How do GPs treat women who've taken abortion pills in Ireland?

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All GPs would regard the need to terminate a pregnancy as a failure of family planning.

IT’S ESTIMATED THAT around 1,500 abortion pills are used on the island of Ireland each year, or around 5 pills a day.

That figure is based on a study conducted on women in Northern Ireland and the Republic, the number of seizures of abortion pills, and the number of pills ordered by women from online providers.

In the same survey, of the 1,000 women on the island of Ireland who bought abortion pills online, around 10% reported experiencing side effects after taking the medication.

(To be clear, these are pills that are illegal in Ireland because of our abortion laws, but are considered medically safe. One of the pills, misoprostol is listed on the World Health Organisation’s list of Essential Medicines.)

In that same group, 0.7% required a blood transfusion, 2.6% required antibiotics, and overall 9.3% experienced symptoms potentially requiring medical attention. There were no deaths.

In cases where women have taken abortion pills to end their pregnancy and experience side effects, there’s a danger that they will be slow to report those problems.

In its submission to the Oireachtas Committee on the Eighth Amendment, the Irish College of General Practitioners, the organisation said:

The ICGP understands that an increasing proportion of women will purchase online hormonal abortifacient medications.

In these instances, it may or may not become known to their GP in subsequent consultations.

“There is clearly increased use of ‘illegal abortifacients’ both from anecdotal evidence from GPs, objective measures such as customs seizures, and a recent paper which suggests that 5,560 women requested abortion pills between 1 January 2010 and 31 December 2015.”

It also said that “women who use abortion pills ordered online may fear presenting to
Irish health services if they develop problems”.

Speaking to TheJournal.ie, two GPs shared their experiences of treating women who had taken abortion pills, saying that despite the pills being illegal, the process from a medical point of view was straightforward.

“The medical part is simple,” said Dr Brendan O’Shea, who runs a large practice in Co Kildare and has been practicing medicine for 30 years.

“From a medical perspective, [our aim is] to understand what’s happened.

“We do a clinical evaluation of the severity of the pain, check pulse and blood pressure, see if there’s a real active risk of hemorrhage or not, and you do all that in 10 minutes.”

When asked whether it’s easy to evaluate this, as women might underplay symptoms or be reluctant to share them given they’ve taken a medicine that’s illegal in Ireland, Dr O’Shea was clear:

“As a GP, part of our skills set is to deal with uncertainty – we know our patient very well, so we’ve a greater probability of getting relevant details than a hospital’s emergency department.”

Dublin-based GP Dr Mark Murphy said that the abortion pill is “very effective”, so medical intervention after the pill is taken is only needed in “unusual circumstances”.

“For most women it just works and that’s it,” he said.

In cases where there are side effects or complications of some kind, Murphy said that women “may not go to their GP” and instead “might go directly to the emergency department”.

Dr Murphy, who is part of the Together for Yes campaign, says that people are generally comfortable telling their GP about their health concerns because a GP would most likely be familiar with their patients’ medical history.

They’d be more nervous telling a doctor they don’t know. Oftentimes [at an emergency department] they might say they’re miscarrying. That’s clearly not ideal.

Abortion pills can be taken up to 10-12 weeks of the pregnancy, meaning that in the event of a ‘repeal’ vote in the upcoming referendum, the majority of terminations would be carried out through taking a pill.

Although it’s difficult to discern exactly how many abortion pills are ordered online by women in Ireland each year, it’s considered that that number is increasing.

“The number of people travelling to the UK for terminations is in decline, and although this is partly linked to an increase in contraception-use, it’s also linked to an increase in the use of abortion pills in Ireland,” Murphy says.

O’Shea says on the subject of abortion, all GPs would view the need for a pregnancy termination as “a failure of family planning”.

The view that the Eighth Amendment reduces that is simply not the case.

He says that what will reduce the rate of abortions and unplanned pregnancies in the country is more effective messages on contraception.

“The programme of legislation is definitely part of the answer to that question, but this time round we need to be more forward-looking, need to increase family planning services, and remove the remaining barriers, such as cost.”

We seem to be obsessed with legal experts, scientists, gynecologists, hospitals, and are making people take frightful risks with their own sexuality.

This is like the seatbelt issue – we sorted seatbelts when we started to place responsibility on dangerous drivers. Hundreds of thousands engage in sexual activity, you have the service supply but you also need a stronger public service campaign.

In response to the calls for a more robust contraception and sexual education campaign, the Department of Health directed us to a speech by Minister Simon Harris.

In it, he announced that the country’s National Sexual Health Strategy 2015-2020 would be updated based on the recommendations of the Oireachtas Committee on the Eighth Amendment’s ancillary recommendations.

The three-year programme will include:

• Revised and enhanced resources, lesson plans and other supports for teachers in both primary and post-primary schools
• Implementation of sexual health promotion training for professionals in youth sector, those working with at-risk groups, and for parents
• A new sexual health and ‘safer sex’ public advertising campaign
• A sexual health initiative with the higher and further education sector
• A repeat of the general population survey on sexual health and crisis pregnancy to provide up-to-date data to support implementation.

He also pledged to increase the distribution of condoms and information about safer sex behaviours.

The government recently announced it would review sexual education at primary and secondary level; and also that it would look at making the morning after pill free of charge (although this ran into complications this week).