Abortion law falls short of women’s needs and creates ‘chilling effect’ on clinicians, HSE report warns

Abortion legislation in Ireland “falls short” of women’s needs, creating anguish and shame, while causing a “chilling” effect on clinicians, a Health Service Executive report published on Tuesday warns.

The Unplanned Pregnancy and Abortion Care (UnPAC) study, conducted by Trinity College Dublin, finds the legislation “problematic” for women seeking abortions at all stages of pregnancy but particularly “harrowing” for those facing diagnoses of fatal foetal anomalies (FFAs).

Commissioned as part of a review of the Health Regulation (Termination of Pregnancy) Act 2018 it draws on in-depth literature and policy reviews, along with interviews with focus groups, stakeholders and with 58 women who sought abortions.

The Act, which came into effect on January 1st, 2019, provides abortion without restriction up to 12 weeks’ gestation, and after that where there is a risk to life or health of the mother, or in cases where it is judged the foetus will die before or within 28 days of birth.

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Of the 12 women interviewed who experienced serious foetal anomaly diagnoses, just six qualified for abortion care in Ireland. Among the words used by them to describe their experiences are: awful, draining, anguish, arduous, harrowing, uncertain, protracted, cast out, shame, highly distressing, alone.

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Under the Act a woman qualifies for abortion only where two doctors certify “in good faith” that the baby “is likely” to die before or within 28 days of birth. Doctors face criminal sanction if they breach this. Where they cannot comply, the woman faces continuing the pregnancy to term or travelling abroad for a termination.

Reaching the level of certainty requires several rounds of tests, lasting several weeks, and input by multidisciplinary teams.

“Women found themselves in what they depicted as the “bizarre situation” of hoping for the condition to be deemed ‘fatal enough’,” the study finds. They felt their right to decide what was best for them and their babies was taken from them.

When women qualified they “deeply appreciated” the care they got in Ireland. When they did not, however, they reported clinicians “closing down” — reluctant to discuss prognoses, such as how long the baby might live, quality of life or even if the pregnancy would miscarry.

Parents were left “alone” and “unsupported” and, when they had to travel for termination, experienced “feelings of shame when denied access to care in one’s own country”.

The report notes: “The current restrictions on legal access to termination in cases of foetal anomaly fell short of women’s needs ... Aspects of the legislation negatively affected how health professionals could respond to service users. Criminalisation of doctors [had] a chilling effect on the interaction between health professionals providing abortion care and people seeking abortion care.”

Those seeking early medical abortions (EMAs), under 12 weeks, faced “problematic” situations too — particularly around timely access to care.

The mandatory three-day wait between asking for an EMA and accessing one was seen as “infantilising”, though most accepted it could be beneficial for some women.

Not all were aware of the HSE’s My Options website — the main source of information — and some “struggled” to find a GP providing abortion.