Abortion Review Chair accused of getting "basic facts wrong" at Oireachtas hearing  

  

The Oireachtas Joint Committee on Health has heard concerns from TDs around current practice which permits at-home and remote abortions, and around proposals to scrap the three-day waiting time for abortion made in the abortion review. 

Last week saw barrister Marie O'Shea, chair of the Abortion Review, sharply criticised after her evidence at the Committee where she said she was unaware of any other European countries that had mandatory waiting periods when discussing the 3-day wait before abortion. 

A spokesperson for the Life Institute accused O’Shea of "getting the basic facts wrong."  

Fine Gael Senator Martin Conway asked Ms O’Shea about the three-day waiting period before abortion, querying if there was “any other example in Ireland or anywhere in the world where there is a three-day delay for any medical procedure?” 

Ms O’Shea responded, “Not that I’m aware of" - a response that was described by Life Institute as an "extraordinary lapse, given that Ms O'Shea was advising against the retention of the 3-day ‘time to think’ before abortion.”

"Many other European jurisdictions do, in fact, have a mandatory period of reflection before abortion,” Megan Ní Sceallaín of Life Institute said. "Belgium requires a wait of 6 days, while Italy mandates 7, and Germany requires a 3-day pause. It is unacceptable, given that Ms O'Shea is pushing for a change in the law, that she does not seem to be aware of the relevant information and getting basic facts wrong in her evidence to the Committee."  

"Ms O'Shea is being presented to the Committee - and the country - as an expert on matters relating to abortion, and has been given a position of power by the government which is being used to push against the 3-day wait for abortion." 

"Yet she is telling TDs that she is unaware of other mandatory waiting periods  - when they are part of abortion regulation in more than 10 European countries," the pro-life spokeswoman said.  

"We know that the Abortion Review also failed to talk to even one woman who had changed her mind about abortion during the 3 day wait -  and now we know that the Chair of the Review was unaware that such wait periods are typical in many European countries.

"This review is increasingly shown to be a farce, and should not be relied on to break promises made to the electorate in the referendum when voters were told a waiting period before abortion would be part of abortion law," Ms Ní Scealláin said.  

After Ms O'Shea's response, Dr Catherine Conlon, who led research for the Abortion Review, and was also giving evidence at the Committee, corrected by saying: “In regulating abortion care in other jurisdictions waiting periods are enforced.” 

     

  

Evidence at Committee

The four-year review of Ireland’s abortion law was published in April, after Barrister Marie O’Shea BL was appointed last January to examine Ireland's abortion law, introduced in 2019 after the eighth amendment was repealed. The Chair of the Abortion Review recommended broad changes, including removing the waiting period mandated under the law. 

In April, government Ministers referred recommendations for legislative reform included in the review to the Oireachtas joint committee on health for its consideration. 

The report recommendations could possibly see abortion permitted in a wider time-frame, and without limit for babies diagnosed with a life-limiting condition in the womb.  

The Review has met with criticism, and was described as “fatally flawed” over its failure to take into account babies aborted following misdiagnosis in the State; failure to hear from women who changed their mind and did not proceed with abortion after the three-day wait and an initial consultation; and failure to address the steep rise in abortions in Ireland, with the annual number of abortions increasing from 6,666 in the first year of legislation, to 8,156 last year.  

 

Three day wait shows 'thousands of women' changed their minds

Peadar Tóibín began his questioning of the witnesses at the committee by saying that the admission that none of the women who have “benefitted” from Ireland’s three-day wait period "were ever spoken to at all" for the abortion review sent “shockwaves” around Leinster House and among the public. 

Figures given to Carol Nolan TD, regarding the number of women who had an initial abortion consultation last year, led the HSE to state that a total of 10,779 women had received an initial abortion consultation last year. 

Figures released by the Department of Health showed there were 8,156 abortions in Ireland in 2022 – which pro-life TDs say indicates that 2,623 women had an initial consultation but did not, for whatever reason, undergo an abortion in Ireland. 

Figures provided by the HSE have been examined by statistician Jim Stack, who says that the data puts the percentage of women who do not return for an abortion at 20% in 2021 “when 1,601 out of 8,284 initial consultations did not end in abortion”. 

Deputy Tóibín said that the review’s “very significant” recommendation that the three-day wait period should be deleted “probably shocked people.” 

“Section 11 of the report refers to the START doctor group survey, which indicated that approximately 2% of mothers did not proceed to a second abortion meeting or an abortion,” the TD said. 

“At the same time, the HSE was producing figures showing that 16.5% of mothers were not proceeding to a second abortion meeting or an abortion. Would our guests agree that the 2% figure within the report is incorrect?”

Ms O’Shea replied by saying it was not apparent why women did not return, stating: 

"First of all, we do not know why they did not return. That is the first issue. We do not know whether they miscarried or went somewhere else. I do not know. One cannot make this presumption. It is a presumption, at best, that they continued the pregnancy as there are no data to support that.” 

Ms O’Shea indeed noted that the only data the review had showed that only 2 per cent of women did not return, according to the Irish Family Planning Association. 

