When is an abortion not an abortion?

Twenty years ago the Irish government, in the person of Attorney General Harry Whelehan, sought to take custody of a child made pregnant by rape, because she needed to have an abortion and the Irish government thought it entitled to prevent that: their intention was to force the child to have the rapist’s baby.

This became the “X” case, and on appeal, the Supreme Court of Ireland ruled that the Irish government did not have the right to force a woman through pregnancy/childbirth at the risk of her life – and that risk to her life included her suicide. (Note: edited substantially. I’d misremembered the chronology quite seriously. My apologies.)

Nothing has been done in the twenty years since: the Irish government claims there are no lawful abortions in Ireland, prolifers claim this proves abortion is never medically necessary, and women silently vote with their feet.

The ECHR has ruled:

  • first, anyone may leave their prolife country to have an abortion if they wish and the prolife government is not allowed to prevent them; and,
  • second, that the Irish government must take steps to be sure that a pregnant girl or woman whose life is in danger can have an abortion in Ireland.

The first part the Irish government couldn’t stop, but the second – this the Irish government still refuse to do. Action on X is a campaigning group trying to bring about a change in the law in Ireland. Cardinal Sean Brady, who cares so much for children, is against it.

(There is an agreement that Northern Ireland, while part of the UK, will not pass legislation that would put it significantly out of step with the Republic of Ireland. As I understand it, it’s this agreement that makes it improbable that Northern Ireland will make abortion legal so that women living in NI can have abortions where they live, on the NHS, as they would if they lived in any other part of the UK. Put simply, if abortion was legal in Northern Ireland, women in the Republic of Ireland who needed an abortion would head north to the Six Counties, much cheaper and much less inconvenient for them than going over to London or Liverpool – but also very openly, Northern Ireland would be doing for the women of all Ireland what the Irish Republic will not do for their own citizens – though many think they should.)

how not to be a ‘legitimate’ rape victim:

When I was in eighth grade, a classmate – let’s call her Anna — said that she’d been raped. She told me during lunch at our desks, tipping her chair until it seemed she might fall over. It happened on a rocky lakeshore. The man came off a boat that was anchored nearby and she could hear voices yelling to him in the darkness. She was freezing. When it was over, he threw her jeans in the water and said, “I hope you get pregnant.”

Abortion has been legal in Ireland only on the most tightly-defined grounds, but where it is legal, it is obtainable. Only when an Irish hospital can be absolutely certain that the woman will not survive unless the abortion is performed and the fetus will never be viable.

The two most obvious instances of this are ectopic pregnancies (the egg implanted outside the uterus) and molar pregnancies (the egg never received the full chromosome set from both parents, and so the fetus will never develop). Abortions for ectopic and molar pregnancies are always performed early.

At the other end of the pregnancy, there can be instances where the fetus will not survive and the woman’s best chance of life and good health is to have an abortion. In those circumstances, Irish women tend to be advised to “travel” – Liverpool Women’s Hospital sees two or three patients from Ireland every week, every woman with a story like this:

Ruth Bowie, a gentle, sincere woman of “very strong faith”, remembers breaking the news to her mother, also a devout Christian. “She was so shocked – not by our awful news, but by the fact that we had to travel to the UK for a termination . . . Even our own [healthcare] colleagues don’t realise that in our situation, we have to travel . . . I’ve worked in healthcare for long enough to realise that bad things happen to people everyday and that the world is simply an unfair place – but to have to travel like this? That’s cruel.

“Having to walk around Birmingham for five hours when you’ve just ended your baby’s life, you’ve had an anaesthetic and are bleeding and cramping . . . I believe in a loving, caring, understanding God and that I won’t be damned for what I did . . . I want to say to people who would judge us – Where is your compassion? Where is love in all this?,” she says, her voice cracking.

This is expensive and heartbreaking, and I entirely support this campaign:

When people in Ireland discover that their much wanted baby has a fetal abnormality that will not allow them to survive outside of the womb, they should be provided with every possible support and care by the State. This unfortunately is not the case. Distraught parents, choosing the terminate their pregnancies under these very sad circumstances, are abandoned by the Irish Health care system, and forced to go it alone. We believe that the ‘exportation’ of these tragic cases is inhumane and needs to be stopped.

Petition: We are seeking to have the legislation in Ireland changed to facilitate termination for medical reasons.

