Connell is now bringing up the prohibitive cost of contraception and issues with sourcing emergency contraception, particularly at the weekend.
Discussing domestic violence, O’Connell says some women “may be in a relationship that has them essentially trapped where they are forced to become parents against their will”.
Recalling Peter Fitzpatrick’s comments about the lack of babies available to adopt in Ireland, O’Connell says: “Are we going into a Handmaid’s Tale situation here? … That’s up there with the most shocking thing I’ve heard today. I hope no one forces me into that situation, good luck to ye if ye do.”
Independent Senator Lynn Ruane says it feels like the IFPA speakers have been on trial at certain points today, noting they didn’t sell abortion to her when she sought advice as a pregnant teenager.
“It’s very hard to separate the personal from the political when I sit in this room,” she states.
Dr Henchion says coming up with socio-economic grounds for abortion is not the way to go, noting women and girls make decisions based on what is best for them – not always choosing termination.
Replying to Fine Gael TD Bernard Durkan, Behan says about half of the women who come to the IFPA for counselling haven’t yet decided what to do about a crisis pregnancy.
Behan says there is “a misconception” that most of the IFPA’s clients are teenagers, saying about 75% are aged 24-34 years. He says “very few” rape survivors seek help from them, but some do.
Also replying to Durkan, Dr Henchion says women have told them IFPA counselling has been a “really, really big support at a time when they didn’t feel supported” – regardless of what decision they made about a crisis pregnancy.
Dr Henchion says women and girls not getting the opportunity to sit down and discuss their options with a medical professional due to current legisaltion can lead to problems.
Behan says legislation doesn’t stop women in Ireland having abortions, it just makes it more difficult.
Speaking about her own abortion in the 1980s, Solidarity–PBP TD Bríd Smith notes how it was illegal for the IFPA to give her any information, even a phone number. She thanks them for the support they gave her at that time, saying it was an even darker situation for women dealing with crisis pregnancies than now.
Smith then raises the lack of follow-up care women and girls receive after having an abortion abroad, stating that the current legislation leaves women “open to severe consequences”.
Dr Henchion says contraception and sexual health education need to be properly funded and promoted in order to help stem crisis pregnancies. She says the risks to a woman’s life from taking abortion pills bought online are very rare, but that there are other concerns including lack of follow-up care.
Speaking about women in Direct Provision, Dr Henchion says they have even more obstacles to overcome if they need an abortion, including getting a travel document that has to be stamped in a garda station.
She says they then need to contact the Department of Justice, as well as gather enough money to have an abortion – despite having no income.
On another note, she says the IFPA is unable to call clinics in the UK on behalf of women and girls who are deaf and therefore unable to make a phone call.
Fianna Fáil Senator Ned O’Sullivan says he’s “not sure where I stand yet” on the issue, but is disappointed that some agencies who’ve been invited are not attending the committee’s hearings.
He adds that the committee doesn’t rubber-stamp things, as some people have suggested.
Replying to O’Sullivan, Dr Henchion says the IFPA is happy for husbands or partners of women seeking help due to a crisis pregnancy to be involved in the process.
She says the organisation also advises that parents are there to support girls dealing with a crisis pregnancy, if possible. She says the more support for the woman or girl, the better.
Sinn Féin Senator Paul Gavan starts by saying that, despite disagreeing with Fine Gael on most topics, he wants to praise Noone’s chairing skills in the face of other committee members trying to “undermine” her.
Replying to issues raised by Gavan, Dr Henchion says getting women to meet certain criteria before they can have an abortion will leave many women behind.
“Irish women are having abortions every day and we need to actually provide those services in Ireland,” Henchion says, noting that if this happens the services can be “properly monitored and overseen” to make sure they are of a high standard.
Independent TD Mattie McGrath says Irish Aid and the IFPA help run a sexual health programme in Bolivia. He asks if this programme promotes abortion.
Behan says it does not. Noone reminds McGrath the committee is there to look into the Citizens’ Assembly’s recommendations about the Eighth Amendment, not the situation in Bolivia.
McGrath accuses people of laughing, saying this is unacceptable.
Recalling a quote he made earlier about gardaí being “embarrassed” to have to look into IFPA counsellors telling women they could lie to their doctors about having an abortion, Behan says he was expressing his opinion.
