Dr. Karena Hanley:

I will talk about the impact on the health of the woman. I will start with travel. Reflecting on the vignette, one can understand the psychological cost to that woman, the stress, the loneliness and the psychological burden of travelling to procure an abortion. There is also a physical risk to women who, as they travel, do not have access to post-abortion services that are available in the country where it was performed. There are also logistical difficulties and financial costs. Crisis pregnancy can have a profound effect on the woman's partner and wider family, but for this presentation we have focused on the woman only. The logistics of travel also mean that women travelling from this country tend to have later abortions and a higher proportion of surgical interventions. There are also women who cannot travel, including those who are disabled, without financial means, socially isolated and asylum seekers, who cannot leave this country for abortion.

We would like to bring to the committee's attention the harm that can be done by inaccurate information from unlicensed, unaccredited counselling agents, who sometimes give distressing and incorrect information.

I will address the Protection of Life During Pregnancy Act. It allows for lawful abortion when there is a real and substantial risk to the life of the mother. Most of the 25 terminations conducted under this legislation are performed by our obstetric colleagues and GPs are not involved, but we are in involved where the risk to life is a risk of suicide. The clinical pathway in this context requires referral from the GP to local general psychiatry services. Two psychiatrists and one obstetrician then need to agree that an abortion is lawful under that Act. Very few cases have been performed under this arrangement and the experience of Miss Y needs to be considered. This arrangement tends to lead to delays in accessing termination of the pregnancy and, if the second psychiatrist is outside the location, this adds to the difficulty. Criminalisation needs to be considered. This relates to the increasing numbers of women who procure abortion pills online. They may be criminalised with the potential of a 14 year prison sentence. This may prevent them from reporting to Irish doctors, which could seriously impact their health.