Representatives from the British Pregnancy Advisory Service and support group One Day More addressed the Eighth Amendment Committee today.
Welcome to today’s liveblog of the Oireachtas Eighth Amendment Committee. It’s Órla Ryan here.
The agenda for the meeting is as follows:
- Session A: International legal/services context [Dr Patricia Lohr, Medical Director, British Pregnancy Advisory Service]
- Session B: Termination in cases of foetal abnormality [Liz McDermott, One Day More]
You can watch proceedings below:
At the start of today’s session, the committee is going to address accusations of bias.
Social Democrats TD Catherine Murphy called for the meeting after two members of the committee – independent TD Mattie McGrath and independent Senator Rónán Mullen, who are both pro-life – accused the proceedings of being biased.
Murphy told TheJournal.ie she called for today’s meeting because accusations are being made about witness bias, which she said does not exist.
“There’s very inaccurate information being put out there,” Murphy said.
Chairperson Senator Catherine Noone has repeatedly denied the committee is biased.
Murphy is now addressing committee members, saying the committee has heard from several medical and legal experts. She says when an organisation such as the World Health Organization (WHO) gives clinical information showing that the Eighth Amendment isn’t working, that is a fact, not biased information.
The notion that there’s 24 on one side and four on the other is utter nonsense.
“Facts don’t alter,” she says, adding that all witnesses and their evidence should be respected.
Fine Gael TD Kate O’Connell echoes Murphy’s sentiments, noting that some committee members may have changed their opinions throughout the course of the committee’s work.
“People will say ‘they’re all pro-choice’ – well maybe the world is becoming more pro-choice,” she says.
Fianna Fáil TD Anne Rabbitte says it’s not the committee’s fault if certain pro-life groups rejected the invitation to attend, but perhaps replacement witnesses with a similar viewpoint should have been sought out.
Labour TD Jan O’Sullivan says witnesses are not asked to give a side, but to share expertise.
Independent Senator Lynn Ruane says Senator Rónán Mullen was given about three times longer than the six minutes he should have been allocated at one hearing, but she didn’t leave the room “screaming bias”.
Ruane says such misrepresentation is “the last sting of a dying wasp”.
People Before Profit TD Bríd Smith defends Noone, saying she has been unfairly undermined and accused of bias.
Sinn Féin TD Louise O’Reilly agrees with this, stating: “The chair enjoys the support of the vast majority of the members of the committee.”
Fianna Fáil TD Lisa Chambers says she thinks the public have “seen through” repeated attempts to undermine Noone, telling her: “You deserve a medal at the end of this for your patience.”
Her party colleague Senator Ned O’Sullivan agrees with her, saying the treatment of some of the witnesses “borders on un-Christian”. He questions why certain members stay on the committee if they have so little faith in its work and their colleagues.
“Many of us are on a learning curve here, I find my position has changed because of the information I have received,” he says.
Senator Rónán Mullen is disagreeing with the other members. He says the committee is “belatedly” discussing bias because “the cat is out of the bag”.
Mullen says he, Mattie McGrath and Fine Gael TD Peter Fitzpatrick are in the minority on the committee.
He says pro-choice advocacy groups have been invited to appear before the committee, while pro-life groups have not.
Mattie McGrath says other committee members “are waiting to jump on us”. Lynn Ruane is unimpressed, saying he and Mullen are only interrupted because they go over their allocated time.
McGrath accuses other members of sniping and behaving like “ganders”.
He says the committee invited 24 pro-choice witnesses and just three pro-life groups.
Last month, the committee voted to recommend that the Eighth Amendment should not be retained in full, meaning it will recommend a referendum be held.
The final vote was as follows:
- Yes: 15
- No: 3
- Abstentions: 2
The three No votes were Mullen, McGrath and Fitzpatrick. The two abstentions were Fianna Fáil TDs James Browne and Anne Rabbitte.
At the time Mullen and McGrath both opposed the vote taking place, calling it a “farce”. They wanted the vote to be deferred until all witnesses had been heard.
McGrath today says this vote amounts to committee voting in favour of abortion, and proves its bias. He says he understands why pro-life groups have refused to appear given the “predetermined outcome” of the committee’s work.
Fine Gael TD Bernard Durkan says the assertion that the committee has voted in favour of abortion is incorrect.
“It is the people and the people alone who can make that decision.”
Sinn Féin TD Jonathan O’Brien says committee members should be more focused on questioning witnesses than giving press conferences.
O’Brien says he doesn’t view himself as pro-life or pro-choice, rather as “a realist” after listening to the evidence. He recently stated that his viewpoint had been changed due to his work on the committee.
O’Brien tells Mullen “your behavior in this committee is downright disgraceful”.
“The only person who is biased Senator Mullen is you, not the committee.”
At a previous session, O’Brien said he might lose his temper, accusing Mullen and McGrath of unfairly trying to undermine Noone.
McGrath references this today, asking O’Brien how his temper is. O’Brien does not appreciate this.
“I don’t know why you feel you’re exceptional here, please stop talking,” Noone tells McGrath after he keeps speaking.
Mullen wants more time to conclude his points, he is not given this as the session has run over time.
“There’s three or four men having arguments here …. while women wait for a decision on their reproductive rights. What are we like?,” Bríd Smith says.
Noone says she doesn’t take the criticism of her personally. She says her role as chairperson is both a privilege and a challenge.
She says the vote taken by the committee last month means it will recommend that a referendum be held – not that it has taken a position on abortion.
She wants the meeting to be adjourned briefly so the witness can enter the room.
