Colette Kelleher (Independent) | Oireachtas source

I thank the Minister of State for coming here and I thank the Cathaoirleach for selecting my Commencement matter.

In light of recent media reports concerning St. Luke's Hospital in Kilkenny, I raise the issue of access to the full range of termination of pregnancy services there and in the 19 maternity units in Ireland. The obstetricians in St. Luke's have argued that the hospital is not an appropriate location for medical or surgical abortion. I welcome the decision made by the Minister for Health to appoint an additional obstetrician to St. Luke's last week. However, hospital-based termination of pregnancy cannot be delivered by one staff member alone.

The issues in Kilkenny are symptomatic of wider access issues. Only ten of the 19 maternity services currently provide the full range of abortion services under the 2018 Act. In addition to situations of fatal foetal anomaly and serious risk to the woman's health or life, women may need access to hospital-based abortion care for many reasons, for example, individuals for whom medical abortion is contra-indicated, and women and girls, such as those living in homelessness or violent relationships whose personal circumstances may not be amenable to home self-management of medical abortion.

The absence of an abortion service in nine maternity units also impacts on community provision. The ability of GPs to serve the needs of women requires a referral pathway for women to their nearest maternity unit in those situations, for example, where the pregnancy exceeds nine weeks or in the rare event of a failed medical abortion. As the Minister of State will know, women have a legal entitlement to the termination of pregnancy, and the HSE must organise services where this right is vindicated in practice through local accessible abortion services.

If St. Luke's has declined to participate on the basis of resources, has it also refused to provide care to women undergoing a miscarriage? If not, how can this discrimination against women who need abortions be justified? The recently circulated letter assures local GPs that women who are morbid or septic will be dealt with. What does this mean? Is the Minister for Health satisfied that the hospital's position is in compliance with the law? Would a woman presenting at St. Luke's whose life is at risk be referred to another hospital or be required to wait until her health has deteriorated to the point where the medical team is satisfied that a termination is justified? Under the legislation there is no right to conscientious objection in emergency circumstances where a woman's life is at imminent risk or her health is at risk of imminent serious harm. Is St. Luke's providing for those women and how?

Beyond St. Luke's, on what basis are other hospitals refusing to provide abortions? What referral pathways are in place and to where? Have women requiring abortions who presented at these hospitals been referred elsewhere or been required to travel? How many women are we speaking about? Does the Minister foresee any risk of legal action due to medical negligence, for example, if a number of hospitals decline to participate in the abortion service?

Will the Minister of State outline what actions have been taken to roll out services in the remaining nine units, including Kilkenny? Is there a national implementation plan by the HSE? Has the €12 million allocated for abortion services in the 2019 service plan been released in full? Will abortion care in early pregnancy be available in all 19 units by the end of 2019? Do smaller units have the facilities and expertise to provide abortion care in cases of fatal foetal anomaly and risk of serious harm to a woman's health? If not, how is a woman's care managed in those situations? Are there clear and robust referral pathways to larger hospitals?

Perhaps the main issue here is an issue of fear and fear of the unknown. Dr. Nóirín Russell, a consultant obstetrician and gynaecologist at Cork University Maternity Hospital, CUMH, has made the useful suggestion to partner the non-providing hospitals with a providing hospital to help.

Dr. Mike Thompson, a general practitioner and spokesperson for Start, the Southern Taskgroup on Abortion and Reproductive Topics, a group of doctors who support reproductive rights, expressed a worry that the attitude of the doctors in St. Luke's would "embolden other hospitals" to issue a similar diktat. He said that it was "effectively institutional obstruction", and that while they were trying to "conflate it with resources", St. Luke's was no less resourced than any other hospital.Given that we gave a resounding vote for such law to be put in place, I would like the Minister of State to outline how he will ensure that every woman in Ireland has access to safe abortion care and what the position is in respect of those hospitals that are refusing care so that all 19 maternity units can offer all the care that they need to.