Analysis Abortion

Ireland’s Protection of Life During Pregnancy Bill: 21 Years After X, Business as Usual?

Lisa Hallgarten

In the wake of the tragic and preventable death of Savita Halappanavar, Irish politicians promised that this government would "not become the seventh to 'neglect and ignore' the issue of the Supreme Court ruling abortion on the X Case." Six months later, the cabinet has proposed a bill it says will not "change the law" on abortion.

In the wake of the tragic and preventable death of Savita Halappanavar, Irish politicians promised that the government would “not become the seventh to ‘neglect and ignore’ the issue of the Supreme Court ruling abortion on the X Case.”

Six months later, the cabinet has proposed a bill it says will not “change the law” on abortion. That is certainly clear. The bill does not change anything for the women who make the heartbreaking trip across the Irish Sea to Liverpool to end much wanted pregnancies following a diagnosis of catastrophic fetal anomaly. The bill does not address the thousands that fly into London, Liverpool, and Manchester to access abortion when they simply cannot contemplate having a baby (or another baby) at this time. The bill does not offer any comfort to those who are pregnant due to rape or abuse. The bill will not change the law. The question is will the bill provide the clarity that women and doctors so desperately need to prevent another tragic and unnecessary death?

Did anyone notice how seamlessly the name of this bill was changed from the “protection of maternal life” to the “protection of life during pregnancy”? Significant? The bill states more than once that its intention is not to ask doctors to weigh the life of the fetus against the life of the woman. However, when it demands that a doctor provides a reasonable opinion, its definition of “reasonable opinion” is “an opinion formed in good faith which has regard to the need to preserve unborn human life as far as practicable.” So fetal life remains a consideration.

Similarly the bill quotes the 1992 Supreme Court judgment on the X case, that “it is not necessary for medical practitioners to be of the opinion that the risk to the woman’s life is inevitable or immediate, as this approach insufficiently vindicates the pregnant woman’s right to life.” At the same time it emphasizes that there must be a “real and substantial risk to the woman’s life.” This is typical of the confusing, equivocal, and obfuscating tone of the whole bill. We want to save women’s lives, but…

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The regulations state two grounds for allowing an abortion: the serious risk of death for the woman from “physical illness” and the risk of death from “self-destruction” (suicide). In the meantime the bill offers no clarity about where on the trajectory between diagnosis of a pregnancy complication or expression of suicidal ideation, and death a doctor can legitimately provide abortion? This is exactly the conundrum that faced the doctors in the Halappanavar case.

When clinicians in the United Kingdom (excluding Northern Ireland) tell you that they would rather err on the side of caution, it means proceeding with abortion before a woman is at death’s door. In legally restricted jurisdictions such as Ireland, the side of caution means ensuring you and your patient are not risking 14 years in prison by acting too soon. It is not clear that the process set out in the bill will solve this problem because it is notoriously difficult to assess or even get agreement from colleagues about the level of risk a woman faces until often it’s too late.

As Obstetrician/Gynecologist Christian Fiala explains, “All laws which allow abortion only to ‘save the life of the woman’ are inherently unworkable. For a simple reason: you only know after the woman died that her life really was in danger. It is impossible to exactly predict when a patient will die. And as long as she is still alive there is always someone in the medical team who will raise his voice and ask to wait for another day and another day … until it is too late. The same applies to the current initiatives to verify whether or not a woman is really suicidal. This is impossible to reliably predict beforehand. If you really want to know, you have to see and wait … until it is too late.”

Given that the bill calls for two doctors to make the decision in the case of “physical illness” (except in an emergency situation) and three in the case of “self-destruction” there is generous scope for disagreement and procrastination.

So what does the bill improve? For those doctors who felt too vulnerable to act, even to save a woman’s life, regulation may be welcome. It provides a clear process for them, if an uncertain outcome for the woman. The process may rule out the possibility of abortion, but the doctor will have done the “right thing” by trying. The process is convoluted and possibly unworkable, especially in the case of suicidal ideation, but for the first time at least it’s in writing—it’s official.

It may appease Ireland’s friends and neighbors who looked on appalled as the Halappanavar case played out; and, in a dim light, it appears to meet the demand for legislation on this issue. As RHM Editor Marge Berer says, “It is a gift to the politicians who must have felt (no matter what their personal views) that their political lives were not worth having this fight. They can now say, ‘We did exactly what we were told to do by the European Court’ and no more. It will be impossible to oppose it—in those terms—from any point of view. The person/people who drafted it deserve a gold star for compliance with the political necessity involved.”

