FAQs and the 8th Amendment #repealfacts About: I’m a Consultant Obstetrician and a Professor of Maternal and Fetal Health. I qualified in 1993 from the University of Liverpool Medical School. I trained in the management of high risk pregnancies in a range of busy specialist hospitals in the UK including the Liverpool Women’s Hospital, Queen’s Medical Centre in Nottingham and St Mary’s Hospital in Manchester. I worked at Cork University Maternity Hospital as a Consultant Obstetricians from June 2006 until January of this year. I’m now on a career break from my job in Cork and working as the Pro Vice Chancellor of the Faculty of Health and Life Sciences at the University of Liverpool and as a Consultant Obstetrician back at the Liverpool Women’s Hospital. You can read more about my qualifications here: http://research.ucc.ie/profiles/C004/lkenny I’m from an Irish Catholic family. However, my experience of providing care for Irish women who presented to the Liverpool Women’s Hospital seeking termination of pregnancy under the most desperate of circumstances altered my opinion about termination of pregnancy. My opinion was confirmed during the time I worked as Consultant Obstetrician at Cork University Maternity Hospital. In what is now 25 years of clinical practice, I have never met a woman who wanted a termination of pregnancy, but I have met many women who desperately needed one. This document contains facts (with supportive evidence) underpinning why I will be voting YES on 25th May. I hope you find it useful and I will update it weekly between now and May 25th. What is the 8th Amendment? The 8th Amendment of the Constitution of Ireland was approved by referendum on 7th September 1983 and signed into law the next month. The 8th Amendment confers equal status to the right to life of the mother and to the unborn. The unborn is defined as any embryo1 or fetus2 regardless of the stage of pregnancy and effectively restricts legislation for termination of pregnancy. Under the terms of the 8th Amendment, termination of pregnancy is only legally permissible if there is a real and substantial threat to the life of the mother. A subsequent referendum in 1992 approved the: • 13th Amendment which permits travel to obtain abortion in another jurisdiction; • and the 14th Amendment which permits Irish citizens to provide information about services in other countries. th The 12 Amendment, also presented during the 1992 referendum, sought to exclude a risk of suicide as grounds for abortion but this was defeated. 1
An embryo is the name given to the fertilised egg from approximately two weeks after conception and up to 8 weeks of gestation. 2
A fetus is the name given to the unborn after 8 weeks gestation and up to birth.
Following the death of Savita Halappanavar at Galway University Hospital in October 2012, the Protection of Life During Pregnancy (PLDP) Act, which commenced on January 1st 2014, provided further clarity around the circumstances and processes within which abortion in Ireland can be legally performed. The PLDP Act states that: • The ‘unborn’ is an embryo or fetus that has implanted in the womb as opposed to embryos that have not implanted in the womb (such as ectopic pregnancies or those conceived via in vitro fertilisation (IVF) but not yet transferred). • Termination of pregnancy can be performed when there is a ‘real and substantial risk to the life’ (as opposed to the health) of the mother. This includes physical illness and a risk to life through suicide. • Anyone who performs or procures a termination of pregnancy outside the provisions of the 8th Amendment and PLDP could be subject to a 14-year custodial sentence. So what does this really mean? • •
The 8th Amendment (and subsequent Amendments and the PLDP) mean that Ireland has one of the most restrictive legislations in Europe for termination of pregnancy . Termination of pregnancy can only occur in Ireland when there is a ‘substantial’ risk to the life of a woman. However, women are allowed to travel to other countries, such as the UK, to obtain a termination of pregnancy and organisations are allowed to provide Irish women with information about obtaining a termination of pregnancy overseas.
So how does this impact on women who enter pregnancy with medical complications or who get sick during pregnancy? •
There is no medical or legal definition of ‘real and substantial’. This lack of certainty is dangerous, particularly when doctors are faced with a seriously ill woman. Deciding when a woman is sick enough to require a termination of pregnancy is always difficult and sometimes impossible. Because of the risk of a potential custodial sentence, doctors have to wait until they are agreed that there is a substantial risk to the woman’s life, in line with the wording of the 8th Amendment and PLDP. The 8th Amendment and PLDP do not make provision to preserve the health of a woman. There is an important difference between preserving the health and preventing the death of a woman. This means that under the 8th Amendment, a woman would be expected to continue with pregnancy even it may significantly damage her health. For example, a woman with diabetes and an unintended pregnancy would be expected to continue with that pregnancy even if it may leave her blind or in renal failure and on dialysis. Should she wish to terminate her pregnancy, she will need to make arrangements to travel to the UK, at her own cost.
This isn't easy. It costs a minimum of £1000 (€1200) for a termination of pregnancy (this includes the price of flights and the procedure), and if the pregnancy is very complicated, this can be a lot more. In the case of women who are very sick, it becomes even more complex. Irish doctors cannot refer a woman to doctors the UK, so women with complex medical needs have to arrange their own treatment. Doctors in the UK are reliant on women being able to provide all the correct medical details- which can further endanger the life of an already sick woman. Most importantly of all, if a woman is too sick to travel, she has to remain in Ireland, and remain pregnant until she is so sick her doctors agree her life is in danger or until the pregnancy is advanced enough to deliver.
