Today’s hearing focused on mental health, and medical and international law.
Hello, it’s Órla Ryan here. Welcome to today’s liveblog of the Oireachtas Eighth Amendment Committee.
The agenda for the meeting is as follows:
- Session A: International legal/services context [Dr Gilda Sedgh, Principal Research Scientist, the Guttmacher Institute; Leah Hoctor, Regional Director for Europe, Center for Reproductive Rights, US]
- Session B: Medical law review [Dr Ruth Fletcher, Senior Lecturer in Medical Law, Queen Mary University, London]
- Session C: Risks to mental health [Dr Anthony McCarthy, Consultant Perinatal Psychiatrist, National Maternity Hospital, Holles Street, Dublin]
You can watch proceedings below:
Today’s hearing is set to begin shortly.
While we wait, here’s a round-up of what happened at the last meeting on 25 October – it focused on mental health, termination arising from rape and and termination in cases of foetal abnormality.
We will be sending out an email round-up of what happens at the committee later today.
To get the weekly round-up, just enter your email in the box at the bottom of this article.
Committee chairperson Catherine Noone has started today’s proceedings, noting that 12 items of correspondence have been received by the committee.
One of these is a letter from Renua. Noone says the party will not be invited to attend a future hearing as: “They’re a political party as opposed to an expert witness.”
Letters from Dr Martin McCaffrey, a Professor of Pediatrics at the University of North Carolina, and pro-life group Both Lives Matter will be published on the committee’s website.
Noone says the committee has not decided that the Eighth Amendment should be repealed, as suggested by some pro-life advocates and groups. She says the committee has decided it should not be retained in full.
Senator Rónán Mullen is critical that the letters won’t be read out. Noone says it’s regrettable that certain people are not appearing before the committee. She notes that witnesses are waiting to be heard and tries to move proceedings on.
Deputy Bernard Durkan says he agrees with Mullen. He notes he is “not in favour of abortion” but wants to hear differing views on the subject.
Deputy Mattie McGrath also calls for the letters to be read into the record.
Three weeks ago, 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 Senator Rónán Mullen and Deputy Mattie McGrath (both independent) and Fine Gael’s Peter Fitzpatrick. The two abstentions were Fianna Fáil TDs James Browne and Anne Rabbitte.
McGrath has today said this vote was like a jury deciding on a verdict halfway through the trial.
In his letter explaining why he would not be attending the committee, Dr McCaffrey wrote: “Over the past weekend I discovered that the Oireachtas Committee had, on October 18th, already taken the crucial vote to repeal the Eighth.
“I’m not sure many can imagine my reaction. It was clear then that the late invitation for my testimony, only issued after the vote on repeal had already been taken, was a retrospective effort to attempt to offer some illusion of balance to the Oireachtas hearings.
“It is with great regret that I will be respectfully declining the invitation to offer testimony to the Committee. I will not partake in a charade which has already reached its preordained conclusion by offering testimony which some might be led to misinterpret as indicative of the Committee’s deliberative objectivity.
In reviewing the proceedings, testimony and transcripts from records on the Committee website one can only conclude that the Oireachtas Committee on the Eighth is a ‘kangaroo court’.
“As disturbing is that it appears most Committee members did not see the need for a fair hearing for such a momentous issue as the repeal of the Eighth Amendment, but were satisfied with the prejudiced process that took place. I hope that the Irish people will not be deceived by such theater [sic].”
Deputy Bríd Smith and Senator Lynn Ruane say they agree with Noone, noting that if people have refused to appear before the committee their letters should not be read out. The letters will be available online for anyone who wants to read them, Smith notes.
McGrath is trying to call for a vote on the letters being read to take place.
Noone says he can’t, noting she is the chair of the committee. She says the committee will return to the topic later on.Source: TheJournal.ie/YouTube
The meeting is being suspended for five minute to allow witnesses to take their seats.
Dr Gilda Sedgh, Principal Research Scientist at the Guttmacher Institute in the US, is now giving her opening statement.
She notes: “We estimate that worldwide, about 56 million abortions took place each year in 2010 to 2014. The annual number of abortions has increased slightly since the early 1990s.
“It can be more useful to talk about how many abortions take place for every thousand women of childbearing age. This is because the absolute number of abortions can increase as the number of women in a population increases, but the number of abortions for every 1,000 women, also known as the abortion rate, is not influenced by the size of the population.
