Sir, – Amnesty International notes the concerns expressed by several obstetricians in their letter of June 19th about what our new report on Ireland's abortion law says about the treatment of women experiencing miscarriage.
Our report does not suggest a general mismanagement of miscarriages or pregnancy loss in Ireland.
The report, She Is Not a Criminal: The Impact of Ireland's Abortion Law, is about the violation of women's rights by Ireland's laws, not by its doctors. As the World Health Organisation has repeatedly said, restrictive abortion laws, regardless of the country, lead to lower quality of care. Our research indicates that Ireland is no exception.
As with all of Amnesty International’s reports around the world, this one builds on the testimonies of those directly impacted, including women, doctors and counsellors. Women told us of the experiences they had while miscarrying.
Doctors and counsellors told us how the Eighth Amendment and the abortion law push them to provide lower quality of care than they would otherwise, whether it is in the provision of information, having to wait until a woman’s health deteriorates to a life-threatening condition, or having to wait for foetal demise in the context of miscarriage or fatal foetal impairment, before an abortion can be provided.
It is for this reason that Amnesty International is calling for a legal framework on abortion that respects and protects women’s human rights and allows doctors to do their job. – Yours, etc,
GAURI van GULIK,
Deputy Director Europe
and Central Asia,
Amnesty International,
Easton Street,
London.
Sir, – Doctors for Choice fully supports Amnesty International’s report and its recommendation to repeal the Eighth Amendment.
Their insightful report provides written testimony of the trauma experienced by women and families as a direct result of Article 40.3.3 of the Constitution. We are indebted to these brave individuals whose powerful voice has clearly highlighted the wide-ranging effects of the Eighth Amendment on standard obstetric care, on crisis pregnancy management and on women’s human rights.
We are also very disappointed that several obstetrician colleagues discounted their concerns as “unwarranted and unfounded allegations”, which is both insulting and insensitive. We recognise that the authors of the letter have significant obstetric experience. We cannot understand therefore their insistence that the management of miscarriage is not affected by the Constitution.
Savita Hallapanavar’s death in 2013, from a septic miscarriage, was as a direct result of our Constitution granting the unborn an equal right to life to the “mother”. Recommendation 4b of Prof Sabaratnam Arulkumaran’s report to the HSE on the death of Savita Halappanavar, stated: “There is immediate and urgent requirement for a clear statement of the legal context in which clinical judgment can be exercised in the best medical welfare interests of patients . . . We recommend that the clinical professional community, health and social regulators and the Oireachtas consider the law including any necessary constitutional change and related administrative, legal and clinical guidelines in relation to the management of inevitable miscarriage in the early second trimester”.
Similarly, Prof Peter Boylan, former master of the National Maternity Hospital and an expert witness at the coroner’s inquiry into Savita Halappanavar’s death, claimed that the Constitution itself contributed to Ms Halappanavar losing her life.
In late 2014, the case of an effectively dead woman, in early pregnancy, came before the Irish courts and it became patently clear how the Constitution very much affects standard obstetric practice.
The letter also states that Irish maternity care is among the best in the world. While Irish maternal mortality rates are average by international standards (at approximately eight per 100,000) – which is a credit to the wonderful work performed by under-resourced nurses and doctors in obstetric units – we should note that maternal mortality is not the sole arbiter of whether an obstetric service is safe, effective or patient-centred.
The letter-writers seem to overlook the experiences of over 150,000 Irishwomen who have been forced by the State to travel abroad, in the midst of a crisis pregnancy, to access safe abortion services.
Article 40.3.3 abandons them and criminalisation forces stigma, isolation and financial burden on their shoulders. Irish women are forced to have later abortions as a result of the Constitution and the process of travelling causes health ill-effects. This is not safe. This is not compassionate or effective care. This is the antithesis of patient-centredness.
The “safest country in the world for maternity services” narrative is a myth. In fact we are one of the most dangerous countries in the world to have a crisis pregnancy, in no small part due to the Eighth Amendment. Let’s repeal it. – Yours, etc,
Dr TIERNAN MURRAY,
Dr MARY FAVIER,
Dr MARION DYER,
Dr MARK MURPHY,
Dr ROSS KELLY,
Prof VERONICA O’KEANE,
Doctors for Choice, Ireland,
Kilmacud,
Dublin 14.