The issue of Down Syndrome (DS) and abortion is obviously going to loom large in the referendum debate with justifiable concerns raised that in a growing number of countries a large majority of babies are aborted once DS is diagnosed in the womb. The concern is that more Irish women will opt to do this if we repeal the 8th amendment. Let’s dig a little deeper into the international situation.
Fintan O’Toole in his Irish Times column this week essentially argues that this concern is overblown.
He says it leaves out the 30-40pc of pregnant women in Britain “who choose not to be screened”. He claims the increase in screening has not wiped out the births of children with DS , and he says the number of Irish women taking this option is “strikingly small”.
In his article he refers to figures from the England and Wales (he says ‘the UK’, but he appears to mean only England and Wales) and the Netherlands. Let’s consider England and Wales first.
The National Down Syndrome Cytogenetic Register for England and Wales tells us that while the percentage of DS children who are aborted following a prenatal diagnosis has remained stable at about 90pc (a huge figure), their absolute number has significantly increased because the percentage who are being screened has also increased greatly. Fintan O’Toole does not point this out.
In 1989, 70 percent of children diagnosed with Down Syndrome were born. By 2013, this had dropped to 37pc. What happened to cause such a drastic drop in the percentage born alive? The answer is more screening and more abortion. The percentage who opted to abort a child with DS may have been more or less static since 1989 (a year O’Toole refers to in his article), but the number being screened greatly increased from 30pc then to 65pc in 2013 and the number of abortions went from 302 to 1108!
A similar trend can be observed in Denmark, a country with the highest rate of screenings in Europe. In 1989 the number of children with DS born alive came to 62% of the total, which includes postnatal diagnoses. By 2000 this had dropped to 42%, and by 2013 it had fallen to just 14.5%, meaning more than 85pc were aborted (95pc of those diagnosed in the womb) or miscarried. (Here are the official tables from the Dansk Cytogenetisk Centralregister.)
O’Toole notes that in England they decreased from 92% to 90%, without mentioning the absolute numbers, as this is somehow significant, and as a proof that the increase of screenings hasn’t wiped out Down Syndrome children. So 90% is not a wipe out. Do we need to wait until it is 100%, as in Denmark in 2015?
O’Toole also refers to the Netherlands because their case was presented at the Joint Oireachtas Committee on the 8th Amendment.
He points out that the screening rate there is 35%, much lower than the European average. There are historical reasons for this, well explained in this article, but the non-invasive prenatal testing was extended to every woman only in April 2017, after a long public debate, and it is too early to assess its impact.
The Dutch expert told the Committee that the number of children born with Down Syndrome is stable. But, in spite of a lower screening rate compared to other European countries, the percentage of DS children aborted following a diagnosis is still close to 90pc.
Why do some women choose not to have a prenatal test? O’Toole speculates it is because these women “have already decided even if they test were positive they would continue with their pregnancy anyway”.
This may be the case sometimes, but there are other reasons, such as the concern that some prenatal tests will cause a miscarriage. New forms of non-invasive prenatal testing overcome this fear, but we still have to see how the number opting for a prenatal test increases.
Finally, Fintan O’Toole claims that the number of Irish women having abortions in England under Ground E (disability) is small. This is true compared with the very high rate in other countries, but why would we think this will not increase with more prenatal testing and with abortion freely available in Ireland?
The issue of illegal abortion pills was raised a number of times in recent debates following the publication of the Report of the Joint Committee on the Eighth Amendment of the Constitution. How spread is this phenomenon?
Even if some Irish politicians seem to have discovered only recently the availability of abortifacients, those pills have been offered by online services for twelve years, since 2006. There are two main websites selling abortion pills and I will call them WOW and WHW, to avoid publicising them. What do we know about their use?
The very few studies published on this issue have one great limitation: they are co-authored by the providers of the abortion pills and so their data cannot be verified independently.
Based on those studies, pro-abortion activists talk of three women per day, about 1,000 per year, taking those pills in Ireland, although estimates vary. In one of my previous blog entries I have shown that even if we assume double this number of Irish women are using the abortion pill nonetheless the Irish abortion rates would still be significantly lower than nearby countries with liberal laws.
How are those pills accessible? After an online consultation, the two drugs (mifepristone and misoprostol) are dispatched by mail. This might result in seizure by the Irish customs authorities. Although obtaining those two drugs is not illegal under Irish law, using them to procure an abortion is a criminal offence. No one has ever been prosecuted, however.
There is an assumption that the abortifacients will be consumed by women in a crisis pregnancy, but they could be obtained also by a disgruntled partner, an abuser, or a sex trafficker, with the intent of procuring an abortion without the woman’s knowledge or consent.
According to WOW, the main website offering abortions pills, in recent years the number of pills ordered online has grown, and in 2016 there have been 1,748 online consultations from Ireland and Northern Ireland combined. (Note: the fact that they were ordered does not necessarily mean they arrived and were used effectively.)
This upward trend is somehow in contrast with data provided to the Medical Independent by a more reliable source, i.e. the Health Products Regulations Authority (HPRA). According to those figures, the number of tablets detained in 2016 (536) was almost half of those detained in 2014 (1,017). In 2015 the number was 850. It is that the number of pills ordered has, in fact, declined, or it is that the authorities are not so diligent anymore about apprehending them?
It is interesting to note that according to the statistics based on self-reports, the majority (54.3%) of requests come from women who have used contraception. The final Report of the Joint Oireachtas committee noticed this (even if they got the figure wrong) while at the same time, paradoxically, recommended free contraception to avoid crisis pregnancies.
The alleged growing use of abortion pills has been presented as an argument to regulate the practice, rather than to prohibit it. But the same could be said about any kind of illegal substance currently available on the internet or from criminal dealers. Obviously, their administration would be safer under medical control, but should we then decriminalise any kind of drug, knowing that they are harmful? Apart from the fact that they cause abortion, and therefore always harmful for the one who is killed, there are concerns for the health of the women that use them. (See this comment of the Lozier Institute about of their safety: https://lozierinstitute.org/rewires-reckless-push-for-mail-order-mifeprex/)
Moreover, according to the Medicines and Healthcare products Regulatory Agency (MHPA), the number of illegal abortifacients seized in the UK has risen exponentially since 2013. This proves that even if Ireland had the same abortion regime of the United Kingdom, the problem of illegally obtaining abortion pills won’t necessarily disappear. In fact, the main organisation that sends abortifacient pills to Ireland (WOW) offers the same service even in countries where abortion is legal, such as the UK.
BPAS, the main abortion providers in the UK, are campaigning to make the domestic use of those pills legal. If abortion is normalised in Ireland, soon or later there will be a similar call here.