Denied an abortion: The questions that need answering

On Friday news broke that a suicidal woman delivered a baby by Caesarean section in her second trimester. She had been refused an abortion. It was reported that the panel of experts “determined the life of the mother and the child was not at risk from suicide”, but given the advanced nature of the pregnancy a decision was made to deliver the baby.

This case, which is believed to be one of the first under the Protection of Life During Pregnancy Act, 2013, immediately led to questions being asked. If the panel had deemed the woman’s life to be at risk from suicide and given the advanced stage of the pregnancy it is likely a Caesarean section would have been the only possible outcome given the Eighth Amendment to the Irish Constitution. But if the panel decided there was no risk from suicide why was the Caesarean section carried out?

As additional information became available, across various newspapers, some of which contradicted what had previously been reported it became apparent that (a) trying to explain this story without giving away too many indentifying and personal details would be almost impossible and (b) we may never know exactly what happened, especially at crucial times during this case (more on that later).

On Saturday, the Irish Independent follow-up to their initial story stated that the woman discovered she was pregnant at a late stage. An abortion was refused even though the two psychiatrists on the expert panel “believed that an abortion was justified on suicide grounds, notwithstanding the advanced gestation.” Her life was deemed to be at risk, but an abortion was no longer an option as the pregnancy was too far advanced.

The woman became even more distressed when she was informed that an early delivery rather than an abortion was to be administered. According to the article she began refusing food and liquids. In response the HSE sought a care order as they feared that the woman would starve herself.  In the end, however, she agreed to the early delivery before the care order was finalised.

The Sunday Times (opening paragraphs available here with the rest behind a paywall) reported that the young woman, who is not an Irish citizen and has limited English, became pregnant as a result of rape and sought to have an abortion as soon as she discovered this at eight weeks.

We now have two versions of events. The first being that the woman only discovered she was pregnant late on. The second that the woman found out about her pregnancy at eight weeks and immediately sought an abortion. The woman claims that her request was delayed until it was too late. Her legal status meant that she was unable travel to the UK. A High Court order prohibits the full details of the woman’s circumstances being reported.

It was also reported that following the woman’s refusal of food and liquids the HSE “brought an emergency ex-parte High Court application on Saturday, August 2, seeking orders allowing it to forcibly hydrate the woman to protect her and the unborn baby’s life. It also sought declaratory orders allowing it to carry out certain medical procedures relating to the woman’s pregnancy.”

The hydration order was granted with subsequent reports saying that the order was not implemented because the woman agreed to the Caesarean section.

Over the next few days, the information given about the woman became more personal. She has not been named, but The Guardian published her age and the Irish Independent that she’s an asylum seeker. Could the story have been told without making these things public knowledge? I don’t know, but it seemed that every article had something new that could possibly make the woman identifiable.

In an interview with the young woman The Irish Times have named the agency that she was dealing with before being referred to hospital by a GP after a suicide attempt was interrupted.

While we have heard from the woman herself (although she has still not been named) it can’t have been easy for her to know that her ordeal was news. Did this play a part in her decision to tell her side of the story? Is going public with abortion stories the only way to get anything done in this country? Will any woman who has to rely on the Protection of Life During Pregnancy Act have the details of her life, if not her name, reported in the media? There has to be a balance between cases that are in the public interest and the privacy of the people involved.

RTE is reporting that the expert panel made a certification under Section 9 of the Protection of Life During Pregnancy Act that “a termination of pregnancy should take place, by way of Caesarean section.” In other words, the pregnancy was ended, they did their job as far as they’re concerned. The hospital and the consultants involved have not been named.

Bringing me back to the point about a c-section possibly being the only option, under the law, considering the pregnancy was in the second trimester. The guidelines that could answer this have yet to be officially published, although a draft copy was obtained by The Guardian. This is despite the fact that the law came into force eight months ago.

The HSE is to investigate the sequence of events in this case. This could be crucial in finding out what happened in the 12 weeks between discovering she was pregnant and coming to the attention of the HSE at 21-22 weeks. That the HSE assert she only came to their attention in the second trimester may be why the Irish Independent concluded that the woman only discovered her pregnancy late on.

What documents was she told would be arranged for her? Why was the issue of the cost of travelling not mentioned at an earlier stage? Why was it a GP that referred her to hospital and not the agency she had been attending? If the woman shared her suicidal ideation and attempts with this agency what did they do about it?

I hope this report fills in the 12 week gap between when the woman discovered she was pregnant and being examined by the expert panel. Further, that it clears up any inaccuracies. I would not be surprised to see our old friend “systems failures” deemed to have played its part in this case.

We now have a young woman who was already dealing with traumatic circumstances left even more traumatised by the way the State treated her. We have a premature baby who is expected to be taken into care and may face long term health issues as a result of being born at 24-26 weeks.

We have a nation saddened, angered and asking how and why this was allowed to happen, a nation seeking assurances that this doesn’t happen again.

We have said “never again”, far too often. And yet, here we are. Again. The more I think about Margaret Atwood’s The Handmaid’s Tale the less it seems a work of fiction, more a how-to manual.

It was our abortion law, rather than our lack of law, that caused the issue this time. We need to repeal the Eighth Amendment. It won’t be an easy task and it won’t solve the problem immediately, but it’s a good place to start. We need to decide on the type of abortion laws we actually want and need. We need to move forward.

Update – Wednesday, August 20th

Today it was revealed (here and here) that the young woman actually came to the attention of the HSE back in May. Two months earlier than had previously been reported.

What happened between being referred to “a HSE staff member” in late May and when she was examined by the expert panel? What kind of care, if any, did the vulnerable young woman receive during this time?

Will Crisis Pregnancy Agencies be given the protocols they now feel they need when dealing with suicidal pregnant women?

Minister for Health Leo Varadkar wants to read the HSE report before engaging with the case in a detailed way. That report is due at the end of September.