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How do Ireland's proposed abortion laws compare with Europe?

It has been compared to the UK, but how does it stack up to other countries?

Image: Sam Boal/RollingNews.ie

WITH POLLING DAY in the referendum on the Eighth Amendment a little over a week away, discussion has turned to what would happen in the event of a yes vote.

While a no vote would retain the amendment and leave the Protection of Life During Pregnancy Act 2013 as the country’s only law around the provision of abortion, a yes vote would lead to the government progressing its legislation.

Much of the discussion has focused on any possible similarities with the UK’s system, but is that what Ireland’s law proposes?

24 week question

Much of the debate around the proposed law is around whether or not a woman will be able to get an abortion up to six months of pregnancy.

The draft legislation put forward by Health Minister Simon Harris proposes to legalise abortion up to 12 weeks in any circumstances.

After 12 weeks, the legislation says a termination of pregnancy would be lawful if two medical practitioners certify the following three things at the same time:

  • there is a risk to the life of the pregnant woman or a risk of serious harm to her
  • the foetus has not reached viability
  • and the termination of pregnancy is an appropriate way to avert the risk.

Viability is at approximately 23 to 24 weeks, which is roughly six months pregnancy. The two doctors – one of whom would be an obstetrician – would have to agree that all of these conditions were being met. Obstetrics experts say that these would be in a small number of extreme and exceptional cases.

In the UK, abortion is available up to 24 weeks under different grounds. Its Abortion Act 1967 says:

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In the UK in 2016, 92% of abortions were carried out at under 13 weeks gestation and 81% were carried out at under 10 weeks.

The key difference between the UK’s Ground C and Ireland’s proposed Head 4 is the use of the word serious, which is absent from the 1967 legislation of our neighbour.

While the Irish legislation would be similar to the UK legislation in some aspects, it actually has more in common with laws in other European countries, most notably Austria and Portugal.

Waiting period

In the UK, there is no mandatory waiting period to obtain an abortion. In Ireland’s case, a woman would have to wait three days for what Taoiseach Leo Varadkar called “reflection and counselling” before undergoing the procedure.

If a woman who is less than 12 weeks pregnant wants to terminate her pregnancy, she will have to visit her GP. After that initial consultation, she will have to wait three days and return for a second visit before she is prescribed the necessary pills.

It is envisioned that she will take the first pill while in the presence of her doctor, and the second two or three days later at home.

This is similar to Portugal, which legalised abortion by popular vote in 2007, and the Netherlands which has a five-day waiting period.

12 weeks

While a 12-week gestational limit for termination without restriction puts Ireland beyond a couple of European countries, the proposed legislation puts the limit at half that of the UK and 50% less than Sweden’s.

That limit is in line with what the Oireachtas Eighth Amendment Committee recommended.

Rates

More than 170,000 women and girls have travelled to another country for an abortion since 1980. Some 3,265 females travelled from Ireland to the UK for abortions in 2016, the latest year for which we statistics are available. That means Irish females accounted for almost seven in 10 (67.9%) of the non-resident abortions carried out in Britain that year.

This compares with 63,900 live births in the same year.

In the HSE’s briefing document to the Citizens’ Assembly, it puts the 2014 Irish rate of abortion at 3.9 per 1,000 women aged 15 to 44. However, this is a difficult figure to quantify because many women in Ireland take abortion pills and it is believed many who travel do not give Irish addresses.

Estimates have put the Irish rate anywhere between 5.7 and 7.7 per 1,000 women.

The lowest abortion rate of our European neighbours is Austria, which has been between 1 and 1.2 for the past decade.

Conversely, the UK’s rate is over 20 per 1,000 women and Estonia’s is 25.65 per 1,000 women.

Around Europe

Here is an overview of how abortion law is applied across Europe.

Abortion_Laws_2014 Source: EUpedia

AUSTRIA

Available up to three months of a pregnancy, without restriction.

After 12 weeks, abortions can be performed if there is a physical or mental health threat to the woman, if the patient is under 14 or in cases of fatal foetal abnormalities. Austria’s conscientious objection law is similar to Ireland’s proposal – no medical professional will be made perform an abortion unless the life of the woman is at risk.

The laws are more similar to Ireland’s proposed legislation than when comparing it to the UK’s.

Rate: 1.27 per 1,000 women.

BELGIUM

Available up to 12 weeks; afterwards in case of serious health concerns for the mother or baby.

A woman can receive an abortion after receiving counselling six days prior and must check in with her doctor in the weeks after. Later terminations are allowed in cases where the life of the woman is at risk or if the foetus shows signs of severe and incurable illness or disability.

Rate: 11.45

BULGARIA

Available up to 12 weeks; beyond that if the life of the mother is at risk, or for severe foetal malformations. Between 12 and 20 weeks, abortion is only permitted for women who suffer certain illnesses. After that it is in the case where the life of the woman is at risk or severe impairment to the foetus.

