Social Science
‘Still travelling’: Access to abortion post-12 weeks gestation in Ireland
Lorraine Grimes,
Joanna Mishtal,
Joanna Mishtal
Department of Anthropology, University of Central Florida, Orlando, FL, United States of America
Karli Reeves,
Karli Reeves
Department of Population Health Sciences, College of Medicine, University of Central Florida, Orlando, FL, United States of America
Dyuti Chakravarty,
Bianca Stifani,
Bianca Stifani
Department of Obstetrics, Gynecology and Women's Health, Montefiore Medical Center, New York, United States of America
Wendy Chavkin,
Deirdre Duffy,
Deirdre Duffy
Senior Lecturer in Sociology (Global Social Inequalities), Lancaster University, Lancaster, United Kingdom
Trish Horgan,
Mary Favier,
Mark Murphy,
Antonella F. Lavelanet
Antonella F. Lavelanet
Department of Sexual and Reproductive Health and Research, World Health Organization, Switzerland
Peer Reviewed
Abstract
This article focuses on access to abortion in Ireland post-12 weeks gestational age. It critically examines abortion access under the legislative sections 9, 10 and 11 of the Health (Regulation of Termination of Pregnancy) Act 2018, the Multi-Disciplinary Team (MDT) process, as well as the appeals process in place. We highlight existing ambiguities in diagnosing and certifying cases of risk to health during pregnancy, particularly mental health, as well as the challenges in diagnosing and certifying cases of fatal fetal abnormality (FFA). The article incorporates service users' experiences in obtaining abortion in Ireland post-12 weeks, particularly in cases of FFA, and includes recommendations for policy and legislative change.
Key Questions
What are the main provisions of the Health (Regulation of Termination of Pregnancy) Act 2018 concerning abortions after 12 weeks?
The Act permits terminations beyond 12 weeks in specific circumstances:
- Section 9: Allows termination when there is a serious risk to the life or of serious harm to the health of a pregnant woman, after examination by two medical practitioners.
- Section 10: Permits termination in emergency situations where there is an immediate serious risk to the life or of serious harm to the health of a pregnant woman, after examination by one medical practitioner.
- Section 11: Allows termination when two medical practitioners are of the opinion, formed in good faith, that there is a condition affecting the fetus that is likely to lead to death before, or within 28 days of, birth.
These provisions aim to balance the rights of the pregnant woman with considerations for the fetus, allowing for terminations in cases of significant health risks or fatal fetal abnormalities.
What challenges exist in diagnosing and certifying cases of risk to health during pregnancy, particularly concerning mental health?
The article identifies ambiguities in diagnosing and certifying cases where there is a risk to health during pregnancy, especially in relation to mental health. Medical practitioners may face difficulties in assessing and determining the severity of mental health conditions and their impact on the pregnancy, leading to inconsistencies in certification and access to termination services.
What are the difficulties in diagnosing and certifying cases of fatal fetal abnormality (FFA)?
Diagnosing and certifying cases of FFA present challenges due to:
- Medical Uncertainty: Variability in medical opinions regarding the severity and prognosis of certain fetal conditions.
- Legal Ambiguities: Unclear definitions within the legislation may lead to inconsistent interpretations and application.
- Emotional and Ethical Considerations: The sensitive nature of FFA cases can complicate decision-making processes for both healthcare providers and patients.
These challenges can result in delays or barriers to accessing termination services for those facing FFA diagnoses.
What are the experiences of service users seeking abortions in Ireland post-12 weeks, particularly in cases of FFA?
The article incorporates service users' experiences, highlighting:
- Emotional Distress: Many individuals experience significant emotional turmoil when navigating the complex processes required to obtain a termination post-12 weeks.
- Systemic Barriers: Challenges such as delays in diagnosis, referral processes, and access to specialized care can impede timely access to services.
- Support Systems: The availability and quality of support services, including counseling and peer support, play a crucial role in the overall experience of service users.
These insights underscore the need for a more streamlined and compassionate approach to care in such circumstances.
What recommendations does the article make for policy and legislative changes?
The article suggests several recommendations to improve access to abortion services post-12 weeks, including:
- Clarifying Legislative Definitions: Providing clear guidelines for diagnosing and certifying cases of risk to health and FFA to reduce ambiguities.
- Enhancing Training for Medical Practitioners: Implementing comprehensive training programs to better equip healthcare providers in assessing and managing complex cases.
- Streamlining the MDT and Appeals Processes: Simplifying procedures to reduce delays and administrative burdens on patients and providers.
- Improving Support Services: Expanding access to counseling and support resources for individuals undergoing the termination process.
These recommendations aim to create a more effective and compassionate framework for abortion services in Ireland beyond 12 weeks gestation.
This comprehensive analysis provides valuable insights into the current state of abortion access in Ireland post-12 weeks gestation and offers practical solutions to address existing challenges.
