Last October a pregnant woman died in an Irish hospital in circumstances that made headlines all around the world. The woman in question was Savita Halappanavar, an Indian woman working in Ireland who was admitted to Galway University Hospital while miscarrying. Tragically, she died a few days later, 17 weeks into her pregnancy.
The Irish Times broke the story the following month.
Savita’s husband, Praveen, said his wife had asked for a termination, but this was refused. A nurse told him why: She said, “This is a Catholic country.” Praveen was informed that a termination could not take place while there was a fetal heartbeat present, that is to say, while the baby was still alive. The story quickly developed that she died because of Ireland’s “pro-life” law. We were led to believe that had she been admitted to a hospital in a country with a more liberal abortion law than Ireland’s—a country like England or the United States, say—she would be alive today. This was the message broadcast to the whole world. Ireland stood indicted in the court of world opinion.
The death of Savita gave huge added impetus to demands that Ireland liberalize its abortion law, something that happened just this summer after a national debate that lasted for months and drew tens of thousands of people out onto the streets, mainly in opposition to the law. Unfortunately, this particular case drove legislation that almost certainly belied the true state of public opinion. Taken in by the original media presentation of the Savita Halappanavar case, most members of the public believed our law had to be liberalized to ensure that there would be no such cases in the future.
Indeed, it can be argued that the “debate” over liberalizing abortion was done and dusted the very day the story broke because of the way it broke. The idea that Savita died because “This is a Catholic country” became indelibly impressed on the public mind. By the time the results of official investigations into her death were published, it was too late. (As will be explained in more detail below, the main reason she died is because her medical team did not spot until it was too late the fact that she was developing a deadly infection.)
But first, let’s go back 30 years to the 1983 abortion referendum. This inserted into the Irish Constitution Article 40.3.3, which protected the right to life of the unborn with due regard for the equal right to life of the mother.
Nine years later the Irish Supreme Court decided the X-case, which involved a 14-year-old girl who became pregnant as a result of statutory rape. To cut a long story short, she was told she could not travel to England for an abortion and could not have an abortion in Ireland because her life was not in danger. The case was appealed to the Supreme Court, which heard that she was suicidal. It ruled that this threat of suicide constituted a real and substantial risk to her life, and therefore she could have an abortion under Article 40.3.3. In the event, she had a miscarriage.
As a result of the X-case ruling, an Irish woman can have an abortion if it is ruled that there is a “real and substantial risk” of her committing suicide if she does not have one. Since then, there has been intermittent pressure to introduce statute law to give effect to the X-case ruling. Successive governments have failed to do so, until now.
Three things happened in rapid succession to ensure that this time the X-case ruling would be given effect in statute law. The first was the 2011 election of a new government consisting of Fine Gael as the senior coalition partner and Labour as the junior partner. These parties had not been in power together since 1997, and Labour had long ago committed to legislating for X. In the meantime, Fine Gael had become “pragmatic” on the issue. If they saw the tide of public opinion shifting in a pro-choice direction, they would go with it.
The second factor was a finding against Ireland by the European Court of Human Rights (ECHR). Again to cut a long story short, the ECHR ruled that Irish law was not sufficiently clear about when a woman could and could not have recourse to an abortion under Article 40.3.3 of the Constitution and under the terms of the X-case. The government could have responded to this ruling in several different ways. For example, it could have completely ignored it. Other countries have ignored rulings of the ECHR, including Britain, and suffered no legal consequence because of it. The Irish government could also have appealed the ruling, which it did not do. There was a third option open: Instead of introducing a law permitting abortion in certain circumstances, the government could have clarified the existing medical guidelines. It didn’t do this either.
What the Irish government decided to do was to go down the legislative route, which included the introduction of the threat of suicide as a ground for abortion. This was despite the fact that in the General Election of February 2011, Fine Gael explicitly promised not to legislate for abortion. Pro-life groups (rightly) feared X-case legislation because they knew from the experience of other countries that once you open the door to abortion at all, and especially on psychological grounds, it becomes harder and harder to control.
If the first development that paved the way for this legislation was the election of a new government, and the second was the decision by the ECHR, the third was, of course, the death of Savita Halappanavar. As presented in the media, the Savita case seemed to prove yet again that Catholic moral theology is very dangerous for pregnant women, because it places the lives of the babies above the lives of mothers. This is why international pro-choice organizations were also very keen to highlight this case. Ireland has long stood out on the international scene because Irish law on abortion is so restrictive. If our law isn’t endangering women’s lives, then this becomes a very useful piece of propaganda (in the best sense of that word) in the arsenal of the pro-life movement everywhere. On the other hand, if our law is endangering women’s lives, then it becomes instead a very useful piece of propaganda for the pro-choice movement.
