Amnesty International Ireland has called on the Irish government to take immediate steps to comply with their human rights obligations concerning abortion.
In their report issued today, entitled 'She Is Not A Criminal - The Impact of Ireland's Abortion Law', Amnesty have called on the authorities to repeal the eighth amendment of the constitution, decrimnalise abortion, repeal the PLDPA and replace it with a "legislative framework that ensures access to abortion both in law and in practice", and repeal the Regulation of Information Act.
In their executive summary, the international human rights organisation report that up to 12 Irish women and girls will travel to England every day for an abortion.
The majority of these females are aged between 20 and 34, and their reasons for seeking an abortion vary, but their reason for travelling is the same as they "cannot access legal abortion services in Ireland, as procuring an abortion there is a criminal offence except where the pregnancy poses a 'real and substantial' risk to their life", the report states.
Amnesty criticises Ireland for having "one of the most restrictive abortion laws".
"For over 20 years, Ireland refused to engage in abortion law reform, despite repeated criticisms and calls for action from international and regional human rights bodies. Instead, the government has relied on the “safety valve” of women travelling to England and other jurisdictions, abdicating its responsibility to address the issue," the report sates.
Referring to the death of Savita Halappanavar, the report says Ireland was forced to act in order to comply with a decision by the European Court of Human Rights, as well as respond to the "shocking, preventable and highly publicised death" of Ms Halappanavar.
"Yet, this recent reform has left Ireland’s legal framework on abortion largely unchanged. The Protection of Life During Pregnancy Act 2013 (PLDPA) criminalizes abortion on all but one ground. A woman may only obtain a legal abortion in Ireland if her life is at risk, including through suicide," the report states.
The PLDPA and accompanying guidance is criticised by Amnesty for being "unclear, highly restrictive and provide little meaningful guidance".
"They offer little clarity into the circumstances in which women and girls may lawfully access an abortion, failing to define what constitutes a risk to life, as opposed to health. At the same time, the law and guidance introduce numerous barriers that must be overcome before a woman or girl may hope to qualify for a legal abortion.
"Women, health care providers and anyone who assists them face up to 14 years in prison for violating the PLDPA," the report states.
The lack of clarity in the law and threat of prosecution means that women and girls who are seeking an abortion for medical reason are "forced to wait until their condition deteriorates sufficiently in order to justify a medical intervention".
"The narrow construction of Ireland’s life exception means that longer-term risks to the life of a pregnant girl or woman, such as cancer or heart disease, are entirely disregarded," the report states.
The report also contains testimony from the lawyer acting for Miss Y.
The young asylum seeker, who claims she was raped in her own country, became the first to seek an abortion under the Protection of Life During Pregnancy Act passed in mid-2013.
Miss Y sought an abortion under the Protection of Life During Pregnancy Act on the grounds of feeling suicidal.
She encountered several agencies during her pregnancy and was eventually judged suicidal when she was 26 weeks' pregnant after appearing before a panel of three doctors convened under the legislation.
The baby was born by Caesarean section at about 26 weeks, on August 6.
A review into the State's legal strategy in that case is currently underway.
The following account of Ms. Y’s experience was relayed to Amnesty International by her lawyer, Caoimhe Haughey, C.M. Haughey Solicitors, Dublin. All the quotations in this testimony are from Ms Y’s lawyer.
"Ms Y is a young woman who travelled to Ireland seeking asylum after brutal persecution and violence in her country of origin.
"In February 2014, prior to arriving in Ireland, Ms Y was kidnapped, held against her will, beaten and raped repeatedly by the head of a paramilitary organisation. Her lawyer noted: “I understand he kept her for himself and raped her repeatedly. She was violently beaten and still bears the scars of those beatings, which are quite significant scars... not to mention the psychological trauma.”
"Eventually, she managed to escape. She was able to flee the country with a family member and arrived in Ireland at the end of March 2014. She and her family member were transferred to a Direct Provision Centre for accommodating asylum-seekers.
"Within days of arriving in Ireland, Ms Y felt unwell. A nurse who saw her determined that she was pregnant.
"Ms Y 'was devastated and became very distressed upon hearing this news,' says her lawyer. She made it clear to the nurse and other officials who dealt with her that the pregnancy was as a result of rape, was unwanted and that she was feeling suicidal as a result. Giving her account of her ordeals was extremely difficult and traumatizing for Ms Y. Her reporting of feeling suicidal continued and escalated.
"Ms Y was told she would have to travel to the UK or Europe for an abortion – but that the obstacles to travelling abroad for such a purpose were many. Ms Y was told she would need to complete complicated forms to obtain a visa and a temporary travel permit. The paperwork was extensive and in English, a language which Ms Y does not speak. In addition, Ms Y was told she would need at least €1,300 for the travel documents, flights and abortion costs. At the time, she was in receipt of €19.10 per week as an asylumseeker.
