Are Abortion Pills Putting Women in Danger?

With abortions being illegal in almost all circumstances in Ireland, Orla Keaveney investigates the safety of abortion pills ordered online.When the details about abortion access were removed from the Winging It in UCD handbooks, it drew attention to the fact that this information is still illegal to distribute in Ireland. The 1995 Regulation of Information Act states that information regarding abortions is only legal under certain vague conditions. One of the main conditions is that the information be solicited.Information about how to obtain an abortion, through pills, in Ireland is illegal, although there has never been a prosecution for this crime. Nobody has been charged for taking abortion pills in Ireland since the 2013 Protection of Life During Pregnancy Act outlined the Destruction of Unborn Human Life as an offence.The limits of the law have been publicly demonstrated by pro-choice advocates. In October 2016, People Before Profit TD Bríd Smith brought abortion pills into the Dáil and showed them to her fellow TDs, challenging the government to arrest her. “You could arrest me for having it and give me 14 years, but you ain’t going to do it” Smith told the Dáil. “You know that if you dare to implement it, you would bring hell-fire and brimstone down on top of this house.”
“Doctors in Ireland continue to be put in the inappropriate position of having to interpret the Constitution in the course of caring for sick women.”
The activist group, ROSA (for Reproductive rights, against Oppression, Sexism & Austerity) has operated a Bus 4 Repeal since 2015, distributing abortion pills to people in cities across the country. These pills were obtained from Women On Web, an international organisation that provides mifepristone with misoprostol, which are taken together to induce miscarriage. Although only about twenty women got pills from the Bus 4 Repeal during its three day tour of Ireland, the British Medical Journal reported that three Irish women order pills direct from Women On Web’s site every week.Lauren* is a UCD student and abortion rights activist, and has been an active member of ROSA since she was 19. While travelling on the Bus 4 Repeal in 2015, Lauren saw first-hand that the laws regarding abortion pills were not enforced: “We were very open about the fact that we had pills and we were going to give them to women. It was in the papers, we had journalists on board – and nothing happened.”“The police spoke to us once that I can recall, in Galway, to tell us to move our bus because it was creating an obstruction. They didn’t say anything about the pills. When a journalist asked them, ‘Why aren’t you arresting them?’ they said ‘We have no evidence,’ even though we had pills on board.” Lauren says that highlighting the ineffectiveness of the law was one of the main motives for the Bus 4 repeal. “It is very unenforceable, and that’s the point. The rule exists, not to stop women from having abortions, but so that Irish people can pretend, ‘Isn’t Ireland great? Irish women don’t have abortions’ but that’s not true and it’s never been true.”
“I think it would be absolutely appalling if a doctor, or any medical person, who was given that information reported it.”
According to Senator Ivana Bacik, Reid Professor of Criminal Law, Criminology, and Penology at Trinity College Dublin, “To hand out pills randomly to people, even if you tell them they’re abortion pills, is not an offence.”“Similarly, it would have to be proven that this was a pill that was capable of causing miscarriage. What happens when people import pills that are seized by customs is that the Irish Medicines Board will examine them. Until the forensic evidence establishes that that’s what it is, there’s not going to be a successful conviction.”Ireland’s legal system is founded on common law, which means that criminal judgements are largely based on decisions in past cases (“precedence”) along with the constitution and laws. Since a case regarding abortion pills has never come before the Irish courts, it’s unclear how much evidence would be needed to convict a woman for taking an abortion pill, or how strict the punishment would be.In Northern Ireland, unlike the rest of the UK, abortion is still illegal in most circumstances. There have been cases where women have been prosecuted for the use of abortion pills. Most recently, in 2016 a Belfast resident was tried for terminating a pregnancy after her housemates reported her to the police. After pleading guilty, she was given a three-month sentence, suspended for one year.In the Republic, to prove that a woman has committed the Destruction of Unborn Human Life, the most likely source of evidence would be from the woman herself, or people she shared this information with.However, if a woman suffered any complications in her induced miscarriage, she would need to seek medical help. This could involve informing a doctor or medical professional of the fact that she used an abortion pill to terminate her pregnancy.According to the Medical Council’s Guide to Professional Conduct and Ethics for Registered Medical Practitioners, a doctor is required to maintain patient-doctor confidentiality wherever possible. “Confidentiality is a fundamental principle of medical ethics and is central to the trust between patients and doctors. Patients are entitled to expect that information about them will be held in confidence. You should not disclose confidential patient information to others except in certain limited circumstances.”However, it is unclear whether an illegal abortion falls under these “limited circumstances.” For instance, a doctor must disclose patient details “when ordered by a judge in a court of law,” which would only happen if the case was already brought to trial. Doctors are also expected to break confidentiality “in exceptional circumstances when