These abortions are carried out for the health of the mother: in any rational and humane health system, these women would get to decide to have an abortion, supported by her friends and family, in a familiar hospital, without needing to travel to another country and depend on the kindness of strangers.

But there is a valid reason for not carrying out these abortions in Ireland, and it’s horribly simple: they’re medically complicated. Early abortions are simple, the later an abortion gets the more complicated it gets. A healthcare system like Ireland’s which does not train or support doctors and nurses to perform late-term abortions would have to send women who need them into another country, even if the law was changed, unless they were to hire people who had received the proper training elsewhere: the main difference would be financial cost to the patient and the acknowledgement of the patient as a woman deserving of support by her country, not an inconvenient don’t-count-her to be pushed elsewhere.

You don’t have to think of yourself as pro-choice to see that these women are being mistreated by their country for the sake of a moral stance that has neither compassion nor sense:

Why do anti abortion campaigners never cover themselves in glory? From graphic posters, to underhand tactics and lets be honest here- this is a pretty weak attempt at sabotage. Her email went on about abortion undervaluing society etc. It annoyed me it really did.

But what of the ectopic and molar pregnancy abortions carried out at the early end of pregnancy – clearly life-saving, clearly justified since there is no possible way for the fetus to survive – how does the medical establishment of Ireland, which publicly claims to perform almost no abortions, justify this?

Very simply: they don’t count them.

Fintan O’Toole, yesterday in the Irish Times:

If you count something, it becomes real and if it becomes real you might have to do something about it. Thus, for example, the system didn’t count the number of children who died in the care of the State until it was forced to do so.

Here’s something else the system absolutely refuses to count: the number of abortions carried out within the State. It’s not a big number (based on Northern Ireland figures, a rough estimate would be about 120 a year) but it matters because it encapsulates the need to legislate on the basis of the X case.

And it’s a bloody awkward number. It adds up to a fact that is not supposed to be a fact: abortions are legal in the Republic in certain (very restrictive) circumstances and they are being performed, probably more than twice a week.

So, quite literally – abortions taking place in Ireland are not counted. Irish abortions are not counted in another way – the thousands of women and girls who travel, usually to London, to have elective abortions of unwanted pregnancies are not counted, because that would involve admitting that the Irish healthcare system outsources its abortions to the UK at the expense of every woman who ever needed an abortion.

The outrageous arguments against girls and women being “allowed” to choose abortion if made pregnant by rape at once illuminates the prolife viewpoint that sees a woman merely as a vessel for man’s use, and obscures the real issue: It is outrageous that any girl or woman should be forced through pregnancy and childbirth against her will.

Republican Vice presidential candidate Paul Ryan:

REPORTER: …Specifically where you stand when it comes to rape, and when it comes to the issue of should it be legal for a woman to be able to get an abortion if she’s raped.

RYAN: I’m very proud of my pro-life record, and I’ve always adopted the idea that, the position that the method of conception doesn’t change the definition of life.

The sanctimonious prolifer who says that to force women to give birth is “pro-woman and pro-child” is telling an awesome, awful lie. The campaigners who argue that there’s just no need for a pregnant woman whose fetus will not survive to be able to have an abortion in Ireland, are telling a dreadful, despicable lie. What both lies have in common is the absolute refusal to consider the human rights of a pregnant woman.

People mistake the term “objectification” to mean “looking at with lust”, but what it actually means is “reducing someone to an object to be used.” Sexual objectification is assuming that because women turn you on, they are for sex, instead of a person whose sexuality should be an expression of their agency. What anti-choicers engage in is reproductive objectification. Women are among an array of objects to be used. The refrigerator is for storing food. The bookshelf is for holding books. The woman is for making babies. You no more give her a choice in the matter than you would give your refrigerator veto power over what food it hold because it didn’t like your method of shopping.

But still. There are the few abortions that are carried out lawfully in Ireland. Why don’t they count?

This poses a puzzle: the Health Service Executive collects figures on everything that happens in hospitals, so how come the State has a “lack of knowledge” about abortions? In fact there’s not really a lack of knowledge – there’s a deliberate unknowing.

This is revealed in the State’s unpublished draft response to the United Nations human rights committee on its concerns about the implementation of a range of obligations.

In it, the Government reveals the method by which it ensures that it does not know how many lawful abortions are performed here: “No statistics are maintained in relation to the number of abortions taking place in Ireland each year. Information in relation to the in-patient treatment of women with ectopic pregnancies is coded as management of ectopic pregnancies on HIPE (Hospital In-Patient Inquiry Scheme) system. This system does not differentiate between procedures to terminate an ectopic pregnancy and procedures following a spontaneous miscarriage as a result of an ectopic pregnancy or procedures to treat a ruptured ectopic pregnancy.”

