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Monday 22 September 2014

Young woman in abortion case 'got lost' in the system

Dearbhail McDonald and Fionnan Sheahan

Published 20/08/2014 | 02:30

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The young woman's baby was delivered early by caesarean section when she was 25 weeks pregnant after she was deemed to be at risk of suicide (picture posed)
The young woman's baby was delivered early by caesarean section when she was 25 weeks pregnant after she was deemed to be at risk of suicide (picture posed)

THE Health Service Executive was informed that there were “serious concerns” for the mental health of a teenage rape victim when she was 14 weeks pregnant and actively seeking an abortion.

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The Irish Independent has learned that the Irish Family Planning Association (IFPA), to whom the young girl was referred by a HSE nurse, contacted the nurse last May.

The phone call alerting that nurse to her deteriorating mental health was placed by the IFPA during the teen’s last counselling session, where she learned that it could cost more than €1,500 to travel overseas for an abortion.

The IFPA then lost contact with the young woman after she moved to a new accommodation centre within the country’s direct provision system.

She later presented, at 22 weeks’ gestation, at a GP’s clinic in another location seeking an abortion on mental health grounds. However, her baby was delivered early by caesarean section when she was 25 weeks pregnant after she was deemed to be at risk of suicide.

The call is one of a number of "critical interactions" now being investigated by the HSE and comes as senior government sources have queried how the young woman "got lost" in the system.

"Why wasn't the Act invoked earlier?" a senior government source asked last night.

Last night the IFPA said it is unable to comment on the specifics because of the confidentiality of its counselling service.

The IFPA said it operates internal procedures that govern its pregnancy counselling service, including protocols concerning vulnerable clients.

Within government circles, questions are being raised about why the woman was not referred for a psychiatric assessment when she was being medically examined and advised on her options.

The woman, who was raped in her home country, discovered she was pregnant during a public health screening process which all asylum seekers undergo when they enter direct provision.

She was approximately eight weeks pregnant when she learned that she was pregnant.

She immediately requested an abortion and was referred to the IFPA, a non-statutory agency and charity that provides sexual health, family planning and pregnancy counselling and training services.

Over the course of the earlier stages of her pregnancy, the woman is known to have come into contact with the public health nurse and the IFPA, and she was also sent to a women's health facility for a scan for the purpose of establishing her exact gestation.

As a result, she came into contact with a number of health professionals before presenting, at 22 weeks' gestation, to a GP in a new location, to which she had moved.

The teen formally requested an abortion under new legislation which came into effect last January.

But her baby was delivered at 25 weeks' gestation by caesarean section after the expert panel deemed that she was at risk of suicide.

"Why did they not refer her to a psychiatrist?" a senior 
government source asked last night.

Distressed

"If at eight weeks or 16 weeks (pregnant) she was distressed, why was she not assessed?"

It has also emerged that the young woman was not actually on hunger strike when the HSE sought a court order to allow her to be rehydrated.

She had been refusing to eat and drink in the previous week, which prompted the application for a care order, as the planned date for the delivery of the baby was approaching.

"The fear was the hunger strike would return as preparations for the procedure were in train. It was a safeguard, as it wasn't used," a source familiar with the case said.

Every effort was made by medics to ensure the safe delivery and survival of the baby boy, who is now expected to be taken into care.

In the days leading up to the delivery, his mother was treated with steroids to increase the baby's lung functions.

It is the first example of suicide being cited as grounds for the termination of a pregnancy under the 2013 law.

The HSE, which has launched an investigation into what medical care was given to the vulnerable teen, who has had no contact with her newborn baby, said that all interactions would be 
investigated by the review team.

The investigation, ordered by HSE Director General Tony O'Brien, will seek to establish the facts of the case, the sequence of events, the care the woman received and the operation of last year's Protection of Life During Pregnancy Act in the case.

Last night the IFPA said it is unable to comment on the specifics because of the confidentiality of its counselling service.

The IFPA said it has worked with many women and 
girls in a crisis pregnancy 
situation whose freedom of travel is restricted.

"Asylum-seeking women and girls who decide to access a safe abortion face multiple financial, legal and bureaucratic barriers, which can significantly delay their travel to access services," said a spokesperson.

The IFPA said it has consistently raised concerns to the relevant national authorities and international human rights bodies regarding the unacceptable situation these women and girls face.

Irish Independent

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