By Dr. Peter Saunders
Editor’s note. Dr. Saunders is a former general surgeon and CEO of Christian Medical Fellowship, a UK-based organization with 4,500 UK doctors and 1,000 medical students as members.
Savita Halappanavar was an Indian woman who tragically died on 28 October in Galway University Hospital, Ireland from overwhelming infection after allegedly being denied an abortion.
Her death, on 28 October, is now the subject of two investigations by Ireland’s Health and Safety Executive (HSE) and by University Hospital Galway.
The death has led to an international campaign calling for Ireland’s abortion laws to be changed.
Currently abortion in Ireland is illegal under section 58 and 59 of the Offences against the Person Act 1861.
However in 1992 Ireland’s Supreme Court ruled in the X case that abortion is admissible in the case of a ‘real and substantial risk’ to the mother’s life (as opposed to her health).
Section 21.4 of Ireland’s Guide to Professional Conduct and Ethics for Registered Medical Practitioners also recognises that in exceptional circumstances, it may be necessary to intervene to terminate the pregnancy to protect the life of the mother.
So both Irish law and Irish medical professional codes already allow abortion to save the life of the mother (see detail on my earlier blog).
As I have previously argued if faced with a choice between intervening to save one life (that of the mother) or standing by and allowing two (both mother and baby) to die, then I would have no hesitation in intervening and have previously already done so in the case of ruptured ectopic pregnancy.
I have never heard a doctor say he or she would not intervene in this type of situation although some such doctors might possibly exist.
Thankfully bringing a pregnancy to a premature end in order to save the life of the mother is vanishingly rare. In the UK it was reported in 1992 that in the first 25 years of the operation of the Abortion Act 1967 only 0.013% of all abortions were performed ‘to save the life of the mother’ and it is even questionable whether many of these required such radical action.
Some people are arguing (for example see Jen Gunter’s blog) that this is a case of negligence or mismanagement and they may well be right. But there are already disputes about the real facts of the case as well documented here.
Personally I would like to see the full report before coming to a conclusion rather than relying solely on the testimony of Savita’s bereaved husband as reported in the Irish Times and Spectator.
But the real issue is whether Ireland’s law needs changing as a result of this case.
The issue has come to a high boil after the European Court of Human Rights issued a ruling in the A,B and C case saying that Ireland must ‘clarify’ under what circumstances abortion could be legal under the current law.
While the Court did not say that Ireland must legalise abortion, this has not stopped abortion activists from insisting that abortion be declared legal. The report on abortion’s legal situation by the government’s expert group, which has been expected imminently for months, was reportedly delivered to the Health Minister on Tuesday.
Minister for Health James Reilly has confirmed he will be bringing the report of the expert group on abortion to Cabinet on Tuesday week but said that it could be early 2013 before a clear Government position is made.
Amnesty International has also called on the Irish government to change the law.
Prochoice activists around the world, who were circulating emails announcing the case before it even appeared in the newspapers, have meanwhile mobilised people to protest in Irish cities and outside the Irish Embassy in London.
But it is clear that many of these groups are seeing this case as an opportunity to advance a much more radical agenda.
53 MEPs have signed a letter asking Ireland to legalise abortion when the mother’s ‘life or health’ is at risk. This would be a quantum shift to a law like Britain’s which has resulted in over seven million abortions since 1967.
The abortion ‘provider’ ‘Planned Parenthood’ is running a campaign to ‘support a woman’s right to make her own medical decisions’ which sounds to me like an appeal for abortion on request.
Similarly ‘Education for Choice’ is asking its supporters to write to the Irish Prime Minister (Taoiseach) saying that ‘This tragic case demonstrates once again that the prohibition of abortion in Ireland is not just undermining the autonomy of the women across the country, it is leading to unacceptable suffering and even death’.
The pro-abortion group ‘Population institute’ has said that the case ‘is a tragedy that should never have happened, and unfortunately it is not an isolated incident. Tragedies like this happen every day in countries where abortions are illegal or highly restricted.’
So is it really true that tragedies like this happen ‘every day’ in Ireland? This is actually a very easy question to answer as maternal mortality statistics are readily available.
The maternal mortality rate (MMR) is the annual number of female deaths per 100,000 live births from any cause related to or aggravated by pregnancy or its management (excluding accidental or incidental causes). The MMR includes deaths during pregnancy, childbirth, or within 42 days of termination of pregnancy, irrespective of the duration and site of the pregnancy, for a specified year.
Ireland actually has one of the lowest MMRs in the world at just six deaths per 100,000 live births. This compares with 12 in the UK, 15 in the US and 200 in India.
As there are about 75,000 live births a year in Ireland this means that there are an average of four maternal deaths per year from all causes.
So to suggest as the Population Institute does that ‘tragedies like this happen every day in countries where abortions are illegal or highly restricted’ is a gross misrepresentation of the truth.
In other words, despite the fact that abortion is illegal in Ireland, there are very few places where it is safer to have a pregnancy or delivery. The standards of Irish medical care are very high indeed.
Now it may transpire after this case has been fully investigated that there has been mismanagement or negligence but that will not be an argument for a change in the law if the object is really saving women’s lives.
But what about pre-born babies’ lives?
We know from Department of Health Statistics that 4,149 women with Irish addresses had abortions in Britain last year. By contrast there are about 200,000 abortions in Britain each year involving women from England (189,000) and Wales (12,000).
Just under 4.6 million live in the Republic of Ireland as against 60 million in England and Wales. So if Irish women were having abortions at the same rate as English and Scottish women there would be not 4,149 a year but over 15,300.
In other words abortion being illegal in Ireland saves over 11,000 Irish pre-born babies from abortion every year (This assumes that a change in Irish law will mean that Irish abortion rates will approach British rates–a not unreasonable assumption given how British rates have escalated in spite of what is on the surface a very restrictive law).
If the law did change Ireland would probably still have a maternal death rate that was well below that in the UK (6 per 100,000 live births versus 12 per year 100,000 per year), that is, a total of four maternal deaths annually (that is if no women then die as a result of abortion).
But there would be thousands more babies who would lose their lives.
Of course if you think a preborn baby is nothing other than detritus then that won’t bother you.
But if you think it is worth anything at all then you will support the law in Ireland staying as it is.
This first appeared at http://pjsaunders.blogspot.com/2012/11/changing-irelands-abortion-law-will-not.html