Breda O’Brien: Abortion review is right about one thing – women’s needs are not being met

Women are being failed on systemic level, leading some to feel that their only, despairing choice is abortion

It is sad and strange how the same words can mean diametrically opposite things to different people. For example, in barrister Marie O’Shea’s independent review of our abortion legislation, she states that the numbers travelling to the UK for abortion have fallen. It is now primarily women who travel before 24 weeks on the grounds of the mental or physical health of the mother, or with no gestational limit where there is a serious risk that the child would suffer from serious mental or physical disability.

The comment on this fact is striking: “These figures indicate that not all needs are being met.” People who oppose abortion would agree strongly, in the sense that women’s needs are still not being met, leading some to feel that their only, despairing choice is abortion. Women are being failed on a systemic level, and this affects all pregnant women, whether or not they are contemplating abortion.

People who believe that there are always better choices than abortion also deplore the ableism of the UK abortion legislation clause dedicated to allowing the elimination of human beings with serious disabilities. This clause was severely criticised by the UN Committee on the Rights of Persons With Disabilities in 2017, stating its “concern about perceptions in society that stigmatise persons with disabilities as living a life of less value than that of others and about the termination of pregnancy at any stage on the basis of foetal impairment”.

In contrast, when the review talks about needs not being met, it suggests that there is not enough provision for abortion in Ireland on these grounds. Same words, entirely different meanings.


Starkly different meanings attributed to the same words are in evidence elsewhere. The report states baldly: “‘Fatal foetal anomaly’ is not a medical term. There is not any definitive list of conditions where death occurs in utero or within 28 days of birth.”

During the referendum, pro-life people were derided for stating that “fatal foetal abnormality” is not only not a medical term, but also dehumanises children with life-limiting conditions. It is still used constantly by pro-choice activists and politicians, and the media.

Currently, as there is no bright line when a diagnosis becomes fatal, and some babies with life-limiting conditions have lived for months and years, doctors act with great caution. You might think the abortion review would praise this commendable caution but instead (on page 63) it suggests that denying abortion to women whose babies might live “days or weeks” beyond 28 days, “arguably is extremely unfair”.

This is shocking, especially given that one German study over a five-year period showed that almost one in 10 babies designated as comfort care only (to relieve distress in dying babies) were discharged to home or hospice. In other words, these babies often do better than expected.

Instead of abortion, we should offer wraparound care for parents from the moment of prognosis and top-class palliative and other practical supports for as long as these babies with severe impairments live.

The report acknowledges that babies are born alive after abortion, including after termination for life-limiting conditions, which was also dismissed as irresponsible scaremongering during the referendum.

O’Shea describes a well-developed palliative care pathway “for babies who are born pre-viable or in a condition where they are expected to die shortly after birth”. On page 74 she says this came into being because we did not have abortion until 2019 for life-limiting conditions.

While there may be a well-developed pathway in hospitals, parents of babies and children with life-limiting conditions who live longer will tell you they have to fight for every single support. They have to cobble together a patchwork of help from excellent but overstretched organisations such as LauraLynn, and the Jack and Jill Children’s Foundation.

The only lobby group O’Shea mentions regarding life-limiting conditions was Termination for Medical Reasons (TFMR), which is pro-choice. Minister for Health Stephen Donnelly refused to meet women who continued with their pregnancies and who wanted to destigmatise babies with life-limiting conditions. What possible justification is there for excluding and marginalising their voices?

Most media coverage focuses on the three-day waiting period, while ignoring even more extreme and radical proposals. The thrust is towards more abortions, by more types of healthcare professionals, in more places. The review even suggests removing medical personnel from the scope of Section 23, that is, decriminalising medical personnel who act outside the law, a step wide open to abuse. The vast majority of countries continue to criminalise those who act outside legal parameters. Even the UK, one of the most lax abortion regimes anywhere, continues to criminalise abortion while allowing exceptions delineated by the Abortion Act 1967.

Taoiseach Leo Varadkar has been attacked by other politicians for being “reluctant and uncomfortable to make any big legislative changes so soon after that referendum”. Politicians are not normally criticised for keeping their solemn commitments to the electorate, especially commitments that swayed uncertain voters. There is, however, something ominous in the words “so soon”. Do commitments have a time limit?

Politicians respond to voters. Prominent pro-choice campaigners told us that there were about 4,750 abortions in Ireland every year including abortion medication before Repeal. There were 8,500 abortions in 2022. If you find those figures or the radical nature of the review troubling, respectfully lobby your politicians before it is too late.