Dr. Rhona Mahony:

I wish to make a couple of points on medication and abortion pills. There is a safety record when the correct tablets are taken correctly. However, when medication is obtained over the Internet, its source is not known, which is a risk.

In addition, occasionally people have ectopic pregnancies, where a pregnancy has occurred in the tube and not the womb. That can cause significant risk in terms of misdiagnosis. It is much better that care is offered with a degree of expertise and women are not completely going it alone in terms of care during pregnancy.

On perinatal testing, first trimester screening looks at chromosomal anomalies, specifically trisomy 21 or Down's syndrome, Edward's syndrome and Patau syndrome. The test is currently about €350. The number of women accessing it in Holles Street has increased. When the test was first introduced three years ago, two or three women requested it and now more than 1,000 do so. There is a significant cost which means that women of limited means are not able to afford the test.

The commonest prenatal diagnostic test is ultrasound. In my experience, most women will opt to have a foetal ultrasound. Very few women refuse or decline ultrasound during pregnancy. The reason we have ultrasound is to be able to give the best possible care to a baby where an anomaly has been identified and we can prepare for birth. It is an important reason we look for foetal anomaly.

In terms of maternal mortality and morbidity, we looked at morbidity and I agree with Professor Malone that people of different ethnicities have different outcomes. There is no doubt that it is not enough to look at maternal mortality because those numbers are small and have been relatively stable over recent triennials.

Women of different ethnicities are disproportionately represented in terms of morbidity for all of the reasons outlined by Professor Malone. These include access to care and perhaps not coming for antenatal care. Some women, by virtue of their ethnicity, naturally have an increased risk of pre-eclampsia or fibroid uterus which poses attendant risk.

On the idea that Ireland is the safest place in which to give birth, I do not think people would say it and it is not a sensible approach. The point is that we monitor the data and check outcomes constantly. One should not practise clinical medicine unless one is looking at outcomes. We are trying to identify trends. I referred earlier to my concern about the trend of increasing haemorrhage, for example. We are trying to monitor such trends in order that we can safeguard women in the future and plan our services to provide the best possible care given the current challenges faced by any health service.

I wish to make a brief comment on Down's syndrome. It is not one condition. There is a spectrum of disorder in Down's syndrome. Some children with Down's syndrome will be born very healthy. Others have very serious cardiac or other defects which mean they will not survive in uteroor will die very soon after birth. We have to take that into account. It is very likely that it comes into account when women are making decisions regarding termination of pregnancy. It is not simply one disorder. Infants with Down's syndrome can have a broad spectrum of challenges.