Dr. Rhona Mahony:

As a supplementary, and coming back to the last two questions on after-care, particularly on the taking of abortion pills, I re-emphasise to patients that if they present our primary consideration is to provide care for them. It is not just the physical consequences. There are also psychological consequences, and the circumstances in which a young person might choose to obtain tablets from a source she does not know and take them with all that risk, and why she is doing that on her own without accessing good medical care. I am referring to children, women of limited means who cannot travel and the other components and complexities that can exist for women who find themselves in a position where they do not want to be pregnant.

I re-emphasise the primary reason for foetal anomaly scanning is to identify treatable conditions in foetuses so when the babies are born we can optimise the care we give them. We know this can have a significant impact on survival. The classic example is congenital heart abnormality, where we are ready for the baby, we can institute the correct therapy, and the surgeons meet the mother in advance of delivery when plans can be made. It makes a big difference with regard to diaphragmatic hernia and gastroschisis for us to know the conditions are there so we can plan for the baby and enhance survival.

The Deputy is right that anomaly scanning is performed at 18 to 22 weeks. There is a cut-off limit in the UK at 24 weeks in general for termination of pregnancy. This can mean patients suddenly have to grapple with a diagnosis in which we say to them our experience tells us the baby will not survive. If they choose to make the decision to travel to the UK for termination of pregnancy they must make the phone calls, find the appointment and organise their travel, their children, their jobs and other elements of their lives. Unfortunately, there are big resource issues not just in Ireland but in the UK, and increasingly women face delays in the UK in areas such as Liverpool, which have provided a great deal of service to women in this context.

With regard to post mortems, we do not have very good perinatal services in Ireland. We have a very limited number of perinatal pathologists. It is a very specialised area. We are lucky in Holles Street and the Rotunda to have such specialised doctors and laboratory technicians, but this is not the case throughout the country. In many hospitals in Ireland there is a real difficulty at present in accessing post mortems. As Professor Malone said, this can make a big difference because some diseases have a significant recurrence rate and parents need to know this if they are going to embark on another pregnancy. The same goes for genetic services. We have very few perinatal clinical geneticists in this country, but if we look at how the technology is progressing, there is microarray and the ability to look at chromosomes and genetic material. We can now characterise the entire human genome. All of this technology is coming down the track, including the ability to edit the human genome, and we have very limited genetic services in this country.