Time for a grown-up abortion debate

We like to pretend that we live in a civilised, 21st century western-style democracy. Yet the appalling denial of human rights – and the sheer level of individual suffering, unnecessary danger, cruelty and hardship – that is caused by the Irish ban on one of the most commonly performed medical interventions in the world, lines us up alongside the most barbaric, repressive regimes on this planet.
Criminisation doesn’t work. 42 million abortions take place per annum globally. Of these, 20 million are illegal and potentially unsafe. This directly leads to 80,000 deaths and countless more mutilations, perpetrated on women every year. 25% of the world’s female population live in countries with severely restrictive abortion laws; most of these women are based in developing nations in Latin America, Asia and Africa. That is, apart from, in the European context, those women who are based in the Roman Catholic dominated island of Malta and in our own still strangely backward island off the west coast of the continent.
It is important to get certain facts straight about abortion. The irrefutable reality is that criminalisation does not prevent abortion. As many of us know first-hand, a woman who us unwilling to carry on with a pregnancy will do almost anything to stop it. The only reason women in Ireland are avoiding the gruesome, humiliating deaths that occur, for example, in many Asian countries, as a result of illegal or botched terminations is our proximity to countries where abortion is both legal and safe.
Meanwhile, the culture of shame and stigma which surrounds abortion – generated by both its criminal status, and by the patriarchal moralising of fundamentalist religious dogma – forms yet another type of intimidation: a thick layer of prohibition makes it difficult even to talk one-to-one about the reality and Every six minutes in the world, a woman dies needlessly from an unsafe illegal abortion. The majority leave children behind.

A reduction in the suffering and deaths of women seeking abortion is the mission of the extraordinarily effective international organisation known as ‘Women on Web’ (WoW).
An online medical abortion service that refers clients to a licensed doctor, WoW helps women around the world who are denied access to safe legal abortion in their own countries, by delivering safe medical abortion in the form of mifepristone and misoprostal – abortion pills that have become widely available in the last decade – to postal addresses specified by clients. The pills, which are statistically very safe and highly effective, only work up to the ninth week of pregnancy.
“After you complete an online consultation, if there are no contraindications, the medical abortion will be delivered to you,” the WoW website explains. “A medical abortion can be done safely at home so long as you have good information and have access to emergency medical care in the rare cases where there are complications.”
WoW is an international digital community of women who have had abortions, and individuals and organisations that support abortion rights. (It is common for women who have had to struggle to access abortion to volunteer to help others in the same predicament; a friend of mine, for example, used to escort Irish women travelling alone to England for abortions, having been through the experience herself.)
“WoW answers thousands of emails a day in many languages from women around the world,” reads the website. “As WoW helps women in very many countries, there is no phone number to the helpdesk, but the organisation promises to respond to every email and will support you. You can count on us!”
While WoW is a non-profit organisation, it requests a minimum of €90 donation from women who can afford it. “The donation is part of a chain of solidarity needed to keep the website online and to ensure that other women can also be supported. If you can donate more than €90, you will help us to provide the service to women who cannot donate the full €90 . If your economic situation is particularly difficult, please contact us: together we will try to find a way to help you.”

helping to empower women
Clare McCarthy (not her real name) is an Irish woman living in Dublin who availed of the WoW abortion service two years ago.
“There was absolutely no way that my boyfriend and I could’ve become parents at the time,” she says. “Luckily I’d heard about Women on Web before I needed to use them. They won’t post the abortion pill to addresses in the Republic, because their packages had been seized; but they’ll post it to an address in Northern Ireland for a pick-up for you.
“I got it posted to a friend of a friend, because I didn’t actually know anyone in Northern Ireland myself,” she explains. “There was some delay because one of his housemates signed for the delivery and it went unnoticed in their house for a few days. So I was freaking out about whether the package got there or not; you can only use it up to nine weeks’ gestation, so it’s a very tight period between when you actually find out, have the consultation online, get approved for it, have it sent over, get to pick it up and get to take it. Any additional delay is not feasible.”
Clare was able to go through the abortion – which is essentially an induced early miscarriage, and hence painful – at home with the support of her partner.
“It was so much cheaper than having to go to England later on in the pregnancy,” she says. “I found it more comforting to be able to do it in my own country without the stress and unnecessary hassle, emotionally and physically as well as financially, of having to travel.”
There is an aftercare programme that can be availed of.
“Afterwards I went to the Well Woman Clinic for a check-up,” Clare adds. “They do free post-abortion care, funded by the government, which is incredibly hypocritical, because they’ll pay for your care afterwards, but they don’t care what happens to you during! I noticed at the Well Woman Clinic they were careful not to ask me anything about where or how I’d had the abortion; I think they must see an awful lot of women self-administering, and just don’t ask, because women are uncomfortable saying it; because you’re admitting to a highly illegal act. I did something highly illegal that I could be prosecuted for – that’s why can’t put my face to this story, even though I may want to.
“I was so relieved and grateful to Women on Web,” concludes Clare, “for being a safe and reliable provider that I knew I could trust. I had no worries when I was taking the medication, because I knew that it was coming from a safe source.”

