In response to the publication today of the three-year review of Ireland’s 2018 abortion law, Amnesty International said that, while nearly 18,000 pregnant people were able to access legal abortion care since the law came into operation in 2019, serious gaps and barriers were revealed and must be addressed urgently by the Government. Amnesty International welcomed the report’s recommending decriminalisation of healthcare professionals and says the Oireachtas health committee must now treat abortion as the healthcare service it is and address the gaps in law highlighted by this review.
Criminalisation of Healthcare Professionals
“Today’s report shines an important spotlight on some serious gaps and barriers in the 2018 Act. We strongly welcome its recommendation that healthcare professionals no longer be criminalised under that Act. The review confirms our concerns expressed at the time that criminalisation would create a chilling effect on health providers’ ability to provide care, and lead to women availing of care being stigmatised,” said Fiona Crowley, Amnesty International Ireland’s Interim Director, Human Rights.
Preventing harm to women’s health
“We highlighted other concerns and gaps while this law was being passed, including that the ‘risk of serious harm’ to a pregnant woman’s health is too high a threshold and medically unclear. This is confirmed in today’s report. It notes the possibility that women are being denied the care they should be entitled to under this ground and are having to travel. It is deeply troubling that the report also finds it possible that some health professionals do not realise that abortion is lawful where there is a risk of serious harm to the health – not just to the life – of the pregnant woman. This is a pressing human rights concern that urgently needs to be addressed.
Three-day Mandatory Waiting Period
“We welcome the recommended removal of the unjustifiable three-day mandatory waiting period for access to abortion on request. Nowhere else in healthcare is such a requirement imposed. However, we are concerned that the report does not recommend extending the 12-week limit for abortion on request. Instead, it proposes very narrow exceptional circumstances where this limit can be exceeded. This is particularly troubling in light of the 2022 WHO Abortion care guideline urging states to move away from having grounds or gestational limits in law at all. This review should be an opportunity to make the law work for women and girls, not tinker at the edges of what was a relative restricted law when enacted.”
Definition of Fatal Impairment
“Another gap we have repeatedly highlighted is the lack of lawful access to abortion in cases of severe but non-fatal foetal impairment diagnoses. We welcome the report’s recommendations for amending the narrow and rigid definition of what constitutes a fatal impairment, but more will be needed to meet minimal human rights compliance. One immediate interim measure could be to both extend the 12-week limit for access on request up to viability, and to provide a wide ‘risk to health’ ground in later pregnancy. Again, however, Ireland should be taking steps towards full compliance with the 2022 WHO guideline by moving away from grounds and gestational limits. It will be important that the Oireachtas committee fully consider this.”
Limited Availability of Services
The report also highlights serious issues affecting abortion service provision in some geographic regions, with still just 11 of the 19 maternity hospitals providing abortion services. Worryingly, it found in some counties a reliance on a limited number of providers in primary care and hospitals, which it says is making the service there ‘untenable’.
“We again acknowledge the incredible work of healthcare professionals to get this service up and running, and their efforts to safeguard the rights of pregnant people”, said Ms. Crowley.
“However, it is concerning that today’s report finds providers so overstretched. A recommendation we made in 2018 was to expand the range of health professionals who can lawfully provide abortion services, including midwives and nurses. This is echoed in today’s report and must be acted upon. We again recommend that this be left to medical guidelines rather than legislation, in line with WHO advice.”
Refusal to provide care on conscience grounds
The report also found that ‘conscientious objection’ is a significant factor in this uneven geographic distribution and number of providers, and is impeding the roll-out and development of services in the hospital setting.
“We are seriously concerned at the report’s finding that refusal by some health professionals to provide services on the basis of conscience is impacting women’s right to abortion care. It is wholly unacceptable that some are actively obstructing or delaying access to care by providing misleading information, and ‘with impunity’. There is no human right to refuse to provide healthcare on grounds of conscience or religious beliefs in international law. Rather, the Government is obliged to protect pregnant people’s human right to access healthcare. It must ensure sufficient numbers of healthcare staff who are willing and able to provide services. We are also calling for urgent Government action to compel objecting staff to give accurate information and make timely referrals to other healthcare providers.”
Amnesty will now review today’s lengthy report in detail and await information on the Government’s and Oireachtas health committee’s next steps.
“While we welcome the Government’s referring these proposed legislative amendments to the Oireachtas health committee, we call on the Minister to look at all immediate actions he and his Department can take on the more urgent concerns. Every day and week that passes, women, girls and other pregnant people could be denied care or forced to travel outside Ireland to access healthcare that should be their right here at home. We look forward to seeing what steps will be committed to and taken by Government pending the committee’s review. We will also be calling on the committee to take a more expansive approach to its review, towards a law that fully respects the human rights of pregnant people and treats abortion care as healthcare.”
The Health (Regulation of Termination of Pregnancy) Act 2018 was signed into law on 20 December 2018 and commenced operation on 1 January 2019. Section 7 of the Act provided that review of the operation of the Act must be initiated within three years of its commencement. We and others campaigned for this review clause to be included, and that it should ensure that the substance of the Act, and not just its operation in a narrow sense, be reviewed. The report is available on the Irish government’s website.
Read our submission to the review process. It called for the focus and aim in this review to be on ensuring safe and timely access to abortion services in law, policy and practice, in a manner respectful of pregnant people’s human rights to health, bodily integrity, autonomy, privacy, equality and dignity.
Amnesty International Ireland is a signatory to the submission made by the Abortion Working Group, which comprises over 20 civil society organisations and healthcare providers led by the National Women’s Council.