Professor Veronica O'Keane:

I will start with the Deputy's second question on floodgates. I do not understand the floodgate phenomenon. A good presentation made to the committee earlier showed that the rate of abortion had been steady over the years, although I hope that it will decline slightly with better contraceptive care. The availability of abortion pills on the web has increased and the rate of travel for surgical abortions has reduced. The floodgates are open and always have been. They have only been pointed towards the UK. We have a de factoabortion service. It is just not in our own country. I cannot see making abortion legal in Ireland changing the number of women having abortions. Rather, I hope that, by having a better health service that is more women focused, inclusive, sensitive and compassionate, we will reduce the number of unwanted pregnancies and improve our care for women with unwanted pregnancies. At the heart of this matter is giving care to women who have unwanted pregnancies.

The Deputy's other question was on whether a woman who was depressed would be at an increased risk of developing obstetric problems or other physical ill health. That is definitely true. If one is depressed in any circumstance in life, one is at greater risk of becoming medically unwell. That is because our stress system is controlled in our brain. It is the control station for the secretion of our stress hormones. If I am stressed, my brain tells my adrenal glands to secrete cortisol. Being in a stressed condition for a long period of time is damaging physiologically. It has been shown to lead to cancers, heart disease, lung disease and osteoporosis. Every physiological system is sensitive to stress hormones, particularly long-term exposure. During pregnancy, there is a rapidly developing foetal system. It will of course be sensitive to stress hormones.

If we are thinking about abortion care, we should be thinking about it in the care of the general mental health of pregnant women, and as I stated previously, specifically in the area of unwanted pregnancies. "Yes", is the answer. Are specific disorders that are specific to pregnancy, such as pre eclampsia, Caesarian section and obstetric complications, more likely during pregnancy if a woman is depressed? "Yes" is the answer. Being depressed disadvantages the woman and the foetus, and the delivery of the foetus into the world.