However, for those doctors who previously relied on their clinical judgment and did provide life-saving abortions, they may now find themselves tied up in red tape and delays, jumping through hoops that weren’t there yesterday. The powerful need to deny the very notion of life-saving abortion has meant that, to date, abortion has sometimes taken place, but quietly without fuss or comment, without anyone even naming it let alone publishing statistics on prevalence. According to one commentator, “The bizarre official position is: abortions happen in Ireland, but we don’t count them.” The nation, it seems, turned a blind eye. Now there are no blind eyes. All eyes are on the doctors.

Moreover, the details of the bill give a very clear message. The need for a specific combination of different clinicians who must practice in specific institutions, who will need to be certified and registered as suitable by professional associations to follow professional guidance that is yet to be written, and who will all need to be available in the right place at the right time, and if they can’t agree it will have to go to appeal, which could take up to seven days, and it is not entirely clear whether that appeal process might also be open to those hoping to block the abortion, and all this must happen in what may be a short window of opportunity to save a woman’s life—the message is that it may be easier to travel, or to die. So, business as usual then.

Roundups Law and Policy

Gavel Drop: The Fight Over Voter ID Laws Heats Up in the Courts

Jessica Mason Pieklo & Imani Gandy

Texas and North Carolina both have cases that could bring the constitutionality of Voter ID laws back before the U.S. Supreme Court as soon as this term.

Welcome to Gavel Drop, our roundup of legal news, headlines, and head-shaking moments in the courts

Texas Attorney General Ken Paxton intends to ask the U.S. Supreme Court to reinstate the state’s voter ID law.

Meanwhile, according to Politifact, North Carolina attorney general and gubernatorial challenger Roy Cooper is actually saving taxpayers money by refusing to appeal the Fourth Circuit’s ruling on the state’s voter ID law, so Gov. Pat McCrory (R) should stop complaining about it.

And in other North Carolina news, Ian Millhiser writes that the state has hired high-powered conservative attorney Paul Clement to defend its indefensible voter ID law.

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Alex Thompson writes in Vice that the Zika virus is about to hit states with the most restrictive abortion laws in the United States, including Alabama, Louisiana, Mississippi, and Texas. So if you’re pregnant, stay away. No one has yet offered advice for those pregnant people who can’t leave Zika-prone areas.

Robin Marty writes on Care2 about Americans United for Life’s (AUL) latest Mad Lib-style model bill, the “National Abortion Data Reporting Law.” Attacking abortion rights: It’s what AUL does.

The Washington Post profiled Cecile Richards, president of the Planned Parenthood Federation of America. Given this Congress, that will likely spur another round of hearings. (It did get a response from Richards herself.)

Kimberly Strawbridge Robinson writes in Bloomberg BNA that Stanford Law Professor Pamela Karlan thinks the Supreme Court’s clarification of the undue burden standard in Whole Woman’s Health v. Hellerstedt will have ramifications for voting rights cases.

This must-read New York Times piece reminds us that we still have a long way to go in accommodating breastfeeding parents on the job.

Culture & Conversation Family

‘Abortion and Parenting Needs Can Coexist’: A Q&A With Parker Dockray

Carole Joffe

"Why should someone have to go to one place for abortion care or funding, and to another place—one that is often anti-abortion—to get diapers and parenting resources? Why can’t they find that support all in one place?"

In May 2015, the longstanding and well-regarded pregnancy support talkline Backline launched a new venture. The Oakland-based organization opened All-Options Pregnancy Resource Center, a Bloomington, Indiana, drop-in center that offers adoption information, abortion referrals, and parenting support. Its mission: to break down silos and show that it is possible to support all options and all families under one roof—even in red-state Indiana, where Republican vice presidential candidate Gov. Mike Pence signed one of the country’s most restrictive anti-abortion laws.

To be sure, All-Options is hardly the first organization to point out the overlap between women terminating pregnancies and those continuing them. For years, the reproductive justice movement has insisted that the defense of abortion must be linked to a larger human rights framework that assures that all women have the right to have children and supportive conditions in which to parent them. More than 20 years ago, Rachel Atkins, then the director of the Vermont Women’s Center, famously described for a New York Times reporter the women in the center’s waiting room: “The country really suffers from thinking that there are two different kinds of women—women who have abortions and women who have babies. They’re the same women at different times.”

While this concept of linking the needs of all pregnant women—not just those seeking an abortion—is not new, there are actually remarkably few agencies that have put this insight into practice. So, more than a year after All-Options’ opening, Rewire checked in with Backline Executive Director Parker Dockray about the All-Options philosophy, the center’s local impact, and what others might consider if they are interested in creating similar programs.

