How the ban on abortion puts women’s health at risk
While Abortion is legal in nearly all European countries, Ireland does not provide its women with a choice. Right now, an Irish woman’s only option to end a pregnancy is to have her life being at risk, leave the country or to order an illegal abortion pill online. The abortion pill usually is a safe method to end an early pregnancy and the World Health Organisation even lists them as an essential medicationi. However, while there are trustworthy sources for ordering these pills online and getting them shipped to their homes, there is a risk of obtaining fake, ineffective and even dangerous medications. Not every woman has to possibility to travel abroad and since the stigma linked to the termination of a pregnancy, abortion keeps being a taboo topic. The only way to ensure that Irish women will be able to have an effective and safe abortion and the support needed, physically and mentally, is to legalize their availability.
In the Offences against the Person Act from 1861, the unlawfully attempting of causing a miscarriage was a crime punishable by up to life imprisonment. Since the Eighth Amendment passed with 67% in 1983, the Article 40.3.3° in the Constitution protects the right to life of the unborn. It states that “The State acknowledges the right to life of the unborn and, with due regard to the equal right to life of the mother, guarantees in its laws to respect, and, as far as practicable, by its laws to defend and vindicate that right.” However, in 1992, the Supreme Court ruled that abortion was permitted where pregnancy presented “a real and substantial risk to the life, as distinct from the health, of the mother” including suicide. This decision fuelled the debate on the eighth amendment and since 1992 due to the thirteenth amendment, the right to travel abroad to have an abortion and the right to obtain information about pregnancy termination services, legally available in other countries, were added. Until today, however, the article causes a problematic distinction between a pregnant woman’s life and her health. Page Break
Since 2013, the governing law is the Protection of Life During Pregnancy Act 2013. This act defines the circumstances within and processes through an abortion can be legally performed in Ireland itself. It allows for an abortion in a hospital when the pregnancy endangers a woman’s life. If her life is put at risk based on a physical illness, two physicians have to concur. One Obstetrician and a specialist in the field of the relevant condition. A single physician is required to provide a diagnosis and perform the termination if a risk of loss of the women’s life exists based on a physical illness in an emergency. The last scenario which is considered putting a woman’s life at risk is the risk of suicide. In this case, three physicians, including two psychiatrists and an obstetrician have to approve the termination of the pregnancy. If an abortion is requested but denied, a woman can appeal to the Health Service Executive which then will establish a panel of at least 10 physicians from whom then a committee of two or three will review the application. This obviously raises the already existing mental pressure on a suicidal woman or girl. “Just” being the victim of rape or incest without being suicidal, are no criteria to be eligible for a legal abortion in a hospital in Ireland itself.
Those whose life is not at risk can travel abroad for an abortion in a clinic. However, according to the Irish Family Planning Association, an abortion can cost between €600 and €2000. This still excludes travelling and accommodation. The costs depend on a woman’s pregnancy, Body Mass Index, medical history and personal preference of method. If a woman is not able to cover these costs, she has no option left but to keep the unborn or order abortion pills online. The legal consequences for those who order and take these medications at home can be high. A woman can be sentenced to a fee, to up to 14 years in prison or both for having an abortion at home.
Abortions in Ireland
While there were people protesting against the current law for a long time, the movement grew rapidly in recent years. Irish citizens are protesting against the 8th amendment and the ban on abortion. During the “March for Repeal” on International Women’s day this year, many participants claimed that “Abortions in Ireland are happening anyway and not legalizing them only puts women’s life on risk instead of preventing them from happening.”
Figure 1 – Women from the Republic of Ireland accessing abortion services in England and Wales 1983 – 2016 (UK Department of Health)
Statistics show how many Irish women have to access abortion services in the UK but exclude women who travel to other countries, those who came from Ireland but gave UK addresses when accessing the clinic and those who order abortion pills online. While it is nearly impossible to figure out how many abortion pills are ordered by Irish Women every year, the organisation Women on Web (WoW) explained during 2017, they mailed pills to 878 Irish households. This number is nearly three times higher as in 2016 where the organisation provided 302 women with the medication. These, however, are only the figures of one organisation of many.Page Break
A lot of the women on the March also explained that since abortion is linked to a big stigma, many fear to consult a doctor when experiencing side effects after the termination in the UK or especially after taking the illegal medication at home. This fear seems to exist despite the fact that a patient’s information is confidential, and a doctor would not be allowed to report a help-seeking woman to the authorities. One of the women protesting explained that “aftercare wouldn’t be a problem at all if abortion would be decriminalised.”
