Repressing Abortion in Ireland
ireland / britain |
gender |
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Wednesday June 29, 2005 22:14 by Mary Favier - Doctors For Choice
An analysis of the pro-choice struggle in Ireland
The Republic of Ireland has one of the most draconian abortion laws in the world. At present abortion may only be performed where continuation of pregnancy poses a 'real and substantial' risk to a pregnant woman's life - about 5 cases per year of 50,000 pregnancies
The ban on abortion and continued attempts to make all access virtually impossible, approximately 7000 Irish women every year exercise their right to choose abortion and travel to England to access legal abortion there, largely through charities providing abortion services and private clinics.
Photo is from an anti-abortion march at the time of the 'X-case' in the early 1990's
Repressing Abortion in Ireland
by Mary Favier (Doctors For Choice)
The Republic of Ireland has one of the most draconian abortion
laws in the world. At present abortion may only be performed where
continuation of pregnancy poses a 'real and substantial' risk to a
pregnant woman's life - about 5 cases per year of 50,000 pregnancies.
In reality a woman must be dying before a lifesaving abortion can be
performed.
The long-standing ban on abortion was strengthened in 1983 by a
constitutional referendum. However in 1995 the Supreme Court ruled
that a minor in the care of the state could travel to England for an
abortion because her life was at risk from suicide. Right wing groups
saw this as a breach of a total ban on abortion and further attempts
at restricting abortion were introduced as a constitutional amendment
in March of 2002. This attempted to include in the constitution a
specific prohibition on the provision of an abortion for a woman
whose life was at risk by suicide.
Yet in spite of the ban on abortion and continued attempts to make
all access virtually impossible, approximately 7000 Irish women every
year exercise their right to choose abortion and travel to England to
access legal abortion there, largely through charities providing
abortion services and private clinics. This figure of 7000 includes
only those who are documented in English statistics by the giving of
an Irish address. It does not include those who use UK addresses for
reasons of confidentiality or those who travel to other countries.
There has been about a 10% rise in the figures every year. An
interesting statistical fact is that the majority of Irish women who
have had abortions are married and already have children. It is
estimated that about 150,000 Irish women have had an abortion - this
averages about 1:10 of adult Irish women. Thus for Irish women
abortion is common and important.
Unlike previous abortion referenda which had focused on religious
issues (1983), and legal issues (1992), the public debate on the 2002
referendum was largely about medical issues, particularly women's
mental health and foetal abnormality. This was a significant change
from abstract religious and legal arguments as it involved issues
people could themselves identify with. With considerable effort and
organisation across a broad range of groups the referendum was
narrowly defeated. This was significant in a number of ways. It was a
defeat of the conservative forces of the Right that were attempting
to further restrict nonexistent abortion access in this country.
Pro-life organisations had been particularly successful in getting
their message heard in political circles in Ireland in the 1980's and
90's. Successive governments have buckled under the well-funded
pressure and agreed to regressive referenda. Most recently a minority
government relied on the support of four independents that were
actively 'pro-life' and their agreement to support the government was
traded for another referendum to further restrict access to abortion
particularly in the area of suicide risk.
Silence
The referendum was actively supported by the main government
party, Fianna Fail and by the Catholic Church. The significance of
the defeat of these combined forces by the Irish people should not be
underestimated. It marks a turning point in the Irish church/secular
divide and in the Irish urban/rural divide. The considerable ability
of the church to influence national political debate was eroded and
exposed as being a waning force. Furthermore all significant urban
areas such as the main cities and towns defeated the regressive
referendum while it was substantially carried in rural areas. This
marks the end of the historic dominance of rural culture and politics
in Ireland - a welcome development for progressive politics.
A further important result of the referendum debate was the ending
of the silence around abortion. Until now the thousands of women who
have had abortions and returned to their lives and families in
Ireland were a silent group who have had no voice and whose
experiences were never heard. This changed with a number of women
making public statements about their abortion experiences. With an
approximate ratio of 1:10 Irish women having had an abortion, there
is someone in everyone's family who has had an abortion yet nobody
knows them, as it is not discussed. For the first time, abortion as
an important public issue was discussed without the usual 'baby
killer' name-calling, (probably a sign of a change of strategy by
pro-life groups rather than evidence that they have gone away). It is
now apparent that one of the positive results of the referendum for
those who support a woman's right to choose, and a huge setback for
those who reject it, is that the genie is out of the bottle as
regards publicly discussing and considering abortion. The ending of
the silence has been slow and is by no means complete, however its
progress is inexorable and is to be celebrated as a coming of age for
Irish political debate.
