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What if it were you?

A couple of weekends ago, among topics such as the Rio Olympics, Pat Hickey, and GAA semi-finals, trending on Twitter, one story clearly stood out. ‘Two Women Travel’ was the name of a Twitter account created by two Irish women who were documenting their journey to the UK for one of them to obtain an abortion. They didn’t provide their names, their age or where they were from. They could have been anybody: daughters, sisters, friends, mothers. Maybe they are someone you know. Maybe they are one of your patients. Maybe you’ve seen them. In your surgery. Upset. Fearful. Not sure where to turn. Did you know what to say? Did you feel comfortable providing them with their options? Did they cry as you gave them numbers for counselling services in measured sympathetic tones? Are you sure that as you finished the consultation that they felt reassured? Supported?

The highly controversial Protection of Life During Pregnancy Act, which was intended to provide clinicians and their patients with clarity surrounding the issue of abortion, in which there is a deemed risk to a pregnant woman’s life, felt like a hastily arranged attempt by our Government to deal with an increasingly restless and frustrated public in the wake of tragic cases …

Maybe they will come to you, weeks later, the weight of their body sinking into the chair in your surgery, just as it did in a waiting room in a clinic completely unfamiliar to them, in some nameless grey town or city in the UK. They will sheepishly enquire about contraception, when can they start it? They’re not sure, the clinic may have told them, but they can’t remember, it’s all a blur. Their faces may cave when they finally tell you what they’ve been through. “Does it have to be written in my notes Doctor?” they hesitantly ask. “What if people find out. I don’t want anybody to know.” Maybe it’s a request for a sick note, they “had a bug” and are “just not ready to go back yet”.

These two women endured this process, just like the average of 10 women who travel from Ireland to the UK each day to obtain a termination. The reasons behind why they have chosen to access abortion services are diverse and ultimately personal. The reasons behind why they must travel to do so, as we all know, are not. Our legislation does not provide them, their partners, their families or their doctors any other option in this instance. Recently, Dr Lara Kelly, an Irish GP wrote eloquently about her and her husband’s personal experience of travelling to the UK to obtain a termination following the heart-breaking diagnosis of a fatal foetal abnormality. It was a brutally honest piece, borne no doubt partially out of frustration at seeing our elected politicians continue to fudge actively dealing with the Eighth Amendment, a piece of legislation that now seems archaic and ill-equipped to deal with an area of reproductive health that has so far been exported to our British medical colleagues.

The highly controversial Protection of Life During Pregnancy Act, which was intended to provide clinicians and their patients with clarity surrounding the issue of abortion in which there is a deemed risk to a pregnant woman’s life, felt like a hastily arranged attempt by our Government to deal with an increasingly restless and frustrated public in the wake of tragic cases, such as that of Savita Halappanavar, and rulings from the European Court of Human Rights in 2010 deeming that the Irish Government had violated Article 8 of the Convention on Human Rights. It generated much debate on our airwaves and in Cabinet, often emotive and lacking in any real substance and when rolled out, issues such as limited resources and access to specialists such as perinatal psychiatrists, with confusion surrounding referral pathways, highlighted how ineffectual this Act was going to be going forward. The legacy of the X case, over 20 years on, looms large. It still serves as a reminder of how time marches on, yet so much remains the same.

Much of the rhetoric surrounding what is inarguably one of the most controversial topics in society today is largely that of a black and white perspective, polarising opinions, intense emotion, anger. What is lost in this debate, is the nuance, the grey, the ‘what if it were you?’ perspective. The reality is that these two women are symbolic of all the thousands of women who make that journey across the water annually. They are making that journey irrespective of whatever opinion you may have. There are many more who cannot travel. They are your patients. They need to trust you; they need your support. How much longer are we willing to tolerate a situation where the clinical care that they need is denied to them?

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