On 25 May, Ireland will hold a referendum that has been 35 years in the making. And it’s one of particular significance to women, whichever side they’re on.
The question is whether the 8th Amendment, which recognises the equal right to life of the unborn, should be removed from the constitution. While it is still in place, abortion cannot be legislated for or regulated in Ireland.
The only scenario in which abortion is currently legal in the Republic is where there is a “real and substantial” risk to the life, as distinct from the health, of a woman. In all other circumstances, including rape, incest and fatal foetal abnormalities, it is a criminal act to obtain one, with a maximum sentence of up to 14 years in prison.
This puts Ireland’s abortion laws well behind all other EU countries aside from Malta and Northern Ireland (as part of the UK). And it’s a human rights debate that has been raging in this historically Catholic country ever since conservative campaigners pushed for the amendment to be added back in 1983.
The impact of the current situation on Irish women and their health is clear, with thousands travelling abroad every year – mainly to England – to terminate unwanted or non-viable pregnancies. But what is it like to be the pro-choice medical professional who cannot support them? And what impact does the 8th have on Ireland’s maternity services as a whole?
“I was one of those people who grew up ‘pro-life’ and became pro-choice,” says midwife Jeannine Webster. “As I understood it then, you were not really a good person if you had an abortion. And then you learn, you know?”
Webster, who is 52, became a midwife in her early forties. She currently works at one of Ireland’s largest maternity hospitals, and has three adult children. In 2016 she became part of the campaign group Midwives for Choice.
For her, the issue with the 8th Amendment is the disparity in the level of care she can provide to women who make different choices: “There’s no equality in healthcare. Because as much as I can 100 per cent support a couple that want to continue with their pregnancy, I can’t do that for those who feel emotionally that would be too much.”
Webster tells me a story about a couple who came into her clinic a few months ago. During this visit, they learned their baby had a fatal foetal abnormality and would not survive outside the womb. The mother was in her second trimester of pregnancy with their third child.
“The woman said, ‘Can we not just have the baby now?’ And I said, ‘No, because the baby still has a heartbeat.’ And she turned around to me, ‘But what’ll happen? What can I do?’ And I felt I couldn’t tell her what she could do. I can’t.”
In Ireland, as a medical professional, giving out information on abortion services abroad is subject to strict guidelines. It must not be accompanied by any advocacy or promotion of abortion and all options must be fully outlined. It is also against the law to make a referral to an abortion service on behalf of the pregnant woman. This makes difficult conversations tricky to navigate.
Despite this, 3,265 women travelled from Ireland to the UK in 2016 to have an abortion. That figure accounts for nearly 70 per cent of all non-resident abortions carried out in the UK that year.
Dr Jennifer Donnelly is a consultant obstetrician at Dublin’s Rotunda Hospital who deals with foetal abnormalities and complex maternal problems. She says that being unable to refer patients for termination services either at home or abroad creates health risks and unwelcome gaps in care.
“If somebody has got a devastating diagnosis and then has to try and negotiate a whole other health system with minimal support, it absolutely makes a traumatic situation massively more difficult for them,” she says. “We want to provide care for women. Part of that care is looking after women who are bereaved under those circumstances.”
Not all medical professionals agree.
“The Eighth Amendment has one medical effect only: it prevents Irish doctors from deliberately, as an elective matter, causing the death of an unborn child,” wrote Professor Eamon McGuinness, a consultant obstetrician and pro-life campaigner, in The Irish Times earlier this month.
“That right does not restrict doctors from acting to save the life of a woman where a serious complication arises,” McGuinness continued, in reference to recent reports of women being denied life-saving cancer treatment due to an unplanned pregnancy.
Dr Maeve Eogan, a fellow consultant obstetrician, was quick to point out on social media that although abortion is lawful where there is “a real and substantial risk” to a woman’s life, McGuinness had failed to address a number of important areas. For example, sexual violence and life-limiting foetal conditions, “or the fact that women travel and take unregulated medications every day”.
Eogan is Medical Director of Ireland’s National SATU (Sexual Assault Treatment Unit) Services. She has witnessed the trauma caused to women by both sexual violence and fatal foetal abnormalities first hand. One of her primary concerns is women’s fragmented experience of care.
“At the moment, Irish women who travel to the UK for termination of pregnancy – or access unregulated medications online – are not getting the full range of termination of pregnancy care,” she says.
“So they’re not getting the post termination follow-up, and they’re not getting the appropriate contraception. There isn’t the holistic care package. They’re accessing one piece of the jigsaw, but they’re not accessing the other things which promote their health in the long-term.”
When it comes to continued pregnancies in Ireland, pro-choice health professionals have differing views on whether the 8th Amendment plays any role.
Philomena Canning, a 57-year-old independent home birth midwife and founder of Midwives for Choice, believes the 8th Amendment undermines the rights of all pregnant women; not just those seeking an abortion.
“The 8th Amendment strikes at the core of midwifery,” Canning says. “And at the core of midwifery is respect for the human rights and personal decision-making of the woman. It in essence means that women have no guaranteed role in decisions about their care and treatment from the time they get pregnant until the baby is actively born.”
She cites the 2016 case of Geraldine Williams, from Ballyjamesduff, Co Cavan, who had three children delivered by caesarean section and wanted to have her fourth child naturally.
In September of that year, when Williams was 40 weeks pregnant, the Health Service Executive applied to the High Court for an order allowing it to carry out a caesarean section against her wishes. This was to assert her baby’s right to life under article 40.3.3 of the constitution. Williams had already been hospitalised and would not agree to a c-section.
The judge ultimately refused to grant the order, saying the increased risks associated with a natural birth did not justify “effectively authorising to have her uterus opened against her will, something which would constitute a grievous assault if done on a woman who was not pregnant”.
But Eogan and Donnelly, both specialist consultants in their fields, insist that the impact of the 8th is generally restricted to women seeking terminations.
“That kind of situation is extremely rare,” says Donnelly. “A woman’s wishes should not be overwritten and a procedure should not be done to her without her consent.
“I think rather than it being the 8th Amendment, there certainly can be old fashioned attitudes from doctors and midwives to core ways of approaching things,” she concedes. “The woman’s views should not be disregarded and I think that would be a traditional patriarchal model, which is definitely changing, but I’m sure it may still be present in certain places.”
Though their views might differ on this subject, all agree that Ireland’s maternity services still have a way to go to compete with the UK’s progressive, midwifery-led model for low risk births.
“We have pockets of excellent community midwifery in a whole range of areas in Ireland,” says Eogan. “But it is not universal. And some women who may wish to attend a community midwifery service, proximate to their home and their hospital, may not be able to do so.”
“While I may not agree personally that the amendment affects care in the labour ward, I don’t think it should be used as an excuse for poor professional behaviour either,” says Donnelly. “Our aim is to provide an excellent standard of care for women and we shouldn’t be using that as a barrier to consent, to exploring women’s concerns and choices in labour. From a cultural perspective, listening and communication is totally crucial, and if getting rid of the 8th helped to improve that culture, then I’m all in favour of that too.”
And how might that culture change in Ireland, if the 8th Amendment is removed? “I hope that because that provision won’t be there that undermines women’s rights and choices that their voices will be a little more heard,” says 32-year old Dublin midwife Róisín Smith.
“And the things that women want – whether it be midwife-led care, midwife-led units, homebirths, being allowed more flexibility in terms of time in labour – all of that will be much more possible.
“We don’t have to have the 8th Amendment in our constitution for us to be able to value women and unborn babies as a society. Those kind of moralistic arguments that people make for the 8th, those morals don’t have to disappear because we also want to value women as mothers and decision-makers.”