Elements of Ireland’s abortion system are “not sustainable” in their current form and the service could collapse, according to a researcher involved in a review of the State’s laws on terminations of pregnancy.
Dr Deirdre Duffy, now at Lancaster University, and a team of researchers from Manchester Metropolitan University were appointed by the Government to carry out a study looking at the experience of abortion service providers such as hospital staff and GPs.
Their research has identified issues around guidance on conscientious objection as well shortcomings in the spread of services available around the country and the availability of staff and facilities in hospitals.
This work was due to form a major part of the review of the Health (Regulation of Termination of Pregnancy) Act 2018, which has now been sent to Minister for Health Stephen Donnelly.
When the original law allowing access to abortion care came into effect, the Government decided there should be a review of how effectively the system operated within three years. It has looked at the experiences of women and service providers, and there was also a public consultation. The overall review, chaired by barrister Marie O’Shea, has also assessed the extent to which the objectives of the Act have been achieved.
The research into the experience of women using the service was published in advance of the wider review being completed, but Dr Duffy’s contribution to it has not yet been.
Speaking about her research into the system, Dr Duffy said: “There are parts where I have real concerns that the service could collapse because it is just not sustainable in its current form. It’s a consultant-led service and there aren’t very many consultants.”
[ Review calls for Ireland’s abortion rules to be relaxed ]
Dr Duffy and her team spoke with health providers across the country, including midwives and consultants in hospitals that do and do not provide terminations of pregnancy. She also carried out a survey of GPs to establish some of the reasons why they do not provide such services.
Asked for her assessment of the current provision of abortion services based on her research to date, she said: “It is better than before the referendum but it is a postcode lottery. It can fall down in so many areas. It is inequitable.”
In terms of conscientious objection, she said there was regulation and guidance but their research had uncovered evidence of conscientious objection being interpreted in various ways that was not consistent with these regulations.
“Where someone breaches their obligations in a hospital, it is almost impossible to challenge them. If you take someone off the ward for unprofessional conduct for example, there may be no one there to fill their post,” she said. “There is a lack of consistent management of conscientious objection.”
Dr Duffy said the availability of facilities and staff were major issues and there were instances of people being sent back from operating theatres or “timing out” of abortion access because of this. Details of these instances have been included in her research.
[ Donnelly receives final report on review of State’s abortion laws ]
She said there was “outright confusion” around how many GPs actually provided abortion services. She also highlighted issues with staff being given adequate time and the size of the workforce.
“When researchers, including myself, have asked, who handles calls for referring patients from the community? They might be for scans or complex needs, it could be one person on a part time post who was taking the mobile home at weekends or on holidays. But what if they got sick? There is no consideration of how to have an excellent service.”
She added that there were issues with abortion referrals under section 9 of the Act, which allows termination of pregnancy to be carried out if there is a risk to the life of the woman or a risk of serious harm.
“There is very limited guidance and no stable pathway for mental health applications,” she said. “There is no consideration on how to manage multidisciplinary teams.”