Dr Patricia Lohr, Medical Director of the British Pregnancy Advisory Service (BPAS), is now giving her opening statement.
She tells the committee: “I trained in Obstetrics and Gynaecology at the Harbor-UCLA Medical Center in Torrance, California completed a Fellowship in Family Planning and Contraception Research and a Masters Degree in Public Health at the University of Pittsburgh. I am a Fellow of the American College of Obstetrics and Gynecology and of the US Society of Family Planning. I have an Honorary Fellowship from the UK Faculty of Sexual and Reproductive Healthcare.
“During my career, I have focused on the delivery of evidence-based abortion care and family planning; developing protocols, training doctors and nurses, providing services, and conducting research. I am a member of the Royal College of Obstetricians and Gynaecologists (RCOG) Abortion Task Force for which I am currently working on postgraduate curriculum development and a pathway for the care of women needing abortions who are medically complex.
“I am a founding member and the Treasurer of the British Society of Abortion Care Providers which is a RCOG Specialist Society, and currently sit on the National Institute for Health and Care Excellence (NICE) Termination of Pregnancy guideline committee which has been tasked with development a new evidence-based guideline for England. I was a member of the development group who wrote the last RCOG guidance on abortion care and have contributed to other national and international guidelines on contraception.”
Dr Lohr continues: “BPAS is a charity which was established in 1968 to provide not-for-profit abortion care that the National Health Service (NHS), at the time, either could not or would not provide . Today, we provide contraception, pregnancy options counselling, abortion care, and miscarriage management from more than 40 centres across England, Wales and Scotland. As part of our charitable remit we also provide education on the causes and consequences of unwanted pregnancy – and our nurses visit schools and colleges to provide information about contraception and fertility to young people, to empower them with the knowledge to make their own reproductive decisions.
“The majority of our services are provided under contract to the NHS, meaning the vast majority of women we see do not pay for their treatment. That now includes women from Northern Ireland, whose care is funded by the UK government and will be managed through a Central Booking Service. The remainder are fee paying patients who overwhelmingly come from the Republic of Ireland.
We provide care at or below cost to women from Ireland in recognition of the financial challenges they have already faced in reaching the UK, and we have a policy of never turning any woman away based on her ability to pay.
“While I am someone who believes strongly that abortion care is a fundamental part of women’s reproductive healthcare, I am here today to provide you with factual information on the experience of Irish women who travel to the UK, how their abortion care is provided, and the limitations of the current framework for providing the highest standard of care. We have no financial interest in Ireland changing its laws, and will continue to provide not-for-profit services to Irish women if they cannot access abortion care at home.”
“In the UK – with the exception of Northern Ireland – women can access lawful abortion if they meet the terms of the 1967 Abortion Act, and two doctors agree in good faith she does so. Any abortion outside of that framework falls under the 1861 Offences Against the Person Act and carries the threat of life in prison, both for the woman and those helping her. All abortions must be performed in NHS hospitals or specifically licensed premises such as those run by BPAS.
“The majority of abortions are performed under Ground C – which stipulates that the pregnancy has not exceeded its twenty-fourth week and that the continuation of the pregnancy would involve risk, greater than if the pregnancy were terminated, of injury to the physical or mental health of the pregnant woman. A smaller number are performed under Ground E – that if the pregnancy continued the baby would be born with a serious mental or physical disability.
The vast majority of abortions – 92% last year – were carried out at under 13 weeks’ gestations, and 81% were carried out at under 10 weeks. This is in no small part due to the increasing availability of medical abortion, which can be offered at some of the earliest gestations. Medical abortion involves taking two medications, mifepristone and misoprostol, ideally 24-48 hours apart for maximum efficacy. Medical abortions account for more than 60% of the total number of abortion performed, although this method becomes less acceptable to women as gestation increases.
“Small numbers of abortions are performed after 20 weeks’ gestation, and account for around 1% of the total number of abortions performed. Some of these will be for reasons of foetal anomaly which are not detected until the 20 week scan. Others will involve late detection of pregnancy, sometimes as a result of contraceptive use which has disturbed bleeding patterns – so that a missed period is not interpreted as a potential marker of pregnancy. While teenage pregnancies have declined dramatically over the past decade, younger women with an unwanted pregnancy are more likely to need a later abortion. This may be because a pregnancy was not suspected, or because she has felt unable to confide in anyone about her circumstances,” Dr Lohr says.
Dr Lohr tells the committee: “Overall the picture of abortion within the UK is as follows:
- Abortion rate is stable (around 16 per 1,000 women)
- Largely unchanged since the late 1990s
- The age profile at which women have abortions is changing: the teenage pregnancy rate has decreased dramatically and more older women requesting abortion care; we see more women over the age of 35 than women under 20
- It is estimated that one in three women will need an abortion in their lifetimes, and that one in five pregnancies end in abortion
“The abortion rate in England and Wales is similar to that in socially and economically comparable countries such as France and Sweden – that is to say the UK is not an outlier in regard to its abortion rate.
“There is, in any event, no evidence that laws influence the numbers of abortions: the respected Guttmacher Institute has shown that the rate of abortion in countries with highly restrictive abortion laws is comparable with that in countries with more liberal frameworks.”
Speaking about Irish women travelling to the UK for abortions, Dr Lohr states: “Last year 3,265 women were recorded in the annual abortion statistics produced by the Department of Health in England as having given an Irish address when they presented for treatment. Over the past 10 years, the number of women giving Irish addresses has fallen, from 4,600 in 2008.
