Dr. Gilda Sedgh:

On whether there are other precedents that can help us to understand what might happen in Ireland, the precedents being countries where women were previously able to travel somewhere else to have an abortion and then did not have to do so, none comes to mind. When the Deputy was asking her question, I thought about Zambia where women travel to South Africa for abortions, but we do not have the rest of the scenario described by the Deputy, where the abortion law or access to legal abortion changes, in Zambia.

I am hard-pressed to find a case where we know definitively what happens to the incidence of abortion before and after a change in the law because of the clandestine nature of abortions before that change. We have seen countries, my own home country of the USA among them, where the abortion rate declines after abortion has been legal for some time and that shift from clandestine to recorded abortions has taken place. It declines because women increasingly start to use contraceptive methods or else to shift from less effective to more effective methods. If there is concern at some point over the numbers of Irish women obtaining abortions then, all of the evidence from other countries suggests that what needs to be looked at is whether or not something might be preventing these women from using contraception.

Members asked about abortion pills accessed online and how prominent a role these might play as a proportion of total abortions being carried out. When it comes to medical abortion in general, these pills play a large role. The case-loads of online services like Women on Web, from which a woman can be sure she is getting proper pills, proper dosage and proper information, are not in fact very large. In countries with more restrictive laws, however, which are often developing countries, we see large numbers of women obtaining Misoprostal through the black market. Misoprostal is but one of the two drugs that make up that medication abortion regimen and women are obtaining it through a variety of means: from pharmacists; from what they call their "chemists"; and from open-air markets. The drug is often obtained in various doses and thus not necessarily the optimal dose or regimen, and without any guidance or counselling. I do not know if that speaks to Irish concerns in particular but my overall point is that medication abortion in general can play a major role where abortion is clandestine.