Maeve Sheehan: Traumatic journey of a pregnant girl
Published 24/08/2014 | 02:30
SHE was suicidal because of a pregnancy which, she says, was a result of rape, and so was entitled to seek an abortion in Ireland under legislation passed last year. But the vulnerable asylum seeker in State care was apparently unaware of this until it was too late to terminate the foetus. On Friday, the HSE launched an investigation into the care given to Ms Y. But new details obtained by the Sunday Independent suggest that the young woman's escalating distress was flagged with State authorities at an early stage, raising more troubling questions over her care.
A young woman turned up at the Office of the Refugee Applications Commissioner on Lower Mount Street in Dublin, impoverished and unable to speak English and alone. How she got here is not clear but she came seeking asylum from a conflict in her native country. Her family members had been murdered and had been raped. She was vulnerable, in terror of a relative, and apparently unaware that she was pregnant. She was dispatched to an accommodation centre run under the auspices of the Department of Justice.
In early April, she learned that she was pregnant during a medical screening, the news delivered to her by a public health nurse assigned to her centre but employed by the HSE. In the young woman's only interview, published in the Irish Times last Monday, she said she told the nurse how difficult this was for her. The nurse rang the Irish Family Planning Association, a non-governmental agency which offers pregnancy counselling, to set up an appointment for a second test and advice.
A few days later, the young woman had her first counselling session with the IFPA, through an interpreter provided by the agency. The young woman said she told the counsellor: "I am not capable of going through with this. I said I could die because of this . . ."
But according to informed sources, she appeared distressed but not suicidal during that first session with the IFPA counsellor. She wanted an abortion and the counsellor explained her options, which at that point, did not include invoking the relevant "suicide" clause of the Protection of Life during Pregnancy Act.
According to one account given to the Sunday Independent, the young woman was told how to apply to the Department of Justice for travel papers allowing her to leave and re-enter Ireland, and separately apply to the British Embassy for a visa. There would be paperwork to fill out and the application would take weeks to process, and there was no guarantee she would get them. According to sources, she was told that there would be costs involved.
The counsellor set up an appointment for a gestational scan a day or so later, and that showed that she was eight weeks and four days pregnant.
The IFPA regarded her case as serious and complicated, according to sources. It's understood that at the first counselling session, IFPA staff briefed a public health nurse at her centre on what had transpired and what the young woman's wishes were.
Later in April, the young woman returned to the IFPA for a second counselling session.
According to informed sources, her distress had escalated since her last visit. Another non-governmental agency was by now also involved, to help her fill out the complicated paperwork associated with her application for travel documents.
The IFPA arranged a third counselling session for the young woman through a public health nurse at her centre, towards the end of May. The purpose of it was to progress her application for travel papers. That was when she was told the cost of travelling to the UK arose, causing the penniless young woman to despair. In her Irish Times interview, she said she was told the costs could be €1,500: "I said to her, 'I could die because of this pregnancy. I am prepared to kill myself. I said, 'We're getting too far, and she said, 'No, in England they carry out abortions up to 28 weeks.' She said: 'That is not the problem. The problem is the money'. This was the final thing for me. I cried."
Reportedly, this was the first time that the young woman expressed her suicidal thoughts to the IFPA. Sources said there was a sense of heightened anxiety at that session and that the young woman was acutely distressed. But it is understood that she indicated that she wanted to continue with her plans to travel to the UK. According to sources, the HSE staff at the woman's accommodation centre were kept informed of her anxious state during this period.
Questions were asked last week as to why the young woman wasn't told that there were other ways of covering costs. Several UK charities help fund abortions for women without means. The details of what she was told will most likely be examined by the HSE inquiry. However at one point the young woman was advised to seek financial help from her community welfare officer to pay the Department of Justice's €80 fee for travel papers, as the IFPA is not legally allowed to pay clients' fees. Sometimes, the community welfare service will grant one-off special payments to people in need.
The young woman clearly despaired. She was by then just over 14 weeks into her pregnancy and her distress had clearly escalated to the point where she was suicidal. She later said she attempted to take her own life that night, but was interrupted.
The HSE's investigation will likely examine whether the health and justice authorities were aware of her suicide attempt, what was done for her, and if the authorities were aware, whether the Protection of Life during Pregnancy Act could have been invoked at that point to give her the termination she wanted.
In early June, the young woman was referred to Spirasi, a group that supports victims of torture, by the state's refugee legal services, for a medical and legal assessment. The physician who examined her found her suicidal. She sent a letter to the HSE's medical team at her accommodation centre, warning that the woman was suicidal and that she needed psychological care. She was also advised to see her GP.
Greg Straton, Spirasi's director, said: "The moment that she raised the issue, we made immediate contact with the HSE".
Around that time, Spirasi also learnt that she was to be moved to another accommodation centre elsewhere in the country - apparently at her own request. According to Mr Straton, they lobbied against it, believing that it would be disruptive and against her best interests, at a time when she was distressed, suicidal and pregnant. She would have to start building relationships all over again, with counsellors and doctors and support groups.
