"More broken promises": At-home abortions made permanent, Department confirms 

The Department of Health has confirmed that remote abortions, introduced temporarily in Ireland during Covid-19, have now been made permanent, despite warnings that taking the pills without seeing a doctor in person may enable coercion and cause harm.

The changes to Ireland’s abortion regime were referred to by Minister for Health Stephen Donnelly on Wednesday – who described it as “an important step.” However, Life Institue said the move constitued another "broken promise" on abortion, even as the rates "soared".

Speaking in the Dáil, the Minister sais that the abortion act "as initiated, requires two consultations with a GP with a three-day gap between them.

“During Covid-19 we moved to what is being referred to as a blended model whereby one of the two consultations is essentially remote, via a phone call. Typically, the first consultation is a phone call with the GP but the second meeting could be the phone call.”

“On the basis that this approach worked successfully through the Covid pandemic, I asked my Department and the HSE to do an appraisal to see if we could continue to operate that,” Minister Donnelly said, adding that this had now been agreed upon:

“I received a recommendation from the chief clinical officer and Chief Medical Officer that they were in agreement that this could be done. Last night, I authorised that this approach continue on a permanent basis. The Act will now operate in that way."

In response to a Gript query, the Department of Health confirmed that full remote provision of early abortions may now be provided in Ireland, while stating that this “will not be routine” but will be permitted in what it said would be “extenuating circumstances.”

Asked whether it was concerned about removing safeguards provided by seeing a doctor in person, the Department said as part of the statement that telemedicine abortion is “safe, effective and acceptable” to “both service users and providers.”

In response, the Department said: “The Revised Model of Care for Termination of Pregnancy (TOP) Services was introduced in response to the COVID-19 pandemic.

“In light of the easing of COVID-19 restrictions in 2021, and as recommended by the Chief Medical Officer, the Department requested the Health Service Executive (HSE) to review whether remote consultation as part of a blended approach to termination of pregnancy care should be continued post public health emergency, in community care settings.

“This review found that remote consultation as part of the termination of pregnancy service is safe, effective and acceptable to both service users and providers.   It improves access for many women and addresses geographical and logistical barriers. It also alleviates some of the difficulty associated with the mandatory three day waiting period.”

It continued: “Under this Model, early medical termination of pregnancy will be provided in-person or with a blend of the first consultation taking place remotely and the second consultation in-person.

“While full remote provision of early medical termination of pregnancy will not be routine, it may be provided in extenuating circumstances, using clinical judgement and putting appropriate safeguards in place.”

It added: “As is the case for an in-person consultation, medical practitioners undertaking a remote early pregnancy TOP consultation will a) take a detailed medical history, b) remain alert for any verbal or visual cues which might raise concern about the patient’s safety and c) determine the duration of pregnancy based on the date of the woman’s last Menstrual Period (LMP).

Minister Donnelly first said that the abortion pill could be prescribed remotely during the Covid crisis; previously, the HSE had said pregnant women were required to attend a pre-abortion consultation at a surgery or clinic.

The change in policy sparked fears over women’s safety when it was made in March 2020, with pro-life doctors and nurses among those to warn that dropping the requirement for a physical consultation could be dangerous.

They pointed out that an ultrasound may be required to determine gestation – and can be crucial to determine if the pregnancy is ectopic, since an undiagnosed ectopic pregnancy can be life-threatening.

Mary Fitzgibbon, of Nurses and Midwives for Life, said at the time that prescribing the abortion pill by video conference would be an unsafe and retrograde move, and warned that failing to provide an ultrasound meant that ectopic pregnancy could be missed with life-threatening consequences. Other critics said that gestation in pregnancy would not be reliably established.

Life Institute said that, during the 2018 referendum, voters were told that women were putting their lives in danger by importing abortion pills and taking them without medical supervision. Then Taoiseach, Leo Varadkar, said that if people voted No it was “only a matter of time before someone haemorrhages or bleeds to death after taking one of these pills unregulated”

 "It's another broken promise on abortion - and likely another factor in increasing the already appalling abortion rates which are soaring. Women are being deprived of the best care, that's the truth of it, however much the Minister wants to pretend otherwise," the group said today.

"This move will simply enable coercion and likely cause harm to women," they added.