The 56 million abortions that take place each year translate to 35 abortions for every 1,000 women of childbearing age. Another way of saying this is that roughly 3.5% of women of childbearing age have an abortion each year, globally. The global abortion rate has declined slightly over the past 25 years.
“We have also estimated abortion incidence across the 17 major subregions of the world. We were not able to estimate incidence for every individual country because we did not have enough data on which to base country estimates.”
Dr Sedgh continues: “Globally, when we grouped countries according to their abortion laws, we found that, on average, the abortion rate in countries where the procedure is prohibited altogether or allowed only to save a woman’s life is not significantly different from the rate in countries where abortion is allowed without restriction as to reason…
“We estimated that about 73% of all abortions worldwide are obtained by married women, and 27% are obtained by unmarried women. In the developed world, about 69% of the abortions are obtained by married women.”
Dr Sedgh says the World Health Organization (WHO) defines safe abortions as “those that are done by a trained person and using methods appropriate for the gestational age of the pregnancy”.
“Less safe abortions are those for which only one of these criteria are met, and least safe abortions are those for which neither of these two criteria are met.
About 31% of abortions are in the least safe category in countries where abortion is illegal on all grounds or only allowed to save a woman’s life or preserve her physical health; less than 1% are in the least safe category in countries where abortion is permitted without restriction as to reason.
“We also found that abortions are also more likely to be unsafe in low income countries than in high income countries,” she states.
Speaking about the age at which women have abortions, Dr Sedgh notes: “The abortion rate is lower among adolescents than among women in their 20s and 30s.
“In almost all of these countries, adolescents’ share of all abortions has decreased since the 1990s. In the countries that further break down the ages of women into smaller windows, the majority of adolescents’ abortions are obtained by 18-19 year olds.
Dr Sedgh says, according to evidence compiled from 15 countries (European countries, the US and New Zealand):
- 48-74% of women who obtained an abortion already had at least one child;
- In all but two of these countries, more than half of women obtaining an abortion already had at least one child.”
Based on preliminary findings of research by the Guttmacher Institute, she says 90% or more of abortions are obtained in the first trimester.
Dr Sedgh says women “obtain abortions for a wide variety of reasons”.
“For example in Belgium, about one-fourth of women said they sought an abortion for socioeconomic reasons, and another one-fourth had an abortion for partner-related reasons – for example, their partner didn’t want to have a child or their relationship was dissolving.
“About 18% wanted to space their children or postpone having a child, and another 13% already had as many children as they wanted or could manage. About 1% said they were having an abortion because of issues related to the health of the foetus. In the other three countries, less than 1% of all abortions were for reasons related to foetal health.
“In a survey in the United States, women who had an abortion were asked to indicate all of their reasons for having the abortion. And an interesting take away message from this survey is that many women gave more than one reason. Financial issues, wanting to space or delay childbearing and partner-related issues remained common. About 30% of women said they sought an abortion because they needed to focus on the children that they already had.”
Speaking about international abortion access, Dr Sedgh states: “Some 75 of all countries allow abortion without restriction as to reason or for socioeconomic reasons; 58 countries allow abortion to preserve a woman’s physical or mental health, and 40 allow abortion to save a woman’s life. Ireland is one of these 40 countries.
“In 26 countries, abortion is not allowed for any reason, though some of these countries make exceptions in cases of rape, incest, or foetal anomaly.
“Looking now at just the 50 developed countries (using United Nations’ classification of countries according to whether they are developed or developing), 41 of these countries allow abortion without restriction as to reason or for socioeconomic reasons, five allow abortion to preserve a woman’s physical or mental health, one –Ireland – allows abortion to save a woman’s life, and three (Andorra, Malta and San Marino) do not allow abortion on any grounds.”
Leah Hoctor, Regional Director for Europe, Center for Reproductive Rights, is now giving her opening statement.
Hoctor notes that the centre’s work in regard to Ireland “has focused on representing Amanda Mellet and Siobhán Whelan in relation to their complaints to the United Nations Human Rights Committee, filed in 2013 and 2014, and the decisions issued by the Human Rights Committee in 2016 and 2017…
“In both decisions, the Human Rights Committee held that Ireland is obliged under international treaties to provide effective remedies and full reparation to Ms Mellet and Ms Whelan. It detailed that these remedies must entail compensation, psychological support services, and reform of Irish abortion law, including if necessary the Constitution, in order to prevent similar violations from occurring in the future.”