What about women carrying pregnancies complicated by fatal fetal abnormalities? • • • • • •
The 8th Amendment and PLDP make no provision for termination of pregnancy in the case of a fetus with fatal fetal abnormalities. Women who are carrying a baby with fatal fetal abnormalities, who will die during or at birth, and who want a termination of pregnancy, have to travel to the UK. They too do this at their own cost. Many parents have spoken to the abject grief of not being able to attend their own baby’s funeral because they could not afford to stay in the UK any longer. Others have spoken about the difficulties of bringing their baby’s remains home. The Liverpool Women's Hospital provided termination of pregnancy for 61 women with complex medical or fetal issues in 2017. This is just one hospital.
What about women carrying pregnancies resulting from rape? • •
The 8th Amendment and the PLDP make no provision for termination in the case of pregnancy following rape and incest. Women and girls who are pregnant as a result of rape (and incest) and who wish to terminate their pregnancies have to travel.
But shouldn’t the unborn have some rights? What about the posters of fetuses at 12 weeks yawning and kicking? • • •
Repealing the 8th isn’t about removing rights- it’s about rebalancing rights. Comparing the potential to life of an embryo or fetus to that of woman is wrong. At least 50% of all pregnancies naturally miscarry before 12 weeks, often in the very early stages of pregnancy and often before a woman may realise she is pregnant . Comparing an early embryo to a grown adult woman is like comparing an acorn to an oak tree. Every acorn has an outside chance of becoming a tree, but the overwhelming majority of acorns don’t become trees- and it’s the same with human embryos.
• • • •
A fetus at 12 weeks is not capable of purposeful movement. The nerves supplying the muscles are not connected to the brain, which is itself still very immature. Movement at this stage represents basic reflexes and not yawns or kicks. The fetus cannot experience pain at 12 weeks’ gestation . Fetuses born before 23 weeks of pregnancy do not survive . Those born after 24 weeks of pregnancy can survive but many have significant physical or neurodevelopmental complications . However, after 24 weeks, obstetricians and neonatologists will do all they can to help to help the fetus survive outside of the womb.
But the no side have said that repealing the 8th will lead to the elimination of Down’s Syndrome and the late abortions of healthy babies from health mothers? • •
• • •
Of all the offensive lies from the NO side- I think this is the worst. Under the proposed legislation to replace the 8th Amendment, the only circumstances in which a pregnancy would be ended after 12 weeks of pregnancy is if there is a serious threat to a woman’s health or if the fetus has a life limiting severe congenital abnormality. Whatever else happens, if a woman is sick and needs to end her pregnancy after 24 weeks, we will do as we do now, we will deliver the baby and do our best for both. On the specific point about Down’s syndrome, Down’s syndrome Ireland have asked both sides of the debate to avoid including people with Down’s syndrome as part of the argument. However, early and accurate screening for a host of chromosome problems is readily available to Irish women now. The majority choose not to have the test. Of those that do and have a positive test- some travel, some don’t. There is absolutely no evidence to suggest this would significantly change on 26th May of the 8th Amendment is repealed.
But isn’t it abortion on demand? •
This is really offensive. Women do not want abortions: they sometimes need them. THERE IS ALWAYS A REASON.
But abortion is really harmful to women- most regret it and I heard it can cause cancer? •
Safe termination of pregnancy (as defined by WHO) is a VERY safe procedure. 1 in every 100,000 women having a safe termination will die, which makes termination of pregnancy 14 times safer than childbirth and twice as safe as having a single injection of penicillin . Termination of pregnancy is not associated with short-term or long term adverse health outcomes for women. Specifically, termination of pregnancy is not associated with cancer, infertility or adverse mental health [8,9]. ‘Post Abortion Syndrome’ does not exist. It is not recognised by any medical or psychological professional body. It is a term that was invented by an American antichoice activist who was not medically qualified .
But why change anything? Ireland is the safest country in the world for women to give birth? • • • • • • • • • •
Ireland is a safe place to give birth despite the 8th Amendment – not because of the 8th (and also if I might say so because my colleagues and I are good at our jobs!) Abortion is already here. It’s just not legal and that makes it unsafe. It’s worth reminding everyone that conservative estimates state that unsafe abortion kills approximately 25,000 women every year around the world and possibly many more . 3265 women who had a termination of pregnancy in the UK in 2016 gave an Irish address. 66 of these women were 17 or under and 10 of them were under 16. Abortion was introduced into the UK exactly 50 years ago. In the decade before it was legalised, unsafe abortion was the leading cause of maternal death- an average of 60 women died every year. Now death from abortion has almost vanished. Women in Ireland have died because of the 8th Amendment (see below). Because women living in countries with restrictive legislation have to travel or access unsafe abortion, they invariably have later abortions. Countries with the most permissive legislation for termination of pregnancy tend to have the lowest rates of termination and terminations tend to occur at earlier stages of pregnancy. Repealing the 8th Amendment will bring Ireland into line with the majority of other European countries. In countries who legislate for termination of pregnancy- the rates usually fall and throughout most European countries, rates of termination of pregnancy are falling steadily.