McGrath says his claim is an “outrageous statement”.
Senator Jerry Buttimer starts by reiterating his support for Noone. He is also critical of groups who were invited to appear before the committee but decided to not do so and air their views in the media instead.
Mullen doesn’t agree with this and there’s back and forth between the pair before Noone steps in to restore order.
Replying to Buttimer, Dr Henchion says the vast majority of abortions happen due to socio-economic reasons.
Behan adds that women nowadays are coming to the IFPA much more informed than in previous years, having researched their options beforehand.
He says the stigma surrounding a crisis pregnancy has lessened but is still there. He says women today are more likely to have confided in a number of people about the pregnancy.
Noone has thanked today’s speakers and the committee is now taking a 20-minute break before its second session.
Janice Donlon of the HSE Sexual Health and Crisis Pregnancy Programme is now delivering her opening statement:
“The HSE Sexual Health & Crisis Pregnancy Programme (the Programme) is a national programme situated within the Health and Wellbeing Division of the Health Service Executive.
“The Programme is mandated by a statutory instrument to reduce the number of crisis pregnancies and to provide support to those who have a crisis pregnancy.
Legislation defines crisis pregnancy as “a pregnancy which is neither planned nor desired by the woman concerned and which represents a personal crisis for her”.
“The Programme understands this definition to also include the experiences of those women for whom a planned or desired pregnancy develops into a crisis over time due to a change in circumstances.
“A pregnancy may be considered a crisis for a number of reasons. Crisis pregnancy can be related to a perceived inability to cope with a child at that time; being too young or too old; not being in a financial position to support a child; the potential impact that becoming a parent at that point might have on their education, training or employment.
“Research finds that approximately one-third of women who have been pregnant and one-fifth of men who have experienced a pregnancy in their lifetime have experienced a crisis pregnancy.”
Donlon continues: “Counselling for a woman is about creating space to allow her to discuss and reflect on her crisis pregnancy and to support her through the decision making process.
“While many women experiencing a crisis pregnancy resolve the crisis for themselves, or have support from family and friends, research finds that they see a clear role for a counsellor. The importance of a supportive listener and non-judgemental support allows them to consider how the pregnancy impacts on their lives.
“It is the counsellor’s role to provide space and time to facilitate women to work through difficult conflicts in a non-judgemental and non-directive manner…
“If, after appropriate counselling on all options, a woman makes the decision to terminate her pregnancy she should be given as much information as is necessary.
Information about abortion services in other countries may be made available under certain conditions. The law on the subject was passed in 1995 and is usually known as the Abortion Information Act. Its full title is Regulation of Information (Services outside the State for Termination of Pregnancies) Act 1995. The Act sets out how information about legal abortion services outside Ireland may be given to individuals or groups in Ireland.
“Information on how to access abortion services including names and addresses of clinics can be provided as can information on the types of procedure that may be available to her. Crisis pregnancy counsellors are not medically trained and any specific medical questions are referred to the woman’s GP.
“All information should be provided in a manner that is accurate, unbiased, impartial and in accordance with the law. This is necessary to allow the woman to make an informed decision as to the most appropriate course of action for her to follow. Information may be given in different formats including written material which the client can take home with her.”
“The numbers of women attending crisis pregnancy counselling services has fallen significantly in the last number of years. In 2010 4,662 individual clients attended for crisis pregnancy counselling, by 2016 that number has fallen to 2,570. The majority of women attending crisis pregnancy counselling services are between the ages of 25-34.
“It is recognised that in the 20 years since the commencement of the Abortion Information Act there have been many developments in technology including access to the internet. Many women are now bypassing crisis pregnancy counselling services and accessing information on abortion services directly from the internet.
“While the numbers attending services are decreasing, counselling services report that those attending services are presenting with more complex and multiple issues.
“The challenge for the Programme and the counselling services is to ensure that women in most need of crisis pregnancy services and supports feel that their services are relevant to them and will meet their needs.
“Many of the counselling services funded by the Programme also support women and their partners through the diagnosis of a fatal fetal abnormality or life limiting condition. Additional training and support has been provided to these services to ensure they are able to respond to the needs of this client group. Counselling services have forged links with maternity services and have the expertise and the capacity to support women and their partners through this difficult time,” she says.
