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GP group admits it did not survey members on three-day wait

The Irish College of General Practitioners has admitted that it did not ballot or survey its members – including the more than 400 GPs who provide abortions – before it told an Oireachtas Health Committee yesterday that the 3-day wait before abortion should not be retained. 

This was despite the fact, one Fine Gael TD said, that many consultants and GPs across the country are “firmly of the view that the three-day wait should stay in place.”

“Of the 400 or so GPs who are providing the [abortion] service, was there an actual survey done of the GPs that are providing the service?” Fine Gael TD for Cork North Central, Colm Burke, asked. 

The TD said that there were “two sides” to the international evidence around a mandatory waiting period for abortion, including in fourteen European countries.

While the Irish College of GPs (ICGP) is the education and professional and educational body for general practice in Ireland, and claims 4,900 members, those members had not been consulted in relation to the 3-day period of reflection, the Oireachtas Committee heard.

Opening the hearing, the ICGP’s Dr Ciara McCarthy said the amendment proposed by Sinn Féin “better aligns legislation with these clinical frameworks, supporting comprehensive clinical care while considering a woman’s individual needs and preferences.”

“The proposed amendment would remove the legally mandated three-day waiting period which currently exists, whereby a minimum of three days must elapse following a woman’s initial consultation before she can commence a medical or surgical abortion,” she said. 

The ICGP reps came under sustained questioning and some criticism from TDs across the political spectrum, some who said they were “shocked” that the ICGP came to the Committee as a representative organisation, but one which had not consulted with their members on their statement in regard to the 3-day wait.

Neither had the GPs group spoken to women who had changed their minds during the three-day wait, the Committee heard.

“I was just wondering, did you consult with any of your members ahead of today’s meeting, and what was the feedback?” Deputy Burke asked representatives from the ICGP.

“We didn’t consult with a wider membership on this,” a spokesperson for the organisation admitted.

So there wasn’t a survey done of the 400 GPs that are providing service – the reason I’m asking those questions is because I’ve spoken to a number of people who are providing the service, consultants and GPs, and they are firmly of the view that the three day wait should stay in place,” said Deputy Burke.

Aontú Senator for Cavan, Sarah O’Reilly, shared a personal testimony of discovering she was pregnant as a teenager, adding that she understood “the panic that sets in” and the need for a second appointment.

“I am a woman who got pregnant at sixteen, so I understand what it’s like to have a crisis pregnancy, and I understand the trauma and the confusion and the panic that sets in. So, I believe that taking away that second appointment – I think that’s a crucial appointment, particularly for women like me,” she told Wednesday’s Committee.

10,000 women changed their minds: ‘They weren’t contacted’

Dr McCarthy said it was the organisation’s view that the proposed change to the law would better align clinical and legislative frameworks for the various groups of women.

I have been contacted by women who kept their babies because of the three-day wait. And there are thousands of these women out there, and their voices have been nowhere in this conversation today, nowhere,” Senator O’Reilly told Dr McCarthy.
They weren’t contacted – the 10,000 women who never came back – they were not contacted for their evidence as to why they didn’t come back, so I don’t think we can really clearly talk about that.

Would you agree as the lead for women’s health that the voices of these thousands of women cannot be excluded from this debate of such an important safeguard?” she asked Dr McCarthy, a GP in Cork city who is the current ICGP/HSE GP Clinical Lead in Women’s Health.

Senator O’Reilly also said that there were many GPs, some of whom she had spoken to personally, who agreed with keeping the three-day reflection period in law. She also said it was worth noting that 90 per cent of GPs do not provide abortions.

I have spoken to many GPs myself, and who agree with keeping the three-day wait, so I do think that it’s important that that should be on the record, that there are GPs out there who are practicing, who agree with keeping the three-day wait.

It’s worth noting that 90% of GPs, um, do not provide abortion, and, um, you are not representing the views of the majority of your membership,” said O’Reilly.

The Senator told the ICGP clinical lead that she was of the belief a woman should have “two appointments if she wants to get an IUD, a coil, but only one if she wants an abortion.”

“So, abortion is an irreversible decision. How do you stand over these two conflicting positions?” she asked.

Deputy Colm Burke said while he accepted that what the ICGP was giving “expert evidence,” he was “getting a different line from the people who are providing the service, and who have a different view as well from what has been presented.”

The ICGP said that its recommendation to scrap the three-day wait, introduced as a legal safeguard in the 2018 legislation, was based on an Irish study of just 59 women and their experience of the three day wait.

In fairness, the people that I spoke to were of the view that it was helpful to the patients to have that three-day time period,” responded Burke. “You spoke earlier about best international practice – there are fourteen European countries where there is a mandatory time period. For instance, in Italy, it’s seven days. Belgium is six. In Germany, Portugal and Hungary, it’s three. So that’s international. You’re quoting international best practise – yet fourteen European countries do have time periods similar to Ireland.”

The ICGP insisted that the time period in place in Ireland was “burdensome” for women, and that such time periods were not necessarily rooted in evidence.

“But when you talk about international evidence […] the people I spoke to believed it was a benefit to the patients, to the people receiving the care,” said Deputy Burke.

“They believed that by having that second consultation, it was beneficial. from all aspects, and that was their big argument to me about it. That is the argument being put forward – they believe the three-day rule should not be changed.”

“One of the points being put to me by the practitioners is that sometimes when a person comes in and they want a termination, they haven’t thought it through fully – both the pros and the cons – they haven’t looked at all of the information.”

