Focus on Down syndrome in Eighth debate wrong, leading medic says

The debate on the future of the Eighth Amendment to the Constitution is one that has dominated news agendas for decades.

As the referendum on article 40.3.3 of the Constitution nears closer, the issues are beginning to come into sharper focus.

While the proposition to be put to the people is still not entirely clear, it is evident the issue of Down syndrome will be a significant tool in the anti-abortion side’s armoury.

This is despite the Oireachtas committee on the amendment having taken a definitive position on this issue. The committee voted against allowing terminations on the basis of foetal abnormalities – or, in non-medical terms, a disability.

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While noting the burden placed on the woman and the family in such situations, members of the committee said they did not accept that these were sufficient grounds for termination.

However, this has not prevented organisations opposing constitutional change from seeking to introduce uncertainty into the debate.

Members of the anti-abortion campaign claim changing the current legislation would lead to the elimination of Down syndrome in Ireland.

Misleading

Dr Peter Boylan, chair of the Institute of Obstetricians and Gynaecologists, is critical of that suggestion, claiming it is misleading and misinformed.

Foetal abnormalities, he tells The Irish Times, are seldom identified until the 20-week anomaly scan. Such screening is not provided in every hospital and a third of women do not access the scan due to poor infrastructure in maternity facilities.

Termination after the first trimester will be permitted only for conditions that are fatal – ie where the baby will die at or shortly after birth.

If abortions are provided up to 12 weeks without restriction, Dr Boylan says it is technically possible to identify disability within the first trimester but stresses it is “not practical and highly unlikely”.

Dr Boylan, former master of the National Maternity Hospital, says diagnosis of Down syndrome involves a three-stage process.

First, a scan must be performed to determine gestation. Second, a blood test must be taken between nine and 11 weeks to analyse free foetal DNA in the mother’s bloodstream.

This test costs more than €500 and is not available to public patients as it is not funded by the State. The test is not available in every hospital and a woman would have to formally request it.

Results take two weeks to be returned as there is no test facility in Ireland and samples must be sent for analysis to the UK or the United States. These tests are indicative and are not 100 per cent reliable.

If an abnormality is suggested, a third, confirmatory stage is required.

This is by way of chorionic villus sampling, where a small sample is taken from the developing placenta and analysed – usually in the UK – to confirm or refute the diagnosis. This stage takes at least three working days.

First appointment

“It is clear, therefore, that such diagnoses, while technically possible, can rarely or realistically be achieved before 12 weeks in Ireland,” said Dr Boylan. “In practice the majority of Irish women have their first hospital appointment between 12 and 20 weeks.”

The Government has been examining legislation to allow for abortions up to 12 weeks, in line with the recommendations of the committee. Under the current measures it is examining, a three-day waiting period would be required.

There is another test offered to women in their first trimester of pregnancy called a nuchal fold scan. It is provided between 11 and 14 weeks of pregnancy.

A certain set of criteria has to be met in order for this to be carried out, covering, among other things, the mother’s age and the quantity of fluid behind the foetus’s neck.

The nuchal translucency scan is not a diagnosis but can help identify those at risk of having Down syndrome.

However, results take 10 days to return and therefore a termination could not be provided within the 12 weeks.

Organisations opposing change to Ireland’s abortion laws also suggest allowing terminations when a mother’s mental health is at risk may open the door to abortions when Down syndrome is confirmed.

However, Dr Boylan rejects this claim. “The floodgates did not open after the Protection of Life During Pregnancy Act when terminations were allowed in cases of [threat of] suicide. Women were not turning up saying they were suicidal to get a termination. That did not happen.

“So it comes back to trusting women. We need this debate to be informed by accurate, evidence-based and factual information.”