Last May, almost two-thirds of the eligible population turned out to vote on whether to repeal the Eighth Amendment and pave the way for the introduction of legislation to permit termination of pregnancy in certain circumstances in Ireland. The result was an overwhelming majority in favour of repeal.
It would have been hard to imagine such a definitive result even a decade ago. In contrast to the toxicity, hyperbole and outrageous rhetoric of 1983 this referendum was very different. Its hallmark was honesty – the searing honesty of the personal stories told by women and their families. Women had been telling their stories for years – in homes, in the High Court, in European courts and on television and radio programmes. Each story giving permission for the next and as the momentum grew, so did the solidarity. The solidarity that brought women home to vote because of the women forced to leave before in such heartbreaking circumstance. The solidarity that allowed us to pitch real life against ideology.
The other striking feature of the referendum campaign was the excellent work of the Oireachtas health committee and the Citizens’ Assembly, facilitating strong civil and medical engagement and forums where medical facts and experience were presented by a wide range of doctors, midwives and other healthcare professionals. Doctors engaged strongly with the Yes campaign in the knowledge that they would ultimately deliver this service.
Dilemmas
Doctors on the Yes side who were asked questions about medical facts answered them honestly, even when those answers were not on message for the Yes agenda – on the difficult issue of screening for chromosomal disorders, for example. During the years and months preceding the referendum, it seemed as if Ireland would never stop discussing termination of pregnancy as Irish people faced up to myriad medical and ethical dilemmas. People thought deeply on these matters, just as women do when they are faced by pregnancies they cannot continue.
We must retain that integrity now. Voters were given assurances before deciding how to vote about what the legislation allowing for terminations would say should they vote Yes. It was a non-binding but unambiguous commitment and people voted on that basis. To renege on that commitment now could be very challenging for those who struggled with their decision but who ultimately found themselves able to accept the terms put forward.
Now is the time to focus on providing the services that have been promised
The detail of the planned legislation was widely disseminated during the campaign and became very familiar. It was made clear that a termination would be lawful when a woman was pregnant for 12 weeks or less and that she would not have to qualify according to any set of imposed criteria. After that but before foetal viability, a termination would be lawful if two medical practitioners certified that there was a serious risk to the life or health of the pregnant woman. A termination would also be lawful in cases of fatal foetal abnormality.
The scheme of the Bill also allowed for conscientious objection within the medical profession. So anyone with such an objection is required to transfer the care of the pregnant woman to another medical practitioner so that she could have a termination should she choose. Voters were told clearly that this was what they were voting for.
So we should implement what we told the voters we would implement. Yes there are of course aspects of the proposed legislation governing the termination of pregnancy that I find challenging. For example, the introduction of a three-day ‘cooling-off period’ between when a doctor certifies that a woman can have a termination and when she can actually get one raises the practical problem of additional medical visits and cumbersome process. It also potentially makes an already painful process more distressing.
The international evidence suggests that women rarely change their minds as they have made careful, thoughtful decisions prior to presentation in the first place. But some people felt this insertion to provide for reflection gave weight to the enormity of the decision being made and perhaps in a supportive environment someday even one person might reverse the decision to terminate.
Provision of services
We can debate these issues, and many people have amendments they would like to make to the forthcoming legislation. But to deviate now from what the voters were clearly told would be to choose to ignore the clear promises made in the campaign. Now is the time to focus on providing the services that have been promised. To put in place the required resources to ensure that services are delivered in a safe, compassionate and comprehensive manner and that broader issues of family planning and sexual health are addressed. It is time to determine the pathways of care and to adopt best practice in terms of medical and surgical termination of pregnancy.
Women have been harmed and let down by a system that has not invested sufficiently or appropriately in women’s health. Women have been frustrated by their lack of autonomy and partnership in aspects of their healthcare. It is time to rewrite this narrative of the past and to acknowledge and support the great strides that are being made. The publication of the first maternity strategy affirms the Government’s commitment to women’s health and it is vital that important initiatives get widespread support.
Dr Rhona Mahony is master of the National Maternity Hospital and was part of the Together for Yes campaign