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Conscientious objection prevents full rollout of abortion services in several maternity hospitals

The Health Department said it will be asking the HSE to fully implement abortion services in all maternity hospitals and units by September.

Letterkenny University Hospital.
Letterkenny University Hospital.
Image: Google Streetview

THE FULL ROLLOUT of termination of early pregnancy services has been prevented in at least three maternity hospitals because of conscientious objection complications, documents seen by TheJournal.ie show.

Following the Eighth Amendment referendum last year, Health Minister Simon Harris gave 1 January as the date by which abortion services for pregnancies at 12 weeks or under would be provided.

Some abortion services were already legal under the Eighth Amendment in cases where the mother’s life was at risk; the new services provide for medical and surgical abortions up to 12 weeks based on the pregnant woman’s decision, and in cases of fatal foetal abnormalities. 

As most abortions up to 9 weeks can be carried out through taking pills, the majority of abortions (an estimated 80%) will take place through GP practices or at a local clinic. For those that want the termination of a pregnancy between 9 – 12 weeks, or cannot take the pill for health reasons, a surgical termination is required where women are referred to “acute” services – maternity hospitals or units.

The rollout of full abortion services has been slower than expected: although there is some level of abortion services available in all maternity hospitals, just ten out of 19 maternity hospitals or units offer full termination of pregnancy services.

All hospitals will provide terminations in emergency situations, and 13 hospitals will provide both medical and surgical terminations up to 12 weeks. One hospital, University Hospital Waterford, will provide medical terminations only.

According to an update sent in April from the National Women & Infants Health Programme (NWIHP) to the Department of Health, five hospitals haven’t been able to implement abortion services due to “operational issues”, and four hospitals have had complications in relation to conscientious objection and recruitment. 

Among the hospitals or units where conscientious objections have hindered the rollout of early-pregnancy abortion services are Letterkenny University Hospital, Sligo University Hospital and Wexford General Hospital.

In December it was indicated that Cavan General Hospital would provide the full abortion services, but later correspondence shows that it would likely be Q3 (August-October) of this year before the hospital “had the staffing to provide the service”.

Separate correspondence, which outlines the provision of abortion services across the 19 hospitals and units as it stood in April, states that “an issue with conscientious objection has prevented the service commencing” in Wexford General Hospital. It also stated that there would be an update available in Q2 (May-July) and that there were also “some infrastructural challenges which will need to be addressed”.

A briefing document dated from May 2019 and released to TheJournal.ie under a Freedom of Information request by the Department of Health states that “conscientious objection is still a significant challenge in Letterkenny University Hospital”.

An April document also states that: “The issue in Letterkenny is conscientious objection and no progress has been made as yet to resolve this issue. The NWIHP has committed to engage further with Saolta as part of the attempt to resolve the impasse.”

Sligo University Hospital also had issues with conscientious objections; in April an update was given that given the length of time needed to recruit, “it is likely to be Q4 before this service commences”. 

Other issues

Correspondence also outlines the “operational challenges” that are preventing the introduction of abortion in the remaining five hospitals/units.

One document states that South Tipperary General Hospital has “the smallest number of births in the country (900 a year) and maternity services represent a small part of its activities; to establish a service in the hospital will require dedicated clinics, which may have little or no demand”.

A service would require “a minimum of two clinics and at least one theatre slot a week”; the HSE said that introducing abortion services “would not represent optimal use of scarce resources given the proximity of STGH to other hospitals providing the service”.

The Midlands Regional Hospital Portlaoise, is (as of April this year, according to this FOI release) using “a networked approach to the delivery of termination of pregnancy services, with the procedures being carried out in the Coombe”. 

An update was to be provided in Q3 on when University Hospital Kerry and Portiuncula University Hospital would be able to supply the full rollout of abortion services.

The document adds that “it is unlikely” that St Luke’s General Hospital in Kilkenny could commence a service in 2019; as was reported in June, four consultants wrote a letter to the HSE stating that it’s not possible to provide medical or surgical abortions at St Luke’s. 

In response to the various issues delaying the implementation of abortion services, the Department stated that it was “extremely disappointed that, at this stage, there are still only 10 hospitals providing full ToP (termination of pregnancy) services”. 

“From the outset the Minister and the Department have been very clear that government policy is to normalise ToP service provision within our maternity hospitals and that services will be provided from all 19 maternity hospitals.” 

In that context, it is not acceptable that the NWIHP should seek to defer introduction of the service on the basis of low demand or because of sufficient regional coverage or, indeed, because of preference to provide services on a networked basis.

The Department states in the document that it will be asking the HSE to aim to have abortion services implemented in all hospitals and units by 1 September this year. 

Statements in response

The HSE has said that all maternity hospitals are providing the following termination of pregnancy related services:

  • Managing complications arising from termination;
  • Providing appropriate care and supervision for women following a diagnosis of fatal foetal abnormality, and referral to the appropriate tertiary unit;
  • Providing appropriate care and supervision in cases where maternal health/life is at risk, and referral as appropriate.

In a statement, the Department of Health said that it is in regular contact with the HSE in relation to the implementation of termination of early pregnancies.

“It is acknowledged that 10 out of 19 maternity hospitals/units are providing the full service. However, the HSE has advised that additional units are expected to begin providing termination of pregnancy services in the coming months.”

In relation to conscientious objections, the Department said: “It should be noted that the legislation provides that a medical practitioner, nurse or midwife shall not be obliged to carry out, or to participate in carrying out, a termination of pregnancy where he/she has a conscientious objection.

However, conscientious objection is limited to persons involved in the delivery of the treatment only and does not extend to institutions.

“The HSE has advised that where conscientious objection has arisen in relation to the provision of termination of pregnancy services, hospital groups are working with the hospitals in question to find an appropriate solution.” 

The Ireland East Hospital Group (IEHG), which oversees Wexford General Hospital, said in a statement:

“In line with the Health (Regulation of Termination of Pregnancy) Act 2018, the Ireland East Hospital Group is working closely with all its maternity hospitals on the implementation of termination of pregnancy as part of the national rollout of the service. 

“Gap analyses and values clarification programmes are being developed in IEHG hospitals which are yet to provide the service and where conscientious objection has been raised IEHG is working closely with the hospital to provide an appropriate solution as soon as possible.”

A statement has been requested from the two other relevant hospital groups on whether conscientious objection issues have since been resolved. They weren’t provided at the time that this article was published.

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