Madam, - No doctor or nurse who has ever delivered a baby with anencephaly would wish this on any woman. It is very sad and distressing for all concerned. This is why one gets angry that it is allowed to happen to any woman in this country, when it could so easily be prevented by adequate doses of folic acid. This needs to be taken daily by the would-be mother from 12 weeks before trying to become pregnant. Unfortunately, only half of pregnancies in this country are planned; only 1 per cent of teenagers plan theirs. And teenagers are not noted for eating a diet rich in folic acid - found mainly in lettuce, broccoli and spinach.
Fifty per cent of people in this country lack one or both genes needed to utilise folic acid in their diet - or, in the case of a foetus, from the mother's blood stream. The foetus needs folic acid to build a healthy nervous system early in pregnancy, before the mother even realises that she is pregnant. Given these facts, would it be unreasonable for the state to legislate for mandatory fortification of flour with folic acid?
An editorial in the British Medical Journal puts it thus: "Rare is the opportunity to implement a sustainable, inexpensive, and effective intervention to prevent major human diseases. Folic acid fortification of flour is one of those rare opportunities. The available evidence argues that governments that do not ensure that flour is fortified with sufficient folic acid are committing public health malpractice."
The US and Canada have successfully done so, but no European country has followed suit. Yet 2,500 foetuses with anencephaly and other neural tube defects are aborted every year in Europe. Ireland has set a headline in imposing the smoking ban. Why not set one also in fortification of flour with folic acid?
Many people writing in your newspaper have expressed deep compassion for "Miss D". I hope this feeling will translate into preventing such cases in the future, rather than into legislating for abortion.
As regards Ms D, how certain can one be at 18 weeks that her baby is actually suffering from anencephaly? Ninety-nine per cent certain? One European-wide survey showed that it was wrongly diagnosed in 1.2 per cent of cases before 24 weeks. Apart from the ethical issues, allowing abortion for congenital abnormalities has a lot of disadvantages. Mistakes can be made in diagnosis - one has read of cases where women who were advised to have an abortion but declined (or where the abortion failed) later gave birth to normal babies. Where abortion is "allowed" and readily available for congenital abnormalities, women soon become pressurised into having one. Some years ago, a court in France judged that a disabled child had a right not to be born. The judgment was later overturned when doctors threatened to strike. And, as is obvious, abortion can mean that there is little incentive to take measures to prevent abnormalities. - Yours, etc,
Dr HELEN T.O'BRIEN, Rosemount, Booterstown Avenue, Co Dublin.