Donlon continues: “Some organisations that advertise as crisis pregnancy counselling services have a hidden agenda. The service they provide is designed to influence the choice a woman makes and to pressure a woman into doing something she may not want to do.
“Once these agencies have been contacted by a client they can seek to delay the counselling process and, in certain cases, show clients inappropriate images or use other tactics in an effort to influence their decision.
“These organisations are not State-funded and women are advised to find out as much information as possible about a pregnancy service before they make an appointment. All HSE Sexual Health and Crisis Pregnancy Programme funded services are advertised on www.positiveoptions.ie and will provide non-directive, non-judgemental counselling.
“Post-abortion counselling is provided by the same funded services which provide crisis pregnancy counselling, details of these post abortion counselling providers are available on www.abortionaftercare.ie.
Information on the availability of free post abortion counselling in Ireland is also provided by abortion clinics in the UK and the Netherlands. The Programme links with abortion providers to ensure the information is made available to women who have travelled from Ireland.
“Post-abortion psychological support allows a woman a safe space in which to explore and articulate her feelings, whatever they may be, towards the decision made and perhaps the experience of the abortion itself.
“A client may require a number of counselling sessions post abortion and the counsellor is available to support the woman depending on her individual needs. A woman may attend for post-abortion counselling shortly after her abortion or she may attend at a later stage if issues emerge related to other life events etc.
“The number of women who access post abortion counselling has remained steady over the last number of years and in 2016 1,377 clients were seen for post abortion counselling.”
She states: “A post-abortion medical check-up is available for women to ensure they have fully recovered from their procedure. A post-abortion check-up normally involves a blood-pressure check and an examination of their abdomen. The doctor will:
“The numbers attending these services is low, in 2016, 442 women attended medical checkups funded by the Programme. Women may attend their GP on their return if required, or depending on the type of procedure they have undergone may not require a post abortion medical check-up (for example early medical abortion).”
Donlon tells the committee: “As a core function of its work, the Programme monitors behavioural trends relating to its mandates, using a range of tools and indicators including general population surveys and statistics.
“Research informs us that crisis pregnancies happen to women and their partners from different ages, socioeconomic backgrounds and with different relationship statuses.
“The majority are married, engaged or in steady relationships when the crisis pregnancy occurs. The most common reasons why the pregnancy is seen as a crisis is because it wasn’t planned or the woman and her partner consider themselves too young. The average age at which a crisis pregnancy occurs is stable at 24 years for women and 25 years for men.
Parenting is by far the most common outcome for women who experience a crisis pregnancy. A survey of the general population found that when asked about their most recent crisis pregnancy 73% of women reported that they chose to parent.
“In the same general population survey, 2% of those asked about their most recent crisis pregnancy reported that they chose adoption. Traditionally in Ireland adoption was a common response for women experiencing a crisis pregnancy; however, the number of women placing their babies for adoption has decreased significantly in recent decades.
“24% of women in the same general population survey who reported experience of a crisis pregnancy reported that they chose to have an abortion following their most recent crisis pregnancy.”
Speaking about women travelling for abortion, Donlon says: “It is well documented that many women travel from Ireland to other countries to access legal abortion services. The Programme analyses data collated by the Department of Health in the UK and the Ministry of Health in the Netherlands on the number of women travelling to those countries from Ireland for an abortion on an annual basis.
In the majority of cases, women travelling from Ireland for an abortion travel to England. In 2016, 3,265 women gave Irish addresses at UK abortion services representing a rate of 3.2 per 1,000 women. There has been a gradual decline in women availing of abortion services in the UK since 2001. In that year there were 6,673 abortions to women from Ireland in UK abortion clinics representing a rate of 7.5 per 1000 women.
“The Ministry of Health in the Netherlands has collated data on women providing Irish addresses in Dutch abortion clinics since 2010. Prior to 2010, the Programme linked directly with the main abortion service providers in the Netherlands to establish the number of women providing Irish addresses there.
“In 2015, 34 women were recorded to have provided Irish addresses in abortion clinics in the Netherlands. These figures have significantly declined since their peak in 2006 when the number was 461. The Netherlands has emerged as the only other jurisdiction to which women from Ireland have been travelling for abortion procedures in any significant numbers.”
