Teen abortion case: the crucial missing 12 weeks

HSE to carry out an investigation into the circumstances of girl's care

Few subjects are as explosive or as charged emotionally as abortion

Health Minister Leo Varadkar.

thumbnail: Few subjects are as explosive or as charged emotionally as abortion
thumbnail: Health Minister Leo Varadkar.
Dearbhail McDonald, Fionnan Sheahan and Eilish O’Regan

An investigation has been launched into what medical care was given to a vulnerable teenager in the 12-week period between her first request for an abortion and the date her baby was delivered.

Questions are being asked about what help, if any, was given to the young asylum  seeker who was said to have been acutely distressed when she discovered she was pregnant.

The teenager, a victim of rape, requested an abortion in April when she was about two months pregnant.

But it was three months before a GP referred her for assessment under the Protection of Life In Pregnancy Act 2013 as he deemed her to be suicidal.

She gave birth to a baby boy by caesarean section at 25 weeks after being refused a termination by an expert panel.

The roles of the Department of Justice, which has responsibility for the asylum system, and the HSE which provides medical services for asylum seekers, will now come under the spotlight.

The plight of the young woman, first revealed in the Irish Independent, has reignited the three decades long abortion debate.

The teenager came to the country to escape a conflict in her home country where she was raped.

She learned she was around two months pregnant soon after arriving here and asked for an abortion. She received abortion and travel information from a family planning clinic. But sources claim the authorities “kept fobbing her off” when she requested access to an abortion.

“From the moment she discovered she was pregnant, she wanted an abortion. The fact she couldn’t get one made her suicidal,” a source involved in the case told the Irish Independent.

It has now emerged that she moved between two asylum seeker centres at her own request.

The baby boy was delivered by Caesarean section the week before last. The baby is still in an incubator and is expected to be taken into State care.

A very premature baby born at around 25 weeks may not survive or have long-term problems - but a very small number escape with few complications.

Much depends on the child's birthweight, condition at birth and absence of infection.

The woman has now left hospital and is being treated in a HSE facility.

However, there is now a possibility she will sue the State.

Her application for refugee status was treated sympathetically and she is now expected to be granted resident status.

The case is the first example of suicide being cited as grounds for the termination of a pregnancy under the new abortion laws.

However, the legislation has been employed in a number of other cases where abortion took place on medical grounds.

The asylum seeker's case is the first where the outcome of the use of the legislation has been the birth of the baby.

The identification of this woman is protected by High Court order under Section 27 of the Civil Law Miscellaneous Provisions Act, 2008. Therefore, her exact nationality, where she is based in the country and where the baby was born cannot be divulged.

The HSE is going to conduct an internal inquiry into its handling of the case.

The Department of Justice is responsible for the welfare of asylum seekers, providing them with accommodation, food and clothing, known as direct provision, through the Reception and Integration Agency. The Department is also in charge of the processing of asylum seekers applications. But the HSE is in charge of the medical needs of the asylum seekers.

After talks with Health Minister Leo Varadkar, HSE director general Tony O'Brien commissioned a report to establish the full facts of the case, the sequence of events, the care the woman received and the operation of the abortion law.

The report is expected to be completed by the end of September. Subject to privacy restrictions, it will be published.

However, the report will not seek to review the decision taken by the clinicians involved in the case as they had a specific statutory function as detailed in the 2013 Act.

The woman was pregnant when she arrived in the country. She received some form of medical treatment while she was in the direct provision centre for asylum seekers.

She is believed to have been referred by a nurse to an Irish Family Planning Association clinic, where she received counselling and information on her options and what visas she would require to leave the country and return. However, the clinics do not provide funding or make arrangements for women seeking an abortion.

The woman subsequently moved to a second location. She came into contact with a man with medical training from her own country who tried to assist her as she became distressed.

After she was pregnant for 20 weeks, he got in contact with an expert in the field who told them to contact a GP locally. The GP referred her to a hospital for assessment on the suicide grounds.

Mr Varadkar welcomed the inquiry, saying some of the commentary on this issue "may not be correct".

"It will provide welcome clarity. In the meantime, I would encourage people to await the outcome of the HSE report before jumping to conclusions, and to avoid turning a very difficult, traumatic case into a political cause before knowing all the facts. I would again ask people to remember that we are talking about a woman and a child who need care and compassion," he said.

The head of one of the country's largest maternity hospitals has indicated the hospital has carried out terminations under the new abortion law.

However, the Master of the Rotunda Hospital, Sam Coulter Smith, said the hospital would not have acted differently before the Protection of Life in Maternity Act, 2013 was passed.