Irish Family Planning Association
Opening Statement – Oireachtas Joint Committee on Health
Review of the Health (Regulation of Termination of Pregnancy) Act 2018
27 April 2022
Thank you for the invitation to share our perspectives. The IFPA is a specialist provider of early abortion care, contraception and specialist pregnancy counselling. We have advocated for sexual and reproductive health and rights since 1969.
The last time we addressed an Oireachtas Committee in relation to abortion it was to call for the introduction of abortion: to be here today to discuss its review feels genuinely historic.
The review clause in the 2018 Act is a wise and prescient measure—we have insights now from the provision of abortion care that were simply not available in 2018.
Two key insights are: firstly: the Act has been transformative for reproductive rights in Ireland: abortion provision is now an established social good;
Secondly: significant challenges arise for the operation of services from the interaction of the legal framework, health system challenges and pervasive abortion stigma.
To start with the positives:
The availability of services to terminate pregnancies and the public funding of those services unambiguously signal that abortion care is essential healthcare.
The law provides for access to abortion on request: No one who seeks early abortion care is required to explain or justify their decision about their pregnancy.
We know from our clinics how important this is to service users.
The protection in law of these principles is a real strength of the Act.
Moreover, the model of care works well for those who can access it:
1 The availability of abortion care within mainstream, local healthcare, and without cost, helps reduce the stress of unintended pregnancy and the stigma associated with abortion.
2 In principle, women (1) can choose their provider: they can opt for a specialist reproductive healthcare provider, such as the IFPA, attend their regular GP, or find a GP through My Options.
3 The introduction of telemedicine has broadened women’s access to essential, time-sensitive healthcare.
4 Critical additional supports—including specialist pregnancy counselling—and a 24/7 medical helpline, are also available without cost to users.
But there are problems:
The Act is modelled on the Protection of Life During Pregnancy Act: a restrictive, criminal statute. And that framing gets in the way of access and choice. Outside Sections 9 to 12, abortion is subject to prosecution and harsh punishment on conviction.
Criminalisation relegates abortion to the margins of healthcare. As the European Court of Human Rights recognised in A, B and C v Ireland, criminal laws—even if not aggressively enforced—create a ‘chilling effect’ on healthcare providers. (2)
Section 23 fosters stigma towards the conscientiously committed providers of abortion and discourages others from its provision.
Furthermore, while the right of healthcare practitioners to deny care on grounds of individual beliefs is recognised as conscientious objection, this implies, erroneously, that only those who refuse care, but not those who provide it or access it, act with conscience.
The Act is restrictive.
The IFPA knows from our services that the vast majority who present for abortion care have thought through their personal circumstances, assessed the supports available to them and made a clear decision.
Yet, Section 12 requires that they must first see a doctor and then wait three days. So, in fact, the gestation limit is 11 and a half weeks.
And the waiting period implies distrust of pregnant women’s capacity to make rational decisions.
It forces doctors to impose a delay for no reason related to women’s health, even when that delay pushes her past the gestational limit.
Most women and girls living in Ireland avail of abortion care well before 12 weeks of pregnancy. But crisis in pregnancy cannot be neatly confined to the first trimester.
And the IFPA’s experience is that the burdens of the 12-week limit disproportionately affect the young, the vulnerable, the marginalised and disadvantaged.
After 12 weeks, access is restricted to narrowly defined grounds of health risk and fatal foetal anomaly. This excludes women and girls. We know from our specialist pregnancy counselling service how traumatising this exclusion is.
The IFPA recommends that Ireland follow the World Health Organization (WHO) Abortion Care Guideline, (3) published last month.
The guideline calls for decriminalisation of abortion in all circumstances. It recommends that instead of the imposition of mandatory waiting periods, grounds and gestational age limits in laws, access to abortion should be on request.
This would mean aligning service availability with the best interests of women and girls who need abortion care, rather than organising this part of the health system around exclusionary, restrictive provisions.
