It is not acceptable that a woman like Deirdre De Barra cannot obtain the treatment of her choice in Ireland, argues Prof Walter Prendiville.
Irish attitudes to sexuality and reproduction are changing. For most couples sexuality is no longer considered as being inseparable to procreation. Also, an expanding range of contraceptive methods has freed most couples from the fear of unwanted pregnancy.
But despite the very comprehensive range of contraception at our disposal, many Irish girls and women conceive unintentionally each year. Of these a proportion will choose to have an abortion; currently 19 do so each day. The reasons are complex and varied but clearly our society has failed to affect this growing number.
We have put very few resources into implementing programmes designed to reduce this number. It is high time that we did so.
Is abortion ever justified? Most people fall into one of three categories. Firstly there are those who say it is never justified and secondly there are those who say that it should be available on demand. But these two camps probably represent a small proportion of couples of reproductive age.
A larger group, I suspect, believe that abortion should be available in specific circumstances. Broadly speaking this group would accept termination of pregnancy when that pregnancy poses a serious threat to a mother's life (Eisenmenger's syndrome, some cancers and other very rare serious medical conditions) or when the fetus has no chance of survival (a fetus with no brain, an anencephalic fetus, and certain lethal chromosomal abnormalities). It is difficult to understand why the all-party Oireachtas committee didn't include this latter circumstance in its referendum proposal.
The dignified and honest letter by Ms Deirdre De Barra in this week's letters column of The Irish Times highlights the real human suffering inherent in the currently worded proposal. It is worth noting that this referendum will not change the way she is medically treated within the Republic. In my opinion this is not acceptable.
A previous plebiscite has decided that we condone abortion so long as it takes place abroad. This referendum is about whether or not abortion should happen in Ireland and only on those very rare occasions when the mother has a pregnancyassociated risk of death which abortion might negate or dramatically reduce.Either outcome is extremely unlikely to change the number of GPs who prescribe post-coital contraception (50,000 prescriptions per annum for the morning-after pill).
Either outcome is extremely unlikely to change the number of women choosing abortion. Either outcome will be extremely unlikely to change the practice of obstetricians with the single exception of removing the threat of legal action when a mother's life is seriously threatened by pregnancy.
If passed the victim of rape (incestuous or not) will still be forced to travel to the UK, providing of course that she can afford to so do. And rape does happen in Ireland. If passed the mother with a diagnosis of fetal anencephaly at 10 or 12 weeks will be forced to continue her pregnancy to 28 weeks or later. If passed the woman with a pregnancy related suicidal condition will be forced to travel to the UK. I accept that there is not consensus among psychiatrists on this issue, but to rule out the possibility is simply naïve.
Whether or not the referendum is passed, the number of Irish women travelling to the UK for an abortion will not decrease and on past evidence will continue to rise.
The Irish woman travelling to the UK will however be much less likely to have received any care or counselling. She will be at a later stage of pregnancy than her UK counterpart. She will probably be more likely to require a surgical procedure than her UK counterpart. She will be more likely to suffer post-abortion pelvic infection than her UK counterpart.
This referendum is an attempt to answer a complex and varied clinical question in a simplistic manner. It ignores the reality of our high abortion rate and is unnecessarily divisive.The referendum should be rejected. The next government has a clear responsibility to address the fundamental issue of how to prevent unwanted pregnancy.
Walter Prendiville Associate Professor Of Obstetrics at the Royal College of Surgeons in Dublin and Consultant Obstetrician at the Tallaght and Coombe Women's hospitals.