A further benefit of the referendum was the emergence of
organisations that actively support a woman's right to choose. Some
groups also went on to publicly support the right of Irish women to
access abortion services in Ireland. One such organisation was
Doctors for Choice. The emergence of Doctors for Choice isn't that
surprising. While there is a constitutional ban on abortion in
Ireland, women's lives are not any different to those who live in
countries where abortion is legally available. Wherever they live
women need access to comprehensive reproductive health care,
including abortion. For better or worse, women have always used
abortion as a way of controlling their fertility. If it is not legal,
they will, in desperation, seek it illegally. In many developing and
fundamentalist countries doctors see the results of this desperation
every day, in the form of infection, infertility and agonising death
from botched abortions. In Ireland, women are fortunate that they
live close to a country that has legal accessible abortion - England.
If this escape route did not exist we would also see the horrors of
back street abortion here. However, one of the down sides of our
proximity to the UK is the safety valve it has provided to successive
right wing governments who refuse to acknowledge the need for
abortion services yet acknowledge that 7000 Irish women travel to
England every year. As one prominent politician (Mary Harney) who
supported the failed amendment, stated in 1992 'if we were an island
in the middle of the Atlantic we would have an abortion service by
now in this country...'
Low Pay
In their daily work family doctors see the reality of the failure
of the state to legalise abortion. They see the palpable horror of
the woman who awaits a pregnancy test that she fears is positive. She
must face this situation in the knowledge that she can not have an
abortion in Ireland. Most often, women who have unwanted pregnancies
make decisions about abortion without support and in silence. In
spite of this many women chose abortion as the best option for them.
However it is not always as simple as that. As with so many other
health issues, class issues have a significant impact on any decision
that will be made. It costs approximately 1000 Euro to travel to
England from Ireland for an abortion, covering clinic costs, and
travel and accommodation costs. This amount of money is rarely
immediately available to women in poverty or low-paying jobs or who
are raising children alone. Family doctors have seen women get credit
union loans, not pay the mortgage, take the Holy Communion savings,
the holiday money and money from under granny's mattress. Money
lenders have been involved, with the woman eventually paying several
times over - such is the desperation of women to control their
fertility as they see fit. Child-care issues are highly significant
for many women particularly in a silent community where excuses must
be made for why one is away for the weekend. Teenage women are
particularly vulnerable to cost issues and many opt to continue the
pregnancy as the costs become insurmountable.
A direct consequence of the financial issue is that Irish women
have more late abortions that the average English woman. Late
abortions after 14 weeks involve more invasive procedures, general
rather than local anaesthetics and a greater risk to health. The
delay is contributed to by difficulties in getting good information
about abortion services in the England, delays in raising the money
and the need to arrange the trip in secret. Airline strikes and bad
weather on the ferries take on a new meaning on Monday mornings when
the distraught woman rings the surgery to see if she still has time
to reschedule. Similarly an asylum seeker must be told that if she
travels to the UK for an abortion she is likely to forfeit her asylum
application. The result is she must now face an enforced pregnancy.
These are examples of the silence around women and abortion in
Ireland - their distress is not documented or considered valid.
Doctors have traditionally expressed a conservative voice on
abortion. In reality many doctors have been dealing with the issues
of abortion in their daily work and have formed opinions not usually
expressed publicly. In the past, public statements have been left to
those doctors who have generally adopted a pro-life position. This
has become the safe, acceptable position on abortion for doctors.