“This decline may be underpinned by a number of factors, including: better access to contraceptive services, and emergency contraception, increased access to abortion medication, as well as raised awareness that free treatment can be obtained with a UK address. A paper in the British Journal of Obstetrics and Gynaecology published in July reported that between January 2010 and December 2015, 5,650 women from Ireland and Northern Ireland contacted one online provider alone to request medical termination of pregnancy.
BPAS has been providing abortion care to women from Ireland since 1968. There is little difference between the reasons why women from Ireland present compared to those from the UK – they will be diverse and multifaceted, involving financial hardship, knowledge that her family is complete, inadequate partner or family support, domestic violence, or simply feeling they are not in the position to care for a baby at that point in their lives.
“While some abortions take place of pregnancies that were planned and indeed wanted, such as those for foetal anomaly, the majority of the women we see were trying to avoid pregnancy when they conceived.
“The majority of women who we treated from Ireland were using a form of contraception when they conceived. An analysis of 2,703 women from Ireland who were treated at BPAS over a four-year period found the following:
- 3.1%: IUC/implant/sterilisation
- 28.8%: Injection/oral contraceptives/patch/ring
- 47.6%: Condom/diaphragm/fertility-awareness based methods
- 20.4%: No method
“Of Irish women who receive abortion care in the UK, 70% are married or with a partner. Nearly half have already had at least one previous birth, meaning they are already mothers. All this is in keeping with information we have for women from the UK.”
Dr Lohr continues: “As previously noted, medical abortion now accounts for the majority of early terminations in the UK. Many women prefer it as it is akin to a natural miscarriage, they can avoid an anaesthetic, and they can be at home when the pregnancy passes.
“In contrast, the majority of early abortions provided for Irish women are performed surgically – 71%, compared to 28% for women resident in England and Wales.
“This is because for financial and practical reasons, many women travelling from Ireland often aim to fly in and out of the UK within a day, and as medical abortion involves leaving the clinic after taking the second set of medication and going home to pass the pregnancy, it is not clinically optimal for that to happen on the way to the airport or the flight home.
“Effectively this means that women from Ireland are in all practical senses denied a choice of method in abortion.”
She is now showing the committee the below stats:
“Nearly a third of abortions (31%) for women from the Republic of Ireland are performed at 10 weeks and over, compared to 20% for women resident in England and Wales.
“Abortion is an extremely safe procedure, but the earlier in pregnancy it can be performed the better for women’s physical and mental wellbeing. Reasons for later presentation will include the time it takes to organise travel and make logistical arrangements, particularly for those with work and childcare commitments,” she states.
Speaking about contraception, Dr Lohr says: “All women who receive NHS-funded treatment at BPAS are also entitled to contraceptive counselling, can choose from the full range of methods available, and if they wish to, can leave with the method of their choice.
“Provision of contraception at the time of abortion has several advantages: the woman is known not to be pregnant, it confers immediate protection against pregnancy, and, with regard to implants and intrauterine contraception, increases the likelihood of receipt of the method compared to women who must return to undergo insertion at a later date.
“Irish women who attend BPAS are also offered contraceptive counselling, and the overwhelming majority take that up.
“However, because of the costs associated with receiving their chosen method, as well as the logistics of integrating contraception care with travel, in our analysis only 31% chose to receive their preferred method from BPAS. This is compared to 85% of those who are funded.
“This means that an important opportunity to enable women to make a choice about contraception and receive that method is lost. It is possible women do visit their GP or family planning clinic on return to Ireland and receive the method they have chosen, but we have no way of establishing this or following this up.”
Discussing post-abortion care, Dr Lohr states: “All women undergoing an abortion at BPAS have access to 24-hour telephone support, and while follow-up appointments are only provided to those women who want them, all women know they can contact the clinic which treated them and return for a checkup or discuss any concerns at any time.
“Women from the Republic of Ireland can access the telephone support line, but if they have any concerns that need in-person care will need to access local services, which can present its own problems in view of the stigma and secrecy that continues to surround travel for abortion.”
She is now showing the committee the below information:
“In terms of the mental health impact of abortion, the risk of developing mental health problems is the same for a woman facing an unwanted pregnancy whether she has an abortion or goes to have the baby.
“While most women will not require further counselling, post-abortion counselling is available to all women who have had an abortion at BPAS, on the phone or in person. Needless to say for women from Ireland the option of in person counselling would be difficult, although this is available through some of the agencies in Ireland.
“For women undergoing abortion for foetal anomaly – we can arrange the transport of foetal remains for autopsy. Women from Ireland must take the foetal remains home themselves, and find a carrier which will accept the remains on board. If they wish to have an autopsy or other testing, this would be self-funded,” Dr Lohr states.
Dr Lohr says Ireland can learn certain lessons from the UK.
“If Ireland does overhaul its abortion laws, and it is certainly not for me to prejudge, it would do well to avoid some of the pitfalls and problems that the UK framework presents. The 1967 Abortion Act was passed at a time when abortion was almost entirely surgical, and when all surgery was much riskier than it is today.
“Against that backdrop it is unsurprising that politicians stipulated that all procedures should be carried out in NHS hospitals or in specific premises licensed by the Secretary of State for Health, and that all such procedures should be performed by a doctor.
“Few could have imagined in 1967 that early abortion could be safely provided using medication. Our laws have prevented the provision of early medical abortion in line with guidance from the World Health Organization, which recommends that women should be able to use misoprostol at home once lawfully prescribed.
“This means that women can time the passing of their pregnancy and do not have to risk bleeding or miscarriage on the way home, nor have to attend multiple appointments.
