GP-based care must be central to abortion law

 

‘How will I find a thousand euro in two weeks?” The mother of three looked at me with a mixture of panic and despair. “We have Communion coming up and absolutely no money as it is . . .”

This woman’s face stays with me. It is the face of many Irish women as they learn the cost of an abortion in England. It is a face injured by the silent bite of austerity, while already coping with a job loss or mortgage default and now an unwanted pregnancy.

Affluent Irish women have always had abortions. They continue to exercise their right to travel. However, for many Irish women the right to travel now counts for very little. It is the feasibility of travel that is important and this is substantially determined by the availability of money.

Desperation, always a feature of Irish abortion, is now the dominant emotion felt by many women. Ask yourself how would you access €1,000 in less than two weeks without telling anyone the reason you needed the money?

The complete absence of any of the voices of the more than 150,000 Irish women who have had abortions was a striking feature of the Oireachtas hearings last month into proposed abortion legislation as a result of the European Court of Human Rights A, B and C ruling. The lack of a public voice obscures the fact that abortion is not a rare experience for Irish women.

Frequency of abortion

Abortion is the most common gynaecological procedure an Irish woman is likely to have. It is variously estimated that between one in 10 and one in 15 Irish women of reproductive age have had an abortion. An Irish woman is more likely to have had an abortion than appendectomy or tonsillectomy. Yet where are the voices of the women with this experience of austerity as a cause of enforced pregnancy?

A second feature of the hearings was the absence of any general practitioner voice as a part of the medical expertise heard. When you consider that GPs are the doctors who provide the majority of pre- and post-abortion medical care, this is indeed surprising.

If any medical person is to hear the stories of these women it will be GPs. Yet no general practitioner gave evidence at the committee and no aspect of primary healthcare was explored or considered relevant.

Most women with a pregnancy, unwanted or otherwise, first seek medical help in a general practice setting. Almost all antenatal care is undertaken by GPs alone until 16 weeks’ gestation, when women usually have their first hospital-based appointment.

Crisis or unwanted pregnancies will be first discussed and considered with GPs as medical providers rather than obstetricians or psychiatrists.

General practitioners have been found to support a broadly pro-choice position. In a 2012 study, 75 per cent of GPs were found to support a woman’s right to choose abortion in certain circumstances. More than 50 per cent would support a woman’s right to chose abortion in all circumstances. These figures are in keeping with Irish society in general and best place GPs to provide care to women with unwanted pregnancies.

International best practice is that early abortions before nine weeks’ gestation should be medical abortions rather than surgical abortions.

Medical vs surgical

Early medical rather surgical abortion reduces complications, has been found to be more acceptable to women patients and is significantly more cost-effective. In countries such as England where the majority of early abortions are medical rather than surgical, these abortions take place in a primary care setting and not hospitals.

With the licensing of mifeprostone (RU486), early medical abortion in Ireland could and should follow international best practice and take place in a general practice setting with medical supervision by general practitioners. As a result, any proposed legislation must have at its centre general practice-based care and must regulate for GPs to be primary abortion providers in early pregnancy. To fail to ensure this is to ignore best medical practice and trends in reproductive health.

Doctors for Choice advocates the decriminalisation of abortion in Ireland along the lines of the Canadian model where abortion was removed from the criminal code in 1988. For 25 years, Canada has regulated abortion only in the context of the regulation of all healthcare. It has one of the lower rates of abortion for developed countries.

There are no “floodgates”, no “demands” for abortion, just women deciding with their healthcare providers. It is a country where women choose to manage their own fertility, with doctors and nurses providing expert advice and care without recourse to the law or fear of criminal sanction.

Is there a reason why this can’t be replicated in Ireland?

* Mary Favier is a GP and a member of Doctors for Choice

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