On the first anniversary of Savita Halappanavar’s tragic and untimely death, I would like to extend my sincere condolences and solidarity to Praveen Halappanavar and his family and friends. I also salute his courage and fortitude in continuing his painful fight to find out exactly why Savita died and who was responsible. I remain outraged however, that Savita died as she did; and that the laws which were the cause of her death are still in place and remain a threat to the lives of other women in Ireland.
There has been more debate about abortion in Ireland over the past 18 months than the previous decade. In 2002 the people of Ireland rejected in a referendum the Fianna Fáil attempt to roll back the X Case ruling of 1992. That ruling said abortion was legal in Ireland if a pregnancy put a woman’s life at risk – including by risk of suicide. But nothing was done about it. Since 2011 I have put a Bill to legislate for the X Case before the Dáil – twice. It was voted down on both occasions – including by Labour. We then had Savita’s sad death, three enquiries into her death, Oireachtas hearings and James Reilly’s Act – which is so restrictive and punitive that it represents no real progress.
During the debate on my Bill, Alan Shatter – the Minister for Equality and Justice – stated that under Art 40.3.3 of the Constitution women are denied medical treatment in a way that men are not: their right to an abortion to protect their health. He also described it as ‘intolerable’ that a woman should be denied abortion in cases of rape or incest, fatal fetal abnormality, or risk of permanent damage to her health because of pregnancy. He could have mentioned that women can also be denied abortion during inevitable miscarriage, but that may not have been apparent to him.
For this is what Savita’s sad death has shown, as clearly stated by Dr Peter Boylan and by the HSE Report on Savita’s death. In a situation of inevitable miscarriage, in which the death of the fetus is the inevitable outcome, the presence of a fetal heartbeat puts a legal restriction on what a doctor can do.
Prior to the recent Reilly Act, the legal situation on when a doctor could terminate a pregnancy to protect a woman was unclear. Reilly’s Act has not changed that. The Act gives legal protection to the so-called ‘unborn’ from the moment of implantation in the womb until delivery from the woman’s body. There is no legal provision for termination of pregnancy shortly after a woman’s waters have broken (inevitable miscarriage) if there is still a fetal heartbeat.
This point was made by the consultant obstetrician who treated Savita. It informed the medical strategy of ‘wait and see’ that was adopted by her medical team. Yet this is the time when a woman is increasingly at risk of infection: the longer the delay in clearing the womb the greater the risk of sepsis. But doctors are legally obliged to wait until the fetus dies, or until a woman develops sepsis to the extent that her life is at risk, before they can clear the womb and thus remove the source of infection.
We have now had three reports into Savita’s death. Her inquest returned a verdict of death by medical misadventure. The HSE Report listed the medical failings in the treatment of her infection. It also highlighted the fact that she was not offered one particular medical intervention: termination of pregnancy shortly after she was admitted to hospital and diagnosed as having an inevitable miscarriage. Savita herself asked for this but was refused. The HSE Report highlighted the legal restrictions to terminations in such circumstances and called for legislators (the Dáil) to consider legal and constitutional change to deal with these restrictions.
The recent HIQA Report highlighted 13 ‘missed opportunities’ for medical intervention to treat Savita during her deepening illness and the development of the sepsis that killed her. But it did not mention that termination of pregnancy was an intervention that could have prevented the sepsis developing in the first place. By focusing on issues relating to management of infection, HIQA has let Fianna Fáil, Fine Gael, Labour and Sinn Féin off the hook regarding their responsibility to remove the legal restrictions to terminations which can prevent infection taking hold. Neither the consultant obstetrician nor the Galway hospital medical team, who may have made errors in the way they treated Savita, should be made scapegoats for the failure of politicians to remove legal restrictions on the treatment that doctors can provide to pregnant women.
So now, a year after Savita’s death, women in Ireland still face risks to their lives due to denial of the right to an abortion. Reilly’s Act is so restrictive that none but the most desperate, or those in State care, are likely to benefit from it. This Act, and Art 40.3.3 of the Constitution that underpins it, forces women and their doctors into situations where women’s lives are threatened. It also denies women abortions in cases of rape or incest, fatal fetal abnormality or risk of permanent damage to health.
Alan Shatter and Alex White (Labour) have said they support legislation to permit abortion in cases of fatal fetal abnormality and other specific circumstances. I call on them to put a Bill before the Dáil – now, while they are in office and can do it – and stop hiding behind the supposed advice of the Attorney General. Any notion that such a law would be unconstitutional could be tested by putting it to the Supreme Court.
The Reilly Act effectively makes abortion unobtainable in Ireland. It also criminalizes women who use abortion pills they buy over the internet – making it less likely they will go for aftercare. And it denies women the right to choose when they wish they continue a pregnancy. These denials of access to abortion are why I and other pro-choice TDs voted against it.
In order to protect the lives and health of women the Reilly Act must be repealed, as must Art 40.3.3 of the Constitution. I support the broadest possible campaign to get a referendum to repeal 40.3.3. This should include those who support access to abortion on restricted grounds as well as those who support the right of of women themselves to make the choice to continue a pregnancy or not – which is my own opinion – without insisting that everybody agrees with that right to choose.
We owe it to the memory of Savita Halappanavar, to her husband Praveen, and to the many women who have suffered and died because they were denied abortion, to remove the current reactionary, anti-woman legislation from the statute books as soon as we can.