Lack of contact with abortion review authors labelled ‘extraordinary’

Three authors of a review commissioned by Government into the State’s abortion services say they not been contacted by Ministers or officials about their research, in a development which has been labelled as “extraordinary.”

Barrister Marie O’Shea was appointed to review the adequacy of termination laws in Ireland, and delivered her final report in April which was then brought to Cabinet. It recommended widespread changes.

She appeared on Wednesday morning at the Oireachtas Committee on Health to discuss her report alongside Dr Catherine Conlon and Dr Deirdre Duffy, who both completed key planks of research into the experience of women using the service and service providers themselves.

Ms O’Shea also defended her research and again called for the removal of the three-day waiting period and the lifting of criminalisation sanctions in the Bill.

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Asked by Social Democrats TD Roisin Shortall if they had been contacted by anyone in Government to clarify their recommendations since the publication of the report earlier this year, all three said they had not.

Ms O’Shea said that she met Minister for Health Stephen Donnelly before the memo went to Cabinet, but has heard nothing since.

“I haven’t had any communication with the Department of Health since I met with Minister Donnelly, I think it may have been just before it went to Cabinet.” She said there has been no contact with the department since then.

“I can’t help thinking that there is a delaying process at play here to some extent,” Ms Shortall said, adding: “It is very regrettable because I would have expected that senior figures or officials at least would have been in touch to clarify some of your recommendations with an eye to planning the legislation that was recommended.”

The Dublin North West TD also said it was “very worrying” and “extraordinary” that Ms O’Shea had also not been contacted by the HSE’s implementation group to improve services.

Ms O’Shea said: “I would be very interested to find out what is going on,” given she had recommended a “collective leadership” approach to the issue.

Both Dr Duffy and Dr Conlon said they had not been approached on their findings.

“We would have reached in to the Department of Health and the HSE and did an extensive briefing on our study findings but as regards being approached to engage, no,” Dr Conlon said.

The three authors were asked if they believed sufficient research had gone into their review of the State’s laws.

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Dr Conlon, who examined at the experience of those who use the services, said her research began in 2019 and was rigorous.

“We undertook research recruiting people for the study in 35 general practitioner sites, two hospital sites, two women’s health clinic sites, also through the organisation Termination for Medical Reasons and the BPAS UK group. We engaged with over 60 GPs and we invited all GPs that were on the list providing abortion through the contracts office to take part in the study. So we did extensive work in trying to access people. It is a very lengthy and sensitive process to engage people in research like this. We ultimately engaged 46 people in the study. There is no more rigorous methodology. It has been peer reviewed extensively. And the rigor of our methodology has been held up by academic peer review, as well as peer reviewed by the HSE.”

Fine Gael Senator Séan Kyne, speaking on the three day wait to access abortion medication, asked how many women who didn’t have a second appointment with a GP “went on to have children.” He said that when making decisions or forming an opinion, he believed in having data.

Ms O’Shea quoted IFPA research which said that only two per cent of women did not return for a second appointment.

Dr Conlon questioned whether Senator Kyne understood what would be involved in collecting such data, warning that it would be considered “unethical” to interview women and ask why they didn’t attend a second appointment. Dr Duffy said such an approach would not be approved by an ethics committee and would risk “re-traumatising” women.

The committee also heard that the risk of criminalisation is having a “chilling effect” on doctors who provide abortion services.

“The criminal sanction on the providers is something that weighs very heavily on their mind,” Ms O’Shea said.

The existing legislation criminalises anyone who assists a pregnant person to obtain an abortion outside of the provisions of the Act – with a prison sentence of up to 14 years.

On the recommendation to remove the three day mandatory wait, Fianna Fáil Senator Lorraine Clifford-Lee said she does not know of any other medical procedure where a woman would be told to “turn around and reflect on it, if they’ve made their mind up on something.”

The Termination of Pregnancy Act, which came into effect on January 1st, 2019, provides abortion without restriction up to 12 weeks’ gestation, subject to a three-day waiting period.

Terminations are also permitted after 12 weeks if there is a risk to the life or health of the mother or in cases where it is judged the foetus will die before, or within, 28 days of birth.

One of the main arguments advanced by anti-abortion campaigners is that the mandatory three-day wait to access abortion medication should not be removed because they believe it has prevented abortions going ahead because a number of women have changed their minds by the required second appointment.

In the committee, Aontú leader Peadar Tóibín asked barrister Marie O’Shea whether figures released by the IFPA were accurate. That data showed only two per cent of women didn’t return for a second appointment, and went ahead with accessing the medication.

He said that instead, HSE figures showed that 16.5 per cent of women didn’t return for a second appointment.

Ms O’Shea said she checked with the HSE on the figures and said they represent GPs who only billed the State for one appointment.

The committee was told there are a number of reasons why only one appointment was recorded. One was that the woman could have been referred to a hospital after her first appointment. Another is that she may have travelled abroad for an abortion, or miscarried.

“You are making enormous conflations with no scientific basis,” Dr Conlon told Mr Tóibín. She said the data in his parliamentary question response did not have the “scientific rigour” of her research.

The committee was told it is not possible to quantify the number of women who did not attend their second appointment and who subsequently went on to have a child.

Aontú has previously argued for the mandatory three wait to be extended to five days. The review authors said, however, that their research found that women believed the measure to be patronising and that at times they struggled to secure GP appointments on bank holidays or at Christmas.