A timeline of events surrounding the refusal of abortion to an asylum seeker who said she had been raped, according to versions given by the HSE and The Irish Family Planning Association.
They can’t all be telling the truth.
January 2014: The Protection of Life During Pregnancy Act 2013 comes into force
Section 9 of the Act provides that it shall be lawful for
– an obstetrician at an appropriate institution (a list of which in the Schedule to the Act includes most hospitals within the State)
– to carry out a medical procedure in respect of a pregnant woman in the course of which, or as a result of which, an unborn human life is ended
– where three medical practitioners (an obstetrician and two psychiatrists) having examined the pregnant woman, have jointly certified in good faith that there is:
(i) a real and substantial risk of loss of the woman’s life by way of suicide, and
(ii) in their reasonable opinion (being an opinion formed in good faith which has regard to the need to preserve unborn human life as far as practicable) that risk can only be averted by carrying out the medical procedure.
February 2014: The woman in this case conceives, allegedly due to a rape in her country.
March/April 2014: The woman arrives in Ireland claiming asylum.
Early April 2014: Pregnancy identified during routine refugee medical assessment by Health Service Executive. HSE nurse refers woman to Irish Family Planning Association (IFPA) for confirmation of pregnancy and advice.
Pregnancy confirmed by IFPA.
The woman informs IFPA that she is not capable of going through with the pregnancy and could die because of it. IFPA informs woman that abortion is available in England up to 24 weeks but that documentation would have to be arranged in order for her to travel for England and that this process would take six weeks.
A subsequent hospital scan finds that the woman is 8 weeks and 4 days pregnant which even allowing for a six week delay in processing travel documentation should permit an abortion in England within the 24 week time limit. Documentation is completed by IFPA and submitted and the woman believes the process is underway.
Late May 2014 (14-15 weeks pregnant): The woman is informed by an IFPA counsellor that although it is not too late for her to have an abortion in England which it is stated can be carried out at up to 28 weeks (in fact the deadline in England is 24 weeks but the woman is still well within that limit) the cost of the abortion ‘could be’ over €1500 Euros (including travel, abortion and possible overnight stay’) and that the State would not fund these costs.
The woman is told the problem is money.
She does not appear to have been given details of charitable organisations in the United Kingdom, which fund abortions for impoverished women. The woman then states: “I could die because of this pregnancy.I am prepared to kill myself.” That evening, the woman attempts suicide, but is interrupted.
Contact between the IFPA and the woman apparently breaks down after she is moved to a new accommodation centre within the direct provision system.
Around this time, the IFPA make contact with the HSE nurse who initially referred the woman alerting that nurse to her deteriorating mental health. It is unclear whether or not the question of termination under the 2013 Act was discussed in this phone call. It does not appear to have been discussed with the woman by the IFPA.
Mid/Late July: The woman goes to a General Practitioner, explains the situation and states that she is suicidal. She is subsequently admitted to a psychiatric hospital and is interviewed by two psychiatrists. Her pregnancy is confirmed at 24 weeks and 1 day – too far progressed for abortion in the United Kingdom.
July 25- 27: Woman commences thirst and hunger strike.
Care order obtained permitting hydration.
Panel of three experts convened. Current reports ( “the woman’s request for a termination on the basis of suicidality was acceded to” HSE) indicate that the panel was in agreement that the woman was suicidal, and that the pregnancy would be terminated (although initial reports indicated that the expert panel’s decision was not to terminate, due to the objections of the obstetrician on the panel).
July 28: The woman informed that abortion would be carried out the following Monday, August 5
July 30-August 2: The woman is informed that termination to be by way of Caesarean:
According to an interview with her in the Irish Times, she was told “The pregnancy was too far. It was going to have to be a Caesarean. In the world, in the United States, anywhere, at this point it has to be a Caesarean.”
In fact this is not correct.
Methods of late term abortion in the United States and elsewhere involve non-Caesarean procedures such as dilation and evacuation and intact dilation and extraction. Both of these procedures, in contrast to Caesarean section, involve the death of the foetus.
It should however be noted that the medical procedure contemplated by Section 9 of the 2009 Act, which the HSE has stated was assented to, also necessarily involves, by definition, the death of the foetus.
The HSE has stated that “it is important to note that a pregnancy can be terminated by way of delivery through Caesarean section.”.
However Section 9 does not permit ‘termination of pregnancy’. What it permits is ‘a medical procedure in the course of which, or as a result of which, an unborn human life is ended’.
A finding that Section 9 was applicable necessarily meant that the woman was entitled not just to a ‘termination’ of pregnancy, but to have that pregnancy terminated in a way involving the death of the foetus. This appears to be something, which has been misunderstood or ignored by the HSE both in the information provided to the woman and in their subsequent statement of this week.
August 5: Following a meeting with an obstetrician, the woman consented to a Caesarean. As stated, irrespective of the fact that the woman was being told that a Caesarean was her only option, it would appear that if a decision had been made under Section 9 she was entitled, by reason of the wording of Section 9, to another method of termination.
Conversely, if a decision had not been so made, she was entitled to be informed of her right of appeal. Neither of these matters appear to have been communicated to her prior to her giving consent to the Caesarean.
August 6: Caesarean carried out.
On the above timetable, the woman should have been over 25 and quite possibly over 26 weeks at the time the procedure was carried out (on the basis that she had been one day over the 24 week limit for obtaining an abortion in England prior to starting her thirst and hunger strike on Friday July 25).
However a report in the Irish Independent describe her as 23-25 weeks at the date of the Caesarean.
August 13: The woman is released from hospital.
August 16 – 21 : The woman’s story breaks in The Irish Independent. Initial reports indicate that the woman’s application under Section 9 of the 2013 Act was refused.
This is subsequently denied by the HSE who state that the application was successful and that the procedure was carried out by Caesarean. As stated above, this appears to be inconsistent with Section 9 itself.