So this is how it’s done. The State flatly declines to collect abortion statistics.

But how do they begin to justify this to themselves?

Earlier this year I had a conversation on Twitter with a prolife medical student. (She says she’s a medical student, and I have no reason to doubt that.) I have her permission to quote her tweets on my blog. She argues (and argued consistently) that abortions carried out to save a woman’s life don’t count as abortions, shouldn’t even be called abortions, because in her view (and it seems to be a fairly prevalent prolife view) abortion should be judged morally, not medically.

I actually believe she’s a medical student because this kind of tweet would seem to come out of the kind of conversation medical students (none of whom were pregnant/had children) might have in the abstract:

Her mind would be unblown again were she to listen to any of the many prochoice mothers and midwives with actual experience, but as a medical student, she may not have had the chance to hear anything like this:

Choice goes past the decision to be pregnant. Everyone who is pregnant should have the choice of maternity care and birth. Giving birth is such a personal and intense experience, and every woman should be able to do it however she wants. Women who have no desire to endure the intensity of labor or wait out the last few weeks of pregnancy and discomfort or choose to schedule their c-section for any reason should be able to do so. But women who want to experience the natural process of birth without medical interventions should be able to also, and anything in between.

But, moving on. If you’re a prolifer who mentally defines abortion as “an immoral act in which a woman kills her own child” but then you go to medical school and discover that there are medical complications which can only be treated by abortion, then it follows that: either you give up being a prolifer, or you mentally set it up so that when a woman has an abortion because she will die if she doesn’t, this is not an abortion, it is a “something else”.

One can then argue, and this medical student does, that

Except in Catholic hospitals where preservation of the Fallopian tube is not permitted, the first hope for an ectopic pregnancy is that it’s not yet far enough advanced to require surgery: if it’s early in development, a combined treatment of Methotrexate and Misoprostol may induce a medical abortion. Otherwise, surgery to remove the embryo is required (and, often, also the Fallopian tube, which may have ruptured).

The Catholic Church is clear that surgery to remove the embryo from a place where it cannot develop is not an abortion in the religious sense: and apparently a medical student at (presumably) a Catholic teaching hospital is not allowed to learn that there is any method but surgical.


Meckel-Gruber syndrome (MGS)
is

an inherited condition that causes skull abnormality, enlarged cystic kidneys, liver damage, and extra fingers and toes. Findings vary between affected infants (even in the same family), as well as between ethnic groups. Infants with MGS are usually stillborn or die shortly after birth.

One of the woman in the TFMRI gorup has had five pregnancies all affected by MGS:

unfortunetly we decided to try 1 more time as the doctors kept telling us we had a 1 in 4 chance in every pregnancy of this happening so we thought we’d try once more, it happened again just in febuary of this year. at our 12 week scan we were told in the hospital in dublin that it had happened again even to the amazment of the consultant, she just couldnt believe that this had happened again, she kindly gave us infromation on the liverpool clinic and we were once again making arrangements to fly over to have the termination, another 2 thousand spent that we didnt have, got over there only to discover that the baby had died and they wouldnt do the termination so spent all that money for nothing and had to spend the next 2 days walken around liverpool with a baby inside me and had to come home to have the tablet form to clean me out, all this could be so much avoided if they would just make this legal,and to the man who said on the late late show a while ago that the babies feel everything when being terminated, then my baby felt every bit of dieing

To which kind of story the pro-life medical student makes the bloodless response:

Save the Children’s report, Every Woman’s Right: How Family Planning Saves Lives

highlights the fact that girls under 15 are five times more likely to die in pregnancy than women in their 20s. Babies born to younger mums are also at far greater risk and around one million babies born to adolescent girls die every year – babies are 60% more likely to die if their mother is under 18.

Where abortion is illegal, these children don’t have the choice “Child X” had of safe abortion:

Those who turn to the back street abortionists risk infection, bleeding, tears into the uterus or bowel and death. They also face the possibility of emergency hysterectomies as doctors race to save their lives.

