The myth of women's deceitfulness is the rock on which the Government's abortion proposals are founded, writes Medb Ruane
It is not, however, the only myth surviving after 20 years of inhibited debate. From the state of Irish obstetrics to mental health risks during and after pregnancy, whether deliberately or through ignorance, misinformation is the name of this referendum game.
Spurred on by people so heavily invested in opposing abortion they can't acknowledge empirical evidence, some misinformation poses as fact in Dáil and public debate. Other strands emerge from new research with radical implications for the management and care of pregnant women and children.
The Government's proposals assume that the only people who want to access abortion are well-off, promiscuous women too selfish to continue a pregnancy and not to be trusted as a result. Otherwise, the myth continues, Irish obstetric and gynaecological care is "the best in the world".
Central Statistics Office figures question that claim. Over the four years to the end of 2000, 736 fatally abnormal babies were born to die in Ireland. These babies were doomed from conception by congenital disease of a kind which meant they could not survive independently. Almost 500 more babies died of conditions that began after conception. In every case, their prospective parents had no choice but to carry the pregnancy through, often knowing that birth meant death for the baby they wanted so much.
Who can say how many would have preferred to terminate the pregnancy with deep regret, and try to move on? A couple I'll call Patricia and Jack were caught up in such a tragedy recently. Patricia didn't drink or smoke, and planned a midwife-assisted home birth for their first baby. In her second trimester, a scan revealed that their foetus was suffering from severe spina bifida. The hospital had run out of information sheets, but she and Jack were told that new technology might help their baby live for a few months, if they agreed to a number of major operations. Before the couple had a chance to tell their parents, their names were given without their permission to a third party.
CAN such a system really be the best in the world? Patricia says not, and so do the CSO figures. Infant mortality here is above the European average. In 2000, the Irish rate was 5.9 in 1,000 live births. The European rate was 5.2.
Patricia and Jack decided they could not condemn their child to a brief painful life riddled with surgery. After many trials, they went to England where she had a late abortion, because of the late diagnosis and the obstacles put in their way. They wanted to bring the remains home for burial, but further obstacles intervened. In the end they had to carry the remains home in a suitcase, with Patricia at increased risk of medical complications, and both of them paralysed by grief.
Patricia says her experience in Ireland gave her no dignity and no respect because of the blanket ban on abortion. Irish babies have higher than average chances of neural tube defect, she discovered, and she found impartial support groups in Britain who advise prospective parents of severely or fatally malformed babies about their options, including how to manage a quality of life, when possible.
"Membership of a cultural group that considers abortion wrong" is among the most locally relevant mental health risk factors found by the Royal College of Obstetricians and Gynaecologists. This affects parents of malformed babies too, but we don't hear about it very often, or about current research on the topic.
IGNORANCE may account for tales about abortion leading to suicide, as well as the myth that pregnancy itself bestows better mental health: the alternative is not comfortably contemplated. Mika Gissler's oft-cited Finnish study alleging higher rates of suicide after abortion was used in Ireland to argue that pregnancy protects women from depression, whereas abortion makes it more likely. However, its authors had to backtrack on abortion specifically.
"Overall, suicide is rare among women who have had an abortion, and for many women abortion may be an answer to their current problems and a relief. Abortion services should be organised to ease psychological consequences and regrets," they concluded in the British Medical Journal (bmj.com). They noted an increase in admissions for attempted suicide before abortion.
The most serious challenge to mental health myths about pregnancy and afterwards is the recent Avon study led by Prof Jonathan Evans, published by the British Medical Journal in August 2000.
This huge survey - over 14,000 women participated - found pregnant women were at greater risk of depression than women during the first eight months after delivery. It wasn't a matter of minor emotional fluctuations, but of mild to severe symptoms, apart altogether from the relatively rare psychoses that affect some women after birth.
Evidence exists already that maternal depression can damage a foetus, and that living with a depressed mother may have an enduring influence on a child's development. Without taking such evidence on board, the Government's proposals may misdirect attention away from the real needs of pregnant women generally as well as those in crisis, for a political myth that costs so many so much.
mruane@irish-times.ie