State feigns ignorance on abortions in its hospitals
The Republic declines to collect statistics and uses its information technology to ensure no one else can either, writes FINTAN O'TOOLE
HOW DO you make a problem go away? The Irish answer, of course, is to pretend it doesn’t exist. But in the age of statistics, there is a special refinement to this strategy – make sure it doesn’t show up in the numbers.
If you count something, it becomes real and if it becomes real you might have to do something about it. Thus, for example, the system didn’t count the number of children who died in the care of the State until it was forced to do so.
Here’s something else the system absolutely refuses to count: the number of abortions carried out within the State. It’s not a big number (based on Northern Ireland figures, a rough estimate would be about 120 a year) but it matters because it encapsulates the need to legislate on the basis of the X case.
And it’s a bloody awkward number. It adds up to a fact that is not supposed to be a fact: abortions are legal in the Republic in certain (very restrictive) circumstances and they are being performed, probably more than twice a week.
This is a tricky business – if we acknowledge this fact, we have to do something about it, like, for instance, clarifying for women and their doctors the precise circumstances in which these abortions can, and cannot, take place. And once we do that, Holy Ireland vanishes in a puff of incense – we are no longer that special place where abortion is unthinkable.
So how do you hide these numbers in a health system where everything is supposed to be recorded?
Here we encounter an old friend, the Irish variation on Donald Rumsfeld’s famous distinctions – the unknown known. You have to positively decide not to know the awkward fact. And, as we shall see, the Irish system has taken this determination very far – it has programmed its computers so that they literally cannot count abortions in Irish hospitals.
That such abortions take place is not seriously in dispute. Anti-abortion groups, for their own reasons, insist that they not be called abortions. But this insistence has no legal or medical standing. Before the European Court of Human Rights (ECHR), the Government argued that, in fact, there is no problem with obtaining a “lawful abortion” in Ireland: “the procedure for obtaining a lawful abortion in Ireland was clear. The decision was made, like any other major medical matter, by a patient in consultation with her doctor.”
So the official position is that abortion is clearly lawful in Ireland when it is necessary to save a woman’s life.
Given that these abortions are lawful, there should be no hesitation about recording them. The ECHR asked the Government a simple question: how many of these lawful abortions are carried out every year?
The Government, in response, referred to a “database of the Economic and Social Research Institute on discharges and deaths from all public acute hospitals”. But, as the court put it: “The Government’s statistical material provided in response to the Court’s question concerned public acute hospitals and ectopic pregnancies only and thereby revealed a lack of knowledge on the part of the State as to, inter alia, who carries out lawful abortions in Ireland and where.”
This poses a puzzle: the Health Service Executive collects figures on everything that happens in hospitals, so how come the State has a “lack of knowledge” about abortions? In fact there’s not really a lack of knowledge – there’s a deliberate unknowing.
This is revealed in the State’s unpublished draft response to the United Nations human rights committee on its concerns about the implementation of a range of obligations.
In it, the Government reveals the method by which it ensures that it does not know how many lawful abortions are performed here: “No statistics are maintained in relation to the number of abortions taking place in Ireland each year. Information in relation to the in-patient treatment of women with ectopic pregnancies is coded as management of ectopic pregnancies on HIPE (Hospital In-Patient Inquiry Scheme) system. This system does not differentiate between procedures to terminate an ectopic pregnancy and procedures following a spontaneous miscarriage as a result of an ectopic pregnancy or procedures to treat a ruptured ectopic pregnancy.”
So this is how it’s done. The State flatly declines to collect abortion statistics.
But even more interestingly, it uses its information technology systems to make it impossible for anyone to tell how many abortions are due to the most common cause – ectopic pregnancies. There’s a computer code that’s used to record treatments. Someone has gone to the trouble of making sure that abortions, miscarriages and other procedures are jumbled up together.
This takes a certain kind of mind: the point of computerising statistics is that you can see information precisely and use it clearly. (It’s called information technology, after all.) Our (in this case inaptly named) HIPE system has been programmed to obscure information and make it unusable.
This engineered ignorance has its purpose: it confines lawful abortions to the netherland of mystery and shame.
It ensures that the women who have them are not even faceless statistics. They literally don’t count.