Thursday, 7 March 2019
Nithe i dtosach suíonna - Commencement Matters
Abortion Services Provision
I welcome the Minister of State. Since the passing of legislation to regulate termination of pregnancy, early medical abortion has, for the most part, been provided to women by general practitioners and community providers. Clinical guidelines allow for the provision of early medical abortion in the community where gestation is less than ten weeks. These cases are being dealt with quietly and efficiently within the community. However, whereas the legislation permits provision of abortion where the gestation has not exceeded 12 weeks, pregnancies that are ten weeks or more are to be provided for in a hospital setting for clinical reasons.
Where gestation is between ten and 12 weeks, clinical guidelines advise GPs to refer women to hospital, where the abortion can be provided. It appears the method of abortion in the vast majority of these cases is medical. This method is safe and effective. However, it carries a small risk - less than 1% - of ongoing pregnancy following the process. If the pregnancy is ongoing following early medical abortion where it is nearing the 12-week gestation limit, the most effective way to complete the process is by surgical abortion. The availability of surgical abortion in Ireland is not clear to the community providers.
The Southern Taskgroup on Abortion and Reproductive Topics, START, in Cork and the surrounding region, which provides an abortion service in the community, has found that despite initial difficulties, pathways for women seeking abortion are relatively straightforward where gestation is between ten and 11 weeks. That said, there is a concern on the part of this group of GPs that pathways for gestation over 11 weeks are less than clear. Many GPs across the country have found that pathways for the referral to a hospital were created locally as the need arose after the beginning of the provision of services from 1 January last year. Nonetheless, GPs in several parts of the country are concerned that there are no actual pathways for women seeking termination where gestation is between 11 and 12 weeks. It is deeply concerning that should such a case arise, time will be of the essence and it is important that GPs and community providers would be given clear and reliable information about referral pathways for all patients coming under the provisions of the Act, regardless of how close to the 12-week limit they may be.
Will the Minister of State confirm that the State is providing abortion services for all women where their circumstances meet the criteria set out in legislation, regardless of how close to the 12-week limit they may be? If that is so, how many hospitals are participating in this and which ones are they? Will the Minister of State seek to have clear and public published referral pathways for these cases so the community providers can refer women to a hospital that can provide these services in a seamless, established and agreed process?
I am taking this matter on behalf of the Minister for Health, Deputy Harris. I thank Senator Kelleher for her insight and for giving me the opportunity to provide clarification.
On Friday, 25 May 2018, the Government held a referendum arising from the Thirty-sixth Amendment of the Constitution Act 2018. The people of Ireland voted overwhelmingly in favour of deleting Article 40.3.3° in its entirety and substituting an article in the Constitution, the object and effect of which is to articulate clearly the principle that laws may be enacted by the Oireachtas to provide for the regulation of termination of pregnancy. The Health (Regulation of Termination of Pregnancy) Act 2018 was passed by the Houses of the Oireachtas on 13 December 2018 and signed into law by the President on 20 December 2018. The legislation provides for a termination to be carried out in cases where there is a risk to the life or of serious harm to the health of the pregnant woman, where there is a risk to the life or of serious harm to the health of the pregnant woman in an emergency, where there is a condition present that is likely to lead to the death of the foetus either before or within 28 days of birth and without restriction up to 12 weeks of pregnancy.
A public information campaign, My Options, commenced upon the enactment of the legislation. Services for termination of pregnancy have been offered from 1 January 2019 and there is regular ongoing engagement between the Department of Health and the Health Service Executive, HSE, to facilitate the smooth running of the service and to resolve any issues that may arise. As of 1 March 2019, 290 GPs nationally had signed contracts to provide termination of pregnancy services in the community and terminations up to 12 weeks of pregnancy are being provided in ten maternity hospitals or units in the following hospital groups: Ireland East hospital group - National Maternity Hospital, Holles Street and Midland Regional Hospital Mullingar; RSI hospital group - Rotunda Hospital and Our Lady of Lourdes Hospital, Drogheda; Dublin Midlands hospital group - Coombe Women and Infants University Hospital; Saolta hospital group - University Hospital Galway and Mayo University Hospital; University of Limerick Hospitals - University Maternity Hospital Limerick; and South/South West hospital group - Cork University Maternity Hospital and University Hospital Waterford. A woman requiring a termination at one of these maternity hospitals or units must be referred by a GP.
While most terminations up to nine weeks of pregnancy will take place in the community, some may need to take place in a maternity hospital or unit for medical reasons. However, all terminations between nine and 12 weeks of pregnancy must take place in a maternity hospital or unit. When the service for termination of pregnancy was first introduced, an issue arose whereby some maternity hospitals or units were operating an 11-week cut-off for terminations in early pregnancy. However, this issue has been resolved. Terminations of pregnancy carried out in maternity hospitals or units can be either medical or surgical. The type of termination carried out is a matter for the relevant medical practitioner and the woman concerned.
I thank the Minister of State. She stated, "Terminations of pregnancy carried out in maternity hospitals or units can be either medical or surgical." Can she confirm that they are both - as is the right pathway for the woman - because medical can be the right way to go or surgical can be the right way to go? I refer to the particularity of the pathway for a woman who is in her 11th week. There seems to be some doubt in the minds of GPs about the clarity of that pathway. The Minister of State offered me some clarity but she did not offer me the clarity that I am seeking on the issue of the clinical pathway for a woman presenting at 11 weeks and the access to both surgical and medical in the hospital groups. The Minister of State did not answer that question but I would like if she could do so.
As already stated, terminations of pregnancy carried out in maternity hospitals or units can be either medical or surgical. The type of termination carried out is a matter for the relevant medical practitioner and the woman concerned. It is clear from this that they can be either. This comes down to the decision of the medical practitioner.
I am not sure to what the Senator is referring in the context of pathways. Perhaps I can get the Minister to revert to her on the exact pathways that are being taken. From reading the script I was given, it is clear that there is a pathway through the GPs to the effect that, up to nine weeks, it can happen in the community. Thereafter, however, it is essential that women have their procedures in a hospital environment. That is what is happening. However, if the Senator persists, I will seek a reply from the Minister for her on the pathways and on the concerns raised by some of the GPs she mentioned.