"Ms Y was left feeling overwhelmed and abandoned.
"In June 2014, Ms Y was referred to SPIRASI, a voluntary agency that works with asylum-seekers, refugees and survivors of torture and persecution. Ms Y was sent for a medical assessment as part of her asylum application. The doctor who examined and assessed Ms. Y prepared a detailed medical report, which was submitted to the Reception and Integration Agency and other officials dealing with Ms Y’s case at that time.
"The medical report submitted states Ms Y was suffering from post-traumatic stress disorder; it states that Ms Y expressed the desire to end her own life if the pregnancy continued. Ms Y was noted to have a “strong death wish.” Further assessment and counselling was recommended; however, there was no follow up at all.
"Ms Y was not referred for psychological or psychiatric support, intervention or treatment. Nor was she referred for ante-natal maternity care at this juncture.
"'The clock was ticking... she had no one to turn to,' her lawyer relates. 'There were so many agencies involved and she was passed from pillar to post. They all knew of her pregnancy... they knew she was highly distressed and that she was seeking a termination. Nobody was listening to her and there was no intervention.'
"Communicating with those around her was very challenging, necessitating a translator to be available and physically present at all times.
"In July 2014, Ms Y made a desperate, unsuccessful attempt to seek an abortion in the UK. A clinic was identified and arrangements were made. Upon arrival in the UK, Ms Y was arrested and detained for up to eight hours. Her meagre personal belongings were taken from her, as were her clothes. The Custody Records note that she was deemed a risk to herself and that she was given a safety gown to wear. Ms Y was monitored closely and medically assessed. The medical records state 'suicidal since being pregnant as a result of rape'.
"Ms Y was later returned to Ireland, as she was not legally permitted to enter the UK.
"A few weeks later, Ms Y met with a general practitioner (GP). This GP’s medical notes record concern about Ms Y being suicidal. She was referred to a psychiatric unit. It took a number of days before she was eventually admitted to a maternity hospital.
"Ultimately, Ms Y was kept in hospital for several weeks during which time involuntary detention was mooted.
"Her medical records indicate that Ms. Y spoke of suicide on an almost daily basis, with increasing intensity.
"Her lawyer related that Ms Y told her health care providers 'I will kill myself if I cannot get rid of this baby... I don’t want it inside me. I don’t want to discuss it. I don’t want to know about it. I want it out. I cannot continue with this pregnancy.' Ms Y repeatedly threatened self-harm. Nonetheless, Ms Y was not advised of her rights under the Protection of Life During Pregnancy Act. Her medical records reflect that she was instead told: 'you cannot get an abortion in this country.'
"There was 'huge emotional pressure inflicted upon this very young, vulnerable woman by health care providers to get her to continue with her pregnancy, even though she expressed the intention of ‘I am going to throw myself off the top of this building’ and ‘I am going to tie a rope around my neck,’' explains Ms Y’s lawyer.
Ms Y had made an earlier suicide attempt, which was interrupted.
As a desperate measure, Ms Y went on a hunger strike, refusing all food and drink. Told by doctors that they would “terminate” her pregnancy, she resumed drinking and eating. However, “the termination” (as it was described) was postponed and postponed again amidst legal wrangling, resulting in an emergency application to the High Court. In early August 2014, the HSE obtained an order from the High Court to effectively force feed and hydrate Ms Y; an order which was later abandoned. A number of days later, Ms Y delivered Baby Y by caesarean section. This was the only option determined by the two psychiatrists and obstetrician, who certified this procedure as meeting the requirements for a lawful abortion on suicide grounds under the PLDPA.139
“'In my opinion,' says her lawyer, Caoimhe Haughey, 'Ms Y was given no choice. I believe that she did not fully understand what was going on. How could she? I believe that she was unduly influenced into accepting the planned caesarean section, otherwise she would be kept in hospital in order to continue with the pregnancy, which was a life or death decision for my client. From what I have read, viability considerations and other legal implications were first and foremost in the minds of those involved.'
"After Ms Y recovered from the surgery, she was discharged from the hospital and left to pick up the pieces of her life. She was granted refugee status and returned to her accommodation in the Direct Provision Centre.
"Her lawyer believes her after-care medical treatment and support was less than satisfactory in terms of follow-up. She stopped eating and lost a considerable amount of weight. She remained very vulnerable and fragile. Ms Y bears many scars from her ordeals, physical and mental. Her caesarean section scar is a permanent reminder of being raped and her unwanted pregnancy. With the help of her legal team, Ms Y now has a multi-disciplinary medical team in place to support her."