The HSE has also previously admitted it is not collecting any data on complications that arise from "at-home abortions.”

In response to a parliamentary question from Eamon O’Cuiv TD, the HSE confirmed  "no analysis as such on remote consultation has been conducted in Ireland". However, it did add that "the Department has requested the HSE to revisit the Model of Care to review its operation and consider whether it should be retained going forward."

At the Joint Committee on Health last week, Senator Sharon Keogan raised the issue of remote abortion consultations, and how the HSE acknowledged, in March 2022, that remote consultations in respect of home abortions make it harder to identify if a woman is being coerced or abused.

The HSE, despite claiming telemedicine abortion had been a “success,” confirmed last year that the practice had removed safeguards for women, telling TD Carol Nolan in response to a Parliamentary Question that:  “Meeting the woman in person increases the likelihood of the provider identifying any coercion or domestic abuse.”

In Britain, where abortion pills by post were also made permanent in the wake of Covid, one high profile recent case realised certain fears around the removal of safeguards. Mother of three, Carla Foster, was jailed – and then released – for aborting her 32-34 week old baby after she claimed she was not as far along as she was when seeking abortion pills.

Ms Foster accessed abortion pills after a remote consultation where she did not reveal how far along in the pregnancy she was. Foster was able to get hold of the pills to bring on an abortion under the UK’s controversial “pills by post” schemes, which was introduced by the British government during the first Covid lockdown.

Similarly to Ireland, the abortion pill was made available in Britain March 2020 without in person consultation, ending the prior requirement for women seeking abortions to be seen and assessed in person — allowing women to end pregnancies up to 10 weeks at home.

Abortion provider the British Pregnancy Advisory Service (BPAS) sent Foster the pills as they estimated she was seven weeks pregnant based on the information she provided and not seeing her in person. Pro-life campaigners said the case was evidence, among a number of others, of the need for in-person consultation so that gestational age can be established.

The court heard how the mother of three had carried out online searches which prosecutors said was indicative of “careful planning” — and that between February and May of 2020, Foster had searched “how to lose a baby at six months,” “how to hide a pregnancy bump”, “if you get hit in the belly, will you lose your baby?” and “how to have an abortion without going to a doctor”.

The baby’s cause of death was recorded as stillbirth and maternal use of abortion drugs after a post-mortem examination was carried out. She was estimated to be between 32 and 34 weeks’ gestation.

In addition, in May 2020, just two months after at-home abortions were legalised, a leaked email from a Regional Chief Midwife at NHS England and NHS Improvement revealed that there had been "two maternal deaths linked to this issue".

The email also revealed that women were presenting at hospitals after taking abortion pills for a range of incidents including ‘significant pain and bleeding related to the process through to ruptured ectopics’, ‘major resuscitation for major haemorrhage,’ and incidents involving the ‘delivery of infants who are up to 30 weeks gestation.’

An undercover investigation by Christian Concern found that abortion clinics were not carrying out basic checks before sending women abortion pills for use at home.

Fears around the practice prompted significant concern among medical professionals in Britain, with more than 600 medics signing a letter back in 2021 to demand that the controversial ‘pills by post’ scheme be scrapped.

They cited fears that abortion pills mailed after phone or online consultations were being used when the baby was beyond the ten-week limit stipulated - and might even be beyond the 24-week limit for surgical abortion, and said that taking abortion pills at home made it easier for men to coerce women into abortions against their will - and failed to protect women who were being trafficked or abused.

In a Parliamentary Question put to the Minister for Health in March this year, Independent TD Carol Nolan asked whether steps were being taken to identify possible instances of  coercion in response to a request for an abortion. In response, Minister Stephen Donnelly said that “no formal research or analysis on remote consultation” had been conducted in Ireland.

“No formal research or analysis on remote consultation has been conducted in Ireland; however, there has been positive feedback from providers and patients and there is strong evidence from published literature in the UK and Europe that remote provision of abortion care is safe and effective.

"In light of the easing of Covid-19 restrictions in Q4 of 2021, the Department requested the HSE to revisit the Model of Care to review its operation and consider whether it should be retained going forward,” the Minister told Deputy Nolan.

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Maria Maynes

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This article was originally published on Gript and is printed here with permission

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