Abortion in Ireland: what are the possibilities for pregnant women?

My mind, my body, my choice - Image credit Flickr
My mind, my body, my choice - Image credit Flickr
My mind, my body, my choice – Image credit: Flickr Betsie

40 years after the Veil Law, which legalized abortion in France, in Ireland the situation seems to be blocked and pregnant women have to find out different options to end their pregnancy.

Abortion in France is legal since the Veil law, voted by the Assemblée in 1975. However the law includes some specific restrictions: abortion is only legal until 12 weeks after conception. Women can abort at later stages of pregnancy only if two different doctors can certify that the abortion will be done to prevent injury to the physical or mental health of the pregnant woman, or if the pregnancy is a risk for the life of the mother; or if the child will suffer from a disease recognized as incurable. Based on this statement, French people may disagree with abortion, but none of them could ever consider abolishing this law, because it is very well framed. Though, less than 800 km away from Paris, in Ireland abortion is still illegal and we can guess that this situation will not change in the next few decades.

A bit of background is necessary to have a better overview of the situation. It is not absolutely true to say that abortion is illegal in Ireland: under the constitution and thanks to the X case judgement in 1992, abortion is legal when a woman’s life is in danger.  This is theory, but in practice, it is not that simple and the Savita Halappanavar case is a good way to understand that. Even if the constitution legalised it, in fact abortion is almost never practised in the Irish territory. Moreover, it is not illegal to travel outside the country to have an abortion and doctors are allowed to present this option to women in “crisis pregnancy”.

Since savita Halapanevaar's death Ireland is strating to change - Image credit: Flickr Robin Parmar
Since savita Halappanavar’s death Ireland is strating to change – Image credit: Flickr Robin Parmar

According to the Abortion Right Campaign network, 12 women leave Ireland every day to have an abortion. This figure can be balanced by a comparison with French figures: in 2012, more than 600 abortions were done every day, according to the DRESS. Some support networks offer help to pregnant women who want to travel abroad for abortion. The Abortion Support Network, for example, can provide some financial help; they also book the appointment in a clinic in the UK, and can help the patient to find an accomodation near the clinic. It also provides counselling online and by telephone and promises a totally confidential service.

These kinds of support networks are trustable and many women are happy enough with it because they feel helped and supported. However having an abortion abroad can be really dangerous for pregnant women: because many of the patients can’t afford to stay in the UK for a long time, most of the clinics offer a service of abortion in one day. Abortion with medication (called Cytotec of Misoprostol) is a medical procedure which comprises to take two pills with a lapse of time between the pills.

Doctor Julie Gerault, a French doctor in 3rd semester of Medical Internship in Hôpital de la Croix-Rousse, Lyon, France; who is in charge of the medical consultations with the patients before and after the abortion, explains that in France the first pill is given on day one, and the second one is taken on the day after. The first pill prepares the body to abortion and the second one activates the cramps and the miscarriage. Even if in most of the cases the pregnancy is ended during the four hours after the second pill, it may not be, and in this situation it can be really dangerous to travel or fly because the bleeding can turn into a haemorrhage.  Moreover it is necessary to check if the pregnancy is well ended with an ultrasound scan which is supposed to be done a few hours after the second pill. If it is done too soon it can be incorrect and if the pregnancy is not well ended the woman can suffer of a major infection.

In case of a surgical abortion, it is even more important to rest after the medical intervention, so when  women travel abroad to get an abortion they should stay in the country for at least two days. Like any surgical procedure involving anaesthesia the patient must be kept under surveillance to avoid any medical complication like haemorrhage.

It can be really expensive to travel abroad to have an abortion (between €350 and 1,000), so many women cannot do this and therefore manage to abort in the Irish territory. In the past few years the online sale of abortion pills is continually growing. In 2014 RTÉ’s Prime Time revealed that, in 2014, there have been more than 60 abortion pill seizures, consisting of 1,000 tablets in total, but this figure might only be the tip of the iceberg because most of the websites which sell abortion pills don’t communicate their results on these drugs. Buying abortion pills like Cytotec online means that the woman is going to abort on her own. Cytotec is supposed to be used before 12 weeks of pregnancy, in other cases it may not be efficient to end the pregnancy properly, so an unwell informed woman may take some very important risks for her health by doing this. Moreover this drug needs a really precise dosage decided by a doctor. If Cytotec is administering at the wrong dose and at the wrong intervals or by the wrong route then there is an important risk of perforation and that is a very serious complication which needs to be fixed by surgery most of the times.

Many abortion pills are bought online - Image credit: Emeline Paillasseur
Many abortion pills are bought online – Image credit: Emeline Paillasseur

All the more, even if an abortion is not going well and the woman suffers from over bleeding, the patient is often not going to the hospital soon enough because she is alone and frightened. When an abortion by drugs is done in a hospital, like it is in France, the doctors provide advices to the patients: for example they preconize no sexual intercourse, no bath and no tampons during all the bleeding period (which can last between few hours or few days).  If this things are forbidden it is to prevent the risks of blood retention, which often lead sto an infection of the endometrium (the mucous membrane of the womb). When the endometrium is infected it can lead to other damages such as an infection of the pelvis or, if the diagnostic is late, a generalized peritonitis, in some rare cases. These advices are not clearly explained on the websites which sold the abortion pills, so if a woman is going through this on her own, without talking to any doctors, she may be seriously injured and sick.

Moreover, it becomes more and more difficult to get a delivery of Cytotec in Ireland. Most of the websites have decided to stop providing the country with these drugs because of the number of seizures by customs officials. Now most of the pills are delivered in Northern Ireland and then brought into Ireland by the pregnant women themselves.

At least there is still another risk of buying such pills online, according to the Irish Medicines Board (Regulatory Authority): “The IMB strongly recommends that women should not seek to obtain or self- medicate with such potent medicines. The Internet is an unregulated source for medicines and there can be no guarantees that items bought online are effective, safe or of an acceptable standard or quality.”

The Doctor Julie Gerault also insisted on the important psychological risks of abortion with Cytotec bought online: “The major risks of an abortion at home are from a medical point of view: to have an infection or an haemorrhage; and from a psychological point of view: the patient can suffer from a important post-traumatic syndrome and a depressive syndrome and also relational issues and disrupted future sexuality”.

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