Abortion services in parts of State ‘untenable’, according to report

The provision of abortion services in some parts of the Republic is “untenable”, while healthcare workers who abuse their right to conscientiously object do so “with impunity,” a new report has found.

The findings are contained in a document by Barrister Marie O’Shea, who was tasked with examining the effectiveness of Ireland’s abortion regime following the 2018 referendum to repeal the Eighth Amendment.

In her report, she found that some non-providing GPs are directly contravening the law by not making arrangements for the transfer of the woman’s care.

[ Taoiseach and Tánaiste urge caution on proposed changes to abortion legislation on foot of review ]

[ Abortion review: key recommendations may be opposed by some Cabinet members ]

[ The three-day waiting period for abortion: case for retention ]

The report finds that in some counties, service provision is reliant on “a handful of providers across primary care and hospital setting. There is a potential risk that these staff may burn out. The service is untenable.”

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Women have experienced “delay and obstruction”, including the provision of inaccurate and misleading information, through encounters with non-providing GPs, including conscientious objectors, “who are not fulfilling their legal and ethical obligations to make arrangements for the transfer of the woman’s care. Some have experienced rogue agencies purporting to be pro-choice and have felt their decision to terminate their pregnancy to be undermined.”

The review recommends increasing the number of GPs providing service to 6,000 by 2028. It also recommends that the Health Service Executive should consider undertaking a mapping exercise to ascertain the precise number of medical practitioners providing the service.

The review recommends that the current three-day wait to access abortion medication should be optional.

Ms O’Shea’s report said that the mandatory waiting period “can impose a physical and psychological burden on women”.

Furthermore, she found that there is not any statutory prohibition or restriction on healthcare workers who abuse their right to conscientiously object by actively obstructing or delaying a woman’s access to care by providing misleading information.

“It would appear that persons who engage in this conduct are able to do so with impunity.”

The review also recommends the decriminalisation of medical practitioners. It says that the “positioning of abortion in criminal law may deter healthcare professionals from engaging in services, not because they do not want to provide but because they feel that the law does not protect them”.

Geographical coverage

The Department of Health should also consider amending the legislation to expand the range of health professionals who may provide termination of pregnancy services to, for example, midwives and junior doctors.

In terms of geographical coverage, the review finds that fewer contracts between the HSE and primary care providers are recorded in the southeast, northwest, midlands and Border counties.

There is, therefore, uneven geographic coverage of hospitals providing full services

The reason for non-participation by hospitals was attributed by the HSE and the department to the prevalence of conscientious objection among medical practitioners.

In terms of the three-day wait, the review found that as termination of pregnancy services are not configured to run 365 days a year, the wait “can extend to a four- or five-day wait for treatment, if the first visit takes place towards the end of the week, particularly if it coincides with public holidays”.

Healthcare staff should be monitored to ensure they are adhering to rules around conscientious objection in the provision of abortion care, according to the review.

Foetal abnormalities

Minister for Health Stephen Donnelly will bring the review to Cabinet on Tuesday morning. It will be published on Wednesday. As reported by The Irish Times, the report will recommend sweeping changes including the decriminalisation of doctors involved in provision and the removal of the waiting period to access termination medication. It will also recommend changes to the granting of abortions in the case of fatal foetal abnormalities.

Furthermore, changes are recommended for women who need to access an abortion beyond 12 weeks in the case of fatal foetal abnormality.

The current legislation allows for abortion only in cases where two medical practitioners form a reasonable opinion the foetus will likely die before or within 28 days of birth.

The review notes that instead, where medical practitioners have formed an opinion in good faith based on the knowledge available to them that a pregnancy would result in a fatal foetal abnormality, then a termination could proceed.

Changes will also be recommended around the existing 12-week limit for accessing terminations without condition so that terminations could be accessed outside this time but only in certain very specific circumstances. The circumstances would be where a woman was unable to access a foetal scan within the 12-week timeframe, or where abortion medication was not effective within that time.

Meanwhile, Minister for Social Protection Heather Humphreys will outline to Ministers the payment schedule for €200 cost-of-living supports.

The payments are being made this week to 1.3 million pensioners, carers, people with disabilities, working families, lone parents and other groups.

Ms Humphreys will also tell colleagues that a further €100 child benefit payment is on schedule to be paid at the end of June.

Separately, Ministers will also be updated on constraints on capacity within prisons, a clean-air strategy, and the appointment of the ambassador of the Republic of Korea to Ireland.