‘Opening the floodgates’ is a phrase which has slipped lightly off the tongue in many media discussions since the Joint Committee on Health and Children hearings on abortion legislation. There are currently about 4,000-plus abortions performed on Irish women each year, in the UK. Using the term ‘floodgate’ as a collective noun for abortions in the context of maternity care and women’s health is extremely unfortunate. Perhaps the more sensitive among our profession may learn to develop a more scientific and appropriate collective noun.

What is more unfortunate is the lack of medical evidence or scientific knowledge to inform this debate. Abortions are not recorded in Ireland. They are not recorded in Irish hospitals at all. Deaths due to suicide are not always recorded: verdicts following suicide are frequently recorded as ‘misadventure’ and deaths from suicide because of unwanted pregnancy are not recorded in perinatal or other social or medical data. Our UK data on Irish abortion rates are voluntarily supplied by charities who provide abortions in the private sector, and who record the address of the patients as being resident in Ireland. This is clearly not terribly scientific as data goes. But it is good enough data, and it is all we have. Two senior obstetricians provided the government with a ‘guestimate’ of the numbers of medically necessary terminations which are done annually in their Dublin hospitals: both figures varied widely when compared with a rural obstetrician’s postulated national average. Why are these data not available from perinatal statistics? It beggars belief that such important data, from an obstetric, medico-legal as well as social point of view, are actually not being recorded at all, nor published in the annual reports of the various maternity hospitals. Surely, if anything is to come out of the committee hearings, it should be a recommendation that these terminations of pregnancies be recorded? 

Too many unknowns

Estimating the numbers of women who request abortion, which may or may not be associated with suicidal risk, is another unknown. Not one doctor, psychiatrist or otherwise, could present accurate data, based on local scientifically obtained evidence, of how many Irish women seek abortion abroad because of suicidal ideation associated with unplanned pregnancy. 

A plausible reason for this was proposed: women who feel suicidal because of unplanned or unwanted pregnancy do not present to Irish doctors. Therefore, it is not surprising that some psychiatrists estimate that their numbers are nil. It is appalling that these numbers are not being counted, and that doctors at the same time are expected to come before a governmental committee and give ‘evidence’. Evidence means that you have actually recorded what is happening. What was presented to the Joint Committee on Health and Children, therefore, wasn’t evidence. It was an embarrassing lack of data, and as physicians we need to seriously look at the position we have let ourselves be led into if we are to advise the government on important legal change in maternity practice. 

Importance of data records

That Irish women’s requests for abortion are not being recorded, either in perinatal statistics or in any other documents, is shameful. It is shameful not only from a human rights point of view, but it is shameful from the point of view of good science. Ireland and Irish medicine cannot continue to act in such a model whereby we do not collect data on patients, and do not act upon that data. It may well be against the law to provide or obtain an abortion in Ireland, but this cannot ethically be a reason to avoid collecting data, or recording obstetric events. The debate regarding possible legislation for abortion in Ireland will primarily affect doctors, as we are the only professional group that currently stands to be imprisoned for acting according to our best scientific knowledge and for taking care of our clients in good faith, in order to save their lives, their health and protect their wellbeing.  

During the 20 years since the X case judgment there have been many (again, I don’t know the exact number – how could I?) children (under-age pregnancies) who have come before the courts seeking permission to travel for abortions on the grounds of suicidal risk, and these abortions have been granted: but the children have had to travel to the UK in the care of the HSE. Agents for the HSE (or health boards as they were) have sought in the courts permission to travel for abortions over and over again for these children, during the past 20 years, and I only know this because I happen to work with counsellors, psychiatrists and social workers who have advocated for these children – assessing them, providing counselling to them and their parents, providing psychiatric certification before the abortion, after care and so on. The research in this area has found that the risk of suicide in pregnancy is higher for teenagers. To refuse an abortion is to put a teenager at risk. Therefore, where requested, the courts grant the HSE personnel permission to travel with these children. 

The HSE personnel involved are to be commended for their dedication to these children and their parents. The tragedy is that none of these children was ever managed at home. And nobody has ever counted them. In all the ‘evidence’ that was presented, they were never even mentioned.