Spirasi outlined all this in a letter to the Reception and Integration Agency. "We strongly advocated for her to stay within the area where she was," he said.
The young woman was moved, however. Spirasi set up an appointment for her, hoping that she would travel back for it, hoping to maintain the link with her. She didn't make it and nor did she see a GP. "You have to bear in mind that she was going through an asylum process, she was being dispersed, there were language barriers, a lot of people get overwhelmed with everything. There are a whole bunch of barriers at play," said Mr Straton.
By the start of July, the young woman was 20 weeks pregnant. Six weeks had elapsed since her last meeting with the family planning clinic and her suicide attempt and she was now in a new environment.
In the middle of July, a man rang the IFPA helpline looking for advice for a pregnant friend who wanted an abortion. The helpline staff could not give out abortion information over the phone and set up an appointment for his friend.
Coincidentally, a day or so later, a HSE employee separately contacted the IFPA to let them know the young woman they had been waiting to hear from had moved to another direct provision centre.
The day after that, the man rang the IFPA for a second time, this time seeking specific information about a suicidal woman seeking an abortion. This time, he was put through to a counsellor who realised that his friend was their former client, the young woman they had lost touch with. He was advised on the Protection of Life during Pregnancy legislation and advised that the young woman should be seen immediately by a GP, who could then refer her on for psychiatric assessment.
In another coincidence, on July 18, Spirasi hosted an open meeting for asylum seekers, and the young woman turned up. She spoke at the meeting, raising the issue of her pregnancy, according to Mr Straton. "At that point we strongly advised her to immediately go to her GP," said Mr Straton.
The following week, the young woman was admitted to a psychiatric hospital, and an expert panel of two psychiatrists and an obstetrician - as required under the Act - convened. The situation the panel faced was complicated.
She was 24 weeks and one day pregnant. The Act is silent on the gestational stage at which doctors can act when faced with a pregnant woman whose life is in danger.
The Department of Health's unpublished draft guidelines for doctors on treating women with life-threatening conditions under the Act says: "If the unborn has reached viability and the woman's life is in danger, the best course of action may be deemed to be an early induction or Caesarean section . . . This medical procedure would not fall under the Act as it is not a medical procedure during which or as a result of which an unborn life is ended."
In this case the obstetrician reportedly deemed it too late in her pregnancy to abort the foetus.
The woman again despaired on being told she could not get an abortion. According to her own account, she told the doctors: "You can leave me now to die. I don't want to live in this world anymore."
She started her hunger strike on Friday, July 25, and continued it until the following Monday when doctors urged her to end it, so she would be strong enough for the procedure. When she was told later that week that she would not get an abortion, but the baby would be delivered by Caesarean section, she resumed her fast.
On August Bank Holiday Saturday, the HSE made an emergency application to the High Court to rehydrate and feed the young woman, and was back in court on Tuesday. The mother and the unborn baby had separate legal representation. The proceedings were in camera but some newspaper reports said the court was told that the woman had agreed to the baby being born. She said she "would have preferred an abortion".
On Wednesday, August 6, her baby was delivered by Caesarean Section at 3pm. Sources said the medical procedure was certified under section 9 of the Protection of Life during Pregnancy Act.
A week later, the young woman was discharged from hospital and returned to her accommodation, and was assigned a psychiatrist.
Days after her discharge, the Irish Independent broke the story of the first woman to be assessed for an abortion under the Act.
Days later, she was interviewed in a coffee shop by the Irish Times. The Sunday Independent understands that she was alarmed and frightened at the public interest in her case. Professionals say she wants no attention whatsoever.
The baby remains in hospital, the infant's fate is unknown, not least what complications might arise in the future as a result of being born at around 25 weeks.
Throughout last week, and right up to yesterday, thousands of people have turned out at marches in Ireland and abroad to protest at Ireland's abortion laws. But as Sam Coulter Smith, the Master of the Rotunda Hospital, told the Sunday Independent last week: "Regardless of what side of the argument you are on, or whether you are on the middle ground, the outcome represents a failure on the part of the system that's in place."
"What we would like to see at the end of this is a critical analysis of the legislation, how it served the mother and the baby and the professionals involved," he said.
On Friday, the HSE published the terms of reference for its inquiry.
It will establish the "sequence of events" relating to the care given to Ms Y in pregnancy, her care and welfare and her mental health. It is also expected to look at whether the Protection of Life during Pregnancy Act could have been invoked earlier in her pregnancy.
There are many questions for the state services, particularly during the crucial 14 to 22 weeks of her pregnancy. According to Mr Straton, both the HSE and the Department of Justice's Reception and Integration Agency were informed in June that the woman was suicidal as a result of her pregnancy, that she needed psychological help, and advocated against her "dispersal" to another part of the country.
What action did the HSE take? What did the Reception and Integration Agency do and why was she moved? And why did it take so long for her to finally get her the help she was entitled to all along?
"That is the biggest question in my mind," said Mr Straton.