“The HSE figures say that 16.5% of mothers did not return,” Mr Tóibín argued.    

"The 6,728 women who attended the first appointment are women who did not proceed with any abortion, either in a hospital or within the GP's surgery,” he continued. However, Ms O’Shea said she did not have that data, saying it was “not available” when Mr Tóibín said he would get it for her to look at. 

“That is a figure from a parliamentary question,” the Aontu leader insisted. Dr. Catherine Conlon, meanwhile claimed: “That parliamentary question has no scientific rigour to its answer.” 

Questioning how the review was conducted, Mr Toibin said many people feel there “is a chasm of evidence missing from this discussion.” 

He said that while the figure regarding women not returning could be argued back and forth, it was also the case that “there are also hundreds of women who have had adverse incidents as a result of experiencing abortions in this country who are suing the State who have never been spoken to either.” 

He continued: “There are also mothers who had fully healthy children who were aborted under the fatal foetal abnormality element of the legislation who again were never spoken to for the review. It feels that there is an absence of so many people who would have added rich information to the review, and not necessarily from an ideological position. I know mothers who went through with the first abortion meeting and would have loved to have spoken to the witnesses.” 

Fine Gael Senator Seán Kyne told the Committee that as a yes voter in the Referendum of the Eighth Amendment, he was “somewhat comforted” by the three-day wait period promised under the abortion legislation.

“We have not finished our work here, so the Government is waiting for us. I am envious of colleagues who can be so definite on these issues,” Senator Kyne told the Committee.

“I remember attending a pro-life meeting as a public representative during the protection of life in pregnancy legislation, defending it and explaining it as best I could,” he continued.

“At the time, there were a huge number of people coming into clinics in relation to that legislation. There has been a lot of debate on this matter which of course led to the campaign. I voted "Yes". I was somewhat comforted by the three-day wait period. I raised this issue the last time Ms O'Shea was here. 

“I mention the responses to parliamentary questions by Deputy Carol Nolan on the number of women who did not go ahead with a second appointment. Ms O'Shea said that some of those women would have had miscarriages. She is suggesting the Oireachtas change that. How many women who did not go ahead with the second appointment went on to have children?” he asked. 

In response, Ms O’Shea said she did not have the available data. 

“Did Ms O'Shea attempt to get the data?” Mr Kyne asked, to which Ms O’Shea replied, “There is no data on it. I have explained this to the committee.” The Senator said that although data may be difficult to get, “At the same time, for me, making a decision, I believe in data.”

   

'Enabling coercion and abuse of women'

Meath Independent Senator Sharon Keogan was among the politicians to address the Committee on Health on Wednesday on the report of the review of the 2018 abortion law.  

Senator 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.  

Referencing the HSE’s admission, made in a response to a parliamentary question, Senator Keogan outlined: “It recognised that meeting the woman in person increases the likelihood of the provider identifying any coercion or domestic abuse.  

“In her report, Ms O’Shea recommended that telemedicine for abortion should be retained as a staple of abortion policy going forward, at least in a blended form. As we know, telemedicine was introduced as a Covid-19 emergency measure and is still in place,” the senator continued. 

Senator Keogan said she was concerned about the risk of vulnerable women falling “through the cracks” in Ireland’s telemedicine abortion regime, which is still in place, despite calls to end at-home abortions over safety fears, both in Ireland and in the UK. 

 “I have concerns around telemedicine and how it could be seen as enabling coercion and abuse of women that would go undetected, as well as having a detrimental impact on women who are trafficked in Ireland. This country does not have a good reputation on human trafficking,” she said. 

“Is there an added risk of allowing these vulnerable women to fall through the cracks under the telemedicine regime, even if it is optional? That is my first question,” Senator Keogan asked. 

“Second, Ms O'Shea has said a number of times this morning that she felt under pressure to deliver this report. Does she believe that if she had been given more time, or if the review period had been extended from three to five years, it would have helped her to deliver more effective research other than the research she has given on 58 women? “Some €11.2 million has been spent per year on abortion services. I ask Ms O'Shea to answer those two questions.” 

In response, Ms O’Shea said she was “not aware” of the HSE’s admission regarding the risks around remote abortions.  

The HSE, despite claiming telemedicine abortion had been a “success,” confirmed that the practise had removed safeguards for women, telling Deputy Carol Nolan that:  “Meeting the woman in person increases the likelihood of the provider identifying any coercion or domestic abuse.” 

Marie O’Shea, responding, said, “On the remote model of care, I am not aware of the reference the Senator has made to the HSE saying that it has increased the risk of coercive control being exercised on a person's reproductive autonomy.  

“As someone who works in family law, I encounter many people who have been in coercively controlled relationships. As I have said in the report, I believe the remote model of care can work both ways.”  

 “As was stated at the START conference, in most cases GPs have adopted a hybrid model of care. They see benefits in seeing the person on one occasion, at least, for public health issues; for example, to see if these persons need to be screened for various sexually transmitted diseases, to talk to them about contraception, to refer them for rhesus D, and to take bloods to see if they are at risk of the rhesus D factor.  

“This is multitudinous but the remote model of care has certainly ameliorated some of the difficulties for people travelling for abortions also.” 

