Mr. Niall Behan:

The Irish Family Planning Association is glad of the opportunity to assist the committee on this important issue. The IFPA, as we are probably better known, provides medical services to in excess of 20,000 clients per year. Those are mainly contraceptive services and family planning services but also treatment for sexually transmitted infections and post-abortion care. Through our national network of pregnancy counselling services we provide information and support to almost 5,000 women and girls experiencing crisis pregnancies that were unplanned or unwanted, or developed into a crisis because of changed circumstances.

Women use our services because they feel they are not currently in a position to care for a child or, very often, another child. Their reasons include financial worries, diagnosis of a serious foetal abnormality, a pre-existing health problem or relationship issues, or sometimes a combination of all of those issues.

The IFPA knows from its counselling service that women who choose abortion are from all walks of life and each woman has her own reasons for deciding to have an abortion. Women's experiences of abortion are diverse and complex and the decision to have an abortion is not one that women take lightly.

The experience of the IFPA and of many doctors is that medical service providers in Ireland are prevented from acting in the best interests of pregnant women's health at some points, and must navigate some grey areas of law to protect themselves and patients from prosecution. As a service provider, therefore, the IFPA very much welcomes the Government's decision to implement the judgment of the European Court of Human Rights in A, B and C v. Ireland.

Very few of the women who avail of our service do so because of risk to their lives, but some women do. The women who come to the IFPA in life-threatening circumstances tend to present at a very early stage of pregnancy before the risk is imminent and with our services, we are not talking about emergency situations. They tend to be women who have had serious complications during previous pregnancies or who have underlying health conditions, and usually they have been advised at some point previously not to become pregnant or that becoming pregnant again could impact on their health. For example, applicant C in A, B and C v. Ireland was six weeks pregnant when she realised that she had difficulties. These women have taken a decision to terminate the pregnancy rather than incur a risk to their lives or to their health. They are not prepared to wait until the risk to their health deteriorates to such an extent that it becomes a risk to their life.

The serious risk posed to a pregnant woman's health can be for a range of reasons, including heart issues, kidney diseases, oncology, neurology, gynaecology, obstetrics and a range of genetic conditions. The pregnancy may exacerbate the risk to women of a pre-existing condition, for example, epilepsy, diabetes, cardiac disease, some auto-immune conditions and severe mental illness.

The case may be that there is a risk to a woman's health rather than to her life. From our perspective as a medical services provider, it is very difficult. We do not see any kind of bright line distinguishing between a women's life and her health. Indeed, no other country in Europe forces doctors or medical services to make the distinction that is made in Irish law where abortion is only allowed to save a woman's life, but not to preserve her health. Most countries offer abortion on the basis of the adverse consequences for women's health as the only way to ensure that a full range of sexual and reproductive health services are available to her.

For women in these circumstances the burden of accessing abortion services is placed on the woman rather than on the health care system, and that is an important distinction to make. Women who make the journey to the United Kingdom for medical reasons do so in the context of legal uncertainty. There is a chilling effect in the current law and the standard medical referral protocols may not be applied. Women in this context must leave the mainstream health-care service. They must make their own way to a private medical facility in another country without the protection of the protocols that apply in other situations. While some doctors make ad hoc arrangements, we know of women who have travelled without medical files detailing their medical history or proper referral from a doctor.

These women travel outside the State to avail of services that are criminalised in Ireland, a journey that in many cases involves significant psychological, physical and financial burden - a burden that was recognised by the European Court of Human Rights. These burdens fall most heavily on those who are already disadvantaged or vulnerable, namely, those with little or no income, women with care responsibilities, women with disabilities, women with mental illness, women who experience violence, young women and women requiring travel visas.

It is critical that medical service providers and, indeed, the women themselves can rest assured that accessible and appropriate services will be put in place and that women can be confident that their decisions will be respected and free from discrimination, coercion and stigma, and that their rights will be fully vindicated.

In that regard, the legislation and guidelines must not be so complex as to render them ineffective in practice. As the European Court of Human Rights has stated, they cannot be theoretical and illusory. The Government must be guided by the expert group's unambiguous direction so that the potential options are effective and accessible. The expert group considered it insufficient for the State to interpret the court's judgment as requiring only a procedure to establish entitlement to termination without also giving access to such treatment. In this regard, I am heartened by the discussions today that have focused on the barriers that may arise, such as conscientious objection, refusal to care and capacity to provide services.

In regard to the threat to life by suicide, the IFPA has dealt with clients who have had suicidal thoughts or threatened suicide. A small number of individuals followed through on these threats by taking overdoses. The expert group gave extensive consideration to the appropriate legislative and health service response to the risk to life by threat of suicide and the IFPA welcomes the clarification by the export group report that a termination of pregnancy is lawful medical treatment regardless of whether the risk to life arises on physical or mental health grounds. The expert group's approach would place suicidal intent in the context of pregnancy and existing health services without stigmatising either mental health or a termination of pregnancy.

The final issue I wish to raise is criminalisation of abortion. It is clear from the expert group report that the legislation implementing the A, B and C judgment must remove sections 58 and 59 of the Offences Against the Person Act 1861. We understand that some Members of the Oireachtas may be concerned that legislating this way where a pregnant woman's life is at risk might lead to an increase in abortion rates. From the thousands of women we have seen over the years, it is our opinion that criminalisation of abortion does not deter women from seeking termination or lead to lower abortion rates. It has been the IFPA's experience that when a client decides to terminate her pregnancy she has made her decision rationally and is unlikely to change it regardless of the legal obstacles in her way. Her focus quickly shifts to the practicalities of organising and financing the procedure in another country.