Obtaining the medication
Medical abortion pills terminate a pregnancy through the causing of a process, similar to a natural miscarriage. Abortion pills or abortion tablets are designed to be used in abortion clinics with the support of a medical team. In a safe environment like an abortion clinic, Doctors, nurses and experts are available to support a woman not only through the process but also after the termination took place. Abortions which are carried out at home through the intake of illegal medications can be not only dangerous but also even more traumatic than a legal procedure in a hospital. When attending an abortion clinic, a women’s medical history is taken, and any risk factors are identified to make sure that the abortion pills would be suitable for her. This is not the case if she orders these pills online. Also, in a clinic a woman is supported by a specialist doctor on-hand to deal with any complications or problems that may arise during this process, such as excessive bleeding or collapse and a medical team gives advice on which side effects are normal and which are not. When ordering online, a woman cannot possibly be provided with the same assistance as for an abortion in a hospital.
Women help Women and Women on Web are the two most commonly known organisations in Ireland which provide the option to obtain the abortion pill online. Both organisations provide Page Break
important, necessary information on their website and require the woman to fill in an online consultation and to provide a complete correct address. Also, both organisations ask for a donation to a non-profit fund, which is suggested to be at €70 to €90. If a woman is in a difficult economic position, both mark the donation as optional. Women Help Women, as well as Women on Web, are trustworthy providers of the abortion pill. However, as explained, they are not able to provide the same level of support and safety as a medical team.
On the website of WoW, many women were able to contribute their story of their abortion anonymously. While most write that they were happy with their decision, most also explain that they were extremely afraid of being caught by the authorities. Some mention their fear of consulting a doctor or a counsellor when experiencing side effects. In nearly every story, the women describe the heavy bleeding, the pain and often the feeling of uncertainty and fear during and after the termination. Many describe the secrecy they are being forced into based on the illegality of their actions.
Risks of the Abortion Pill
As midwives for choice, an Irish society with the mission to defend the rights of all women and girls to be safe and healthy before, during and after childbirth, explain, the abortion pill is safe in the first trimester of pregnancy and has the same risks involved as in a natural miscarriage. The potential complications can include the by the contributors on women on web’s blog described side effects of heavy bleeding, pain and infections. And even though complications are rare, they can occur, just like with every other medication. Taking an abortion pill without medical supervision can be a serious risk to a woman’s health, not only physically but also mentally. Page Break
Probably the even bigger problem besides the “normal” risks and the psychological stress is the fact, that since it is illegal to order and take abortion pills in Ireland, it is difficult to promote trustworthy websites. On these, women can consult medical experts and be provided with effective and safe abortion medications. But beside the commonly known websites, there are many other organisations and dealers that seem to ship the pills. Some women report of never receiving their orders or even receiving placebos after paying a huge amount of money for an abortion pill.
It is not the abortion pill itself that puts a risk on women’s health. It is more the fact that a woman who is not able to travel to the UK to end her pregnancy to access services which are neither safe nor legal and which can be harmful or even fatal. It is not only possible to end up with ineffective, dangerous medication but can also be a serious threat to the mental health of a woman if she experiences a termination without professional support. Additionally, due to the illegality and the stigma, women have a hard time to receive help from experts or family and friends, due to the fear of being exposed. To reduce the possibility of health risks and to provide women with the necessary medical and consulting support, a decriminalisation of abortion is essential. As Midwives for Choice explain, “The Protection of Life During Pregnancy Act 2013 prevents the provision of the best possible medical care, thereby gravely undermining the health and safety of women.”
The debate that is taking place right now shows two very different views on the whole topic. While the Pro-Life movement focuses on where life begins, the Pro-Choice movement focuses on the providing of choice and the necessary trust in Irish women. During this Discussion, packed with emotion it is necessary to understand the physical and mental risks women are exposed to based on the governing law