Abortion law discriminates against women with mental illness
Published 22/07/2014 | 02:30
UP to 20pc of women in Ireland will suffer from a depressive disorder before, during or after their pregnancy.
Between one and two women per 1,000 will develop a puerperal psychosis, a serious mental health condition that without immediate treatment can lead to suicide and/or homicide.
Research has also shown that 3.8pc of women report some suicidal ideation in pregnancy.
This does not mean that they want to take their own lives but it does mean that they are hugely distressed and need help.
While extremely rare, suicide in pregnancy does happen and is still a significant cause of maternal death.
There are just three consultant perinatal psychiatrists – doctors who specialise in caring for women who are experiencing mental distress during and after pregnancy – in Ireland.
All three are based in Dublin.
The College of Psychiatrists of Ireland says that skilled professional psychiatric services should be available by right to all pregnant women who need them.
But this right is not afforded to women who live outside Dublin.
Psychiatrists specialising in maternal mental health see women with a range of mental health illnesses, similar to those in the general population.
These include depressive and anxiety disorders, severe and enduring mental illness, as well as post-traumatic stress disorder or bereavement related to miscarriage or stillbirth.
They also see a small number of women every year who are suicidal.
As one of the largest maternity hospitals in the country, Cork University Maternity Hospital sees an estimated 9,000 deliveries a year, similar to the Dublin maternity hospitals, yet it has no dedicated specialist perinatal service.
Thanks to the work of organisations such as SeeChange, stigma associated with mental illness in this country is slowly being removed.
However, the absence of a specialist maternal mental health service for women in Ireland means they continue to be stigmatised.
Under Ireland's recently passed abortion legislation, a woman can legally access an abortion here when there is real and substantial risk to her life arising from suicidal intent or physical illness.
It was the inclusion of suicidal intent that caused most debate in the months preceding the introduction of the Protection of Life During Pregnancy Act.
As a noisy debate ensued about the law, women with a history of serious mental illness and suicidal intent could only look on in silence.
For some, this silence was borne of a crippling fear that if their story was heard they would be judged insane, selfish, or potential mass manipulators of the medical profession.
The new act stipulates that a woman whose life is at risk from a physical illness must be assessed by two doctors.
However, when this risk is due to a mental health issue three doctors are required.
Last week, Yuval Shany, a member of the UN Human Rights Committee, asked how this stipulation could be consistent with Ireland's obligation under the International Covenant on Civil and Political Rights (ICCPR) to protect a woman against mental torture.
The clinical guidelines for doctors on abortion stipulate that when a woman's life is in danger due to physical illness, one of the doctors assessing her must be a specialist in that condition.
According to the guidelines, at least one of the two doctors must be registered under the specialty of obstetricians and gynaecology and must practise at an appropriate institution.
The other one must be registered under a relevant specialty – defined in the Act as a specialty relevant to the care or treatment of the physical illness in question.
Sadly, this specialist knowledge is not afforded to women with a serious mental health difficulty.
The guidance document states that of the psychiatrists charged with assessing the woman, one must have provided mental health services to women in relation to pregnancy, childbirth or post-delivery before, but he/she does not need to be a perinatal psychiatrist.
One wonders if the provision that none of the assessing psychiatrists need to be specialists in perinatal psychiatry was a deliberate addition given there are just three in the country?
Once published, no doubt the guidance document will continue to cause debate among the medical profession and the public.
But as medical professionals deliberate and legislators attempt to defend the indefensible, women in serious mental distress will join those who have received a diagnosis of fatal foetal abnormality and women who become pregnant as a result of rape who travel to the UK.
Ireland will do what it has done for centuries: simply turn its back.