Senator Keogan pressed Ms O’Shea, asking her if she could see the system “being open to abuse. as in not being able to actually assess the gestational stage of the pregnancy if there is somebody in domestic abuse, not having face-to-face consultation with the doctor in order to know that the person is suffering domestic abuse, and not being able to see that person's bruises to realise that the person may be coerced into having that abortion? Does Ms O'Shea not feel that is a factor?” 

Dr. Catherine Conlon, Associate Professor of Social Studies at Trinity College Dublin, also responded. She referred to discussions those behind the review had with TCD Professor Stepanie Holt whose expertise is in the area of domestic violence.   

“We have been having some discussions around this. From her analysis of the literature to date, there has not been extensive evidence in the literature or even attention in the literature to this issue. One of the areas of our research direction will be to look at the intersection between domestic violence and reproductive coercion,” Dr Conlon said. 

“The model recommended in the report is the hybrid model. It anticipates that the person will attend with the doctor on at least one occasion. That ameliorates the concern the Senator is expressing there.” 

In response, Senator Keogan referenced a report from October last year, reported by The Irish Examiner, of an instance of coerced abortion in Ireland, which saw an underage girl locked in a room and forced to take abortion pills. 

As reported by The Examiner, who obtained the information from staff at Ireland’s sexual assault treatment unit,  “In one case, a girl, aged under 18, was locked in a room and given abortion tablets to force her to have a termination.” 

Senator Keogan asked, “Was [the case] put into the report and was it considered by the review?” 

Marie O’Shea, coming in to respond, said “I considered it” but went on to insist that remote abortion “can work for and against people in [coercively controlled] relationships.” 

  

"We are talking about the termination of another life

Senator Ronan Mullen also attended the Committee, pointing out that there are other jurisdictions where a waiting period is required, and that it is not something unique to Ireland. 

The Independent Senator said he thought it surprising that it is not acknowledged that waiting periods are required in other jurisdictions or areas of medicine, pointing out that one “obvious” one is euthanasia and assisted dying. 

“I sit on an Oireachtas committee that is currently looking at whether to introduce euthanasia or assisted dying. Even in the most liberal of regimes, part of the so-called safeguards that are discussed in that area is a waiting period,” Senator Mullen said. 

He told the committee that “we are talking about the termination of another life” when it comes to abortion. 

 “The reason for this is because it involves the termination of a human life. I remind witnesses that in the case of euthanasia, it is a person's decision to terminate their own life, whereas with abortion, we are talking about the termination of another life,” Senator Mullen continued. 

He said he found it “strange” that  there “has not even been an acknowledgement by the witnesses to date that there is this obvious example of a similar life and death issue, namely, euthanasia, in various jurisdictions across the world where it is seen as entirely appropriate - not that there would be the possibility of a waiting period but that there would be a mandatory waiting period, and indeed a much longer one than three days” 

“I do not think that really requires an answer. I have not heard it from the witnesses at any stage and it is the most obvious point,” he said. 

He also addressed the issue of research, saying that the “onus was on witnesses to establish” that not a single person changed their mind as a result of a waiting period, something they could not do, given the statistics regarding those who did not go through with a second appointment. 

“The great majority of Irish citizens would believe that, even when those other situations which are possible are factored in, there may well have been several thousand women who changed their mind as a result of that waiting period. As a precautionary principle, the witnesses should be much more attentive to that point. They have never acknowledged it at any stage to my knowledge,” the Senator said.

He went on to address the report’s proposal to introduce a statutory obligation for healthcare workers to “refrain from providing misleading information” or otherwise “engaging in conduct that is designed to, or could reasonably be considered as being designed to, prevent or delay a woman's access to termination of pregnancy,” as set out in the abortion review. 

 “We are all in favour of making sure there is never misinformation, but I find it tendentious and I would like to hear the response of the witnesses as to who they think would adjudicate on what constitutes misinformation,” he said. 

“Since there is also a case to be made, and we have seen it over the years where abortion counsellors and medical professionals have often counselled in such a way as to bolster the choice of an abortion and, indeed, to hasten it.

“I find it strange that the witnesses are only interested in prohibiting through statute conduct that would be designed to prevent or delay a woman's access. I see a lack of neutrality in that.” 

In response, Barrister Ms O’Shea challenged Senator Mullen, claiming that “what is proposed in the report is not taking away from anybody the right to have that reflection period.” 

“In a world where I think we can accept that women have the capacity to make decisions, to weigh up the evidence and to say, "I am not quite sure today. I would like to take the opportunity to come back on the next occasion", there is no threat to persons who have had the experience the Senator mentions, who decided against having a termination of pregnancy and who decided they would continue with the pregnancy. There would be enough safeguards in there to protect those people,” Ms O’Shea said. 

Dr. Conlon, meanwhile, told the Senator: “I trust women to make decisions.” She said that the review sought “a model of care that supports sound decision-making for women and an accessible service. That is the way we can reduce the instance of abortions that are not in the best interests of people.” 

In response, the NUIG Senator described it as “a very ideological response” – adding: “We need something much more objective.”