In relation to the standard legal approach to abortion in Europe, Hoctor tells the committee:
Hoctor states: “Of the 40 European countries that have legalised abortion on a woman’s request or on broad socioeconomic or psychological grounds, the vast majority – 36 countries – have legalised abortion on a woman’s request, either without restriction as to reason or for reasons of distress or social circumstances, within a specific time limit.
These countries are:
- Bosnia Herzegovina,
- Czech Republic,
“In the vast majority of these 36 countries, women do not need to give any reason when they request an abortion. However in a small number of these countries women must explain that they are seeking an abortion because of social or family circumstances or because continuing the pregnancy would cause them distress.”
In terms of time limits, Hoctor notes: “12 weeks is the most common time limit.”
Hoctor continues: “As outlined, of the 40 European countries that have legalised abortion on a woman’s request or on broad socioeconomic or psychological grounds, 36 of them have legalised abortion on a woman’s request within a specific time limit.
“However the remaining four of these 40 countries have not legalised women’s access to abortion on request and instead their laws specify that certain socioeconomic or psychological reasons must exist and be certified by medical professionals or other specialists.
“In each of these countries the socioeconomic or psychological reasons are broadly framed and the time limit varies:
Finland and Iceland:
- Reasons: Personal, social or family situation.
- Time limit: 12-weeks (Finland) and 12-16 weeks (Iceland).
- Reason: Pregnancy involves a risk, greater than if the pregnancy were terminated, of injury to the physical or mental health of a woman or any existing children in her family. Account may be taken of a woman’s actual or reasonably foreseeable environment.
- Time limit: 24-weeks.
- Reason: Continuation of the pregnancy would mean that physical, mental, or psychological injury would be suffered by a pregnant woman or by any existing child she may have, greater than if the pregnancy were terminated.
- Time limit: No limit.”
Hoctor notes: “While the legal terminology used can differ, almost all these laws implicitly or explicitly allow abortion when a woman’s health is at risk. The vast majority of these laws do not specify a time limit for this ground.
“Again, although terminology differs across jurisdictions, abortion in situations of serious and/or fatal foetal impairment is allowed, explicitly or implicitly, by almost all of these countries’ laws.
“In all of the 36 European countries that have legalised abortion on a woman’s request, women who are pregnant as a result of sexual assault can access abortion within the relevant time limit under the request ground.
“While terminology differs, laws in the other half of these 40 countries do explicitly outline sexual assault as a separate ground for legal access to abortion. In many of these countries a later time limit is assigned than that prescribed for abortion on the grounds of a woman’s request or broad socioeconomic or psychological reasons.”
Deputy Billy Kelleher is asking about the father’s role in deciding on an abortion.
Hoctor says she thinks Turkey is the only one of the 40 countries she has mentioned where the father needs to sign off on an abortion in the case of a married couple.
Senator Rónán Mullen notes that advocacy groups are not meant to be appearing before the committee, and so questions the presence of Hoctor, given the Center for Reproductive Rights’ pro-choice stance.
Hoctor says she wasn’t surprised (as Mullen put it) to be asked to appear before the committee, given the centre’s expertise on the subject.
Responding to Deputy Hildegarde Naughton, Dr Sedgh says many of the 10% or so of abortions that happen after the first trimester are due to risks to foetal health and foetal life.
She adds that many later abortions are sought by adolescents, often due to barriers in accessing abortion, or the fact they may not have known they were pregnant or have been too afraid to seek help.
Dr Sedgh notes the role sexual education can play in this, as does the availability and quality of services.
Speaking about ‘the floodgate opening’ if abortion is legalised in a country, Hoctor says there isn’t a correlation between the availability of abortion and rates of abortion going up. She says legalising the practice makes it safer, noting the amount of women and girls who travel to the UK for terminations.
Hoctor says it’s “almost unheard of” to address abortion in a Constitution, as is the case in Ireland and a number of South American and African countries.
