Friday 22 February 2019

Martina Devlin: 'This country has spoken on abortion - yet a cohort of our politicians think it's OK to abuse their power to try to thwart these hard-won reproductive rights'

Health Minister Simon Harris accused some TDs of using “shock tactics” and found the burial amendment “grossly offensive”. Photo: Gareth Chaney, Collins
Health Minister Simon Harris accused some TDs of using “shock tactics” and found the burial amendment “grossly offensive”. Photo: Gareth Chaney, Collins
Martina Devlin

Martina Devlin

Five-and-a-half months ago, the people voted by two to one in favour of abortion reform - a decisive majority which cannot be misinterpreted. This week, a small group of men and women on the Oireachtas Health Committee appeared to be trying to undermine that result.

Despite the clarity of the people's voice, those committee members engaged in what could be interpreted as an abuse of process or an abuse of position. They tabled some outlandish amendments which look suspiciously like diversionary tactics to thwart and dilute the proposed legislation.

Our politicians have an obligation to scrutinise new laws, but not to sabotage them when legislative change is the will of the people. Some of what was issued from Mattie McGrath, Peadar Tóibín and others sounded suspiciously like diversionary tactics.

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Here's an example: an amendment to insist on pain relief for a foetus undergoing termination. Doctors tell us a foetus feels no pain before 26 weeks because its nervous system is not yet functional. Consequently, politicians asking for pain relief are flagging up their view that a 10 or 12-week foetus is a complete human being - this is an absolutist position, it is not yet at that stage of its development.

Currently, when surgery is carried out in the womb on a foetus, it is done without analgesic. The foetus is given an anaesthetic to stop it moving around, which might compromise the procedure, but nothing for pain relief because medics regard it as unnecessary. Procedures carried out in utero include giving a blood transfusion to the foetus in cases where a mother is anaemic.

Another proposed amendment (among 180 in total) which could be classified as verging on the macabre relates to burial arrangements - the "dignified disposal of foetal remains". Remember, we're talking about terminations up to a maximum of 12 weeks' gestation. It is not uncommon for a woman to lose a pregnancy in the first trimester - typically, she begins bleeding and a blood clot is ejected. Are we now expected to have burial services for every late, heavy period which might possibly be a miscarriage?

Such proposals prompted Fine Gael TD Kate O'Connell to reference her own miscarriage: "I find it offensive as a woman who has been in this situation. I don't want to inform anybody what I have done with my foetal remains, I don't want to inform the minister, I don't want it in legislation and I most certainly don't want people in this house prescribing what I should do…"

Health Minister Simon Harris accused some TDs of using "shock tactics" and found the burial amendment "grossly offensive". He said it could criminalise some women going through early-term abortions as the proposal stipulated it would be a criminal offence not to bury or cremate the remains. Hospitals have procedures in place already around stillbirths and miscarriages.

Our public representatives are entitled to express genuine concerns about legislation under consideration. Health Committee members had a duty to scrutinise the Regulation of Termination of Pregnancy Bill. But they had an obligation, too, to bear in mind that more than 66pc of the populace voted in favour of abortion reform on May 25. Measured scrutiny of legislation has been absent all too often this week.

It is natural for people to feel passionately about abortion rights and wrongs. But some of the tabled amendments had little to do with the public good.

Carol Nolan didn't want State money spent on provision for abortion services, a decidedly peculiar suggestion from a former Sinn Féin TD considering it would give rich people easier access than those on low incomes. Rejecting it, Mr Harris rightly questioned how it could be appropriate to send a bill to women who were raped or suffered a fatal foetal abnormality.

The legislation has now passed the committee stage, all of those amendments turned down, and the challenge now for Mr Harris is to push it through both houses before the Christmas recess. He sees it as possible - but whether it is probable is another matter entirely.

One hole below the waterline has emerged already. Some committee members wanted provision for the use of ultrasound imaging 24 hours before termination. Presumably, they think seeing the grainy outline of what they're carrying might change some women's minds.

But there's no denying that Fine Gael promised scans, partly to nudge waverers across the line during the pre-referendum debate. However, ultrasound facilities simply aren't available in GP clinics while hospitals - which do have them - are already under pressure even before adding to their workload.

Scans happen before all terminations in Britain irrespective of gestation. But they aren't strictly essential, especially with early pregnancies. One of the reasons they take place routinely in the UK is because almost all terminations are done surgically there. In Ireland, it is envisaged that people will tend to have medical abortions, ie after taking pills, under a doctor's supervision. Abortions up to nine weeks will be handled by GPs and from nine to 12 weeks in hospitals.

There's another difference. Abortions in the UK have been outsourced to specialist clinics such as Marie Stopes. These clinics are well equipped and scan to ensure the foetus is in utero (not an ectopic pregnancy); check that it's not an undiagnosed miscarriage; and confirm foetus gestation. Some women can be unsure of their dates, particularly if they have irregular periods.

Clearly, in Ireland a scan would be needed to reassure GPs who can't simply take a woman's word for how far along she is in a pregnancy. Doctors need to know a termination is happening legally and that they aren't engaging in poor clinical practice.

But GPs tend not to have ultrasound facilities, although they have been promised a raft of new primary care centres. What's likely to happen is women presenting for abortion will be referred to hospitals for scanning. GPs will be extremely cautious, especially in the initial phase after abortion legislation is passed. But what if a woman is approaching the 12-week deadline and encounters a scanning backlog?

Potentially, this is a serious problem. Even if additional equipment is bought, staff will need to be upskilled or hired in order to use it. I can't believe the public health system is in a position to cope with additional demand. Has anyone considered the implications? How about potential solutions such as licensing private operators to do scans?

Raising such questions would have been a more productive use of the Health Committee's time.

I do hope women aren't going to be left out on a limb on this - it wouldn't be the first time.

Irish Independent

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