Pro-choice activists are critical of what they consider ‘scaremongering’ by the Irish Medicines Board (IMB), who, they allege, are spreading the myth that the abortion pill is unsafe. I’ve also spoken to a Dublin gynaecologist who heard that the IMB are intercepting abortion pills coming into Ireland, and sending what could be considered threatening letters to the women for whom the packages were intended. To investigate these allegations, I emailed WoW with the following questions:

1. Has the IMB issued unfounded warnings of danger
about the abortion pills that you provide?
2. Has the IMB intercepted your packages to
the Republic?
3. Are women in the Republic able to get abortion pills
from you?
4. If not, what is your policy when you get requests
from the Republic?
5. What about requests from women in Northern
Ireland?
6. Is there a risk that women will start turning to less
reputable, profiteering providers of online abortion
pills if they are having difficulty receiving yours?

The speedy response from WoW was thus:

Dear Adrienne,
We hope that your article will highlight the human right of all women to control their own bodies and reproductive lives. Women on Web stands with women in Ireland and N. Ireland who deserve the same access to care as women in Britain, and the ability to decide when and if to become a parent.
Please understand that to protect the women that we serve, we cannot answer some of your questions. We can confirm that the IMB improperly stopped and continues to stop packages to the Republic of Ireland, which is beyond their authority. They harassed women for whom the packages were intended, in violation of those women’s rights to receive medicines for their own personal use. The IMB also legally challenged the license of our physician; they lost that challenge in the courts.
Women on Web continues to help women from the Republic of Ireland and N. Ireland to have a safe abortion with medicines. The IMB has publicly stated that they have stopped hundreds of packages sent by internet providers to the Republic in the last two years. The packages that were stopped in the last two years are not from WoW, so other internet providers are shipping to Ireland. We do not know the quality of those medicines or if women are being scammed as they seek options to end an unwanted pregnancy.
We are sorry, we are not available for interviews.
Warm regards, Women on Web

I spoke to and then emailed the Dublin PR company that handles press queries for the IMB, sending in both my questions to WoW and WoW’s response. I received a long and rather confusing response. However it did say the following:

The IMB strongly recommends that a woman should not seek to obtain or self-medicate with such potent medicines. Any woman experiencing anxiety regarding a pregnancy should consult with her doctor or contact the Crisis Pregnancy Unit of the HSE.
The IMB, in conjunction with the Revenue’s Customs Service, continually monitors and investigates instances of illegal supply of prescription only medicinal products via the internet and actively enforces against suspected breaches of the law. On detection of an abortifacient medicinal product on importation the Revenue Customs Division detains the consignment at the point of importation inspection.
When a package containing an abortifacient or other prescription only medicinal product is detained on importation, the IMB makes contact with the consignee to advise on the medicinal status of the product and of the legal position regarding supply.
There were a total of 1,216 tablets intercepted in 62 individual importations during 2009 and 671 tablets intercepted in 40 importations in 2010. Figures for 2011 have not yet been published.

Attached to the IMB’s email was a brochure entitled, ‘The Dangers of Buying Medicines Online’.
In relation to all of which, I can only say: draw your own conclusions…

Contact Women on Web at womenonweb.org.pervasiveness of abortion amongst women living in Ireland. This silence, which is imposed and policed by the legal, medical and religious establishment, allows the anti-choice brigade to keep peddling their misogynistic propaganda and myths about abortion, as we’ve seen with the recent Youth Defence billboard campaign. Well, the time has come to change that…

setting women free
The anti-choice gang have not always had it entirely their own way. For decades, feminist women and men, both inside and outside of Ireland, have put up a strong resistance to this country’s anti-choice regime. They have campaigned and lobbied for full reproductive rights, which are the sine qua non of equality for women.
These men and women form an underground solidarity network, both open and clandestine, that helps women living in Ireland to access safe abortions. In the past few weeks I’ve had the honour of conversing with some of these activists. The more I speak to them, the greater my conviction that they are heroes of the resistance to anti-choice triumphalism, as indeed are the thousands of women living in Ireland who have managed, and still manage, against all the odds, to exercise freedom of choice over what happens to their own bodies.
Today, as every day, at least 12 women from Ireland will have surgical abortions in the UK. The majority of these women are already mothers, who, for a wide variety of reasons, realise that they cannot support another child. Other women in this large and amorphous group need an abortion to save their own lives. Some of the rest may be carrying foetuses that have no hope of survival beyond the womb; others may be victims of rape or incest. Others again want the freedom to choose when and whether to become a mother. They may have been on the most potent contraceptive cocktail possible and still have become pregnant.
But theirs is only half the story.