I mentioned the numbers of women from Ireland using online abortion services – it may surprise you to know that women living in areas of the UK where funded, legal abortion is available are also turning online. Over a four-month period alone, more than 500 women in England, Wales and Scotland requested help from Women on Web. For some women, the multiple appointments – sometimes considerable distances from where they lived – were an absolute impediment to accessing lawful care.
“Our laws have also prevented the full development of nurse and midwife led services that are now the standard in other areas of care like colposcopy. Nurses are lawfully able to provide surgical and medical miscarriage management – using the same techniques as an early termination – but are prohibited from providing that service to women needing an abortion.”
Dr Lohr continues: “In terms of premises, there is no reason why early abortion – whether by vacuum aspiration or pills – could not be safely provided from a GP surgery, but again our laws make that all but impossible.
“Keeping abortion within the criminal law, as opposed to regulated by healthcare law like all other procedures can be hugely stigmatising. Canada and parts of Australia have opted for the decriminalisation of abortion, regulating it through healthcare law and professional standards. There is no evidence that abortion is more widely used or indeed more available as a result.
“You do not need a criminal law to impose a time limit for example, but keeping the procedure outwith the criminal law and the subject of professional guidance and healthcare regulation means that lawful abortion care can be provided in accordance with the highest clinical standards and best practice, not a rigid law that will only ever be a product of its time.
“Ireland has the opportunity to create a humane abortion framework that is fit for the 21st century. I hope the information that I have provided is helpful for this discussion, and I would be glad to take questions,” she concludes.
Responding to Deputy Catherine Murphy, Dr Lohr notes that, under the 1967 Act in the UK, two doctors need to sign off on a woman receiving an abortion.
She says some women lie about why they are having an abortion as a result, due to the fact they’re afraid they won’t meet certain criteria.
Dr Lohr says the criminalisation linked to abortion has a chilling effect on the medical profession and people who wish to enter the field.
She says Ireland is lucky in that women are able to obtain safe abortions in the UK, unlike their counterparts in certain other parts of the world. She adds that women who don’t have this option resort to unsafe abortions, leading to high mortality rates.
Replying to Deputy Bernard Durkan, Dr Lohr says giving birth has become safer in the UK in recent years, but she says having an abortion is also extremely safe.
She says maternal mortality data shows that the risks associated with continuing a pregnancy to term are higher than having an abortion at any point in the first or second trimester.
Dr Lohr says that over a three-year period there were 11.39/100,000 deaths resulting from pregnancy, and 0.32/100,000 deaths as a result of abortion. She says cases of serious sepsis are very rare.
She adds that BPAS gives women access to a telephone counselling service, something that many women prefer.
Responding to Deputy Jan O’Sullivan, Dr Lohr says women who receive advice about contraception and start it straight away are at a reduced risk of a further unwanted pregnancy.
Dr Lohr says Irish women sometimes present for an abortion at a later stage in their pregnancy because it can take them a while to be in a position to travel to Britain.
When asked by O’Sullivan if there was any evidence of the ‘floodgates opening’ in the UK once abortion was legalised, Dr Lohr says statistics on illegal abortions aren’t available, but notes the abortion rate didn’t increase dramatically after the 1967 Act was introduced.
Responding to Deputy Lisa Chambers, Dr Lohr says most Irish women choose surgical rather than medical abortions because they usually need to travel to and from the UK on the same day.
She says, proportionally, early medical abortions have a slightly higher risk rate than surgical abortions, but the latter method can also have complications.
Dr Lohr says “abortion is a backup for when contraception fails”, and not something women use as a form of contraception.
“I think it’s really telling a that most of the women that we see were using a contraceptive method [when they became pregnant].”
Deputy Peter Fitzpatrick asks Dr Lohr if she agrees with comments he said Ann Furedi, the CEO of BPAS, made on TV show Loose Women stating that abortion should be available if a woman is unhappy with the gender of her baby.
Dr Lohr says she’s not familiar with these comments. She says if a woman’s only grounds for abortion is the baby’s gender, it’s not covered under the 1967 Act.
However, if the woman may face exclusion from her community or domestic violence as a result of the baby’s gender, there could be legal grounds for the termination.
When asked about how many abortions BPAS has carried out because the baby had Down syndrome, Dr Lohr says she doesn’t have the stats around how many terminations have been carried out due to foetal abnormality, but will provide them to the committee at a later date.
Fitzpatrick says he is very disappointed that she can’t answer his questions.
Replying to a question from Deputy Kate O’Connell, Dr Lohr says if two doctors disagree on signing off on a woman’s abortion in the UK, they examine whether a termination should be granted on other grounds (if before 24 weeks of gestation). If it’s after 24 weeks, another doctor needs to be consulted.
Responding to Deputy Bríd Smith, Dr Lohr says it’s important to have access to both medical and surgical abortions. From a socioeconomic perspective, she says women who can afford to travel to have an abortion do, while those who can’t don’t.
Responding Senator Rónán Mullen, Dr Lohr says it’s “absolutely not the case” that BPAS carries out abortions up to birth, rather up to 24 weeks as set out under law. Mullen accepts this correction.
He brings up a Care Quality Commission safety review that was critical of one of BPAS’s clinics, to which Dr Lohr says this is something the organisation learned from and proves the services they provide are properly regulated.
Mullen says one in five pregnancies in the UK end in abortion, while one in 19 in Ireland do. Dr Lohr says we don’t know how many pregnancies in Ireland end in abortion as we don’t have these statistics.
She says she doesn’t keep track of how many abortions she has carried out, adding it may be hundreds or thousands.
Responding to socioeconomic issues raised by Senator Lynn Ruane, Dr Lohr says both the present and future impact of the pregnancy on the woman and her family is taken into account in the UK system.
