At least 25 people have been forced to travel to England to complete failed medical abortions since the introduction of abortion services in the Republic of Ireland in 2019, and at least one has had to continue her pregnancy because of multiple failed abortions. Today, a group of Irish and British organisations called on the Irish government to clarify that patients like these can be cared for at home.
While abortion medications are very safe and effective, they fail around 2% of the time. Despite this, HSE guidance states that even if an abortion does not work, people cannot access abortion care in Ireland after 12 weeks, unless other grounds apply.
Irish residents are still being forced to travel abroad and rely on British healthcare providers and charities for their abortion care. Cathie Shiels, Co-Convener of the Abortion Rights Campaign (ARC), said: “The sad reality is that once you go over the 12-week threshold, abortion care in Ireland is almost non-existent. While we don’t agree with this arbitrary limit at all, we think it is especially inappropriate for people who initiated their abortions in full compliance with the law – and then the pills failed. That’s an awful position to be in. The days of directing people to England are supposed to be over.”
Abortion Support Network (ASN), a charity based in London, provides logistical and financial assistance to people who have to travel for abortions. “Leaving women and pregnant people to their own ends to travel across country borders to complete a failed medical treatment is a shocking form of state-compelled medical negligence,” said Mara Clarke, founder of ASN. “What concerns me even more is that the 25 or so people who have contacted us are only those we know about. There could be more people who did not know there was financial support available to them. This is a massive failing in Ireland’s abortion care system. Not only should these people receive their care in Ireland, but once a medical abortion fails, a surgical procedure should be offered as a matter of course.”
Clarke recalled one client ASN helped in May 2020, during the COVID-19 pandemic: a woman who went through two early medical abortions in Ireland, and both times they failed. Since these medical failures brought her over 12 weeks of pregnancy, “Ireland turned its back on her and told her she had to travel abroad, at her own expense, to terminate the pregnancy. ASN were able to book her flights and accommodation, as well as provide a grant towards the cost of the procedure.”
More recently, ASN heard from a client they could not help: “A woman in Ireland had taken early medical abortion pills three times – and they’d failed. Why did they try pills three times? There was no provision of surgical abortion where she lived, and, by this point, it was too late for her to travel to Dublin for a surgical abortion. Unfortunately, due to caring responsibilities and other factors, this client is not able to travel abroad and will be forced to continue her pregnancy.”
“This is not only a failure in the duty of care to pregnant people, but also an unduly narrow interpretation of the Health (Regulation of Termination of Pregnancy) Act 2018. If medical abortion was initiated within the 12 week time limit, then the resolution of any failure of the first procedure, through a second procedure, should be recognised legally as falling within the legislation. The first causal act of termination took place within the time limit, and it is predictable that 1-2% will fail,” said Dr Ruth Fletcher, Senior Lecturer in Medical Law, Queen Mary University of London, and a member of Lawyers for Choice.
“As doctors, we want to provide care for our patients here at home. We need more support from the HSE to provide surgical abortions and to access scans for our patients immediately after any abortion approaching the 12-week limit. Most of all, we need to be able to provide continuity of care for any patient who takes medications that fail to end their pregnancy,” said Dr Mark Murphy, a member of Doctors for Choice and the START group of doctors.
Donagh Stenson from the independent healthcare charity British Pregnancy Advisory Service (BPAS), based in Warwickshire, said:
“Every week, BPAS provides abortion care to women from Ireland at our clinics in England. This includes women who have experienced a failed medical abortion, and in some cases multiple unsuccessful medical treatments, and are in need of a surgical procedure. Women from Ireland are also presenting for abortion care in England after having been told incorrectly that they were over the legal limit for a procedure in Ireland.
It is heartbreaking that women from Ireland are still being forced to travel overseas, at a huge emotional and financial cost, in order to access essential healthcare. At a time of a global pandemic, when we are all being told to avoid unnecessary travel in order to prevent the transmission of Coronavirus, the lack of follow-up procedures for women in Ireland is putting the health of families and communities at risk.”
“It is cruel, arbitrary and inhumane to exile Irish residents once again when legal medical procedures fail,” said Cathie Shiels of ARC. “We have called repeatedly on the Government to resolve this problem. We expect the Government to take corrective action immediately.”
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Please see ARC blog post for further information