But lots of eminent obstetricians and gynaecologists say that we shouldn’t repeal the 8th and it makes no difference to their practice? •
This is categorically untrue. The majority of doctors working in high risk obstetrics favour repealing the 8th Amendment. This is also supported the current Masters of the three Dublin maternity hospitals and the current and incoming Chairs of the Institute of Obstetricians and Gynaecologists. Of the five Obstetricians and Gynaecologists who have openly opposed Repeal, 4 are long retired and one works in Northern Ireland. International opinion also supports repealing the 8th Amendment. The Royal College of Obstetricians and Gynaecologists in the UK, FIGO and the World Health Organisation all support permissive legislation for legal, free and accessible termination of pregnancy.
The NO side deny that women have died because of the 8th Amendment? • Again- this is untrue. Savita Halappanavar died of sepsis at Galway University Hospital in October 2012, several days after being admitted with a complication of pregnancy at 17 called pre-term rupture of the membranes. It is almost unheard of for a baby to survive when this happens.  The Chair of the independent enquiry
into her death, Professor Sir Arulkumaran, one of the most eminent obstetricians in the world, has unequivocally stated that if she had received a termination of pregnancy when she requested one, she would never have developed sepsis and she would be alive today. â€˘ Michelle Harte presented to Cork University Maternity Hospital in 2010 with an unintended pregnancy whilst receiving a new treatment for malignant melanoma. She was refused a termination of pregnancy under the 8th Amendment and had to travel to the UK. A long delay meant she discontinued her treatment for almost a month, her cancer returned, and she died. â€˘ But not dying is the absolute lowest aspiration we should have for our citizens. Our partners, our sisters and our daughters and their daughters deserve more, they are worth more and they need us to repeal the 8th.
References: 1. https://www.loc.gov/law/help/abortion-legislation/europe.php 2. Personal communication. 3. Jarvis GE. Early embryo mortality in natural human reproduction: What the data say. Version 2. F1000Res. 2016 Nov 25 [revised 2017 Jan 1];5:2765. doi: 10.12688/f1000research.8937.2. eCollection 2016. PubMed PMID: 28580126; PubMed Central PMCID: PMC5443340. 4. Brugger EC. The problem of fetal pain and abortion: toward an ethical consensus for appropriate behavior. Kennedy Inst Ethics J. 2012 Sep;22(3):263-87. PubMed PMID: 23285794. 5. Santhakumaran S, Statnikov Y, Gray D, et al Survival of very preterm infants admitted to neonatal care in England 2008â€“2014: time trends and regional variation Archives of Disease in Childhood - Fetal and Neonatal Edition Published Online First: 07 September 2017. doi: 10.1136/archdischild-2017-312748 6. Pierrat V, Marchand-Martin L, Arnaud C, Kaminski M, Resche-Rigon M, Lebeaux C, Bodeau-Livinec F, Morgan AS, Goffinet F, Marret S, Ancel PY; EPIPAGE-2 writing group. Neurodevelopmental outcome at 2 years for preterm children born at 22 to 34 weeks' gestation in France in 2011: EPIPAGE-2 cohort study. BMJ. 2017 Aug 16;358:j3448. doi: 10.1136/bmj.j3448. PubMed PMID: 28814566; PubMed Central PMCID: PMC5558213 7. Raymond EG, Grimes DA. The comparative safety of legal induced abortion and childbirth in the United States. Obstet Gynecol. 2012 Feb;119(2 Pt 1):215-9. doi: 10.1097/AOG.0b013e31823fe923. PubMed PMID: 22270271. 8. https://www.cancer.org/cancer/cancer-causes/medical-treatments/abortion-andbreast-cancer-risk.html 9. Biggs MA, Neuhaus JM, Foster DG. Mental Health Diagnoses 3 Years After Receiving or Being Denied an Abortion in the United States. Am J Public Health. 2015 Dec;105(12):2557-63. doi: 10.2105/AJPH.2015.302803. Epub 2015 Oct 15. PubMed PMID: 26469674; PubMed Central PMCID: PMC4638270. 10. https://www.guttmacher.org/gpr/2006/08/abortion-and-mental-health-myths-andrealities 11. http://www.who.int/en/news-room/fact-sheets/detail/preventing-unsafe-abortion 12. https://www.ifpa.ie/Hot-Topics/Abortion/Statistics 13. Haddad LB, Nour NM. Unsafe Abortion: Unnecessary Maternal Mortality. Reviews in Obstetrics and Gynecology. 2009;2(2):122-126. 14. Linehan et al. Neonatal and maternal putcomes following mid trimester rupture of membranes: a retrospecBMC Pregnancy and Childbirth (2016) DOI 10.1186/s12884016-0813-3
Complied by Prof. Louise Kenny https://twitter.com/louiseckenny