Rate: 24.85

CROATIA

Available up to 10 weeks; thereafter for medical reasons or in the case of rape. After 10 weeks, procedures must be approved by a board consisting of a gynaecologist, another physician and either a social worker or nurse. This commission can decide if the abortion is needed to save the woman’s life or preserve her health either in pregnancy or during delivery. It can also decide in cases of FFAs, rape or incest. The commission’s decision can be appealed to a second commission, whose decision is final.

Rate: 4.7

THE CZECH REPUBLIC

Available up to 12 weeks; after that in case of serious health concerns for the mother or baby or rape. Medical interventions can be made up to 24 weeks to save the health or life of the mother or if the foetus is not viable.

Rate: 12.08

DENMARK

Available up to twelve weeks. After that the abortion has to be approved by the authorities who take into account exceptional circumstances, like danger to the mother, poor socioeconomic circumstances, rape, incest or risk of birth defects.

Rate: 17.72

ESTONIA

Available up to twelve weeks, and up to 22 weeks for medical reasons and/or for women younger than 15 or older than 45 if there is a risk to either the child or mother.

Rate: 25.65

FINLAND

Available up to twelve weeks. A doctor’s authorisation is necessary but in practice is systematic. Beyond that health and social authorities decide on a case by case basis. Generally, two doctors will need to approve abortions after 12 weeks. Beyond 20 weeks, a threat to the life of the mother is the only reason.

Rate: 11.33

FRANCE

Available up to twelve weeks, and beyond that for medical reasons. In those cases, two doctors must sign off on the procedure, certifying that it is being done to protect the mental or physical health of the woman or foetus. In 2015, France abolished its seven-day “cool-off” period.

Rate: 20.79

GERMANY

Abortion in Germany is permitted in the first 12 weeks upon condition of mandatory counselling, during which counsellors will try to dissuade the woman. Afterwards in cases of medical necessity, but not in case of rape.

Rate: 8.72

GREECE

Available up to 12 weeks, with later abortions in the case of rape or incest up to 19 weeks and foetal abnormalities up to 24 weeks.

Rate: 10.48

HUNGARY

Available up to 12 weeks; up to 18 weeks if the patient is younger than 18, beyond that for medical or social reasons. Permission is required from a commission, which means women go through counselling, a waiting period and must get a certificate from a midwife.

Rate: 19.72

ITALY

Available up to twelve weeks for socioeconomic or medical reasons; beyond that in cases where the life of the mother is at risk or if the foetus is at risk of severe malformation.

Rate: 10.87

LATVIA

Available up to twelve weeks (up to 16 in case of rape) and after that in cases where the life of the mother is at risk or if the foetus is at risk of severe malformation.

Rate: 16.97

MALTA

Abortion is completely banned. Women found to be having abortions face from 18 months to three years in prison.

Rate: 0.87

NETHERLANDS

Available up to 21 weeks on demand and up to the 24th week if there is an urgent medical need. The abortion must take place in one of the 17 abortion clinics or 100 or so hospitals authorised by the government. Women must wait for five days before obtaining an abortion.

Rate: 12.10

POLAND

Abortion is only allowed in case of rape, incest, danger to the life of the mother or the irreversible malformation of the foetus, in the first 12 weeks.

Rate: 0.14

PORTUGAL

Available up to ten weeks on request, and up to 16 weeks in cases of rape. It can be performed up to 24 weeks if the child will be born with severe complications. There is a three-day waiting period.

Rate: 9.64

ROMANIA

Available up to 14 weeks electively and afterwards for medical reasons. Women can receive abortions up to 24 weeks in cases where their health or lives are at risk.

Rate: 20.62

SPAIN

Available up to 12 weeks on request and up to 24 weeks in cases of serious risk to the woman or fatal foetal abnormalities.

Rate: 12.98

SWEDEN

Available up to 18 weeks, and beyond that on the authorisation of the health and social services, usually for medical reasons. Permission is usually granted in cases where the health of mother or child is impacted. However, if the foetus is viable abortion is not allowed. This means there are effectively very few abortions after the 22nd week that are not linked to foetal abnormalities.

Rate: 25.35

UNITED KINGDOM

Available up to 24 weeks, and afterwards for medical reasons.

In Northern Ireland, the woman’s health must be at risk.

Rate: 20.21

Differences to the UK

The comparison to the UK is understandable, with the Save The 8th campaign saying a Yes vote “legalises abortion on the same grounds as the British model right up until the baby is six months”.

But it’s not exactly that cut and dried.

The Irish proposal has a much tighter gestational limit than the UK, but No campaigners fear the section of the bill which allows terminations be carried out until viability would be abused.

This section of the bill allows a termination if two doctors certify that a woman’s mental or physical health is seriously risked by continuing the pregnancy.

There is a similar provision in the UK abortion legislation. It allows for a termination in cases where the pregnancy has not exceeded the 24th week [the six month of pregnancy], but where the continuance of pregnancy would involve greater risk to the woman’s physical or mental health than if it was terminated.

As previously stated, the key difference between the UK’s Ground C and Ireland’s proposed Head 4 is the use of the word serious.

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