Ruane asks how decentralising abortion care could improve access and minimise protests by anti-abortion groups outside their premises. Dr Lohr says providing abortions in centres where other OBGYN issues are dealt with could help in this regard as it’s not clear why a person is attending the centre.
Deputy Clare Daly asks Dr Lohr what Ireland can learn from the UK’s experience in the 50 years since the 1967 Act was introduced.
Dr Lohr says a positive aspect of the Act is that the grounds for abortion can be widely interpreted so most women can access services if they need to, however this changes after 24 weeks. After this time period, she says the woman may have to prove that she is suicidal in order to access a termination.
Responding to Deputy Louise O’Reilly, Dr Lohr says, in the UK, a doctor must prescribe abortion pills, although a nurse can manage the related care.
Replying to Senator Ned O’sullivan, Dr Lohr says BPAS advises women to stay an extra day in the UK if possible so they can be monitored after the abortion – noting the immediate aftermath is the most likely time that complications may occur.
However, she says this is not a realistic option for many women.
Answering a question from Deputy Anne Rabbitte, Dr Lohr says BPAS does not scan women for foetal anomalies – noting this is usually done before they attend the clinic.
Women who come to BPAS clinics have an ultrasound to determine gestation and look for miscarriage. She says women who attend the clinics are also offered counselling.
Replying to Sinn Féin Senator Paul Gavan, Dr Lohr says women from countries other than Ireland travel to the UK for abortions, but not many.
Those who do are from countries with more restrictive laws such as Italy, or are British expats living in places like the Middle East, where they may not be able to access terminations.
Just a quick reminder that we’ll be sending out an email round-up of what happened at the committee later today.
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The committee’s second session will focus on termination in cases of foetal abnormality. Liz McDermott from support group One Day More will address the committee.
She is now delivering her opening statement:
“I am a member of One Day More, a support group which came about because of the experiences of parents who received poor prenatal diagnoses for their babies – either that they would not survive until birth or long after birth, or that their babies had significant developmental defects or anomalies which would impact them for life.
“When we received the poor prenatal diagnosis for our children, some of us were fortunate enough to speak to someone who had gone through a similar experience. We found this emotional and personal support of enormous help and in the end it’s what prompted the setting up of One Day More.
“I have brought along some additional information about One Day More and the stories and testimonies of women we have supported. I would request that these form part of the record of these proceedings.
“Their experiences in maternity hospitals vary from very good indeed to very difficult and disappointing. One mother was told at her initial scan that her baby looked like a Michelin Man and was asked why she was persisting with a ‘futile pregnancy’.
“She was asked at each appointment to consider abortion and had to keep refusing and eventually she was advised to pick a plot to bury her daughter in. This little girl celebrated her third birthday last week.
“Another mother who refused to abort her baby who had Down syndrome was contacted after each hospital appointment to change her mind and have an abortion. She did not change her mind and gave birth to her daughter last summer.”
Liz continues: “Couples have contacted One Day More after they came home from England after an abortion and told us they had not known of One Day More and would have continued with the pregnancy if they’d been able to access the supports and perinatal care available. This shows how necessary these supports and efforts are and that many couples would not choose abortion if perinatal hospice care was talked about more than abortion.
“Some medical experts try to reassure people that abortion would only be available to women who want it, not to those who do not; they and their babies would be given every care and support throughout pregnancy and birth.
“But we can see from the experiences of women who contact One Day More that they did not receive this kind of support. Instead, they were dealt with insensitively and felt like they were almost causing problems for the hospital they were attending for antenatal care.
“Some of our members’ babies died before birth, some not long after birth. Thankfully, some children are still alive and many are thriving against all predictions and expectations.
“There is a very important point to make about this, which is that medical prognoses can be wrong, and occasionally very wrong. Doctors can’t always accurately predict outcomes and parents of sick babies can be amazed at how much better things turn out for their baby than was thought.
Hope is a vital human instinct and gives us strength and support at various difficult times all through life. Challenging pregnancies are no different and One Day More exists to offer support and hope to parents of very sick and disabled babies before during and after birth.
“As well as providing direct support to parents, One Day More raises funds for better provision of perinatal hospice care; we also provide care boxes for families awaiting the arrival of their baby with a focus on making the time they have together as a family as precious as possible.
“When death is expected, the experience is bittersweet but it’s incredibly uplifting to hear families describe the wonderful memories their time with their baby gave them and how much love they all felt towards each other and the baby. Even babies who don’t live very long can bring with them tremendous gifts which can’t be predicted or quantified but only felt by going through the experience.”
Speaking about her personal experience, Liz says: “I became pregnant with John in early summer 2002. He was my second child. All was fine, as far as I thought and I felt okay, though very tired, having a very active two-year-old daughter.
“I had a routine scan at 24 weeks in mid-December 2002 and on that occasion the nurse said she saw something amiss as she saw “shortened limbs” and couldn’t see hands, though this might be positional, she said. My husband and I had to come back the next day for an in-depth scan and you can imagine how we felt overnight.
“The next day we went into the hospital and a consultant obstetrician carried out a scan which took a good while as he wanted to check everything out and take measurements. I remember just looking away from the scanning machine the whole time, facing the wall. I felt numb and very anxious.
“Afterwards he said these words which I’ll never forget: ‘I’m afraid it’s a very serious abnormality. The baby’s limbs haven’t grown, there are two very short arm buds and I can’t even get a measurement on the legs.’ He then showed us the pictures and described in detail what he saw.