I want to briefly mention some other non-legal barriers to access.
The glaring geographical disparities in community and hospital provision mean that some women are denied locally accessible care.
We have concerns about stigma and delay experienced by women we have referred for dating scans to the private provider contracted by the HSE.
Abortion can be provided through either medical or non-invasive surgical methods. However, in Ireland, most women are only offered one method: home-self-management of medical abortion.
Not everyone has a suitable “home” environment; those who don’t are not eligible for hospital referral on these grounds.
The IFPA provides abortion care to undocumented services users. However, the lack of clear arrangements for reimbursement is problematic and isn’t sustainable.
In conclusion, these inequities in the operation of abortion services must be addressed. Following the review, we believe the Oireachtas must:
- address the flaws in the legislation;
- align the law with international best practice and human rights standards;
- identify health systems measures to institutionalise the current strengths of the service and ensure excellence, leadership, innovation and sustainability into the future;
- continue to monitor the operation of abortion care in Ireland to ensure that it is equitable, of high quality and is available, accessible and acceptable to all who need it.
Thank you.
[1] We understand that not all individuals who become pregnant are women and girls – transgender, gender diverse, and non-binary people face significant barriers to sexual and reproductive healthcare, including abortion care. In this submission we use the terms women and girls because our experience of providing abortion services to date has been predominantly to women and girls.
[2] A, B and C v. Ireland, No. 25579/05 Eur. Ct. H.R. (2010).
[3] World Health Organization. 2022. Abortion Care Guideline. Available at: https://www.who.int/publications/i/item/9789240039483
About the Irish Family Planning Association
The Irish Family Planning Association (IFPA) is Ireland’s leading sexual and reproductive health charity. The IFPA was founded in 1969, by a group of volunteers, mostly young nurses and doctors, who were motivated by the devastating impacts on the health of women and families in Dublin’s inner city of the ban on contraception. A 2019 commemorative leaflet, The IFPA at 50, outlines key milestones of the IFPA’s role as an advocate and service provider.
Services
The IFPA clinics, which are based in Tallaght, on the outskirts of Dublin and on Cathal Brugha Street in Dublin’s inner-city, are at the forefront of reproductive healthcare in Ireland. We also have a network of counselling centres nationwide. IFPA services include: early abortion care, post-abortion care, contraception, specialist pregnancy counselling, cervical screening, vasectomy, menopause check-ups and screening and treatment for sexually transmitted infections (STIs). The IFPA operates Ireland’s only dedicated free clinic for women who have undergone female genital mutilation (FGM). We specialise in sexuality education—the IFPA pioneered peer-to-peer sex education in the 1990s and now provides a range of courses for students, parents, health and social care professionals.
Advocacy
Since its foundation, the IFPA has been active as an advocate for the highest attainable standard of reproductive health and for the implementation of the State’s obligations under international human rights law. As a respected authority on sexual and reproductive health in Ireland and internationally, the IFPA has addressed numerous Oireachtas Committees, UN human rights bodies, the Citizens’ Assembly and Joint Oireachtas Committee on the 8th Amendment. We campaigned for decades for the repeal of the 8th Amendment and the introduction of legal abortion in Ireland. The IFPA supported three women, known as A, B and C to take a case to the European Court of Human Rights. A, B and C v Ireland recognised that the State was violating and interfering with women’s rights under the European Convention on Human Rights.
International links
The IFPA is a member association of the International Planned Parenthood Federation and is one of 12 organisations across four regions in the IPPF’s Globalcare consortium on abortion care. The IFPA provides the secretariat to the All Party Oireachtas Interest Group on Sexual and Reproductive Health and Rights (APG). The APG is affiliated to the European Parliamentary Forum on Sexual and Reproductive Rights. The IFPA is also the Irish collaborating partner of UNFPA, the UN sexual and reproductive health agency. The IFPA is a member of the European Society for Contraception and Reproductive Health and FIAPAC, the International Federation of Abortion and Contraception Providers.