“It was always what was best for the baby, not what was best for both of us equally. His safety and well-being was of the utmost importance to me but I needed the pregnancy to end, if the hyperemesis gravidarum [severe sickness] wasn’t cured by delivery I would jump in front of a train.
"I wanted him to be okay but I couldn’t go on another day. I felt like an incubator. I didn’t feel like a human being anymore.”
Rebecca H suffered from hyperemesis gravidarum throughout her pregnancy. This condition is characterised by a permanent feeling of nausea, severe vomiting – sometimes up to 50 times a day, and dehydration. She recalls: “the nausea was incredibly debilitating and even the motion of taking a few steps would cause me to vomit.”
She struggled with “frequent hospital admissions for dehydration and becoming depressed.”
At 14 weeks, she could no longer care for herself and moved in with family. She says she asked for mental health support to help her cope but was never provided with any counselling. “The longer my pregnancy went on the more despondent I became.”
She “began losing hope” and was finally admitted to the hospital in order to manage her condition. She recalls, “I truly believed I was dying and I wanted to… I couldn’t live another day in this hell… At 36 weeks… I spent most days lying in my hospital bed with my fists clenched and my eyes shut tight begging for the world to stop spinning, the nausea was so crippling it was worse than the constant vomiting… I could barely walk to the end of the hall most days.”
Although her health care team told her that she could have an early delivery, it was repeatedly denied to her.
“They would lie to me about when [delivery] would be, first it would be next Tuesday and then it would be next Thursday, then it would be comments about ‘well you say you love your baby, but you can’t love your baby if you want to deliver him early… You are putting your baby’s life at risk…’ all these sort of things. It was completely insane. They said they would induce at 35 weeks then it was 36 and then 37 and then 38… it was just always next week.”
Finally, “I said to them just let me go home, if you can’t help me I will find another way. And then they said ‘well that’s it you can’t go anywhere.’ They said ‘it’s our job to look after the baby, the baby comes first.’ I told them that his safety was the utmost priority to me but at the same time, this is torture. Absolute torture.”
The hospital staff denied her request to be discharged and go home.
Eventually, the doctors agreed to induce Rebecca at 38 weeks. However, they “then started pressuring me to have a natural birth. I was so weak and despondent and I asked them for a [caesarean] section and they said ‘absolutely not, you would be putting the life of your baby in danger.’” Rebecca expressed that she didn’t feel physically capable of labour and natural delivery, but the doctors refused her request for a planned caesarean section. Instead, Rebecca was induced and forced to labour for over 36 hours.
Ultimately, Rebecca received an emergency caesarean section as the baby was having a stress response to labour. Her son spent his first few days recovering in the neo-natal unit.
Rebecca concludes: “The Eighth amendment is currently being abused. It is being used to treat women as objects and not as human beings anymore. I would fear for my life to have another child in Ireland.”
“You’re alone from the diagnosis until the baby’s heart stops. Between that, there’s just a void.” –Nicola
"In 2009, Nicola was 19 weeks into her second pregnancy when a routine scan revealed a problem with the foetus. After a more detailed follow-up scan medical staff told her that the impairment was fatal and there was no chance of survival.
"Nicola told Amnesty International: 'I thought straight away that they would induce me but the nurse explained they couldn’t do that because it’s classed as a termination and wasn’t allowed in this country.'
"She remembers thinking: 'You just can’t leave me carrying the baby when the baby’s going to die. I can’t do it, I can’t do it. I just couldn’t comprehend, I just thought I was going to pass out… I think I cracked when I asked them when they would induce me. I was just so naïve. I just thought automatically that they’d induce me if the baby was that sick.'
"Unable to afford the cost of travelling outside of Ireland in order to procure an abortion, and unwilling to 'put myself and my family under the [financial] pressure' in order to do so, Nicola says she was forced to remain in Ireland and to continue with her pregnancy.
"'I was conforming to what they do in Ireland. So a woman makes that decision, surely then there should be support for her once she’s made the decision to carry her baby – not to have a termination as they call it. There was nothing, no support for me whatsoever, nothing.'"
"Nicola went to the hospital every week for a scan. 'Most women are getting scans to make sure their baby is alive. I was getting a scan to see if my baby had died,' recalls Nicola.
"After five weeks the medical staff confirmed that the foetus had died. 'Straight away the doctor came in, we can take you in tomorrow, this evening, now to induce you.'
"Following her induction and delivery, Nicola developed an infection due to a retained placenta, which required further hospitalisation and care.
"'If I had been offered the induction from the start, I could have been saved this whole trauma, I strongly believe. I would have been saved the trauma of our friends offering us money, feeling under pressure to make this decision, facing the trauma of all these infections and having to spend time in the hospital, reliving my story every night because people were coming in. When I think about it, I just feel nothingness, there was no care.'"