With the advent of Doctors for Choice this has changed. The group
developed from an ad hoc group of pro-choice doctors that felt an
alternative medical position needed to be strongly stated in the
debate around the referendum. The organisation quickly grew from
there. Doctors for Choice represents all the specialities of medicine
but particularly general practice, probably because this is the group
of doctors who actually see the female patients that abortion impacts
on. The aims of Doctors for Choice are to give a voice to doctors who
support a woman's right to choose and to work towards the provision
of comprehensive reproductive health care services including abortion
in Ireland. We see this as a basic health entitlement of women
resident in Ireland. To do this there needs to be provision of
quality abortion services that are accessible regardless of ability
to pay. To this end medical education must include abortion provision
training and abortion must not be excluded from public hospitals by
the religious governance of the hospital. Similarly, doctors who
provide care to patients seeking abortion must be protected by law.
Open and public
Doctors for Choice has been considerably more successful than
initially expected. What was thought of as a long haul to encourage
doctors to join a pro-choice organisation was met with many messages
of support and membership subscriptions. It is notable that as
doctors we had also internalised the silence around abortion in
Ireland. We had allowed the agenda to be set by right wing doctors.
To do otherwise was to risk being labeled an abortion doctor and to
suffer the subsequent silent professional discrimination considered
inevitable in Catholic Ireland.
As an organisation we plan to ensure that our message is heard
amongst the medical profession so as to provide support to those
doctors who thought they were working alone. We also aim to give
support to those women who thought the medical profession in Ireland
did not include doctors who respected their right to make their own
decisions about their reproductive health. The organisation is small
but growing steadily. Our immediate priority is consolidating our
membership. By being open and public, we will make the subject an
easier one for doctors to express a pro-choice opinion on. This task
will be slow, and hasn't been without difficulties. Not all groups
working to defeat the recent referendum agreed with our unequivocal
statements about the right of Irish women to access abortion in
Ireland. It is an unfortunate fact the even those on the left have
internalised the message of silence - that the unmentionable of
abortion in Ireland is too radical to be discussed at this time. It
is our contention that this plays in to the hands of the
conservative, Catholic right wing who have, to date, set the agenda -
one where we can't talk about the right of Irish people to a quality
reproductive health care service, including abortion. As pro-choice
advocates we must be prepared to publicly identify with the 7000
women who access abortion in England every year - we must state that
this service should be available in Ireland. To do otherwise is
defeatist and hypocritical. It is frustrating and undermining for all
the women who travel to England every year, to see political groups
support their right to do so, but not take the next logical step of
publicly supporting abortion provision in Ireland. By shying away
from this statement women's choices are not being fully respected and
validated.
Reality
To change this reticence will be slow, however Doctors for Choice
as a group would argue that only by doing so can we build strength
and unity for what will be a long campaign to achieve abortion
provision in Ireland. However, we don't doubt it will eventually be
successful. Ireland is changing is spite of the efforts of the
Catholic Church and the main political parties. This social and
cultural liberalisation will be much faster in the next twenty years
than the last twenty. With hard work and committed campaigning by
pro-choice groups it is likely that in twenty years time there will
be some form of legalised abortion in Ireland. An important part of
this transition will be informing and changing the opinions of the
medical profession, as their participation is intrinsic to any
abortion provision. To date this has been easier than expected but a
lot of work remains, particularly as prolife organisations are likely
to regroup after their recent defeat and may now choose to target
specific influential groups such as doctors. However the medical
profession is also changing and becoming less conservative and
isolationist. It is this momentum for change that Doctors for Choice
will work with and encourage.
It is likely that there is going to be minimal political will to
change Irish abortion laws. Commitments made by political parties to
legislate along the lines of the X case are likely to evaporate as
they seek to distance themselves from this contentious issue.
Furthermore, any change to allow for suicide risk and foetal
malformation would involve only a very small change in the law and
would not substantively affect the lives of Irish women seeking
abortion. The Labour Party has supported such a change in the law, if
they were returned to government. They argue that this is all that
can be achieved now and is thus better than nothing. It serves their
private expressions of a pro-choice position while publicly sitting
on the fence. Pro-choice activists need to be cautious about being
drawn in to any broad alliance of support for such a limited legal
change. Doctors for Choice would argue that this is a mistake as it
continues to deny the reality of the 7000 women travelling to England
every year. At all times this issue should remain the focus of any
campaign to change the law. Scarce energy and resources are better
spent on creating an acceptance of abortion as a reality in Ireland.
Any campaign should start with where it means to end - Irish women
have a right to access abortion services in Ireland and the law needs
to be changed accordingly.