Responding to Deputy Catherine Murphy, Hoctor says she understands that women in Poland and Malta (two countries that have strict abortion laws) travel to other jurisdictions or access abortion pills, in the same way Irish women and girls do.
Hoctor says, in general, women in Poland have less money to travel and often turn to abortion pills or have unsafe abortions.
Responding to Deputy Lisa Chambers, Hoctor notes that referenda on abortion took place in Switzerland and Portugal, leading to changes in law.
“Our sense would be that Europe is watching and waiting,” Hoctor says in relation to Irish legislation.
Senator Ned O’Sullivan says he was surprised by the statistic mentioned earlier that noted about 73% of all abortions worldwide are obtained by married women, while 27% are obtained by unmarried women. (In the developed world, about 69% of the abortions are obtained by married women.)
Dr Sedgh agrees that this figure is “surprising” and says it’s “interesting” so much of the focus of the abortion debate is on unmarried women, despite the fact they don’t account for most cases of terminations.
On a separate point, she notes that unsafe abortions don’t happen as often in Ireland as in other countries because women and girls here usually have the option to travel to the UK or the Netherlands.
Deputy Bernard Durkan says he’s “a bit uneasy” with the idea that Europe is watching us and waiting for us to change our abortion laws, adding that Ireland is in turn watching Europe in relation to a number of issues.
Responding to Durkan, Hoctor notes that, under international regulation, human rights begin at birth.
When pressed by Durkan on the subject, she reads out this line from the preamble of the UN Declaration of the Rights of the Child: “The child, by reason of his physical and mental immaturity, needs special safeguards and care, including appropriate legal protection, before as well as after birth.”
She reiterates that human rights law provisions begin at birth – not prenatally, adding that the human rights legal approach is that women’s rights are violated when there is no access to abortion.
Responding to Deputy Mattie McGrath, Hoctor says the UN Committee on the Rights of Persons with Disabilities has never expressed any concerns about women being legally allowed to access sexual and reproductive services including abortion.
McGrath is now questioning use of the terms “fatal foetal abnormalities” and “incompatible with life”, noting some parents whose children survived such diagnoses disagree with these phrases being used.
Hoctor says they are commonly used clinical terms.
Responding to Deputy Bríd Smith, Dr Sedgh agrees that, as some women and girls who travel from Ireland to the UK or elsewhere for an abortion don’t given their address, it’s unclear how many females have done this, and what their reasons for having a termination are.
She notes that, based on the stats we do have, most women having terminations in the UK do so in the first 13 weeks of their pregnancy.
Peter Fitzpatrick asks Hoctor if she ever criticises any aspect of the abortion industry.
He mentions an allegation that Marie Stopes International, one of the UK’s biggest abortion providers, pays staff bonuses for encouraging women to have terminations.
The organisation has previously said this claim is untrue.
Hoctor says she is not aware of this practice taking place.
Deputy Kate O’Connell is asking if other countries have had a similar debate about placing equal weight on the unborn and a woman who is already “walking around”.
Hoctor says no other European country places an equal constitutional importance on both, but she believes the Philippines does.
Responding to Deputy Jonathan O’Brien, Hoctor says, generally speaking, countries where women can access abortion have lower maternal mortality rates.
Fitzpatrick notes that Dr Sedgh’s employer Guttmacher Institute previously had links with Planned Parenthood, a non-profit organisation that provides reproductive health care – including abortions – in the United States and globally.
He asks her if she believes any lives have been saved by the Eighth Amendment.
Dr Sedgh says she’s not sure if abortions have been prevented due to the amendment, and that estimates on the number of lives saved by the Eight – often purported to be 100,000 – are dubious.
“You’re asking me to take a position on whether a termination is the end of a life, that’s not something on which the institute has taken a position,” she says.
Fitzpatrick says he’s disappointed with her answer.
When O’Brien says an organisation, without naming it, will be coming before the committee to discuss the number of lives said to be saved by the Eighth, Noone says they actually aren’t.
He says it’s worth noting the Eighth has also resulted in loss of life.
The hearing has now moved on to session two, which will focus on medical law.
Dr Ruth Fletcher, Senior Lecturer in Medical Law from Queen Mary University in London, is now giving her opening statement.