By this time I was actually quite interested. After all, this wasn’t just a regular prolife abortion-denier: this was a medical student who was going to grow up into the kind of doctor who won’t refer patients for an abortion – maybe even the kind of doctor who won’t prescribe contraception because if you don’t want to have a baby you shouldn’t be having sex, okay? I wanted to know what she would call it if she had to perform an abortion (and if she got any training in performing medically-necessary abortions, whatever she called them).

Eclampsia is one of the leading killers of pregnant women worldwide. One reason why eclampsia does not usually kill a woman in a developed country is that the cure is to deliver the baby early – if that’s possible – or perform an abortion, if not. A woman with pre-eclampsia in a country with a full healthcare system will be in a hospital room under observation and it’s entirely possible she will have to make this decision:

I’d like to bring you to my hospital room on December 2, 2007, if you are willing to come with me. Please imagine that you are in a major teaching hospital here in Alberta, Canada the best of its kind for this situation, there’s you, a perinatologist, your husband and your mother. It’s a Saturday, in the evening, you have been waiting for hours. The window looks out on a concrete wall, you can’t concentrate on the hat you are knitting. The perinatologist comes in, she runs another ultrasound. The resident wasn’t pleased about the results of the first. Wanted a second opinion. You hear the words “you are dying and the baby is not doing well”. There’s an ultrasound machine, the floor is littered with strips of fetal monitoring paper. The room is cold and cramped, and you are frightened beyond where you have ever been. They can’t give you any guarantees. Is there a few days? Maybe, but your kidneys are starting to fail. They will start giving you aggressive drugs but you could seize any moment, you could die of a stroke. If left untreated, you will die. There is no doubt. The baby is underweight for gestation, the odds of survival for a baby this size are very slim.

Mrs Spit, the woman quoted above, says otherwise:

I had an abortion.

I will stand up with thousands, hundreds of thousands of women. I will say that we made the best choice we could, at the time, under the circumstances. I’m not sorry if you don’t like my choice. Frankly, I don’t care. Perhaps you think I’m morally bankrupt, perhaps you think we all are. Perhaps you are able to make distinctions between my case and someone else’s. I will say that those distinctions are completely artificial. I will say that I am not flattered when you tell me that you think I had a socially acceptable abortion. I will say that you are dead wrong when you tell me that I didn’t have an abortion at all because I was dying. I will say this: either I have the choice to chose my life above my son’s, or no one does. Either we all have choices, or none of us do.

When you fight about abortion, when you say that I am an exception, when you say that we are wrong or horrible or morally degenerate, when you want to take away a woman’s right to choose what to do with her body, would you remember -

That’s my face up there. That’s me you’re talking about.

I do believe this young woman is a medical student. Just one that’s chosen not to learn very much about abortion. This is allowed: abortion is a medical speciality, and medical students do not have to study all of the possible specialities. Still, no medical student should be promoting such ignorance:

Not only is this just not true – early abortion by a qualified practitioner is very safe, but statistically speaking any abortion is safer than childbirth – but sometimes abortion in itself minimises risks:

Affecting at least 5 percent to 8 percent of all pregnancies, pre-eclampsia is a rapidly progressive condition characterized by high blood pressure, the presence of protein in the urine, swelling, sudden weight gain and headaches, although some women report few symptoms. Women who have previously given birth to a child have lower risk of pre-eclampsia, the researchers said.

The study, published in the International Journal of Epidemiology, shows that women who have had two or more induced abortions reduced their risk for pre-eclampsia by 60 percent. Women who have had one abortion have an approximately 16 percent reduced risk for pre-eclampsia compared with women who have never had an abortion.

If you wonder (I did) if the medical student changed her mind as she learned more, the answer is no, not yet.

As ever: Abortion Support Network (ASN)

is a volunteer-run charity that provides financial assistance, accommodation in volunteer homes, and confidential, non-judgmental information to women in the Republic of Ireland and Northern Ireland who are travelling to England to access a safe and legal abortion.

They need your help to help these women, so if you can spare a bit, think of them.

Update, 10th September

Reported in the Irish Independent, the numbers of women buying abortifacient pills from abroad are rising:

It is believed that Irish women deterred by the cost of an abortion abroad or driven underground by other circumstances are taking the pills at home, even though they are at risk of serious bleeding and infections.

A survey of 325 GPs, including 107 trainees, has shown more than 10pc of family doctors and one in seven trainees have had to treat a woman who had bought such pills.

One doctor said a foreign national was treated in his surgery after she underwent a “surgical backstreet abortion here”.

