Help after an abortion…

The emotive issue of abortion has returned to headline news in recent times, with renewed pressure on the Government for a referendum, the visit of the Dutch abortion ship and the continuing row within the Medical Council on the matter.

If there was a recent shift in emphasis in the debate, it may have been the acknowledgement by some that abortion, no matter how tragic or difficult to accept, is a reality for thousands of Irish women each year. The media circus that swarmed around the Dutch abortion boat did not obscure the central irony that Irish women already take to the sea in order to obtain a termination of pregnancy.

British abortion clinics report that over 75% of all their foreign clients come from Ireland. It means that nearly 7,000 women each year are travelling to obtain an abortion in the UK. In the first three months of 1999 alone, 1,667 Irish women attended UK abortion clinics. Given that just under 14,000 children were born in Ireland during the same period, that means one in nine Irish pregnancies end in an abortion.

Stigma

But for the women who take the difficult step of having an abortion, many feel that there is little in the way of care to return to in Ireland. The stigma and taboo that surrounds abortion makes it very difficult for any woman to reveal the reason for her sudden trip to Britain.

Often, women are too ashamed even to attend their family doctor, despite the fact that everyone should receive a check-up following such an invasive procedure. Since abortion is not available under the Irish healthcare system, neither is specific post-abortion counselling. The result is that thousands of women return to Ireland each year after the most harrowing and physically taxing time, feeling that there is little or no support or help.

Legislation introduced in 1995, following a referendum on abortion, allows doctors or other agencies here to give information about abortion to a pregnant woman in the context of full counselling as to all available options. However, this must be done without any advocacy of abortion and abortion referral is prohibited under the legislation.

One of the few organisations to offer women counselling after an abortion is the Well Woman Centre. The organisation, which runs three centres in Dublin, is one of the few in the Irish health arena to acknowledge that some Irish women have abortions and to offer services to those women. Its centres are in Liffey Street, Coolock and Pembroke Road.

Abortion counselling often begins before the woman has travelled out of the country, says Alison Begas, chief executive of the Well Woman Centre. Last year over 1,400 women attended one of the centre's clinics for non-directive pregnancy counselling. According to Ms Begas, around half of these will have already decided that they will terminate their crisis pregnancy.

"We offer women information on all of their options", she told irishhealth.com. "We give each of them an information pack on where they can go to follow up whatever decision they make, be it fostering, adoption, termination or otherwise. We will talk them through the physical process of a termination if they wish and we can discuss with them the emotional dimension of having an abortion. A lot of women come to us wanting a safe place in which to explore their options".

Legal position

Because of the law, the women who decide to have a termination must make their own appointments and arrangements. "Although we never know what decision they have made when they leave our premises, we do encourage them to come back for a check-up or counselling", said Alison Begas. "We want women to be aware of their own health needs, both physical and emotional, should they decide on a termination".

The Irish Family Planning Association believes that any woman who is considering obtaining an abortion should seek appropriate counselling before they travel. The IFPA offers non-directive pregnancy counselling at their clinics in Clonmel, Cork, Galway and Limerick, as well as three locations in Dublin.

"If you decide to have an abortion you are entitled, subject to certain conditions, to receive information about abortion clinics in England before you leave Ireland", said Tony O' Brien, the IFPA chief executive. "Counsellors or doctors may provide you with such information, as part of face to face counselling, but not by telephone. The IFPA's counsellors will give out abortion information following counselling if a woman requests it".


'The Irish Journey' - an anthology of Irish women's experiences of having an abortion which was published last year by the IFPA.

The Well Woman Centres provide a wide range of counselling and educational services including information on miscarriage, pregnancy, relationships, HIV, infertility, vasectomy and female sterilisation counselling as well as post-termination counselling. However, unlike the pregnancy services which they also provide, these counselling services are not funded by the government.

Clinic visits

Around 400 women attend the Well Woman clinics each year for a post-termination check up and just under 140 for counselling. Obviously this is only a tiny fraction of those who have undergone an abortion over the same period. Generally, the women who attend these services have come to the clinic for a separate reason, such as a smear test or to receive the contraceptive pill and it emerges that they have recently had an abortion.

"In these circumstances, the doctor will offer to examine the woman to ensure all is well", says Alison Begas. "It is rare that a woman would call to book a post-termination counselling session, though some do. Sometimes it is not in the immediate aftermath of their abortion experience that they come to seek counselling, but later".

It is often the case that another event in women's lives triggers an emotional response to their past termination and they need to talk it through in a safe environment. Various events can act as triggers that create the need for help and counselling following a termination, explained Linda Doyle, who works as one of the Well Woman post-termination counsellors.

"Their need for counselling can be triggered by feelings of guilt, or the end of the relationship in which they fell pregnant", she told irishhealth.com. "Their expected date of delivery or the anniversary of their procedure are also trigger dates for many women".

"For some women, feelings come to the surface when a family member or friend falls pregnant. For others, reading anti-abortion sentiments in the media affect them strongly. Sometimes the media is so zealous in its criticism of abortion that women are not only being ignored and not supported, but they even feel that they are being punished".

Reminders

For some women the time for counselling is years later, perhaps when they fall pregnant again or when they discover that they are having difficulties in trying for a child. The stress of such situations is often aggravated and linked to the early experience of having had a termination. Surprisingly, the clinics have also seen a number of men who have experienced trauma and stress as the result of their partner's abortion.

"We have occasional requests from men who wish to attend for post-termination counselling", said Ms Begas. "They are generally either husbands or long-term partners of women who have had terminations. In some cases, it has a deep and lasting impact on them also. I think they are an interesting and overlooked aspect of a debate usually shrouded in hysteria and confusion".

There is also geographical element to who receives counselling and who does not. "Our clinics are in the Dublin area and the IFPA is predominantly in larger towns. Because there is no systematic service, women are falling through the cracks", she added.

"If you live in a rural area, you could be very isolated. It might not be possible to travel to Dublin to receive counselling. Those women are left behind a wall of silence and that silence stops women from grieving".


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