“The argument being put to me by the practitioners, is that they feel that that three days for reflection is extremely helpful, so that when the person takes the final decision, and they take the final decision for determination, they know that it’s their best decision that they’ve taken, and they have no regrets than afterwards,” added the TD.

Aontú leader, Peadar Tóibín, said that a lack of consultation with members had shocked people. He was also sharply critical of the ICGP when it came to the issue of coercion.

Independent TD Carol Nolan started out by highlighting not only the importance of the three-day waiting period, but the severity of the matter at hand, stating that the mandatory waiting period was not only a “minimal safeguard” against the destruction of human life, but also the “destruction of a woman’s life in the process”. 

The majority of people wanted this minimal safeguard kept when it came to the referendum, and now that seems to be discarded and we're going on a different path … even the majority of people in Amárach research that was carried out, they clearly expressed their opinion ion for the retention of this minimal safeguard for unborn life.” Nolan added.

Nolan also reiterated that the absence of a mandatory waiting period before an abortion was not in the minds of the majority of voters in 2018. “The majority of people who voted in the referendum didn't look for this. Like, that's what it should come back to. They did not seek any amendment here to current legislation. We voted the way we did in the 2018 referendum, and nobody looked for that. And in fact, there were assurances given that there would be no change to legislation. So why are we even discussing this here today, is my point. It's just not acceptable”, Nolan stated. 

Nolan said that the evidence used by the ICGP “did not capture” the voices of women who had changed their minds. She described the rationale used as “flawed and biased.”

“You haven’t spoken to those women who decided not to go ahead – the women who I speak to who are glad that the [three-day wait is there,” said Nolan. “We represent them, those voices, those are Irish women. How can you just say that everything is correct just because the WHO attached its name to it? It’s quite frightening actually. It’s unbelievable,” she said.

Fine Gael’s Peter Roche said that he would “never support the bill” and pointed to the fact that there are “somewhere in the region of 10,000 abortions carried out per year.”

He said that “10,534 mothers or women did not return for their second appointment, if you like, between the years of 2019 and ’24—five years. 10,534. So, it is fair to assume that there are thousands of young children under the age of seven happily attending national school, fulfilling the lives of mothers and families, as a consequence of them not returning. If they did return, that joy would be absent from their lives. That’s my take on this. And, you know, that’s 17% to 18% of women. That’s quite considerable.”

He also pointed to an Amárach poll which he said showed that 55.3% of people are against getting rid of the three-day wait – and said “the scrapping of those safeguards would be a profound betrayal of the general public that took to the polling stations to make a decision to protect the life of the unborn.”

Fianna Fáil TD, Pádraig O’Sullivan also queried whether the ICGP had consulted members, saying: “So for me, your presence here today would seem, I suppose, to suggest, at least project, that it’s representative of your wider grouping. And I suppose by your own admission, you haven’t consulted, so clearly we can discern that it’s not.”

He also questioned the argument that a narrowing of the window of opportunity to have an abortion was a reason to scrap the 3-day wait, saying that statistics presented by the START group suggested that that was only true in the case of 1% of the cohort of patients that they studied.

Deputy Michael Healy-Rae said that the political parties and the individual politicians that were “selling the proposal” in 2018, “their mantra to the public was: safeguards will be in place, there will be a 3-day waiting period, we will ensure that the only people that will make this life-changing decision for so many people will take due time, care, consideration, be offered every support in the world for alternatives.”

“But now what we’re proposing, and what the very politicians who sold it in that way, they’re now doing a complete U-turn. And I particularly want to mention people like in Sinn Féin and in Labour who spoke here already today, and to think of the irony: we’re at 65,000 abortions, skyrocketing figures,” he said. 

However, Sinn Féin’s David Cullinane said: “So there is nobody that I know who is seeking to remove that individualized reflection opportunity that a woman should have. And in fact, as was said, maybe for some women it might be 5 days, or a week, or 2 weeks, it might be a second, third, even fourth consultation. But what we’re doing for those who have made up their minds is that we’re removing the mandatory element, which is a barrier.”

“And I also just want to defend the integrity of the people who’ve come before this committee today, because they were asked to come here for a specific reason: to present evidence. And to present evidence not based on consulting every single GP—I don’t think that that would have been reasonable, because I don’t see how that would work, you wouldn’t do it in any other area if you were to come before an Oireachtas committee—you have to study whatever published evidence is available,” he said. 

“And you don’t get to choose what that evidence is, but you have based it on international evidence and evidence which is available here. And I think, to be fair to the witnesses, they have fairly articulated the evidence which is available to them.”

Kerry TD Michael Cahill asked the Irish College of GPs whether they’d support “an independent assessment of the outcomes and needs around unplanned pregnancy before making decisions on changing legislation on the 3-day wait”, as he stated that an important aspect that had not been focused on enough was why Ireland is seeing rates of 10,000 abortions annually — 1 baby aborted for every 5 born alive. 

“The question for why we are seeing abortions on this scale is an important question … Before making any changes that are going to realistically lead to wider abortion, there needs to be a genuine examination of what support pregnant women should have available and what needs to be improved in that context. Would the Irish College of GPs support an independent assessment of the outcomes and needs around unplanned pregnancy before making decisions on changing legislation on the 3-day wait?” Cahill asked. 

The ICGP responded that they essentially had enough evidence to inform their decision making, and that the proposal of Deputy Cahill was unnecessary. 

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