The report on the operation of abortion services in the State, written by barrister Marie O’Shea for the Department of Health, is a comprehensive document which provides a useful blueprint for action in many areas and, in others, points for the political system to consider. Minister for Health Stephen Donnelly was obliged to commission the report three years on from the new regime being introduced after the referendum on the Eighth Amendment. Much has changed since then, but the service levels available to women remain underdeveloped in many cases and the wording and operation of the legislation is causing some problems.
A key issue is that in some areas of the country – notably parts of the south-east, north-west, midlands and border counties – there is a notable lack of service provision. This is due in part to a lack of GPs providing abortion services – only one in two counties – which the report says is largely due to their heavy workload. Meanwhile, only 11 of the 19 maternity units provide full abortion services; another four will do so this year. In some cases the non-provision of services is due to conscientious objectors among medical staff, in others to poor infrastructure.
Access to healthcare services should not depend on where someone lives. The report makes some useful recommendations to address this, partly through steps to broaden availability among GPs and via investment in hospitals and ensuring new medical hires are willing to provide these services. It warns that the pressure on GPs and hospitals which do provide services in areas where many don’t is " untenable”.
The report also calls for the abortion legislation to be clarified in some areas and for change to be considered in others. The sections which relate to risks to the life or health of the pregnant woman are hard for practitioners to implement, it says, and would benefit from ministerial guidelines to provide clarity. So could the requirement on women to seek the medical opinion of two doctors. The report suggests that the requirement should be for two doctors to consult and agree. It also calls for more clarity around section 11 of the legislation, relating to terminations in the case of fatal foetal abnormalities.
The most contentious area of the report is its recommendation that the three-day waiting period which women are obliged to take before proceeding with an abortion be reconsidered. It recommends that it be replaced by a requirement on medics to tell women that they have a statutory right to a reflection period if they so choose, which seems a sensible approach. This is one of the issues which the Oireachtas committee, to which the report is being referred, will consider.
The report says that developing services and practices is inevitably an iterative process. But the clear gaps it identifies need to be addressed.