Three things the Abortion Review did not look at, but should have

The Minister for Health Stephen Donnelly was impressed with the 2023 Abortion Review. He should not have been.

Here are three obvious things (and there are many others) that could and should have been researched as part of the Review, but were instead largely or completely ignored.

1. How many women change their minds about abortion after the initial consultation?
2. Are some abortion providers pushing the abortion option harder than others?
3. Why is there such variation in abortion rates between neighbouring counties?

All submissions to the Review from pro-life sources, that might have answered these questions, or might have indicated how to go about answering them, appear to have been unceremoniously dumped.

1. Women deciding to proceed with the pregnancy

The IFPA reported that, in 2021, 11 of their clients proceeded with the pregnancy after the initial abortion consultation. If the IFPA have this information about some of their clients, then it is likely that the other 400+ abortion providers do too. It would have been a simple matter for the Abortion Review to contact all abortion providers e.g by email, asking “To your knowledge, how many of your clients in the last year decided to continue with their pregnancy, after attending your clinic for an initial abortion consultation?”

That obvious question was never asked by the Abortion Review. If it had been asked. it would have yielded a minimum figure for the number of changes of mind each year - minimum, because it is clear in reports from abortion providers that a large number of women simply fail to return after the first visit and these women too may have decided to continue with their pregnancies.

Why was this obvious question not asked? Was it because a mere glance at HSE payment data to abortion providers (data that was provided to the Review) was enough to indicate that the number of changes of mind each year might well exceed 1000? Ideological opposition to the 3-day reflection period would be hard to sustain in the face of such overwhelming evidence for its success.

Was it easier to not collect this information and then to pretend that the actual numbers changing their minds might be close to zero

2. Are some abortion providers pushing the abortion option more aggressively than others?

This seems a reasonable (some would say inescapable) conclusion from the HSE data for payments to abortion providers and from data for individual (or groups of) abortion providers.

In 2021, for example, IFPA reported that

• 484 of their clients presented for an initial abortion consultation
• 12 of these did not return and 11 others proceeded with the pregnancy
• 25 others were outside the 12-week gestational limit

This means that 48 (=12+11+25) out of 484 initial consultations that year did not proceed to an abortion, which is 9.9% of the initial consultations. For all other abortion providers in 2021 except IFPA, however, it can be inferred from the HSE payment data that 19.9% of initial consultations did not proceed to an abortion. The IFPA percentage figure for women not proceeding to an abortion is less than half the figure for the other providers in 2021.

In the START survey of 27 abortion providers, covering the first 6 months of 2019 (i.e. at the very beginning of the new abortion regime) the percentage not proceeding to an abortion (for whatever reason)was even lower than IFPA, just 5.7%.

There have been a few half-hearted efforts to come up with other explanations for women not proceeding to an abortion after an initial consultation, but most people agree that there are just three major explanations – women changing their minds, women having miscarriages in the course of the 3-day reflection period, and women presenting after 12 weeks gestation.

It is hard to see how two of these - miscarriage rates, or weeks of gestation - would vary much among abortion providers, which suggests that the huge observed discrepancies reported here are mainly due to variation in percentages of women changing their minds.It seems obvious, then, that some abortion providers have far higher percentages than others of women deciding to keep their babies. Which in turn raises serious questions about variation in quality of counselling among the different abortion providers.

The Abortion Review ignored these questions entirely.

3. Variation in abortion rates between neighbouring counties

There is nothing unusual in itself in regional variation in abortion rates. In other countries, as in Ireland, there is a pattern of heavily urbanised regions having much higher abortion rates than rural areas. What is striking about the Irish data is that some neighbouring counties, with similar population densities, nevertheless also have substantially different abortion rates.

The graph below shows abortion ratios (abortions per 1000 live births) for each county in 2020. Some obvious questions arise. Why, for example, is the abortion ratio for Louth so much higher than the ratios for other counties near Dublin such as Wicklow, Kildare and Meath?

The Abortion Review was furnished with information along these lines, including the above graph, but chose to ignore it. Here, too, the answers might prove uncomfortable to pro-choice ideologues. Quality of counselling by abortion providers in different counties might form part of the explanation, for example.

The Review might have shown more interest here if the differences between counties could have been ascribed to small numbers of providers in some counties, an issue which received quite a lot of attention in the Abortion Review Report. But it is clear from the graph that Sligo (which had no GP’s at all providing abortions in 2020) actually had a higher abortion ratio than neighbouring counties Mayo, Leitrim, Roscommon and Donegal, all of which did have GP’s providing abortions. In view of this, a statistical argument for more providers in some counties would have been hard to sustain.

Summary

The examples featured here were chosen mainly because of their importance – these are questions that any serious review should surely have considered – but also because the Review had been supplied with most of the information given above and yet the Chair of the Review appears to have made a conscious decision to ignore this information.

Many other examples, of serious issues being ignored, could have been highlighted in this article. The Review ignored the dramatic and continuing rise in abortion rates here since 2018. It failed to consider measures to assist women who want to keep their babies, or measures to provide proper pre-abortion counselling. It failed to look at hospitalisation rates after taking abortion pills, or at the bizarre payment regime that pays GP’s €450 for dispensing abortion pills (3-4 GP visits) but not much more than half that for managing a pregnancy to term (up to 10 visits).

It looked very much as if a conscious decision was taken in 2018 not to gather much information about our new abortion regime.

This attitude is also in evidence in the Abortion Review, but more so. Not only do we not collect data about abortion that is routinely collected in other countries, we appear now to have reached the stage of suppressing much of the data that we do have.

     

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Jim Stack 

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

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