“I have been asked to focus on the key issues in legislating for the Citizens’ Assembly (CA) recommendations. I have done this by considering how key aspects of the recommendations may be practically implemented in light of best international legal practice…
“If lawful criteria for abortion in line with the CA recommendations, or equivalent, are to be adopted, then it is probably best to repeal and replace the Protection of Life During Pregnancy Act 2013 (PLDPA) as a whole with a Reproductive Health and Access to Abortion Act, rather than amend the PLDPA and repeal the criminal provisions alone.
“The process of adopting a new Act will still enable learning from the experience of adopting and implementing the PLDPA, but the difference between the criteria for legalisation justifies a new Act. Secondly, repealing and replacing the Act provides for a simpler process of working with the Act afterwards, as amending would mean working with two statutes thereafter,” Dr Fletcher states.
Dr Fletcher continues: “Decriminalisation means removing the kind of law that punishes people from the range of legal tools, which regulate abortion care. It does not mean deregulation and it does not mean legalisation.
“Abortion can be decriminalised and regulated by civil law standards of care and by professional regulation, including with the possibility of being sued in negligence for damages due to failure to meet those standards of care.
“Abortion can be decriminalised, but unlawful in particular circumstances ie if it falls outside the criteria for lawfulness as proposed in this Bill. Information, licensing and funding often work well as regulatory tools which oversee the boundary between lawfulness and unlawfulness in health care provision, and provide a viable public alternative to the criminal law.
“There is increasing recognition that criminalisation is a disproportionate response to any need to regulate the boundaries of abortion care, even if most countries still have criminal provisions.
“This is partly in response to recent prosecutions and convictions including in three different cases in Northern Ireland. One of these cases concerns the mother of a 15-year-old who ordered the abortion pill for her daughter over the internet.
“It is being challenged by judicial review on the grounds that the prosecution was inappropriate because the 15-year-old should have had lawful access to abortion in Northern Ireland in her circumstances…
“There are opportunities for professional guidelines, such as the Nursing and Midwifery Board of Ireland’s Code of Professional Conduct and Ethics (2014), to build on the Guarantee of Access [overseen by the Minister for Health], and for the relevant regulatory and professional bodies to consider whether the delivery of medical and surgical abortion care is an area where an expansion in [nurses and midwives] scope of practice would lead to improvements in patient outcomes and in the quality and range of available services.
“Enabling appropriately trained nurses and midwives to deliver medical and surgical abortion is one way of improving the delivery of locally accessible services, possibly at lower cost, in a way that is acceptable to patients (see further Sheldon and Fletcher 2017).”
Dr Fletcher says ‘on request’ abortion models make it more likely that terminations will take place earlier.
She notes that, while the unborn deserve respect, they do not deserve the same rights as women.
Senator Rónán Mullen then asks if infanticide is viewed in the same way as abortion, given the result is a child dies.
Responding to Deputy Hildegarde Naughton, Dr Fletcher notes that in Spain “statutory language does say we want to respect prenatal life”, but has decided the best way to do this is through good reproductive healthcare.
Responding to Senator Lynn Ruane, Dr Fletcher notes that law is “a complex toolbox” and “not black and white”.
“With the PLDPA (Protection of Life During Pregnancy Act) we have seen some non-delivery of abortion care that seemed to meet legal grounds.
“The interpretation of legal grounds needs to be guided by professionals and a code of practice to make sure they’re implemented,” she states.
Deputy Bernard Durkan notes that some women change their minds in relation to wanting an abortion, and cites research in which women said they felt alone and sad after an abortion.
Dr Fletcher says she’s not aware of the research he’s speaking of. She says the feelings women generally say they experience after a termination tend to be “relief and positive emotions”.
When women do say they feel regret, it’s usually to do with how they got pregnant, not the fact they had an abortion, Dr Fletcher states.
She notes that some women need support and counselling pre- and post-abortion.
Responding to Deputy Jan O’Sullivan, Dr Fletcher says it would be clearer if the PLDPA is repealed and replaced with new legislation, rather than trying to operate under two acts.
O’Sullivan makes the point that all committee members have been denied the opportunity to ask detailed questions of pro-life witnesses because they have chosen not to attend, adding this is frustrating for both pro-life and pro-choice members.
Responding to Deputy Clare Daly, Dr Fletcher says “given it’s a big transition” that would have an impact on the delivery of care, it would be more straightforward to create a new Act dealing with abortion access, rather than amending current legislation.
