Why we need official data for abortion providers

Not everyone, who presents for an initial abortion consultation in Ireland, actually proceeds to an abortion. There are three main reasons:

– the woman may change her mind between the first and second abortion consultations– she may have a miscarriage in that time– she may be outside the 12-week gestational limit at first visit.

Whatever the reason, it seems plausible that the percentage of women proceeding to an abortion should not vary that much among the different abortion providers. Why should some abortion providers have significantly different proportions of women changing their minds, or having miscarriages, or first presenting after 12 weeks’ gestation?

Attempting to shed light on these questions, Carol Nolan TD tabled a parliamentary question last year to the Minister for Health in connection with payments for medical abortions under our 2018 abortion legislation.

Deputy Nolan requested, for each year from 2020 to 2023, the number of payments of €150 to each registered provider for initial abortion consultations, and the number of subsequent payments of €300 for completed abortions.

The reply received from the HSE did not, in fact, answer these questions for each provider, but instead aggregated the respective payments across all providers, and reported these. These aggregate results are reproduced here (Table 1) exactly as provided to Deputy Nolan by the HSE:

Table 1 

Two interesting questions are prompted by Table 1.

1. Are these abortion figures in line with earlier data from the Department of Health?

In short, these latest abortion figures are higher than what was previously reported.

For example, the official abortion report from the Department of Health for 2020 stated that there were 6577 abortions in total in that year, whereas the above Table has a higher figure of 6735 abortions completed in the community setting alone (by GP’s etc before 12 weeks gestation), to which should be added more than 100 abortions performed in our maternity hospitals in that year. The original reported figure for total abortions in 2020, therefore, was at least 250 lower than the current reported figure.

How could this happen? Abortion providers are supposed to supply information about each abortion to the Department in a timely fashion – by the end of the following month – but it seems clear that this does not always happen. About 250 of the 2020 abortions, it seems, were reported much later than this.

The county of residence (of the woman obtaining the abortion) is something else that the abortion provider is required to supply, but this too does not always happen. In some years more than 500 abortion notifications have not included the county of residence.

The abortion providers always seem to get paid, however, whether they supply all the required information or not.

2. Is there much variation among abortion providers in percentage of completed abortions?

In Table 1, the number of claims for completed abortions nationally ranged between 81% (in 2021) and 83% (in 2023) of the number of claims for initial consultations.

Between 17% and 19% of women, in short, did not proceed with an abortion after the initial consultation, a remarkable level of consistency from year to year.

However, data from the Irish Family Planning Association (IFPA), probably the largest individual provider of abortions in Ireland, has been very much at odds with the HSE figures. For example, IFPA furnished information to Kitty Holland of the Irish Times (19th April 2023) to the effect that, in 2021:

• 484 IFPA 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

In summary, therefore, 436 of the initial 484 clients proceeded with an abortion through IFPA in 2021, and 48 (= 12 + 11 + 25) did not. That is, 9.9% of IFPA clients in that year did not proceed to an abortion. This figure of 9.9% is a far cry from the 17%-19% nationally not proceeding to an abortion in 2021, according to the information supplied to Deputy Carol Nolan, as per the Table above.

IFPA is the only individual abortion provider making its data public each year. Whether the percentage of completed abortions for other large providers is in line with IFPA, or in line with smaller providers, is unknown. It was precisely to investigate this that the parliamentary question was asked by Carol Nolan in the first place, and it is unfortunate that the HSE avoided answering as requested.

Make no mistake about it, the question is important. All abortion providers sign a declaration saying, in effect, that proper consultation has taken place before each abortion is carried out. If some abortion providers have much higher percentages of completed abortions than others, that raises really serious questions about the amount and quality of counselling that is provided in some settings.

One hopes that, when asked for data about individual abortion providers, the new Minister for Health might actually provide it – unlike her predecessor.

     

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Jim Stack

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Originally published on Gript and printed here with permission

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