- DWWC’s clinical experience supports report’s recommendation to make 3-day wait optional
- DWWC also welcomes the recommendations around improved education and awareness on contraception
26th April 2023 – The Dublin Well Woman Centre (DWWC) has today welcomed publication by the Minister for Health of the 3-year review into Abortion Service provision in which the report’s author, Marie O’Shea, makes several recommendations for legislative reform as well as operational recommendations. DWWC has provided Early Medical Abortion (EMA) services since January 2019 and welcomes the key recommendation to make the current mandatory 3-day waiting period optional, which to date has represented a barrier to care.
Commenting on the recommendation, DWWC’s Chief Executive Alison Begas said: “Our clinical experience and data tells us that the majority of women who contact us for an EMA do so at 5-6 week’s gestation, and that they are clear in the decision they have already made to terminate their pregnancy. Our Clinic Doctors are trained with the necessary skills to recognise when a patient is uncertain about proceeding with an abortion and can refer her, where necessary, to one of our experienced professional counsellors, should she wish to talk through her options.”
Based on analysis of patients who receive their first EMA consultation in a Dublin Well Woman Centre clinic, over 85% go on to receive their second EMA consultation with the DWWC, with 10-12% being referred on to receive their termination in a hospital. This is mostly in cases where they have passed the 9-week cut-off point for service provision in primary care. A small number of women spontaneously miscarry after their first consultation, and in a small number of cases, they opt to continue with their pregnancy.
Alison continued: “There is no evidence that the present mandatory 3-day ‘pause’ period has any influence on a woman’s decision to terminate her pregnancy and there is no medical justification. The World Health Organisation is also clear that there is no health rationale for a pause, which they regard as demeaning to women.”
The DWWC also welcomes the recommendations around improved education and awareness campaigns on contraception and the benefits of various methods, as well as a broadening of the eligibility criteria for the Free Contraception scheme. This is especially important given the DWWC’s 2020 comprehensive research carried out on contraception in Ireland which showed there are still significant mistruths around contraception and fertility amongst women in Ireland, as well as barriers to access.
Commenting on some of the operational recommendations in the O’Shea report, the DWWC’s Medical Director, Dr Shirley McQuade, stated: “We welcome the recommendation that more of the country’s publicly-owned and funded maternity hospitals should be fully engaged in provision of termination of pregnancy services, which will lead to enhanced geographic coverage, and improved access for women.”
“At primary care level, we cannot request a surgical abortion on behalf of a patient, who may need it depending on her circumstances. Where a patient may prefer on social grounds – e.g., no privacy at home, in shared accommodation, homelessness – to have a surgical abortion in a hospital setting, this cannot be currently guaranteed as it is dependent on availability of theatre time and staff. The report’s recommendation that the HSE continues its efforts to make surgical options for termination of pregnancy more available, is to be welcomed.”
Dr McQuade also welcomed the focus in the O’Shea report on the impact on women of a failed EMA: “It is unacceptable to us that a woman who experiences a failed EMA may subsequently have to travel outside the State to terminate her pregnancy. Care should be available to her within Ireland, even after 12 weeks, and continuance of care once an abortion has begun needs to be a clear principle in abortion access.”
The DWWC hopes that the 3-year review process will result in the removal of barriers to timely access to abortion, and to an increase in the number of service-provides, both at primary and secondary level, across the country.
- DWWC also welcomes Ms O’Shea’s recommendations around improving communications from provider hospitals to the referring doctor (at present, where women are referred to hospital for a termination because they are over nine weeks gestation, or their medical history suggests monitoring during the process is advisable, it is not current practice to advise the referring doctor of the clinical outcome, or the patient’s care plan).
- Similarly, post-abortion referrals for investigation of continuing pain / bleeding / positive pregnancy test do not result in a report back to the referring doctor. This is unique to this service, and the DWWC welcome the report’s recommendation around improved communications from secondary care providers to the referring doctor on a standardised basis.
- Other recommendations of note and welcome were around the need for better promotion of awareness of the MyOptions helpline.
- Recommendations around the continuance of telemedicine as a delivery method, which the report saw as particularly beneficial to women in rural areas, or women living in situations of coercive control.
- Recommendations around access to non-directive counselling for women.
- Recommendations around streamlining access to interpreter services (either the HSE’s interpreter service, or the MyOptions translator panel) for EMA providers.
- Recommendations around making access to abortion services available on the basis of residence in Ireland, which would facilitate access for people who do not have a PPS number, such as undocumented migrants and foreign students.
About the Dublin Well Woman Centre:
The Dublin Well Woman Centre was founded in 1978, with the aim of giving women in Ireland access to information and services around contraception, at a time when it was largely illegal. In the 1980s and 90s the organisation fought a number of court cases at the High Court and Supreme Court, eventually winning (at the European Court of Human Rights) the right to give women information on abortion and on abortion services available outside the State.
DWWC operates three women’s health clinics in Dublin, and employs 36 doctors, nurses, counsellors, and administrative staff. Over 35,000 consultations are provided annually, and the DWWC prides itself on offering services that support women at every stage of their reproductive health journey, including contraception, cervical and sexual health screening, fertility, menopause and community gynaecology consultations.