Fletcher notes that for some people the value of prenatal life grows with the gestational period, adding that an ‘on demand’ abortion system would encourage earlier abortions.
She adds that by restricting abortion access “you’re not achieving protection of prenatal life” as it delays women accessing terminations, rather than stops them completely.
After a break, the third session of today’s hearing is now under way. It will focus on mental health.
Dr Anthony McCarthy, Consultant Perinatal Psychiatrist, National Maternity Hospital, Holles Street, Dublin, is now delivering his opening statement.
“I have worked as a Consultant Perinatal Psychiatrist at the National Maternity Hospital in Holles Street for the past 21 years where over 500 women attend the clinic each year.
“Women are seen who are pregnant or who are in the first six months post pregnancy, (which includes pregnancy loss), and where a significant mental health issue is involved.
“Women attending may have a previous mental health history or a significant new crisis may develop during or after the pregnancy. Amongst those who attend will be many who have suffered a miscarriage. Others may have had a stillbirth or may have a baby diagnosed with a significant abnormality, of varying levels of severity, or may have had a previous termination or may be considering a termination.”
Dr McCarthy notes he has previously spoken as an expert witness at the two Oireachtas hearings which led to the introduction of the Protection of Life During Pregnancy Act, and also spoke as an expert witness at the Citizens’ Assembly.
Dr McCarthy continues: “So what can I say now after all of these years of working in this area, and from my understanding of relevant research, and of history. That while having a baby is, hopefully, and fortunately for many, one of the most joyful and rewarding and meaningful experiences of their lives, as you all know, it is also unfortunately often not like this.
“You know this from your own lives, those of your families and friends, and also of course from listening to many of the stories told here to this Committee and to the Citizens’ Assembly.
“Most of you have heard of or personally witnessed stories of depression or distress, of unwanted pregnancies, of rape, or the discovery of major foetal abnormalities, or of the termination of pregnancies in the UK and here in Ireland. These are stories heard so regularly also in my clinic in Holles Street.
Abortion. Oh yes, in an ideal world it would never be needed or requested. But even if we exclude medical emergencies and severe life-threatening indications, we cannot wish abortion away.
“It has been a part of the history of every country, including Ireland. And before it became legally available in the UK 50 years ago, and therefore available for thousands of Irish women every year since, it was illegally available here in Ireland for those who could pay. And, of course, there was infanticide too which was such a widespread practice … We don’t want to go back to an era of illegal backstreet abortions and infanticide.”
He states: “In my clinical work, of course, most of the women who I see for whom a termination of pregnancy is an issue, they are seeing me because of their or sometimes their partner’s concern about their mental health.
“Sometimes that termination could potentially be very damaging for them. For example, a woman who has a planned and much wanted pregnancy, but who develops severe depression which is clearly clouding her judgement about everything in her life, and not just the pregnancy, keeps thinking that she should terminate because she would be a bad mother.
“She needs expert help for her depression. A termination is almost certainly not what she wants and could be very damaging to her mental health. But, for another, she is clear that she cannot continue the pregnancy, she cannot cope and continuing the pregnancy would destroy her life. She is not mentally unwell but may be terrified of becoming unwell.
“How any woman responds to a pregnancy is so personal to her. How she visualises and imagines what is or is not growing inside of her is unique. For example, one woman who has an early miscarriage will say that what she lost was a pregnancy for her, not a baby, that she knows it happens in one in five of all pregnancies anyway, it’s just nature’s way, and it was just like a heavy period.
“For another, she may have a huge sense of loss of a baby, name it and grieve for it, even if the scan actually showed a so-called ‘empty sac’, or even if she has had a rare molar pregnancy where there was only ever placental tissue and no fetus but her pregnancy tests were repeatedly positive.
“It is these sorts of inner perceptions and beliefs and imaginings that determine so much, and often more so than any biological reality. It is part of what makes us human.”
“One woman with a baby with a fatal foetal abnormality may decide that she/they want to continue the pregnancy because she feels she wants to hold onto that baby inside of her as long as possible, and she hopes that the baby will die inside of her, and not shortly after, as it is safe and warm inside of her.
