We've come a long way, but not nearly far enough

I was working in a maternity hospital when the X case happened. It was an extraordinary time. We were delivering babies, sterilising women, removing wombs, treating reproductive cancers, managing miscarriages and looking after women: only women. Most of the staff, midwives and doctors were women. All of the professors, consultants and managers were men. The elephant in the room was the X case, and nobody was actually talking about that. You’d think, in a hospital where pregnancy, contraception, sterilisation and reproduction were the only order of the day, that we might have talked about the X case. There was nothing else that anyone else around the country was talking about. There wasn’t a single other item of interest on the news. And yet in a year in which I worked in a large maternity hospital where we worked on nothing but pregnancies, we never mentioned it.

The professors and consultants were involved, however, and one or two of them became very passionate anti-choice activists. But the vast majority of doctors and midwives felt very differently.

Although we never, ever discussed the politics of what was happening to women in Ireland, to our patients, and our potential patients, it did affect us. In the year of the X case, there were two women in the maternity hospital where I worked who had required mid-term abortions because of a pregnancy that was endangering their lives. Nothing to do with suicide: they were becoming ill because of their pregnancy. And yet, the small number of doctors who were anti-choice activists made hay of their belief that it would never happen - that a woman in Ireland would never need (because of the magnificent maternity services, you understand) an abortion due to illness in pregnancy.

After the X case, the results of three referenda were a huge relief to most doctors. The most important change was the Information Act, which for the first time offered a doctor the legal right to discuss an abortion with a patient, and to provide information about travelling overseas. Before this act, doctors were genuinely afraid that a patient who purported to be requiring information on abortion might be a journalist who’d been set up to ‘frame’ the doctor, exposing him or her in the press as a baby-killer. There was extraordinary mistrust. Only the Stasi or the Taliban could have thought up a situation whereby doctors aren’t allowed to talk to women about their health needs. And yet, that was the way it was. During all those years of the 1980s, the Irish Family Planning Association, the Marie Stopes and the Well Woman Clinics were very brave and a huge support to women whose doctors were afraid to help them.

After the Information Act, many doctors felt that they were sick of being silenced and sick of being forbidden to look after their patients properly. By the time Micheál Martin had proposed another referendum, this time trying to undo the work of the last three, pro-choice doctors were prepared to become active. Around this time, Dr Rebecca Gomperts and the Women On Waves project came to Ireland. This made an enormous difference to the confidence of Irish doctors. The members of Women On Waves are extremely courageous women, and they generated great respect amongst doctors in Ireland. We quickly realised that their radical tactics were correct: if doctors and midwives are the most radical activists on the question of abortion, then we can give courage to those who are not medically qualified, and make them seem more ‘moderate’.

After the government lost that referendum, many things changed. Micheál Martin set up the Crisis Pregnancy Agency, which encouraged women to seek out full information on abortion, and which provides a network of recommended counselling services, which they called Positive Options. Doctors For Choice lobbied the Irish Medical Council, which changed its ethical guidelines on abortion, so that it is no longer professional misconduct to assist a woman in an abortion. Obviously, elective abortion remains illegal in Ireland, and this is still a huge barrier to doctors and to patients. It costs a lot to travel overseas. And the emotional costs are enormous when travelling is added to the emotional burden of early pregnancy loss. The other problem that remains for doctors, albeit a technical one, is that there is no ‘legal’ protection for a doctor who terminates a pregnancy in the case of illness. Although the X case provided constitutional precedent, many obstetricians feel afraid that the terminations that they do for medical reasons could be open to legal challenge. In the meantime, women are turning to the internet. Increasingly I find that women don’t come to their GP looking for information anymore - they go online.

Abortion pills can be bought online and are being imported, although Irish customs do confiscate many. The abortion rate, the rate of women travelling to England who have Irish addresses, was down in 2010 for the ninth year in a row. I suspect that two factors are mostly responsible. The ‘morning after pill’ got a license shortly after the last referendum and this gave confidence to many more doctors to prescribe it, and gave confidence to women to seek it. It’s now over the counter, and it has prevented thousands of unwanted pregnancies. And abortion pills are being bought over the internet.

Women and technology have bypassed the stranglehold of the law, the police and the church, but not in the most ideal way. It is a great shame that an Irish woman who needs an abortion is sitting down at a computer to book her treatment from a stranger over the internet, rather than consulting with her family doctor and local midwife and having her abortion locally. This is well below ideal medical care. But for now, it is a long way from having a passport confiscated at the age of 14, because of a rape. {jathumbnailoff}

Image top: mag3737.