Another told how a young girl took an overdose of non-steroidal anti-inflammatory tablets to induce a miscarriage.

Update, 12th September

This is not just a problem of silly student Twittering, either: a group of pro-lifers unconcerned with maternal healthcare have issued a “Dublin declaration” making just that distinction: abortions are okay if you can call them a “treatment” needed by the pregnant woman “to save her life, even if that treatment resulted in the loss of life of her unborn child” – but it’s perfectly okay to have a total ban on abortions, because abortions are bad.

Eamon O’Dwyer, professor emeritus of obstetrics and gynaecology at NUI Galway and a conference organiser, said its outcome would provide “clarity and confirmation” to doctors and legislators dealing with these issues.

He didn’t explain how.

Abortion BPAS Ireland

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5 Comments

Filed under Healthcare, Religion, Women

5 responses to “When is an abortion not an abortion?

  1. I lived in Northern Ireland for many years, and the biggest barrier to any progress on this is the attitudes of the politicians which are mostly united on this, even if they don’t talk in the same terms as that particular DUP one. I haven’t heard of the agreement hinted at but would well believe it.

    I don’t often get involved in abortion debates so I was interested in the distinction that the medical student draws between abortion and a ‘medical procedure’ along moral lines. It’s a neat distinction from the pro-life lobby as it disguises that they have moved their own position on abortion from what it would have been 20 years ago, but without them having to admit to that.

    • I don’t think this is a moving on: I think it’s an attack action.

      Even if people disagree on who should get to decide/how moral elective abortions are, there will always remain the 5% of abortions carried out where there really isn’t much choice – just a “least bad” decision.

      The Catholic Church’s principle that it is better to let the pregnant woman die than perform an abortion to save her life is not one that a hospital or a doctor can legally adopt and stay within medical ethics: if the woman needs an abortion medically and says so, she has to have one.

      So one point made against the people who say “abortion is always wrong and should always be banned” is: what if the abortion is medically necessary, for the woman’s mental or physical health?

      Mental health is routinely disregarded as a cause: hence the arguments against legal rights to choose abortion in case of rape. Physical health is harder for them to make an ethical case against. But if you argue that when a woman needs an abortion it’s not really an abortion because it’s a necessary medical treatment, then

      (a) This has led – as with the refusal of Catholic hospitals to attempt medical abortion in the case of ectopic pregnancy, or insisting that a woman have a caesarean section or induced labour in late-term abortions (or legally denying her an IDX) regardless what’s the safest method – to providing only abortions that are regarded as morally suitable, that resemble childbirth even if the fetus isn’t going to survive, regardless of the best option for health of the woman.

      (b) And this will lead eventually to doctors just not learning how to perform abortions, because they’re taught that abortion is never medically necessary.

      But it also allows them cover to continue to campaign for a total ban on all abortions. In some countries women don’t get to have abortions even for ectopic pregnancy until the Fallopian tube has actually ruptured and the fetus is therefore definitely dead, because even though the procedure is the same, it doesn’t count morally as abortion if it’s just “removal of the dead fetus”. Death rates from ectopic pregnancy go up considerably wherever this is applied.

  2. Maybe we need to stop discussing the ethics and legality of abortion and start discussing the ethics and legality of unwanted impregnation

    http://www.2ndcouncilhouse.co.uk/blog/2012/09/08/so-you-want-to-outlaw-abortion-eh/

  3. I live in Northern Ireland, and the politicians here have been dragging their heels for years on end.

    The Bourne Adjustment states that an abortion to save the mother from severe permanent physical or mental health problems can be justified, yet guidelines are not issued.

    The FPA has been fighting this for 11 years and the DUP just sits on it. The last party that tried to clarify the law was the UUP and even they couldn’t get it done, as the “but it’s going to be like England and the holocaust” was dragged into it. Honestly….

    And to top it up they tightened the reporting so that now the hospitals have to offer date on EACH abortion rather than a collated report.

    And the Westminster government just couldn’t care less.

    • And the Westminster government just couldn’t care less.

      I want the system to be changed so that anyone can get an abortion on the NHS in the UK. No matter what their home address is, someone who needs a legal, safe abortion should get it without having to worry about the cost.

      In fact, collate the numbers from Ireland and send the medical bill, split accordingly, to the Assembly and to the Oireachtas.

      And to top it up they tightened the reporting so that now the hospitals have to offer date on EACH abortion rather than a collated report.

      That’s just… *has no words*

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