“I remember looking at the baby’s face and thinking he looked like my husband especially round the eyes. He told us it was a little boy. The doctor finished by saying, ‘He’ll never do anything but lie on a bed. I am obliged to tell you that if you want to travel to England it won’t be a problem.’
“I remember instinctively replying that, no I wouldn’t be going to England. I’d just seen my baby’s face and even though I had no idea how I was going to cope, I had no right to interfere with this child’s life in any way. This certainty was instinctive protectiveness more than anything else at that time but I certainly did not relish the prospect of how life would have to change.”
She continues: “I recall feeling jealous of women whose babies were not going to survive as at least their story had a certain beginning, middle and end to it but mine was not going to end soon and the future looked very uncertain and scary.
“I had a number of friends who were expecting babies at the time and all of them had no problems and their babies duly arrived safe and sound and healthy. I did feel very sorry for myself and felt I was living on another planet to everyone else.
“My bump attracted comments like, ‘Gosh, you’re so neat’ and ‘I’m sure you’re all thrilled to be having another baby’. I can identify with all of the harrowing experiences and feelings of isolation which all mothers with difficult pregnancies go through and we can all agree that much more needs to be done for such women and their families too, as the fathers are affected too and don’t know how to process all their emotions.
“I had support from family and friends and I pushed myself to stay connected to the world I lived in rather than go completely in on myself. When times are tough you just dig deep and are frequently surprised at what you can cope with.
We did not receive much in the way of support from the hospital we attended; with one exception, the scan doctor as we called him, all other medical staff appeared unconcerned about us and our baby. We just did what we had to do and I wanted to get the birth out of the way.
“I asked my consultant what would happen when John was born and he said nothing different would happen as there was no reason to think he could not be treated normally. On the day John was born, I went into hospital around 10am and my waters were broken and labour progressed.
“My husband and I were in a room with a student midwife only and a neonatologist came in and spoke about our baby to someone on the phone, saying, ‘Weird case, no limbs’. This is typical of the treatment we received but I was so focused on blocking them all out and getting on with having my baby that I said nothing and restrained my husband from objecting.”
Liz tells the committee: “John was born after 2pm that day. My own consultant told me he was leaving the hospital to go and see other patients in his consulting rooms, if that was okay. At that point I didn’t care who was there or not but I did feel he was choosing not to be present rather than having to leave for some urgent matter. He did not return that day, I recall.
“Right after John was born, a number of doctors descended upon us, standing at the foot of the bed, all in white coats. One of them announced the baby was going to be taken to the Special Care Baby Unit (SCBU) for tests. John wasn’t sick and didn’t need medical intervention at all and I was heartbroken that he couldn’t be with me as I wanted to breastfeed him. But at that moment I was so vulnerable and tired and these total strangers, who looked rather serious and expressionless, were in charge so I didn’t challenge it.
John spent two days in the SCBU and I was in a room on another floor. This was a horrendous time because no provision was made for me and John in terms of comfort and privacy. I had to sit on a waiting room type chair in the middle of the SCBU, feeling in the way with very sick and premature babies all around, who needed the nurses’ full attention. The feeding didn’t go at all well and I was very stressed. I so wanted to give my son this experience of closeness because he could not even use hands and feet to move and comfort himself at all.
“After two days, John was brought down to me and finally we had some privacy and comfort and I was at last able to breastfeed him in peace. It was awkward changing his nappies in the communal changing room. I tried it a few times as it was awkward in the room but silence always fell when I lifted John onto a changing mat so from then on, I just did it in my room. I couldn’t wait to get out of that hospital. No one was nice to us except one doctor.”
Speaking about a vision for future pre-and perinatal care, Liz says: “One Day More, Every Life Counts and places like Hugh’s House represent concrete examples of reaching out to women with very poor prenatal prognosis. But these are a drop in the ocean compared to what could be achieved in the way of supports if our government would undertake research and investment in these areas.
“Women who’ve gone through this know what it’s like and what would help other women; they are a tremendous resource to tap into, if there is the will on the part of government to really look to give women really meaningful support.
“It is very disappointing to see that all through this process and the Citizens’ Assembly, and back the last five years or so, the only focus of political effort has been towards introducing abortion.
“Looking back, I can honestly say the experience of having my son John in 2003 has had a hugely positive impact on me, my family and beyond. I could not have foreseen this at the time I was carrying him of course and that is the nature of life, we can’t predict the future – how things will go, how we will feel and what help we might be able to get down the line.
“It’s a mistake to try and plan these things out because we risk painting a bleaker picture than actually happens, that’s a human tendency and doctors of course feel duty bound to give us the worst case scenario, to avoid unrealistic expectations.
“Deeming people like my son as unworthy of legal protection before birth – is that to become our new definition of progress? It’s certainly what repealing or amending the 8th Amendment would amount to. My story is far from an isolated one. Every day, new stories about women and families feeling pressure to abort emerge.”
Liz continues: “Some people I’m sure find it hard to believe stories the stories I mentioned earlier about pressure from medics to abort babies with special needs. But sadly they are all too real.
“When we try to explain away this pressure, we shouldn’t be surprised when the horror of what I just outlined starts to happen more often. It’s the kind of denial that led to the present situation in England where 90% of babies diagnosed with Down syndrome are now aborted.”
Liz claims abortions can happen up to and even during birth – if a disability wasn’t apparent until that point – in some countries if the woman says she “can’t handle” the diagnosis.
She states: “Last month, the Care Quality Commission in England issued a damning report on abortion providers Marie Stopes. It revealed that staff were being paid bonuses to encourage women to go through with abortions. The inspectors found evidence of a policy in all 70 Marie Stopes clinics in the country directing staff to contact women who had decided not to go through with an abortion, offering them a new appointment.
