By Unarose Hogan
If I asked you to envision a country where reproductive health rights are denied to the extent that women must travel to neighboring countries for abortion “asylum” in 2015; where emergency contraception without a prescription became available only in 2012; and where a woman died from maternal sepsis after doctors delayed performing an essential surgical procedure to remove an unviable fetus in 2012, what country do you envision?
I speak of Ireland.
As I celebrate with my country the legalization of same-sex marriage through popular referendum in May 2015, the struggle for reproductive health rights remains woefully neglected and marked by a regrettable lack of momentum toward abortion law reform. Abortion remains steadfastly inaccessible throughout Ireland.
An estimated 4,000 women traveled to the United Kingdom for abortions in 2014.[1] The current status of abortion law in Ireland is governed under the 2013 Protection of Life During Pregnancy Act, whereby abortion “will be permissible when pregnancy endangers a woman’s life including suicide.”[2] This law represents 22 years of development following the notorious “X” case of 1993, in which the Supreme Court denied an underage rape victim the right to travel to the UK for an abortion. Decades of debate, two public referenda, and an eventual Supreme Court ruling allowing for lawful abortion when the pregnant woman’s life is at risk (including from suicide) formed the backdrop for the law’s adoption in 2013.[3] In 2012, before the law came into effect, Savita Halappanavar, an Indian dentist living and working in Ireland, suffered a partial miscarriage at 17 weeks’ gestation. She subsequently died from septicemia after doctors refused to perform an abortion for the unviable fetus on the basis of a detectable fetal heartbeat. Based on the Catholic ethos of the maternity services and the unclear laws in effect at the time, her death was eventually categorized as a “medical misadventure.”[4]
The Protection of Life During Pregnancy Act, making abortion available only when the woman would die without it, means that the pregnant woman and the unborn child have an equal right to life. Moreover, the law does not recognize rape or fetal abnormalities as grounds for abortion. The limitations of the Protection of Life During Pregnancy Act are immediately apparent. One of the first requests for abortion submitted under this legislation in 2014 came from a woman, Miss Y, who became pregnant as a result of rape. The Irish State denied both her request to travel to the UK for an abortion, and access to abortion in Ireland. The woman went on a hunger strike, until at 25 weeks’ gestation, her viable fetus was delivered by Caesarean section.[5]. Although the Department of Health issued guidance for health professionals on the law in 2014, many gray areas remain, forcing practitioners to interpret the law themselves. They fear legal repercussions from performing an abortion. Currently, obtaining an abortion requires a burdensome process of seeking consensus from three medical experts that the pregnancy endangers a woman’s life, including by way of suicide, and that the risk can be averted only by performing the abortion.[6] Conservative interpretations of the law will result in repetitions of the cases described that deny women in Ireland their sexual and reproductive health rights.
The only option for most women in Ireland who need an abortion is to travel abroad for private services—a costly and stressful experience at an already difficult time, and an option that is out of reach for women who cannot afford it, and for those who lack a UK visa. Shame and stigma drive the practice underground, and the need to travel further disadvantages women from obtaining post-abortion care, including counseling, on their return home.
In global health, we are concerned about the lack of access to health care, and health inequities; these issues are as applicable to Irish reproductive health care as they are to health care settings in lower-income countries. The remarkable difference is that in Ireland we have the capacity to provide safe abortion services for Irish women, but we choose not to.
Abortion opponents in Ireland have clung to traditional Roman Catholic values, with campaigns centering on the right to life of the unborn child. A similar ethical basis was used by campaigners against marriage equality in the recent referendum on same-sex marriage, who used the slogan “think about the children” as the basis for their campaign. The people of Ireland upheld the rights of all people not to be discriminated against and voted to allow same sex marriage. How long will it be before the people of Ireland also uphold the rights of women to control their sexual and reproductive health?
In the wake of the Irish referendum on same-sex marriage, I am proud to be Irish. However, I cannot overlook Ireland’s shame. We cannot deny that we are criticized globally for our stance on abortion, with the UN Human Rights Committee concluding that Ireland has failed to comply with its human right obligations due to its discriminatory abortion law.[7]
Ireland’s first female president, Mary Robinson, made a poignant speech in 1990 in which she said, “I was elected by the women of Ireland, who instead of rocking the cradle, rocked the system.” Has the time arrived for us equal men and women of Ireland to rock the system once more?
Unarose Hogan, RN, BSc, MSc, is Hospital Autonomy Advisor at Deutsche Gesellschaft für Internationale Zusammenarbeit (GIZ) GmbH, Malawi.
Please address correspondence to the author at unarose@campus.ie.
References
1. M. Hennessy, “More than 3,500 women from Ireland had UK abortion,” Irish Times (June 12, 2014). Available at http://www.irishtimes.com/news/health/more-than-3-500-women-from-ireland-had-uk-abortion-1.1829790.
2. Government of Ireland, Number 35 of 2013: Protection of Life During Pregnancy Act 2013 (Dublin: 2013).
3. H. Felzmann, “Bringing abortion to Ireland? The Protection of Life During Pregnancy Act 2013,” International Journal of Feminist Approaches to Bioethics 7 (2014), pp. 192–198.
4. M. Berer, “Termination of pregnancy as emergency obstetric care: The interpretation of Catholic health policy and the consequences for pregnant women; An analysis of the death of Savita Halappanavar in Ireland and similar cases.” Reproductive Health Matters 21 (2013), pp. 9–17.
5. M. Enright, “Suicide and the Protection of Life in Pregnancy Act 2013,” Human Rights in Ireland (August 16, 2014). Available at http://humanrights.ie/constitution-of-ireland/suicide-and-the-protection-of-life-in-pregnancy-act-2013.
6. Irish Department of Health, Implementation of the protection of life during pregnancy act: Guidance document for health professionals (Dublin: Stationery Office, 2014).
7. Irish Family Planning Association, UN Human Rights Committee & Ireland’s Abortion Laws (IFPA, July 2014). Available at http://www.ifpa.ie/node/603.