Dr. Anthony McCarthy:

Are women with high risk pregnancies going abroad? Without seeing the 130,000 women and assessing them, we cannot say definitively. However, what is our impression? We regularly see women in pregnancy who report to us that they have had previous terminations. The reason is often that they were very depressed or suicidal, and did not want the pregnancy because they were worried about their mental health. The rates of suicide and infanticide for countries where abortion is illegal and not available to mothers are much higher than in countries where abortion is available. In Ireland, for example, between 1900 and 1950, 10% of women of child bearing age who committed suicide were pregnant at the time of the suicide. Nowadays, it is 2%. Whether that is due to contraception or abortion we do not know. Certainly, the rates have gone down in that time.

The statistics for infanticide before 1900 are appalling. Dr. Elaine Farrell's study in Queens University Belfast suggests 4,960 cases of infanticide between 1850 and 1900. Dr. Clíona Rattigan's painful book on infanticide and pregnancy in Ireland What Else Could I Do reveals epidemics of infanticide and suicide between 1900 and 1950. These studies suggest there was a huge problem and that it has been reduced, possibly by socioeconomic factors - women are not so poor - and possibly by contraception. I have no doubt, however, that many women are going to England for terminations of pregnancy. That is the direct answer to Deputy Conway's question.

Do we have the ability to differentiate risk of suicide? I tried to say we have huge skills. We are trained all the time to do risk assessments. Do we always get it right? No. Do we get it wrong sometimes? Of course. Are we trained at doing risk assessment? Yes. Do we come up with effective treatment plans all the time or most of the time? Yes. Of course we sometimes get it wrong. We all do the same training but we must make decisions, like the decisions clinicians in Holles Street make about when to induce labour or when to do a caesarian section. Medicine involves subjective decision making on the basis of some objective facts. We have much objective training but there will be differences because of subjective elements. That is human nature. That is life and we have to deal with it.

If suicide is so rare can we not legislate? That is an issue for the Legislature. These things happen. They are rare. The Legislature is dealing with the issue. If it does not deal with it my obstetric colleagues feel very exposed. The 1861 Act is still there. The Legislature has to make up its mind about that. We are clinicians and not legislators. We can, obviously, be in difficult clinical situations.

Yes, we are short of perinatal psychiatrists. Do we need more? Yes. As Professor O'Keane said, women who are pregnant will present to their GP and not to a psychiatrist. They may go to a positive options group or a well woman clinic where they will be assessed. If they are depressed and distressed they may be suicidal but there is no question of them even thinking of an abortion. They may be referred to a local psychiatrist and treated in that way. A very small group, in my view, will be depressed, distressed, want an abortion and be prepared to access a process. If a woman feels she has to go through a process of two psychiatrists and an obstetrician and possibly face an appeal and legal issues, she is not going to come near us. That is not going to change, particularly. I do not see this epidemic coming our way because the legislation, in looking at the life of the mother in this way, is so narrow.

Will legislation open floodgates? Because it is so narrow, I cannot see that happening. I am not a predictor of social trends and with society changing other things may happen. At present, however, I cannot see floodgates opening.

The final question was about women duping psychiatrists. I referred in my submission to the appalling abuse of women and the suggestion that they are all manipulators. That is dreadful. The fact that we, in addition, are supposed to be naive and easily duped is another matter. I do not take so much offence at that. The women we see should be taking offence and not us. We can deal with it.