Medical advances and the changing debate
Mother-of-one, Mara Clarke, a citizen of the United States of America, is the founder of the UK-based Abortion Support Network (ASN), a volunteer-run charity that provides financial assistance, accommodation in volunteer homes, and confidential, non-judgmental information to women in the Republic of Ireland and Northern Ireland who want to travel to England to access a safe and legal abortion. A woman with courage and integrity, Clarke talks to me about abortion on her mobile as she travels on a London bus, between two meetings.
“The Department of Health here has reported that over the past seven years, there’s been a continual decrease in the numbers of women travelling from Ireland to the UK for abortions,” she explains. “The Irish Family Planning Association says the drop is due to increased access to contraception and better sex education, and these may well be factors. But we feel that the numbers of women living in Ireland having abortions are very under-reported, because they only reflect the women who are giving Irish addresses in British clinics.”
This is where the combination of guilt, shame and illegality come in.
“Some women may be giving the addresses of the places where they’re staying in England, or the addresses of friends,” she adds. “Nor do the figures take into account the women from Ireland who are blagging themselves free terminations on the UK National Health Service (NHS). And they don’t count the women who go to other countries, sometimes as far away as Russia, for surgical abortions. Or the women who are having medically-induced abortions within Ireland through the use of abortion pills, which they’re buying online.”
The truth is that medical advances are changing the nature of the debate around abortion – but there is a desperate effort to obscure that fact and to deny Irish women the benefit of the new pharmaceutical options (see Women on Web). In the meantime, it is the same old story for those women who are confronted with the reality of an unplanned and unwanted pregnancy.
“Even if the number of women giving Irish addresses is going down,” stresses Clarke, “the calls to us from women in Ireland seeking help have tripled since we opened in October 2009. The first year we were averaging about seven calls a month; by the second year, 21 calls a month; and now we’re averaging 30 calls a month – although I’ve had the phone for the past two weeks, and in those two weeks I’ve heard from 25 women.”
Clarke attributes the increase to greater awareness of the ASN, and more specifically to the growing numbers of women in Ireland in financial need. Is the ASN able to financially support the increased numbers of women looking for help?
“No,” admits Clarke. “We do the best that we can, and we’re very fortunate in that we have just over a thousand pounds a month that comes in through standing order donations. But that doesn’t go very far when the minimum cost of travelling over and having the procedure is £400.”
According to Clarke, there are women having abortions much later than would be best because of the time that it’s taking them to get the money together to cover the costs.
“According to British Department of Health statistics, the percentage of women who have terminations at over 20 weeks is under 1.6%,” she explains. “But for our clients, the percentage is closer to 14%. Once you go over 20 weeks, the minimum cost for the termination alone is £1,300. Then there’s travel on top of that, plus it’s a two-day procedure so women need somewhere to stay overnight, which is where the ASN also comes in, because women can stay with our volunteers.”
Are there any indicators in relation to these women in particular?
“The women looking for later termination,” continues Clarke, “tend to be (a) women in abusive relationships; (b) very young girls, some of whom may have been raped; (c) perimenopausal women; and (d) wanted pregnancies that become unwanted. Also there are women, usually in couples, with wanted pregnancies, who have found out late about catastrophic foetal anomalies.
“In the UK, those women can terminate at any time on the NHS, but if they’re from Ireland, they have to stick to the 23 weeks and five days limit. So if you find out at 20 weeks that there’s something horribly wrong with your wanted baby, you then you have a week or two to come up with £2,000 to travel and get the procedure – at the same time as going through the shock and grief of the news. It’s barbaric.”
It certainly is.
“The thing that we really like to make clear,” asserts Clarke, “is that we don’t get involved in the morality argument. Because the women who contact us, a lot of them, believe with all their hearts that they are killing a baby. And they’re doing it anyway, because it’s what they have to do. Criminalising abortion does not reduce abortion; it just makes it inconvenient for women who have money, and almost impossibly difficult for women who don’t.”
There is one thing in particular that she is anxious to debunk.
“The anti-abortionists talk about ‘post abortion stress’ disorder; I’d like to talk about pre-abortion stress disorder, and the people who are calling us from Ireland in floods of tears, who are trying to raise the money and figure out childcare and get themselves over…
“There is no end to the desperation that we are hearing about. Women are going to disreputable money-lenders; they’re also selling their cars; and they’re not paying their rent. A lot of women that we hear from have supportive partners, and even between the two of them they’re only able to come up with a fraction of the amount of money required. But there are also many women ringing in saying the men want nothing to do with it: he said it wasn’t his, he spat in my face, he told me where to go – all of that and more. These men are not being forced to run the gauntlet of moral right and wrong and financial hardship.”
But in Ireland in 2012, the women are. It has to change. It has to stop…

Contact the Abortion Support Network at
www.abortionsupport.org.uk