Dr. Patricia Lohr:

The Deputy's first wide-ranging question was on medical abortion. I answered an earlier question regarding the comparable rates of complications in medical and surgical abortion. It is the case that while complications with either method are extremely low, there is a slightly higher risk of complications after an early medical abortion compared with surgical but the risk profile is different. The sorts of complications that one sees after early medical abortion are relatively minor and can often be resolved with relatively minor interventions, for instance, one might use another dose of medications to remove any extra tissue that has not been passed. The processes for medical and surgical abortion are extremely different, however, and I think it is extremely important that women have access to both because they are so different. Women often prefer medical abortion because it is private, they do not need to have a surgical intervention, have an anaesthetic or go into a clinic in some places. They can pass the pregnancy at home and have their partner with them and that is important to some women. For other women, it is important to them to have their abortion done in a clinical setting, to be performed quickly since with a medical abortion there is a somewhat unpredictable time to the passage of the pregnancy, whereas with a surgical abortion it is a day-case procedure, it is timed and one knows when one will be finished. Often those process-related elements matter in some ways more to women than the absolute rate of complications because the complications are low either way and they are pretty similar. It is important women have access to both.

On medical abortion in Ireland and women availing of abortion medications online, it is entirely unsurprising because it is very expensive to travel. What one sees here is what has been seen in many other countries before abortion was legalised or liberalised, which is that women who can afford to travel for abortions or can afford to pay for them do so and women who cannot do not and go on to have unwanted pregnancies. There are consequences of having unwanted pregnancies too.

On affordability, delivering medical abortion services is a very affordable way of delivering abortion services. It can be entirely nurse-led, the medications are not very expensive and the rate of complications are low. It can be offered from a number of locations, which means that it can be less expensive for the woman as she does not have to travel as far to access services, for example. It is a very good model of care, is a highly effective mode of abortion care and is very accessible.

One issue I had not touched on regarding surgical abortion in my answer to the previous question is that women who have surgical abortions not only need to come over themselves to have the procedure but should have someone come with them and to travel back with them. If they have had a general anaesthetic or some sedation, they should have someone to take care of them afterwards and that adds to the cost. That might see women delaying the procedure further in order to gather the money.