Irish Times Thursday May 10th. Op-ed.
Miss D should have been able to have an abortion in a maternity teaching hospital here,
argues Rosie Toner
Another chapter in the abortion chronicles has concluded, for now. Having faced down protracted legal proceedings for the past 10 days, a young teenager can make arrangements to leave the State for a termination.
While the outcome of yesterday's High Court sitting offers some relief to Miss D, the sense of relief is most palpable at a political level. The election agenda has been spared. The issue that few politicians will champion has been dispensed with, for now.
But the lack of a realistic legislative framework on abortion is unsustainable. The legal challenges concerning Miss X in 1992, Miss C in 1997 and Miss D exemplify the inadequacy of the so-called Irish solution over two decades.
As a provider of non-directive pregnancy counselling and post-abortion services, the Irish Family Planning Association (IFPA) is acutely aware of the complexities women face in accessing termination services. For those with a diagnosis of fatal foetal anomaly, these complexities are further underscored.
The deliberations which dominated the High Court case concerned mainly the right to travel and the capacity of the Health Service Executive to determine this. The healthcare needs of the teenager rarely came to the fore. Miss D chose to terminate her pregnancy because of the inevitable demise of her baby, once born. In the interest of her health and potential future pregnancies, she should have been afforded a termination in an Irish teaching maternity hospital. This would have happened if she lived in Britain, France or in most other European Union member states.
With improvements in ultra-sound equipment in recent years, detection of fatal foetal anomalies has become more frequent. For any woman, such a diagnosis is traumatic and usually occurs later in pregnancy when medical testing for anomalies is conducted. In the main, their pregnancy starts out as much wanted and celebrated. The prospect of non-viability beyond birth shatters this.
After careful consideration - usually involving a partner, family or friend - women decide to continue the pregnancy until foetal demise or, more likely, they access a termination. At the IFPA, we provide counselling and information to many of these women before they travel.
Although abortion clinics in the UK are sympathetic to Irish women with fatal foetal anomalies, many recognise that their services are not always appropriate.
Emotional and family support services are not routinely available. Chaplaincy support for grieving women and their partners is absent. Funeral or burial services are difficult to arrange, if not impossible. The procedure can also be more complicated due to foetal defects and because it generally takes place later in pregnancy.
Critically, private clinics are unable to offer a seamless continuum of care which would result in the sharing of information with the woman's medical team in Ireland. This lack of continuity means that interventions to prevent the recurrence of risk in future pregnancies cannot be delivered.
If Miss D was able to access a termination in one of Ireland's maternity teaching hospitals, a post-mortem could be conducted. This test could determine the type of anencephaly suffered by the foetus. Based on this, the medical team could advise on her future healthcare. For example, if she intended to become pregnant again, they could recommend the appropriate intake of folic acid to maximise the chance of a healthy pregnancy.
Women presenting with fatal foetal anomalies should - we believe - have access to seamless long-term physical and emotional care by a specialist medical team, as a right. This will only happen if our politicians act in the best interests of these women by introducing legislation to provide for terminations in these circumstances.Maternity care providers would also need to offer specialised foetal medical services for women in this context.
Women who have used the IFPA's crisis pregnancy counselling services and access a termination based on their foetal anomaly have one thing in common: they wanted the procedure to be carried out in Ireland with the emotional support of their partners, family and friends around them. For some of the women finding out how to access a termination in the first instance has been a challenge. We continue to see women who have encountered emotional bullying and misinformation at the hands of rogue pregnancy counselling services that are allowed to operate in the State without any form of regulation.
Even the Catholic Church's pregnancy advisory service, whose counselling services are funded by the State, is allowed to flout its service level agreement with its funder. For two years, Cura - which only provides information on adoption and parenting options - has refused to pass on details to women about other services where they could secure information about termination services. Their funding remains intact.
Those who suffer are the women with a crisis pregnancy. The result is that some women travel for a termination later in pregnancy than they otherwise would because they encountered barriers in accessing information. It appears that when it comes to abortion, the politicians bury their heads on all matters.
The courts are not a suitable mechanism for girls or women to establish their level of access to termination services. In the future, nobody facing a crisis pregnancy should be subjected to the stress that Miss D has had to endure before the courts.
We elect politicians to create laws and establish rights. Whoever takes office when the 30th Dáil convenes in June, abortion should be on their agenda. With three impending cases before the European Court of Human Rights and the potential of new challenges in the domestic courts, the abortion issue will not go away.
Until, of course, it's dealt with.
Rosie Toner is director of counselling services at the Irish Family Planning Association.