Donlon continues: “The Protection of Life During Pregnancy Act 2013 defines the circumstances within which abortion in Ireland can be legally performed. The total number of abortions carried out in accordance with this act in 2016 was 25. There were 26 in each of the years 2014 and 2015. 2014 was the first year in which data was reported.”
Moving on to abortion pills, she says they are “designed to induce an abortion for a woman who is less than nine weeks pregnant”.
“Abortion pills are used by abortion providers in medically supervised clinics in countries where abortion is legal. These are referred to as medical abortions. The Programme is aware that some women are accessing abortion pills in Ireland from international online providers. In order to try to understand the incidence of this, the Programme set up a reporting relationship with the Health Products Regulatory Authority in relation to the number of abortion pills seized by customs officers annually.
“The Programme has provided training and support to all funded services on this emerging issue. All services have developed protocols in this area and training manuals and online resources have been updated with relevant information.
The reasons women may be accessing abortion pills online are cost and access. For women who have made the decision to terminate a pregnancy, the cost associated with travelling from Ireland to another country for a medically supervised termination is high. Research finds that higher earning women are more likely to travel to other countries for abortions over their lower earning counterparts.
“Until recently it was difficult to make an assessment of the level to which this practice is occurring as limited information was available. However recently published research suggests that more women are contacting online providers of abortion pills annually and becoming more aware about the availability of these drugs online.
“As you have been informed by a previous witness, Dr Abigail Aiken, her study found that over the period January 2010 to December 2016 the number of women from Ireland contacting an online provider of abortion pills tripled. In 2010 there were 548 online consultations completed by women from the island of Ireland – in 2016, the number had increased to 1,748.
“Another research article published by the same authors in 2017, reports on the experiences of women following taking the abortion pill in Ireland. The study reports on 1,000 women who underwent self-sourced medical abortion from the online service.
“The study reports that while the vast majority of women did not need to contact medical services following taking the abortion pill at home, approximately one in ten (9.3%) reported to the online provider that they were experiencing a symptom for which they were advised to seek medical advice and the vast majority of these women sought medical advice as advised.
“The Programme has identified one other main provider of the abortion pill and has sought similar information from this provider for a more accurate assessment of the trend.
“If a woman takes an abortion pill and has prolonged heavy bleeding, bad pain, fainting, or other complications, we strongly encourage that she attends an emergency department or GP straight away. Or if a woman is concerned about her health following taking an abortion pill, we would encourage her to attend a free post-abortion medical check-up funded by the HSE. A list of services is available on www.abortionaftercare.ie.”
Replying to Senator Paul Gavan, Donlon says the HSE provides non-directive, non-judgemental counselling. She says this allows women to explore all their options in a safe environment.
She says the HSE works with a number of organisations that support women who decide to keep or adopt the baby.
Donlon says research shows that the number of women who take up post-abortion counselling is low internationally and that Ireland follows this trend.
She says some women attend counselling years after they’ve had an abortion, while other women feel they don’t need it at all.
Donlon says rogue crisis pregnancy agencies target women and try to delay or stop them having an abortion. She says the HSE provides women with all their options in a non-directive way.
Deputy Peter Fitzpatrick asks what the HSE does to promote adoption as an alternative to abortion.
Donlon says the organisation presents women with all their options and will support them if they choose to adopt the baby.
“It is the counsellor’s role to support the client through her decision-making process,” she says, noting that many women attend a number of sessions before making the decision that is best for them.
Earlier Donlon said research shows that about 2% of women dealing with a crisis pregnancy choose adoption.
She tells Fitzpatrick she’s not sure why this number has decreased over the years. Senator Lynn Ruane tells him it’s because forced adoption isn’t as thing anymore.
Deputy Catherine Murphy starts by asking for clarification that the HSE Sexual Health and Crisis Pregnancy Programme is neutral. Donlon confirms that it is. Murphy says it’s important to point this out.
Replying to Murphy, Donlon says comparing crisis pregnancy services in Ireland to other countries is difficult due to the “quite unique” situation here.
“It’s a difficult area for the woman and it’s a difficult area for the counsellor,” Donlon says, adding that the primary concern is making sure women aren’t too afraid to seek medical help if they need it.
