Policy: Conscientious Objection and Best Practices

As Irish legislators and medical professionals are currently faced with the task of carrying out the terms of the Regulation of Termination of Pregnancy Bill 2018, we must focus on putting key steps in place for the implementation of services, these include, establishing primary care within the GP service, pathways of referral for hospital procedures, issues of dating the pregnancy, conscientious objection and the overall roll out of services. It is important to consider best practise taken by other countries and the recommendations issued by the World Health organisation. Abortion Access Campaign West (AACW) is a women’s collective based in Galway set up to lobby government on legislation and ensure that abortion access is widely available in the West of Ireland. We are focused, in particular, on ensuring the best care for women and pregnant people in the West of Ireland.

The Regulation of Termination of Pregnancy Bill 2018 dates the pregnancy from the first day of the last menstrual period (LMP). According to the World Health Organisation guidance policy on safe abortion, “basic routine observations (pulse, blood pressure and, in some cases, temperature) are useful baseline measurements” for dating pregnancy. (Safe Abortion, 2012, p. 33) Additionally, health-care providers can confirm pregnancy and estimate its duration using less intrusive techniques such as bimanual pelvic and an abdominal examination, which are usually adequate. (Ibid, p. 31) Access to ultrasound machines could pose problems and ultrasound testing should only be used when necessary.

In Canada, abortion pills can be provided directly by the pharmacist and additionally by health professionals including nurses and midwives. Taking the pills in a pharmacy rather than in a GP or hospital setting is treated much the same as the morning after pill which (currently in Ireland) can be taken up to 72 hours after conception. Providing this service in the pharmacy reduces the stigma of abortion. The UK has recently allowed the abortion pill to be taken at home. (BBC News, 25 August 2018)

In Ireland, correctly managing abortion care means we are adding an additional service to an already under-resourced healthcare system. Taking the pill in the pharmacy will free family doctors’ time and resources, as well as those of the hospitals, while at the same time providing safe and accessible options for women and pregnant people in their areas.

From 9 to 12 weeks termination can be carried out medical procedure by taking abortion pills misoprostol and mifepristone or by surgical procedure. It should be the woman’s decision as to which procedure she will undergo. It is important that the woman or pregnant person is given all information in order to make an informed decision. Surgical termination from 6 to 12 weeks will involve referral to the hospital for vacuum aspiration, a common procedure often carried out after miscarriage to prevent problems after partial miscarriage. According to the WHO guidelines, general anaesthesia is not necessary for vacuum aspiration. It also states that dilatation and curettage (D&C) is an obsolete method of surgical abortion and should be replaced with vacuum aspiration. (Safe Abortion, 2012, p.32) Surgical procedure can be under local anaesthetic or sedation and would require half a day in hospital. Overnight stay is usually not necessary.

In Canada abortion is treated like any other medical procedure and there is no provision for conscientious objection.

According to the WHO best practice guide, those who conscientiously object “must refer the woman to a willing and trained provider in the same area, or another easily accessible health-care facility, in accordance with national law… Where referral is not possible, the health-care professional who objects, must provide safe abortion to save the woman’s life and to prevent serious injury to her health”.

“Women who present with complications from an unsafe or illegal abortion must be treated urgently and respectfully, as any other emergency patient, without punitive, prejudiced or biased behaviours.” (Safe Abortion, 2012, p. 69) The WHO guidelines also state that health-care centres which are not staffed and equipped to provide induced abortion must be able to refer women promptly to the nearest services with minimal delay. (Safe Abortion, 2012, p. 33) AACW, believe it should be an offence to hinder a woman or pregnant person from accessing an abortion by deliberately providing incorrect or misleading information or refusing to refer.

A number of countries include a provision to allow for conscientious objection from medical practitioners. In the UK, a medical practitioner can object to the service of abortion but not to the care of the woman or cannot refuse if the woman’s life is in danger. In Portugal, a medical professional must provide a written declaration of their conscientious objection to the hospital director stating clearly that he/she is a conscientious objector. However, he/she must provide an abortion if necessary to save the life of the woman. (Chavkin, Swerdlow & Fifield, 2017) Similarly, in Italy objectors must notify their medical supervisors and must declare their objection. In Italy, regional health departments are responsible for monitoring hospital compliance and hold the right to move personnel if necessary. In reality, this is not enforced and only 60 per cent of hospitals provide the service. (Ibid) There are certain parts in Italy where abortion services are unavailable due to the large number of conscientious objectors and women need to travel long distance to access the service.

AACW is concerned that women and pregnant people will once again be forced to travel for abortion care, costing them unnecessary time and money.

New Zealand manages this situation by centralising information regarding accessible abortion care. It has a website at www.abortion.org/nz. This website provides information on how to access abortion in the country. The online map can detect your current location in the country and tell you where your nearest abortion provider is to you. There is a list of hospitals which provide surgical abortion. If the service is unavailable in your area, your local District Health Board will organise referral and assist with transport costs. The service itself is free. Ease of access to the services must be a priority in Ireland. AACW are particularly concerned that women in the West of Ireland are not obliged to travel long distances to access services.

A website with information on nearest abortion providers and available care would be extremely beneficial in Ireland and could work well alongside the helpline which has been proposed by a number of groups, including START.

AACW are currently working alongside a number of organisations and personnel involved in the implementation of abortion services in Ireland. If you are interested in following our work, please sign up for our mailing list here.

Lorraine Grimes

Abortion Access Campaign West

List of Sources

  1. Abortion pill can be taken at home in England, under new plan, BBC News, 25 August 2018
  2. Abortion Services in New Zealand, Accessed at http://www.abortion.org/nz on 24/10/2018

3.     Maija Kappler, Here’s How Canada’s Abortion Policies Actually Work, Huffington Post, 29 August 2018

  1. Safe Abortion: technical and policy guidance for health systems, Second edition, WHO, 2012
  2. Wendy Chavkin, Laurel Swerdlow, and Jocelyn Fifield, “Regulation of Conscientious Objection to Abortion: An International Comparative Multiple-Case Study” in Health Human Rights Journal, June 2017, Vol. 19 (1): 55–68

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