For this reason it became of the utmost importance to suppress the fact that Ireland is one of the safest countries in the world for a woman to have a baby. However, this vital piece of information barely registered with Irish public opinion, let alone international opinion, despite the best efforts of pro-life commentators and pro-life groups. Back in India, Savita’s homeland, the press were loudly broadcasting that for pregnant women, Irish hospitals were extremely dangerous. This was despite the fact that a pregnant woman in India is about 50 times more likely to die than a pregnant woman in Ireland.
There are various ways of measuring maternal deaths (for example, some countries count a death that occurs within six months of having a baby as a maternal death and others do not). However, no matter how maternal deaths are calculated, Ireland’s annual maternal death rate is very low by international standards. It stands at between four and eight deaths per 100,000 live births, depending on the time period under examination. This means that our maternal death rate is lower than that of either Britain or America, which have very permissive abortion laws.
Some might suggest that the rate of maternal deaths in Ireland is artificially low because Irish women whose lives are in danger due to their pregnancy travel to England for terminations. But according to this argument, British and American maternal death rates ought to be lower than the Irish one, because British and American women don’t have to travel outside of their respective countries for an abortion. The truth is that it is very hard to reduce our maternal death rate much lower than it is; unfortunately, a certain number of women are going to die in even the best-run medical systems in any given year no matter what.
Also, what deaths occur in Britain or the United States or Ireland have little or nothing to do with our respective abortion laws and more to do with simple human error on the part of doctors and nurses, as well as the fact that some deaths are tragically unavoidable. In Britain, as elsewhere, a certain number of pregnant women die from sepsis each year, just as Savita did. No-one can claim that those women are dying in Britain because of its abortion law. Official investigations have shown that in general these women died because the sepsis wasn’t treated on time, because it wasn’t spotted on time.
The fact that our maternal death rate is low disproves the appalling calumny that our anti-abortion law made Ireland an unsafe place for pregnant women. On the contrary, the Irish system should be held up to the world as an example of how to respect the lives of both mothers and their unborn babies. I made this point recently to a Swedish journalist who came over to Ireland to write about our new law. I told her that our maternal death rate was roughly comparable to Sweden’s. I told her that our abortion rate of 6 percent (expressed as a percentage of live births and taking into account the 4,000 or so Irish women who have abortions in England each year) is less than a fifth of the Swedish abortion rate of 33 percent. I asked her which law was more humane, the one that produced a low maternal death rate and a low abortion rate, or the one that produced a similarly low maternal death rate but a far higher abortion rate? The question answers itself. But somehow this message that the Irish law is head and shoulders above that of other countries is not reaching the public, or even very many of our politicians.
Let’s return now to the Savita case. As has been mentioned, she died of an infection. This was known from the moment this story first broke. But the impression given in the media was that despite knowing her life was in danger, the hospital would not terminate the pregnancy because “this is a Catholic country.” What was not known when the story broke is that the staff treating her were unaware of just how badly she was infected until it was too late. This crucial fact emerged following several official inquiries. Essentially, the hospital missed several chances to diagnose just how seriously sick she was becoming.
When the nurse told Praveen Halappanavar that an abortion could not be carried out because Ireland is “a Catholic country,” the hospital at that point mistakenly believed Savita’s life was not at real and substantial risk. At the time Praveen was told this, the baby was miscarrying but a fetal heartbeat could still be detected. The hospital was waiting for nature to take its course, as normally happens when a woman is miscarrying. If it had really been the case that Savita’s life was not in danger, then a termination at that point would indeed have been illegal. But if the hospital had judged that her life was at real and substantial risk, then it could have terminated the pregnancy, which is to say, expedited the miscarriage.
In other words, the law and medical practice as it existed in Ireland in October 2012 when Savita died was almost certainly not the problem. The problem was the failure to spot on time just how deadly her infection was. No law can ensure that a medical team will always properly diagnose an infection on time. Only good clinical practice will do that. Therefore, Ireland was wrongly indicted and Ireland’s new abortion law was introduced based on a faulty public understanding of what really happened in the Savita case.
Our new abortion law, the Protection of Life During Pregnancy Act, gives a statutory footing to the X-case, as I have mentioned. To the extent that this simply codified existing medical practice, even pro-life groups had no objection. Pro-life groups knew that in Irish hospitals it was already the practice to end a woman’s pregnancy if that was the one and only way to save her life. They had no real issue with this. What they had a very big problem with was a law that would also permit a suicidal pregnant woman to have an abortion if two psychiatrists and an obstetrician agreed. As they correctly pointed out, in what way would such a law have even theoretically saved Savita? No one claimed she was suicidal. Pro-life groups strongly opposed the suicide ground because it would lead to the death of an unborn child when alternative treatments were readily available.