“Another will feel she can’t bear to think of the baby suffocating inside of her, or being in pain, or the distress of it dying inside of her. Another will say she wants the baby delivered early and hopefully alive still so that she/they will be holding the baby for a few minutes before it dies. As doctors we must be aware of the complexities involved for everyone, and listen and not prejudge,” Dr McCarthy states.
In terms of mental health, Dr McCarthy notes: “The best overall publication in this area was by the Academy of Medical Royal Colleges in the UK. They published a systematic review of the mental health outcomes of induced abortion in which they reviewed all of the research evidence available and critically analysed all published research which reached basic scientific standards.
Their key findings were that:
- An unwanted pregnancy was associated with an increased risk of mental health problems
- That the rates of mental health problems in unwanted pregnancies were the same after termination or after giving birth
- That the most reliable predictor of post-abortion mental health problems was having mental health problems before the abortion
- That, in addition, women who were pressurised to have a termination, and women who were exposed to strongly negative attitudes towards abortion in general, and to her personal experience, were likely to have worse outcomes
“However, for any and every woman who might seek mental health advice in this situation, it will be the specifics of her individual situation, and her distress and her history, and her personal beliefs and wishes, and often her partners too, which must be listened to and understood. The research evidence is helpful in general, but never specific to any individual life situation.
“The dilemmas for women in such difficult situations will always be painful and distressing. I consider it my responsibility as a psychiatrist not to add to their pain and distress. I hope the committee will be of the same view.”
Responding to Senator Rónán Mullen, Dr McCarthy says it is “certainly not” his job to encourage someone to have an abortion, rather help them find the best path for them.
Mullen describes the current abortion system in the UK as “somewhat horrific”. He asks Dr McCarthy if he has a duty of care towards the baby as well as the woman. Dr McCarthy says he does – noting it’s legally set out. He adds that most women who come to him are seeking advice regarding medication.
Mullen cites research by Professor David Fergusson from the Department of Psychological Medicine of the University of Otago in Christchurch, New Zealand, that states there is no evidence that abortion has a therapeutic effect.
Dr McCarthy says the paper Mullen is referring to is “very good”. He states: “Pregnancy itself is a risk to mental health, that the reason I’ve a very busy service at the National Maternity Hospital.”
He says women are 19 times more likely to be admitted to psychiatric facility in the six weeks after the birth of her baby than any other six-week period in their life. He notes that women may need support regarding their mental health during their pregnancy and after a termination if they choose to have one.
Dr McCarthy says: “Some feminists would say that women’s mental health problems have been caused by men,” before Mullen adds: ”Some men!” to laughter (including his own).
McCarthy says there is an attitude today that everyone needs counselling, such as when they’ve been bereaved, describing this as “rubbish”.
He says people who genuinely want counselling should get access to it, but it’s not something that should be forced on people either.
McCarthy says asking women or girls to see a psychiatrist before allowing them to have an abortion is unfair.
Responding to Senator Paul Gavan, Dr McCarthy says the “ludicrous” idea that many women would pretend to be suicidal to “fool” psychiatrists into letting them having an abortion has been proven to be false.
He says one woman has presented to him since the PLDPA was passed in 2013, adding: “That’s not how it works in the real world.”
Dr McCarthy says his personal views on abortion are irrelevant as “the women who I’m seeing [in my clinic] are going to have an abortion”, regardless of what he thinks.
“They’re either going to have it here or they’re going to buy tablets or they’re going to travel.”
Senator Lynn Ruane questions Senator Rónán Mullen using the phrase “the type of person they were before” in relation to pregnant women presenting to doctors with mental health issues, noting she herself has done this.
She says they are the same person they always have been.
Mullen is not impressed by this, saying he’s being “sniped” at by a colleague. He says if he hadn’t been in the room to defend himself, “The media would be left with the notion that I had some kind of bad attitude.”
Chair Senator Catherine Noone tries to restore order, saying: “If ye want to have a row, will you please take it outside.”
Responding to Deputy Louise O’Reilly, Dr McCarthy says most women who want an abortion will not go through the Irish system set out under the PLDPA as it’s easier to go to the UK.
He reiterates that women shouldn’t have to go to a psychiatrist to have their mental health graded before they can have a termination.
Deputy Peter Fitzpatrick brings up women who regret their abortions, noting the case of Miss C.
