One in seven providers of abortion care experienced verbal threat or attack

One in seven providers of abortion care in the Republic has experienced a verbal threat or attack related to their work, according to research that highlights psychological challenges for health staff involved.

After more liberal abortion legislation was implemented in January 2019, there was, quite rightly, a focus on the patient experience, says Prof Mary Higgins, a consultant obstetrician and gynaecologist at the National Maternity Hospital and associate professor at University College Dublin. But she was one of a research team who also wanted to find out what it was like for the clinicians.

The majority, like herself, grew up and trained in this country where abortion was not legal and they never thought they would be providing abortion care, she says. “Then suddenly you are providing it within a couple of months.”

A study, led by PhD student Brendan Dempsey and published in the Contraception journal last year, found 15 per cent of providers who answered the questionnaire had experienced a verbal threat or attack related to their abortion work (compared to 51 per cent in the US). People who work in hospitals had a higher rate of stigma. In the case of an early medical abortion at community level, Higgins says, a woman being treated is one of many patients attending a GP.

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She takes the medication home to have the abortion in her own home, so not only is the GP anonymous to a certain extent as a provider but “they don’t see the process that is involved”.

Whereas if you take the other extreme of abortion care, says Higgins, looking after somebody who is at 20 weeks’ gestation of a much wanted baby, that turns out to have a fatal abnormality, is a very different scenario for clinicians. First, “you have to go through the process of due diligence – does this meet the criteria? – which can take a couple of weeks, as you need genetic testing and ultrasounds”.

Then the woman is coming in for a medical termination. “You are giving her the tablet and she is labouring. You are seeing her pain and distress – both emotional and physical – and you’re trying to take away both of them by giving her support and analgesia.

"Then you see the baby being born, which, if it has internal abnormalities, will look perfect and that has been shown to be very difficult for staff."
What is coming out of the research is the value for staff of being able to talk about this and having good support and teamwork.

“Our psychiatrists put it wonderfully,” says Higgins. “One of the greatest bonds is between the mother and the child . . . What we are being asked to do in abortion care is to breach that bond and do something that is very uncomfortable.”

People who provide that care  are still willing to do it, she says, but: “They need the space to talk about how difficult it is.”