Donlon says some women use Parcel Motel to receive abortion pills they’ve bought online. Murphy notes that having to do this likely adds to the woman’s stress.
Replying to Senator Rónán Mullen, Donlon says the Abortion Information Act lays out that counselling must be done in a non-directive and non-judgemental way.
Mullen wants to know if Donlon thinks counsellors should offer women the option of seeing an ultrasound before they make a decision about an abortion, noting this may lead to women deciding to keep the baby.
Donlon says when a woman or girl comes to a counsellor seeking help and advice she needs time to consider all her options. Donlon again reiterates that HSE counsellors don’t behave in a directive or judgemental way.
Sinn Féin TD Louise O’Reilly asks if the fact so few women seek post-abortion counselling indicates they are happy with their decision. Donlon says the HSE wants to make women aware that these services are there, but said she doesn’t expect an increase in the number of women attending.
O’Reilly says she welcomes moves by Health Minister Simon Harris to clamp down on rogue crisis pregnancy agencies.
Donlon says these agencies target women through Google ads, but the HSE “tries to outbid them in terms of search words” so positiveoptions.ie comes up first.
Donlon says such agencies often change their names or locations, making them harder to crack down on. She says some women are “traumatised” by their experience with rogue agencies and often want to move on from the experience rather than make a complaint.
Deputy Bríd Smith asks why the HSE is funding organisations such as Cura or Anew, noting they won’t give women information about abortion.
Donlon says, due to their ethos, these organisation won’t give out this information but will discuss the topic. She says this is clearly set out on their websites so a woman can be aware of this beforehand.
Donlon says ultimately the choice of which service she goes to is up to the woman, but notes that geography may play a role in this. She says an advice phone line is being considered to help in this regard.
Replying to Deputy Kate O’Connell, Helen Deely, head of the HSE Sexual Health and Crisis Pregnancy Programme, says research shows that about 18% of people not in receipt of the medical card find the cost of contraception prohibitive.
O’Connell says she views this as high.
O’Connell says that earlier today she spoke to an Irish woman who had an abortion in Liverpool. She says the woman told her a HSE leaflet was in the British Pregnancy Advisory Service (Bpas) clinic she attended.
Donlon says the HSE sends leaflets to clinics in the UK and the Netherlands so that Irish women who attend these services are aware of the post-abortion counselling they can receive if needed when they come home.
Senator Lynn Ruane is asking what support women who are homeless or dealing with an addiction issue receive with they present with a crisis pregnancy.
She says some women are “petrified” to be judged as mothers and afraid the children they already have will be taken away from them.
Donlon says women presenting to counsellors with addiction issues will be supported and referred on for additional support if needed.
She notes that some women, particularly asylum seekers, are limited in the services they can access, including abortion, due to financial constraints.
Deputy Clare Daly describes the situation in Ireland in relation to abortion as “utterly sickening hypocrisy” – noting that women can receive advice and information about abortion as well as aftercare, but not undergo the procedure itself here.
Donlon says the Abortion Information Act is outdated, given how women can access abortion pills online. She says women are often “left alone” with a list of contact numbers for abortion clinics abroad.
Donlon says people with additional needs, such as women who are deaf, or financial difficulties are presented with more challenges.
Responding to Deputy Mattie McGrath, Donlon says a HSE audit was carried out into allegations that IFPA counsellors told women they could lie to their doctors about having an abortion.
She says it was a “robust audit” that involved “in-depth interviews” with staff members. She says all of the audit’s recommendations, which dealt with training and procedural issues, were implemented.
Deely adds that the DPP decided there was no case to answer following an investigation.
Donlon tells McGrath counsellors provide women with evidence-based information. She says clients who have additional health issues, including mental health issues, should be referred on to their GP.
When asked by McGrath about the use of terms such as “fatal foetal abnormality” or “life-limiting condition”, Donlon says medical staff use the language that clients are comfortable with.
Chair Senator Catherine Noone has thanked today’s witnesses and adjourned the meeting. The committee will meet in public session again at 1.30pm next Wednesday.
We will be sending out an email round-up of what happened at the committee later today. To get the weekly round-up, just enter your email in the box at the bottom of this article.
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