Fitzpatrick asks if women are being made aware of the potential mental health implications of having an abortion.
Dr McCarthy says women are aware of the potential risks to their mental health that could arise from carrying on with a pregnancy or having an abortion.
Deputy Kate O’Connell notes that the author of research cited by Mullen earlier (Professor David Fergusson) – which stated there is no evidence that abortion has a therapeutic effect – has said there are limitations to his work and has asked that certain conclusions are not drawn from it.
She says committee members need to be “called out” at times.
Dr McCarthy says the Fergusson study is a good one, but agrees it has limitations and “major flaws”.
He notes that abortion isn’t good for a woman’s mental health, but neither is pregnancy … or marriage (this last point was in jest, in case you were wondering).
On another note, Dr McCarthy says a pregnant woman should not be detained by doctors unless she has a major mental health issue.
Responding to Deputy Catherine Murphy, Dr McCarthy recalls an experience where a woman told him that the day of the abortion of her “much wanted baby” was a lot calmer than the weeks leading up to it, given how “kind” and “non-judgemental” the medical staff were.
Murphy says it’s wrong that Irish women can’t access this kind of care in their own country.
Mattie McGrath is now questioning Dr McCarthy’s claim that someone at a previous Oireachtas committee, ahead of the PLDPA, said “busloads” of women would pretend to be suicidal to get access to abortion.
McCarthy says he doesn’t recall who said it but that it was stated. McGrath asks him to check who said it and get back to him.
McCarthy says he’s never treated a woman who didn’t have an abortion because she couldn’t leave Ireland, but notes that other doctors may have – noting it’s more difficult for certain groups such as migrant women to afford to travel.
McGrath asks Dr McCarthy if he was “being flippant” when he said marriage can be bad for women’s mental health.
McGrath then says he is “the proud parent of eight children” with his wife, before adding: “both Senator Mullen and myself were the result of a pregnancy”.
Committee members laugh, annoying McGrath. Noone tells him the members meant no offence and thought he was making a joke himself. He says he wasn’t.
McCarthy confirms he was making a joke earlier. Committee members laughed at the time. Noone notes it was just “a lighthearted comment” under difficult circumstances.
McCarthy says a sense of humour is important in his line of work.
McCarthy says there are “very few” psychiatrists in Ireland and some have opted out of taking part in PLDPA panels.
He says there have been cases when it has been difficult to find a second psychiatrist to see a woman seeking an abortion on mental health or suicide grounds.
We’re back after a break.
Responding to Deputy John Browne, Dr McCarthy says about 11% of women get postnatal depression. He says the immediate period after giving birth is an “extremely vulnerable time for women’s mental health.”
McCarthy says there are three part-time perinatal psychiatrists in Dublin’s three maternity hospitals, but “almost nothing outside of Dublin”.
The issues that pregnant women present to him with are broad – including drinking alcohol, stopping taking antidepressants for fear they’ll hurt the baby, schizophrenia, OCD.
We’re nearing the end of today’s session and Noone is going back to an earlier issue – Deputy Mattie McGrath and Senator Rónán Mullen had wanted her to read out a letter from Dr Martin McCaffrey, a Professor of Pediatrics at the University of North Carolina, who pulled out of appearing at the committee.
In a letter Dr Martin McCaffrey, who is pro-life, described the committee as a “kangaroo court” and “prejudiced”.
Noone is sticking by her earlier decision to not read out the letter – saying if committees read out statements from people who have decided not to attend, “a lot of witnesses would never attend”. It will be made available on the committee’s website instead.
“That is my decision and I will not be challenged on that … That is my view and it’s final,” Noone says.
Mullen and McGrath are seeking clarification on why Noone has made this call.
After a lot of back and forth, Noone says she is “an extremely patient person” but finds their questioning “inappropriate”.
Sinn Féin’s Jonathan O’Brien then says he may lose his temper, accusing Mullen and McGrath of unfairly trying to undermine Noone – not for the first time.
McGrath doesn’t like this comment, calling it “disgraceful” and asking: “Are they going to kneecap us?”
And on that note, we’re wrapping things up for the day.
We will be sending out an email round-up of what happened at the committee later tonight. To get the weekly round-up, just enter your email in the box at the bottom of this article.
Thanks for staying with us throughout the day. We’ll be back next week. Goodnight.