Home-based abortion by medication will become Irish norm
Method shown to be highly effective and safe when used up to 22 weeks of pregnancy
The abortion drug Mifepristone. Photograph: Phil Walter/Getty Images
It is likely to be at least a year before any first-trimester terminations under new legislation will take place here.
Before doctors in Ireland can provide first-trimester abortions, legislation to make this lawful will have to be passed. A draft Bill has indicated that termination of a pregnancy can be carried out where a medical practitioner certifies the pregnancy has not exceeded 12 weeks. A period of 72 hours will have to elapse between the time of the certification and the termination of the pregnancy being carried out.
Beyond 12 weeks, it will be lawful to carry out a termination of pregnancy only when two medical practitioners certify that there is a risk to the life of or risk of serious harm to the health of the pregnant woman.
Training and some additional facilities will have to be provided to GPs. But once introduced, and following a primary care consultation and a period of reflection, a woman will take medication in her own home. She will be seen for a follow-up check.
There is a growing evidence base to reflect this move from surgical termination in specialist clinics to home-based medical abortion. Primary care/general practice is now considered by the World Health Organisation and other bodies as the preferred location for abortions where the foetus is less than 12 weeks.
Medical abortions will not require an ultrasound scan. Gestation will be calculated based on the date of a woman’s last period. After taking the abortion pills (Mifepristone and Misoprostol) the woman will most likely experience a heavy period, with some cramping. The method has been shown to be highly effective and safe when used up to 22 weeks of pregnancy.
Will maternity hospitals be involved at any point in the process?
Yes, in a minority of cases. Medically induced abortions are similar to natural miscarriages, from a medical process perspective. Just as a minority of women who miscarry will bleed excessively or not expel all of the products of conception, a number of those who have medication-induced abortions will require gynaecological intervention in a hospital setting. Hospitals will require additional resources to provide for additional urgent and out-of-hours demand arising from the treatment of complications of medication-induced abortion
What about healthcare professionals who conscientiously object to early abortion on request?
Minister for Health Simon Harris has indicated there will be provision to allow for this. But a practitioner who is approached to carry out a medical termination, and does not provide the service, will be obliged to expeditiously hand over the woman’s care to a colleague who does. About 25 per cent of GPs are thought unlikely to provide abortion services, either for conscience or workload reasons.
The Medical Council guide to professional conduct and ethics states: “ If you hold a conscientious objection to a treatment, you must: inform the patient that they have a right to seek treatment from another doctor; and give the patient enough information to enable them to transfer to another doctor to get the treatment they want.”
It is essential that the Department of Health now design a service that meets women’s needs while being practical and safe. This must deliver abortion care as part of a comprehensive service which includes full sexual healthcare, the availability of counselling, fully trained staff and with robust transfer arrangements with hospitals.