An independent review into the State's abortion legislation has recommended the removal of the current mandatory three-day waiting period between the certification of a termination of pregnancy and the procedure taking place.
It said this should be replaced with a statutory right of a woman to a reflection period, during which she may exercise at her own reflection.
Expanded access to abortion was enacted in the State following a referendum which repealed the eighth amendment of the Constitution in May 2018.
The Health (Regulation of Termination of Pregnancy) Act 2018 was signed into law in September of that year, enabling greater access to termination of pregnancy services by women in Ireland from January 1st, 2019.
The Act broadened the grounds upon which termination of pregnancy could be provided, permitting it to be carried out where there is a risk to life or of serious harm to the health of the pregnant woman, including in an emergency.
It also provided for terminations where there is a condition present which is likely to lead to the death of the foetus either before or within 28 days of birth, and without restriction where the pregnancy does not exceed 12 weeks.
Prior to the act, termination of pregnancy could only be performed where there was a risk to life of the mother.
Diagnoses
The independent review published on Wednesday also recommended the Department of Health engage with stakeholders to obtain a better understanding of the difficulties in making diagnoses relating to whether the condition of the foetus will lead to death in utero or within 28 days of birth.
The review also recommended the development of ministerial guidelines to provide clarity on the thresholds of “risk” to the life or “serious harm” to the pregnant woman.
It said the department should amend the legislation to acknowledge it may be difficult to predict whether a termination would avert the risk to a woman’s life or health.
To mitigate against the risk that a conscientious objector would not provide a termination of pregnancy where there is a risk to the life or health of the pregnant woman in an emergency, it is recommended the legislation be amended to include a provision obliging suitably qualified medical practitioners to perform a termination of pregnancy in emergency situations where there is an immediate risk to the pregnant woman’s life or health.
It recommended that where there is a refusal of termination, a review should be completed within three days.
It said the department should consider a statutory obligation on healthcare workers to refrain from providing misleading information or engaging in conduct to prevent or delay a woman’s access to a termination.
“Legislation should be enacted to provide for safe access zones and protection of service users and providers by criminalisation of conduct which intentionally or would reasonably be regarded as having the effect of influencing a person’s decision to have a termination of pregnancy or provide the service,” it added.
The independent review, chaired by Marie O’Shea, recommended that under the legislation on a risk to life or health, the necessity of two medical practitioners to conduct physical examinations be replaced with a requirement for consultation of the woman’s case notes.
The review also found there are remaining challenges in removing barriers to services for termination of pregnancy.
“It would appear that the legal framework governing termination of pregnancy is not aligned with Ireland’s human rights obligations, due to the barriers associated with implementation,” the report said.
“This could lead to future challenge by women seeking terminations of pregnancy.
“The review of the Act should be an iterative process. The services have not yet been fully integrated across all counties.
“There is a need to increase and sustain the numbers of providers across both hospital and primary care settings.”
Barriers to access
Under barriers to access, it said the department should consider amending the legislation to expand the range of health professionals who may provide termination services.
It said the HSE should consider undertaking a mapping exercise to determine the precise number of medical practitioners providing the service in each county, and another exercise to determine the furthest distance a woman of reproductive age must travel to access such a practitioner.
Where there is low coverage, the review said the department should consider establishing local health centres for the service.
It said recruitment should positively discriminate in favour of persons willing to provide termination of pregnancy services in settings where there is a low number of providers.
“All job specifications for staff required to run the service in hospitals where there are insufficient numbers to sustain the service, should feature provision of termination of pregnancy services as mandatory requirement as should the contract of employment,” it said.
Based on notifications received by the Minister for Health, the reform of abortion law in the States has met the needs of approximately 17,820 women who underwent terminations of pregnancy between January 1st 2019, to December 31st, 2021.
The Cabinet has agreed to refer the recommendations proposing legislative change to the Oireachtas Joint Committee on Health for its consideration while the HSE will establish an implementation group to deliver the operational recommendations.
