Post Repeal in the Northwest

by Bernie Linnane

On 1 January 2019 the Health (Regulation of termination of Pregnancy) Act came into force, allowing for abortion services in the Republic of Ireland. This very welcome development came after more than 35 years of campaigning against the Eighth Amendment to the Constitution, which conferred an equal right to life on a pregnant woman and a blastocyst, zygote or foetus.

Today abortion without restriction as to reason is available where a pregnancy has not exceeded 12 weeks in duration, and after 12 weeks in certain circumstances – vis. where this is a risk to the life or health of the mother, or where the continued pregnancy is likely result in the death of the foetus.

Abortion care in Ireland is delivered by a “GP-led” service, where terminations are conducted by means of medication prescribed by a GP up to nine weeks gestation, and by surgical abortion after this period, when a woman is referred to a hospital by her GP. GPs who wish to provide these services do so by “opting-in” under the HSE guidelines. People with crisis pregnancies access the service through the My Options hotline, provided by the HSE, or in consultation with their own GPs, who may be providers without being listed on the HSE hotline database, or may refer them to GPs willing to provide care.

While the service in general is performing well, by most accounts, problems nationwide have been clearly identified – the three-day “waiting period” is an arbitrary barrier to care and must be removed; the definition of “serious” risk to the health to the life of the pregnant woman is insufficient; the 28-day prognosis for fatal foetal abnormality has resulted in families continuing to make tragic journeys for care – some issues are particularly apparent in this part of the country.

Unfortunately, in the North West of Ireland we have, as yet, no doctors listed with the HSE in counties Sligo and Leitrim, although we have been told that some GPs in the area are willing to care for their own patients without listing. This would tie in with figures which show that more than 500 doctors have availed of training in the provision of Early Medical Abortion (EMA) while 300+ are listed on the HSE database. The situation is complicated by the fact that no hospital in the region is currently providing surgical abortion (other than in emergencies), leaving GPs without a clearly defined referral pathway for care. It is hoped that all maternity hospitals in the state will be providing full abortion services in the fullness of time, making it easier for doctors to sign up to the provision of a full suite of care for patients experiencing crisis pregnancies.

In the meantime, GPs in Donegal are carrying the burden of caring for people from Sligo and Leitrim, as well as from their own county. We have seen protests outside the surgery in Bundoran, although numbers have been small and such actions have been confined to weekends. No doubt this is because the protestors understand there is no appetite among the general public for seeing pregnant women subjected to intimidation at a time of crisis. Nor is the public likely to approve of the attempted harassment of their doctors – we know that healthcare providers have been bombarded with anti-choice letters and emails, some of which have been extremely abusive and upsetting, and have been told of instances of veiled threats against the families of medical personnel in the North West area. This is not good enough.

Action on exclusion zones is urgently needed – no-one should be able to place any kind of barrier between a patient seeking treatment and a doctor who wishes to provide it. The right to peaceful protest does automatically confer a right to interfere with the rights of pregnant people to visit their GPs.

In a border region, we are also very keenly aware that our government’s promise to provide abortion services for the people of Northern Ireland, while abortion remains illegal in that jurisdiction, is rendered less than effective by those people having to pay €450 for a service that is free to women in the Republic. This is an anomaly which needs to be addressed as a matter of urgency. As the service is free in the UK to residents of Northern Ireland, women are continuing to travel from the North to access care. Women from the Republic are also travelling where the service, as currently provided, fails to meet their needs. The promise of “Healthcare, not Airfare” has yet to be fulfilled.

Bernie Linnane is convener of  Leitrim ARC

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