Half of the counties in the Republic have fewer than 10 GP contracts for the provision of abortion services while nine counties have fewer than five GPs providing abortion care, a new review has found.
An independent review into the effectiveness of the State’s abortion laws has found that uneven geographic coverage could render the service untenable in some places, and that the number of providers has increased only marginally since 2019 when access to abortion became legal for the first time.
Politicians in counties that have the lowest number of GP contracts have now called on the Oireachtas Committee on Health to examine ways to help women access these services.
Data compiled in the report by barrister Marie O’Shea shows that up to 2022, Monaghan had only one GP providing abortion services, as did Longford.
Longford-Westmeath Fianna Fáil TD Robert Troy said “all women have the right to access medical services regardless of their location in the country”.
“We must also recognise that under the legislation GPs cannot be compelled to carry out terminations contrary to their conscience. But they must refer you to another practice, clinic or hospital where the service is available, which in this case is Midlands Regional Hospital, Mullingar. If women need additional support to travel, I believe this is something the health committee should consider.”
Counties Sligo, Mayo and Roscommon have three GP contracts while Carlow has two. Laois and Leitrim have four such contracts, while Cavan, Kilkenny and Wexford have only six GP practices with termination of pregnancy contracts.
Carlow-Kilkenny TD and Green Party Minister of State Malcolm Noonan said women should not be denied access to abortion care because of where they live. “The report has made a number of important operational recommendations on how the existing services could be expanded, including increasing the number of primary care providers and maternity hospitals that provide terminations of pregnancies. I fully support those recommendations as no one should be denied access to termination services on the basis of where they live.”
Independent review of State’s abortion law
Calling for the expansion of services, the report said that at present about 90 per cent of GPs and eight of 19 hospitals did not provide services under the current abortion law.
A study conducted as part of the review also revealed that the uneven geographic spread of GPs had resulted in some women having to make long journeys to access services and some having to do so by public transport, including one whose only option was to take a taxi which cost her €91.
“Arguably, expensive travel costs may act as a barrier to service for people who are of limited financial means. The incurrence of expensive travel costs to access services is at odds with the spirit of the policy to provide care, free of charge.”
The review found that fewer contracts between the HSE and primary care providers were recorded in the southeast, northwest, midlands and Border counties.
The report also found there was uneven geographic coverage of hospitals providing full services under the law. Only 11 of 19 maternity units or hospitals provide full services. This figure has risen by one since 2019. The Cabinet was told this week that a further four hospitals would commence providing full services this year.
The availability of ultrasound scans has also emerged as an issue.
“Access to the service can vary significantly depending on geographic region. In some regions, arranging scans can be a protracted and frustrating process. The timeliness and cohesiveness of referral is impacted by the availability of staff. Staff at some ultrasound centres appear to be unaware of or not respectful to women’s wishes to see the screen or not,” the review said.
Ms O’Shea’s report has called on the HSE to consider undertaking a mapping exercise to find out the precise number of medical practitioners providing the service in each county. The review also said the HSE should carry out a separate mapping exercise to measure the furthest distance a woman of reproductive age must travel to access a providing medical practitioner.
“In areas where there is low coverage and consequently women must travel longer distances to access care, the Department of Health and the HSE should consider supporting the establishment of local women’s health centres, providing comprehensive women’s healthcare services.”