Ms Maeve Taylor:

I thank the committee for the invitation to share our perspectives. The Irish Family Planning Association, IFPA, is a specialist provider of early abortion care, contraception, specialist pregnancy counselling and other healthcare services. We have advocated for sexual and reproductive health and rights since our foundation in 1969. The last time we addressed an Oireachtas committee on abortion, it was to call for the introduction of abortion services. To be here today to discuss the review of those services feels genuinely historic.

The review clause in the 2018 Act is a wise and prescient measure. We have insights now from the provision of abortion care that were simply not available in 2018. There are two key insights. First, the Act has been transformative for reproductive rights in Ireland and abortion provision is now an established social good. Second, significant challenges arise for the operation of services from the interaction of the legal framework, health system challenges and pervasive abortion stigma.

To start with the positives, the availability of services to terminate pregnancies and the public funding of those services unambiguously signal that abortion is essential healthcare. The law provides for access to abortion on request. Nobody who seeks early abortion care is required to explain or justify the decision about the pregnancy. We know from our clinics and our pregnancy counselling service how important this is to service users. The protection in law of these principles is a real strength of the Act. Moreover, the model of care is working well for those who can access it. The availability of abortion care within mainstream, local healthcare and without cost helps reduce the stress of unintended pregnancy and the stigma associated with abortion. In principle, women can choose their provider. They can opt for a specialist reproductive healthcare centre, such as the IFPA, attend their regular GP or find a GP through My Options. The introduction of telemedicine has broadened women’s access to essential, time-sensitive healthcare in very important ways. Critical additional supports, including specialist pregnancy counselling and a 24-7 medical helpline, are also available without cost and are funded by the HSE.

However, there are problems. The Act is modelled on the Protection of Life During Pregnancy Act. This was a restrictive, criminal statute. That framing gets in the way of access and choice. Outside sections 9 to 12, inclusive, abortion is subject to prosecution and to harsh punishment on conviction. Criminalisation of abortion relegates it to the margins of healthcare. The European Court of Human Rights recognised this in the A, B and Cv. Ireland case. Criminal laws, even when they are not aggressively enforced, create a chilling effect on healthcare providers. Section 23, the criminal provision, fosters stigma towards the conscientiously committed providers of abortion care and can discourage others from providing abortion. Furthermore, while the right of healthcare practitioners to deny care on grounds of individual beliefs is recognised as conscientious objection, this implies, very erroneously, that only those who refuse care, but not those who provide it or access it, act with conscience.

The Act is far too restrictive. The IFPA knows from our services that the vast majority of people who present for abortion care have thought through their personal circumstances, assessed the supports available to them and made a clear decision. However, section 12 requires that they must first see a doctor and then wait three days. Therefore, in fact, the gestation limit is eleven and a half weeks. The waiting period implies distrust of women's capacity to make rational decisions in pregnancy. It forces doctors to impose delay for no reason related to women's health, even when that delay pushes a woman past her gestation limit. Most women and girls availing of abortion in Ireland do so well before 12 weeks of pregnancy. However, crisis in pregnancy cannot be neatly confined to the first trimester. The IFPA’s experience is that the burdens of the 12-week limit disproportionately affect the young, the vulnerable, the marginalised and the disadvantaged. After 12 weeks, access is narrowly restricted to grounds of health and fatal foetal anomaly. This is exclusionary. We know from our counselling services how traumatising this is for those who are excluded.

We also recommend that Ireland follow the recommendations of the WHO in its abortion care guideline, which calls for decriminalisation of abortion in all circumstances. It recommends that instead of the imposition of mandatory waiting periods, grounds and gestational age limits in laws, access to abortion should be on request. This would mean aligning service availability with the best interests of women and girls, rather than organising this part of the healthcare system around restrictive provisions.

We also have some other concerns, and I will not repeat some that have been mentioned by our colleague from the National Women's Council.

One issue we are concerned about is choice of method. Abortion can be provided through either medical or non-invasive surgical methods. However in Ireland most women are only offered one method which is home self-management of medical abortion. This suits most women but not everyone has a suitable home environment and those who do not have a home that is suitable for self-management of care are not eligible for referral to hospital on those specific socioeconomic grounds. The IFPA provides care to undocumented service users. Currently, there is a lack of clear arrangements for reimbursement. This is problematic. The IFPA is absorbing those costs but this is not sustainable. We are in discussions with the HSE about this and we hope this will be resolved.

These inequities in the operation of abortion services must be addressed. Following the review of the Health (Regulation of Termination of Pregnancy) Act 2018 we believe the Oireachtas must address the flaws in the legislation and align the law with international best practice and human rights standards. Moving into the future, the Oireachtas must identify health systems measures to institutionalise the current strength of the service and ensure excellence, leadership, innovation and sustainability into the future. We should have a model of an excellent abortion care service in Ireland. We believe the Oireachtas should continue to monitor the operation of abortion care in Ireland to ensure it is equitable, is of high quality and is available, accessible and acceptable to all who need it.