it is necessary to protect the patient or others from serious risk of death or serious harm.” It is not stated whether this applies to a foetus.Doctors themselves have expressed frustration at the lack of clarity surrounding the issue. Last month, Dr Peter Boylan, chairman of the Institute of Obstetricians and Gynaecologists of Ireland, told the Oireachtas Committee on the Eighth Amendment that “doctors in Ireland continue to be put in the inappropriate position of having to interpret the Constitution in the course of caring for sick women. Medical personnel have no difficulties in obeying clear legislation and medical regulations, but we are not trained for the complexities of constitutional interpretation, nor should we reasonably be expected to be.”Senator Bacik believes that it would be highly unlikely and unethical for a doctor to report that their patient had taken abortion pills. “I think it would be absolutely appalling if a doctor, or any medical person who was given that information, reported it. It would be appalling, and it would be very, very dangerous because it would deter women from going to hospitals.”While it is very important that a patient is honest with their doctor about the substances she has taken, Bacik highlights that a woman is under no obligation to disclose the country in which she took the pills. “No doctor should ever ask where the abortion had taken place because clearly, an abortion that you’ve had legally in England, where there is some – rarely, but sometimes – complications, people do have to go to hospital to get help after that, that’s perfectly legal here.”On the Women On Web site and the Bus 4 Repeal, women are asked to share their medical information before obtaining the pills. This relies entirely on the women’s own accounts, as doctors are not able to physically examine the women. Women On Web have no way to verify that the pregnancy is at the stage when abortion pills would be safe to use.According to Midwives for Choice, “The abortion pill is safe in the first trimester of pregnancy up to 13 weeks gestation, equating to the risks involved in spontaneous miscarriage, so problems are rare. The risk of associated complications increases after 13 weeks gestation.” The potential complications associated with abortion pills include incomplete abortion (where the products of conception aren't fully expelled), heavy bleeding, infection, or on-going pregnancy with a slight increase in birth defects. Abortion pills have no impact on future fertility and is considered safer than a surgical termination.
“Women On Web have no way to verify that the pregnancy is at the stage when abortion pills would be safe to use.”
These risks of abortion pills are very similar to those associated with a natural miscarriage, and are “easily treatable.” To ensure that women receive the most effective care, Midwives for Choice would “strongly advise that women fully disclose the medication they have taken and be reassured of the standard of care and support that they'll receive.”Although obtaining abortion pills online is not the ideal option for terminating a pregnancy, it is often the most effective option available to Irish women, and is significantly cheaper than travelling abroad. Women On Web asks for a donation of €70-90 for its services, though it does offer some financial support to women who cannot afford this. The World Health Organisation has classified pills obtained through Women On Web as safe, particularly as an alternative to “backstreet abortions” in countries where terminations are illegal.In his statements to the Oireachtas Committee on the Eighth Amendment, Dr Peter Boylan stated that “in 2017, the eighth amendment is unworkable. When it was enacted 34 years ago, neither the worldwide web nor the abortion pill had been invented... The genie is therefore out of the bottle in respect of online access to the abortion pill. The grave concern that we doctors have as a consequence of this reality is the potential for harm caused by the use of unregulated medication by Irish women and girls.”
“To ensure that women receive the most effective care, Midwives for Choice would ‘strongly advise that women fully disclose the medication they have taken and be reassured of the standard of care and support that they'll receive.’”
Under the current system, the Irish government has no way of regulating the substances that women are sold online under the guise of providing safe abortions. When asked if there would be any legal consequences for people selling fake abortion pills, Senator Bacik responded, “No, there wouldn’t under Irish law.”Although Women On Web is a seemingly safe source for abortion pills, the restriction of information about the subject means that women in crisis pregnancies may not be aware of this organisation. The lack of legal protection means that these women would be easy targets for online scammers, who could offer a cheap solution for vulnerable women who are unable to afford to travel for abortions.Although Lauren never encountered such cases of fraud in her activism with ROSA, she is “sure that they exist, that there are websites out there that aren’t legitimate. That’s why it’s so important that women know about Women on Web, and know that it is safe and the fact that they’re being denied that information and that they’re not able to go to their doctor and get abortion pills, it’s really putting women’s lives at risk. It’s not acceptable at all.”When the removal of abortion information from the Winging It handbooks attracted media attention, many questioned why it was the role of UCDSU to distribute information on abortion. Given the complexity of the issue, especially regarding abortion pills, it is clear that there is a need for organisations like Students Unions to provide reliable information and support for people considering these options.*Not real name.