“This is just one of several recent scandals involving the abortion industry in England and elsewhere. I find it extraordinary that we’re talking about having a referendum in Ireland to introduce abortion and no committee is even looking at what abortion has led to in other countries.”
“Speaking from my own personal experience, I agree with those who say legalised abortion is part of the old order. In the 50 years since it was legalised in England, it has led to millions of babies having their right to life taken from them in a most brutal way and caused a deep, hidden pain for countless women who were betrayed by the sloganeering about “choice” that pretends abortion is without any adverse after effects.
“The Eighth Amendment on the other hand acknowledges the right to life. It doesn’t claim to be its author – merely its protector.
“Those campaigning for repeal of the Eighth Amendment clearly do not regard the right to life as inalienable. Instead they see it as something conferred or withheld by the State based on who the law at any given time deems worthy or unworthy of being protected.
“If we vote to dismantle the Eighth Amendment, we will be saying that we deem certain unborn babies unworthy of legal protection.
“If we vote to keep the Eighth Amendment, we will be recommitting to the goal of making a world that is worthy of the most vulnerable and defenceless members of the human family,” she concludes.
When Noone tells Liz the committee is “indebted” to her for attending as a number of pro-life groups refused to do so, she says she was “in two minds” about appearing.
Responding to Deputy Bernard Durkan, Liz says she and her husband didn’t receive any counselling when they were told about their son’s disability, and were directed to speak to the hospital’s chaplain.
She says she was “often found in a puddle of tears in the corner of a room” due to the situation, stressing the need for better supports for families in this situation.
Liz says babies should not be described as “anomalies” with “fatal” conditions, saying this is insensitive.
Liz says abortions can be “traumatic”, “invasive” and “violent” for women.
She says women instinctively want to nurture their children and “must be dealt with very compassionately” when their baby receives a negative diagnosis.
“I don’t judge or criticise – I fully understand – the fear that creeps in,” Liz says, speaking about why some women consider abortion.
Replying to Deputy Jan O’Sullivan, Liz says hospitals should fully support a woman who decides to carry on with her pregnancy despite a poor prognosis.
Deputy Lisa Chambers adds that the way Liz says she and her husband were treated is unacceptable.
Liz tells the committee there are about 25 people helping to run One Day More, saying the group has reached out to about 20-30 families.
She says the group operates at a grassroots level but could become something “tremendous” if it received investment.
Chambers references the testimony given by Claire Cullen-Delsol of Termination for Medical Reasons Ireland (TFMR) at a committee hearing last month.
Speaking about the death of her daughter Alex in the womb, at the time Claire said her world “fell apart” and hasn’t been the same since. “As the pregnancy progressed, I could feel her getting weaker,” she recalls, noting that she thought her baby died on more than one occasion.
Claire did not travel for an abortion and had to deal with people asking her about her pregnancy, noting: “I couldn’t face the other mams at the school gates.” She developed PTSD as a result of what she went through.
Liz says PTSD could be avoided if women received more support. She says she also had to deal with people asking her when her baby was due, not knowing the reality of the situation. She also recalls an incident where a woman pulled a blanket off her son John and stared at him without saying anything, something that was very upsetting.
Responding to Deputy Peter Fitzpatrick, Liz says she doesn’t believe Ireland can provide the right supports for parents if it also introduces abortion.
“The Eighth Amendment is a positive, life-saving measure,” she states.
Fitzpatrick says it’s a tragedy that some women have abortions without knowing about perinatal hospice care. Liz agrees that this type of care needs to be developed and better promoted here.
Deputy Louise O’Reilly says women should not be directed to have an abortion, but nor is it right that women should be forced to continue with a pregnancy against their will.
“How they feel is how they feel, if they have the right to feel it is not really for me to say,” Liz replies.
Referring to Claire Cullen-Delsol’s experience of PTSD, Liz says this may not have happened had she been better supported at the time. She says PTSD can also be a consequence of having an abortion.
When Liz mentions that she works with Gianna Care, O’Reilly notes that they’re based in the same Dublin office as Ask Majella. Earlier this year an investigation by The Times newspaper found that Ask Majella incorrectly told women abortion causes breast cancer and can lead to suicidal tendencies.
Deputy Catherine Murphy says the way Liz and her husband were treated is an area of concern. She notes that TFMR previously told the committee “you can’t change the diagnosis, but you can change the way people are treated”.
Liz says investment and research is needed in order to improve support for women who are facing an “uncertain and scary” path.
She says her desire is that abortion is made redundant as an option due to the level of support available.
Deputy Clare Daly asks if women should have the option of having an abortion in Ireland, where they can be surrounded by their loved ones.
Liz says there is no right answer to this and “it’s very difficult to airbrush [a baby's life] out of the whole narrative”.
She says she has considered what life would have been like had she had an abortion, noting it would have been easier in some ways, but that ultimately her son’s life was not hers to end.
She says if she aborted him she would have missed moments such as him “rolling over at four months and smiling at me” or his sixth class teacher writing a poem about him.
Daly says she doesn’t think anyone would criticise Liz’s decision, but equally women who decide to have an abortion should also be respected and supported. She says medical evidence shows that abortion is not “violent”, as Liz earlier stated, adding that the foetus doesn’t feel pain before 24 weeks.
Deputy Bríd Smith asks why parents, like Liz and her husband, who are critical of how hospitals treated them don’t make official complaints.
Liz says this is too upsetting for many parents, stating: “You just don’t want to go back there … You’re very vulnerable.”