Since the outbreak of the current economic crisis, several people in Ireland have committed suicide because of their severe economic difficulties. But no one has suggested that they should simply be given money by the taxpayers to solve their economic problems. Why then should abortion, a far more drastic “remedy” than a cash transfer, be deemed a more acceptable “treatment” for suicidal intent? The typical response when a person is deemed to be suicidal is to give them proper psychiatric care until the suicidal feelings abate. The pro-life movement in Ireland knew perfectly well that the suicide ground is effectively a psychological ground. They knew that in other jurisdictions the psychological ground has eventually led to widespread abortion.
Furthermore, and as became abundantly clear during the debate over the abortion law, no medical evidence has ever been produced to show that conducting an abortion can save the life of a pregnant, suicidal woman. It is quite remarkable that the government paid so little attention to this fact. Indeed, they were told that psychiatrists successfully predict suicide in only about three percent of the cases. Law should be founded on sound moral principles and on evidence. The Protection of Life During Pregnancy Act is based on neither.
There is another aspect of our new law that must be pointed out: namely, its attack on the ethos of pro-life hospitals. The law names a number of hospitals that must perform terminations on the grounds now allowed for, including the suicide ground. Two publicly funded Catholic hospitals are named in this list: the Mater Hospital and St. Vincent’s Hospital. Both the Mater and St. Vincent’s have agreed to comply with the law. They have said they will perform abortions as permitted under the new law. They are probably hoping that in practice they will never have to. But it was extremely disappointing that neither hospital stood up to the government and defended their ethos.
What will happen now? One possible silver lining is that we see the setting up of a new political party. Seven Fine Gael TDs (our version of MPs) and senators were expelled from the Fine Gael parliamentary party for voting against the abortion bill. The most high-profile of these was Lucinda Creighton, a young, charismatic, and highly articulate politician who was Minister for Europe and was touted one day to lead Fine Gael and possibly become Taoiseach (Ireland’s term for the Prime Minister).
In all good conscience, Creighton and her six colleagues decided they could not vote for abortion. They are now outside the Fine Gael parliamentary party and contemplating their futures. They have already formed themselves into a group called the Reform Alliance, and there is a fair possibility that they will set up a new party which, among other things, will represent pro-life voters. They certainly have a “market opportunity,” because about one-third of all Irish voters don’t want to vote for any of the existing parties.
What happens now? Members of the Labour party have made it perfectly clear that they see the new law merely as a stepping stone to further liberalization. Pro-choice groups have said the same thing. They want abortion-on-demand. However, Article 40.3.3 of the Constitution still stands in their way. Therefore, they are already highlighting the hard cases our new abortion law can’t cater to, including the aborting of babies whose mothers have been raped and are not suicidal or the aborting of babies with “fatal fetal abnormalities,” again whose mothers are not suicidal.
Article 40.3.3 prevents abortion taking place in either of these cases. Pro-abortion campaigners know there is a lot of public support for extending abortion to cover these categories, and that this support is likely to grow given the eagerness of the media—especially our national broadcaster RTE—to highlight these undoubtedly hard cases. When public opinion has been softened up still further, I believe it will then be proposed that we hold a referendum to delete Article 40.3.3 altogether. It may take an actual hard case, in the public eye, to give public opinion that last push over the line.
The government that proposes deletion of Article 40.3.3 is likely to tell the public that it will at the same time introduce what it will call a “restrictive” abortion law that will be less liberal than the one in the UK. However, this will simply be to allay the fears of those members of the public reluctant to take too big a leap at one go. But once Article 40.3.3 is gone, it will then be far easier for future governments to further liberalize the law, because they will no longer need to go to the people for permission to do so through a constitutional referendum. After that would come abortion on “health” grounds. Other hard cases would be given the required amount of publicity to make this happen.
American and other readers know that once this occurs, Ireland will have abortion-on-demand. As it is, Irish abortion campaigners have been able to make huge progress in persuading the Irish public to support abortions in certain cases. They will keep up the pressure. For its part, the pro-life movement is working hard to further galvanize and motivate its support base and to expand it to make it as difficult as possible for the abortion movement to get to the next stage.
In other words, the abortion battle in Ireland continues, but with the passage of the Protection of Life During Pregnancy Act, pro-choice campaigners have won a truly significant victory.
* * * * *
David Quinn is a journalist who specializes in religious and social affairs. Currently he has columns in both The Irish Independent and The Irish Catholic. He frequently appears on radio and television programs and also contributes to numerous publications overseas. He is also director and founder of The Iona Institute, a pro-marriage and religion think tank.