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Rewire: What led you and Shelly Dodson (All-Options’ on-site director and an Indiana native) to create this organization?

PD: In both politics and practice, abortion is so often isolated and separated from other reproductive experiences. It’s incredibly hard to find organizations that provide parenting or pregnancy loss support, for example, and are also comfortable and competent in supporting people around abortion.

On the flip side, many abortion or family planning organizations don’t provide much support for women who want to continue a pregnancy or parents who are struggling to make ends meet. And yet we know that 60 percent of women having an abortion already have at least one child; in our daily lives, these issues are fundamentally connected. So why should someone have to go to one place for abortion care or funding, and to another place—one that is often anti-abortion—to get diapers and parenting resources? Why can’t they find that support all in one place? That’s what All-Options is about.

We see the All-Options model as a game-changer not only for clients, but also for volunteers and community supporters. All-Options allows us to transcend the stale pro-choice/pro-life debate and invites people to be curious and compassionate about how abortion and parenting needs can coexist .… Our hope is that All-Options can be a catalyst for reproductive justice and help to build a movement that truly supports people in all their options and experiences.

Rewire: What has been the experience of your first year of operations?

PD: We’ve been blown away with the response from clients, volunteers, donors, and partner organizations …. In the past year, we’ve seen close to 600 people for 2,400 total visits. Most people initially come to All-Options—and keep coming back—for diapers and other parenting support. But we’ve also provided hundreds of free pregnancy tests, thousands of condoms, and more than $20,000 in abortion funding.

Our Hoosier Abortion Fund is the only community-based, statewide fund in Indiana and the first to join the National Network of Abortion Funds. So far, we’ve been able to support 60 people in accessing abortion care in Indiana or neighboring states by contributing to their medical care or transportation expenses.

Rewire: Explain some more about the centrality of diaper giveaways in your program.

PD: Diaper need is one of the most prevalent yet invisible forms of poverty. Even though we knew that in theory, seeing so many families who are struggling to provide adequate diapers for their children has been heartbreaking. Many people are surprised to learn that federal programs like [the Special Supplemental Nutrition Program for Women, Infants, and Children or WIC] and food stamps can’t be used to pay for diapers. And most places that distribute diapers, including crisis pregnancy centers (CPCs), only give out five to ten diapers per week.

All-Options follows the recommendation of the National Diaper Bank Network in giving families a full pack of diapers each week. We’ve given out more than 4,000 packs (150,000 diapers) this year—and we still have 80 families on our waiting list! Trying to address this overwhelming need in a sustainable way is one of our biggest challenges.

Rewire: What kind of reception has All-Options had in the community? Have there been negative encounters with anti-choice groups?

PD: Diapers and abortion funding are the two pillars of our work. But diapers have been a critical entry point for us. We’ve gotten support and donations from local restaurants, elected officials, and sororities at Indiana University. We’ve been covered in the local press. Even the local CPC refers people to us for diapers! So it’s been an important way to build trust and visibility in the community because we are meeting a concrete need for local families.

While All-Options hasn’t necessarily become allies with places that are actively anti-abortion, we do get lots of referrals from places I might describe as “abortion-agnostic”—food banks, domestic violence agencies, or homeless shelters that do not have a position on abortion per se, but they want their clients to get nonjudgmental support for all their options and needs.

As we gain visibility and expand to new places, we know we may see more opposition. A few of our clients have expressed disapproval about our support of abortion, but more often they are surprised and curious. It’s just so unusual to find a place that offers you free diapers, baby clothes, condoms, and abortion referrals.

Rewire: What advice would you give to others who are interested in opening such an “all-options” venture in a conservative state?

PD: We are in a planning process right now to figure out how to best replicate and expand the centers starting in 2017. We know we want to open another center or two (or three), but a big part of our plan will be providing a toolkit and other resources to help people use the all-options approach.

The best advice we have is to start where you are. Who else is already doing this work locally, and how can you work together? If you are an abortion fund or clinic, how can you also support the parenting needs of the women you serve? Is there a diaper bank in your area that you could refer to or partner with? Could you give out new baby packages for people who are continuing a pregnancy or have a WIC eligibility worker on-site once a month? If you are involved with a childbirth or parenting organization, can you build a relationship with your local abortion fund?

How can you make it known that you are a safe space to discuss all options and experiences? How can you and your organization show up in your community for diaper need and abortion coverage and a living wage?

Help people connect the dots. That’s how we start to change the conversation and create support.

This interview has been edited for length and clarity.

CORRECTION: This article has been updated to clarify the spelling of Shelly Dodson’s name.

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