Smith asks if abortion services should be “free, safe and legal” rather than privatised with a view to making profits, after Liz raised the issue of how much money private clinics make. Liz disagrees.
Responding to Senator Rónán Mullen, Liz says it’s “insulting” to use terms such as fatal foetal abnormality when talking about human beings.
She says only one doctor dealt with her compassionately at the time, adding that this meant so much to her.
Liz says it’s “inevitable” that more Irish women will have abortions if it’s legalised here, saying some will choose this option as the supports aren’t there to help them continue their pregnancy.
Mullen also says the committee hasn’t heard enough evidence on what stage a foetus starts to feel pain, referring to comments made by Clare Daly.
The hearing is currently suspended while a Dáil vote takes place.
I’ll be handing over to my colleague Rónán Duffy shortly. He’ll keep you up to date with the rest of the evening’s proceedings. Thanks for staying with us so far.
Hi, Rónán Duffy here to take you into the evening.
The committee returned briefly before suspending again as witness Liz McDermott of One Day More has not yet returned.
Catherine Noone begins with a letter from Dr Abigail Aiken who gave evidence before the committee last week.
Aiken spoke about research into how women felt after their abortions. She said that women may feel both positive and negative feelings.
“It is critical to recognise that positive feelings happened much more regularly than negative feelings,” according to Aiken’s letter.
Noone then says the committee will “suspend briefly” again until McDermott returns.
The session has resumed and Deputy Kate O’Connell is asking Liz about how her son John is now. Liz thanks her for that and notes her son is 14 years old.
O’Connell says that additional supports are now available compared with when she had her bad experience.
“I remember getting my own letter for an anomaly scan and not knowing what that was,” O’Connell says of her own experience of pregnancy.
O’Connell says she had a “different experience” when a scan during her second pregnancy revealed a complex physical defect.
She says she asked the doctor whether it may be grounds for a termination. The doctor said it was not.
O’Connell says, had the defect been combined with a genetic defect, it may have been a fatal defect. She says her son is now seven years old.
O’Connell notes that both she and Liz decided to proceed with their pregnancies, but that others may not have that option.
“Do you think we could be more compassionate to women who may not be in as fortunate a position as you or I?,” she asks.
Liz says she does feel that there is a “spectrum” of situations women have to deal with but she does not feel that legislating for abortion is the answer.
“There are always more compassionate responses,” she says.
Hildegarde Naughton is speaking about about the case of a woman who dearly wants a baby but doesn’t feel she can cope with a diagnosis of a fatal foetal abnormality.
This, she says, would be after receiving counselling and discussing it with her partner.
Liz says she does not want to get into the case of hypotheticals.
“The common good must always be legislated for,” Liz says, and adds that an abortion “is not really a solution for a baby”.
Mattie McGrath is again thanking Liz for appearing and notes that she has given a different viewpoint to the committee.
McGrath asks if it is ever the case that it is “cruel” to ask a woman to continue a pregnancy after a diagnosis of a fatal foetal abnormality.
“It’s not about forcing,” Liz says. “It’s about being compassionate and humane to both patients, and to encourage the women to bond with the baby and believe in herself.”
McGrath asks Liz about the terminology used in such cases.
“The language around children who have something wrong with them, like fatal foetal abnormality, it can’t help but dehumanise them,” Liz says.
She compares it to when children with disabilities were described as “mongols” or “spastics” in political debates during previous decades.
At the request of McGrath, Liz reads a poem about her son written by his sixth class teacher.
The poem includes a line about her son using “blue steel”. She thought it was a cartoon reference before Senator Rónán Mullen corrects her.
“I think ‘blue steel’ is the intellectual property of Mr Zoolander,” Mullen says, before Noone moves things along.
Senator Ned O’Sullivan notes that Liz made a very strong choice but he doesn’t think she ever had a doubt about her choice. He says he supports the choice she made.
“Do you not think that the same sense of compassion should be shown to people who have made a different choice?,” he asks.
He also wants to know when she began campaigning on her pro-life position. She says that her convictions about the issue stem from her experience.
On the question about women who may make a different choice to hers, Liz says she does not view it as a choice when a woman is pregnant with a child.
She says she feels that when the UK’s abortion laws were constructed the science of pregnancy was less advanced.
Anne Rabbitte TD says the “biggest battle” she has faced is when she has been forced to consider that the risk to the life of the mother is impacting on the rights of the child.
She says that mothers may have other children or have the possibility of having other children and that this is important.
In response to questions from Deputy Jonathan O’Brien, Liz says it is stated government policy in Denmark to eradicate Down syndrome in society.
TheJournal.ie has previously looked at this claim and determined that, while the number of children born with Down syndrome in Denmark is so low it may be eradicated in the coming decades, it could not be said that there is a policy to eradicate the condition.
Senator Paul Gavan, the final questioner, says he is conscious of time so he wants to ask some direct questions.
He asks Liz about a statement she made that no women are “forced” to travel for an abortion.
“If they want a termination, is it not fair to say they have no choice but to travel?,” Gavan asks.
Liz says: “A lot of the women would not be able to see a way to have their child.
A lot of women don’t have supports, that’s why they travel.
“The geography, where that happens, is missing the point,” she adds.
Liz says she “does not want to say that women are incapable of making a decision” but that during pregnancy women are dealing with a lot of hormones that might influence their decision.
That concludes today’s proceedings, chairperson Catherine Noone again thanks Liz McDermott for attending.
“The point of view you represent, you have done a service to them by turning up,” Noone says.
The committee is adjourned until 2pm tomorrow when we will return with another liveblog.
Thanks for joining us.