Thursday, December 16, 2010

Cork Women's Right to Choose Welcomes European Court Decision on Abortion

16th December 2010

Cork Women's Right to Choose Group Welcomes Momentous European Court of Human Rights Decision on Abortion

Cork Women's Right to Choose Group (CWRCG) pays tribute to the courage of the three women, known only as A, B and C, who brought their cases to the European Court of Human Rights (ECHR), and welcomes today’s ruling on Ireland’s failure to implement the Constitutional right to abortion in cases where a woman's life is at risk.

The 17-judge Grand Chamber ruled this morning by oral hearing that the human rights of one of the three women who took the case challenging Ireland's restrictive abortion laws had been violated because she had no “effective or accessible procedure” to access a lawful abortion in Ireland. The woman – known as Applicant 'C' – had been in remission from a rare form of cancer, and was potentially at risk of a relapse as a result of the pregnancy. Because the lack of clarity in existing medical guidelines puts doctors at risk of possible prosecution, she was unable to find a doctor willing to tell her whether her life would be at risk if she continued with the pregnancy. According to the Court, Ireland's failure to legislate for the ruling in the 1992 X Case, which provides for the right to abortion in the case of a risk to the life of the mother, constituted a breach of C's right to respect for her private life (Article 8 of the European Convention on Human Rights). As a signatory to the Convention, the Irish Government is obliged to take measures to implement the decisions made by the Court.

CWRCG spokeswoman Dr Sandra McAvoy said, "Pro-choice organizations have been calling for legislation on access to safe and legal abortion in Ireland ever since the ruling in the 1992 X case that abortion was legal in certain circumstances. Today’s ECHR ruling is a step forward in that it should force the government to do something it has resisted for 18 years: introduce legislation and provide guidelines for medical professionals.”

In relation to the other two women involved in the case (A & B), a majority of judges ruled that there had been no human rights violations. Although the Court commented on the lack of sufficient medical guidelines in relation to abortion, noting that the Irish courts were not appropriate fora for deciding whether a woman qualified for an abortion, they made no other recommendations to the Irish government for the implementation of further legislation. The judges determined that it was not the role of the European Court to rule more substantially on the right to abortion in Ireland, despite a consensus existing among the majority of Council of Europe member states allowing broader access to abortion than under Irish law.

Spokeswoman Dr. Sandra McAvoy continued, "We recognise the limitations of the Court, but are disappointed that it has not been able to clarify women’s rights in cases where states make a distinction between threats to life and those to health during pregnancy. We welcome the arguments set out in the dissenting position taken by six of the judges who pointed to the strong consensus among European countries for abortion to be permitted on broader grounds. Some 40 Council of Europe member states permit abortion to protect a woman’s health and well-being, and that failure to take account of this might mark a ‘dangerous new departure in the Court’s case law.’ We hope that, in considering legislation, Irish legislators will not close their eyes and minds to the idea that, in the twenty-first century, Irish women should have the same rights to bodily integrity, to health, and to well-being as their European sisters.”

The three women who took the case against Ireland – all of whom had been forced to go abroad to terminate their pregnancies – lodged their complaint saying that the current law in Ireland jeopardised their health and well-being. Their argument, heard in the Grand Chamber on 9th December 2009, was that Ireland's restrictive ban on abortion breached their human rights under the European Convention on Human Rights. The identities of the three women, known as A, B & C, has remained confidential, although the most intimate details of their private lives were discussed publicly during the hearing.

Abortion is illegal in Ireland under the 1861 Offences Against the Person Act. In addition, a 1983 amendment to the Irish Constitution provides an equal right to life for both the "unborn" and the pregnant woman. As a result of the X Case ruling in 1992, abortion may be performed in Ireland where a continuation of pregnancy poses a '"real and substantial" risk to the life (as distinct from the health) of the pregnant woman, which includes suicide. In reality this has neither been legislated for nor tested. The lack of legal clarity means that doctors often do not perform abortions in Ireland even in order to save a woman's life.

McAvoy notes, "The unfortunate women who are pregnant while severely ill, or as a result of sexual violence, or in cases of lethal fetal abnormalities, are forced to travel abroad if they can afford it and are able. Women who cannot travel for any variety of reasons experience extreme and possibly even life-threatening physical, financial and emotional hardship being forced to go through with an unwanted pregnancy."

Since the X Case judgment, the Irish people have consistently shown increased support for access to abortion in Ireland. The most recent Abortion Referendum, which threatened to roll back the X Case judgment, was voted down by the majority of the Irish population in 2002. In 2007, an Irish Times Behaviour and Attitudes Poll found that 54% of women believe the Government should act to permit abortion. Despite this growing support, the Government continues to stall, forcing women to publicly air their private lives in the courts to gain access to services that should be safely and legally available in Ireland.

Dr. McAvoy added, "Cork Women's Right to Choose Group calls on the public and elected representatives to support this landmark ruling. We also call on the Government to swiftly implement the decision, and legislate to provide access to safe and legal abortion in Ireland. This does not mean introducing something on the lines of another 2002 Referendum designed to roll back women's rights, but legislation that protects women's human rights – including those to life and health and well-being. We need to finally make a decision that we will not tolerate the continued violation of women's health and human rights in Ireland."


Thursday, September 30, 2010

Medical Independent: IFPA calls for tougher stance on rogue crisis pregnancy agencies

September 30, 2010
Dawn O'Shea

The Irish Family Planning Association (IFPA) is calling on the Government to introduce statutory regulations for all pregnancy advice services which set out minimum codes of practice and standards.

According to the IFPA’s recently released 2009 Annual Report: “Rogue crisis pregnancy agencies continue to operate unchecked in Ireland, causing considerable distress to women who unwittingly attend their services”.

Last year, 18 women attended the IFPA for counselling after a negative experience at the hands of “rogue agencies” and the Association says it is certain that these figures “represent just the tip of the iceberg”.

Women attending the IFPA described being “harassed, bullied and being given blatantly false information” by these agencies.
The IFPA also voiced its concern surrounding the difficulty experienced by women with travel restrictions in accessing safe and legal abortion services abroad.

Women, such as those seeking asylum or migrant workers, seeking a termination abroad must apply for a visa from the country to which they will be travelling as well as a re-entry visa for Ireland.

According to the IFPA, the process of applying for these travel documents is “complex, expensive and can take several weeks”.
Combined with the financial cost of accessing a termination abroad, such situations may force women to parent against their will or to resort to illegal methods to terminate their pregnancies in Ireland, the Association said.


Inter Press Service: Activists File Writ of Habeas Corpus – for Legal Abortion

Date: September 28, 2010
Author: Marcela Valente

BUENOS AIRES, Sep 28 (IPS) - Heartened by the passage of a same-sex marriage law in Argentina, women's organisations in this South American country stepped up their demands for the legalisation of abortion, on the Day for the Decriminalisation of Abortion in Latin America and the Caribbean.

Some 1,000 members of the Juana Azurduy Women's Collective, better known as Las Juanas, filed a "collective and preventive" writ of habeas corpus at different courtrooms around the country, demanding that the criminalisation of abortion be declared unconstitutional.

They also asked the courts to press the legislature to bring the law that penalises abortion into line with international norms that recognise a woman's right to make decisions about her body.

"We chose the habeas corpus route because it protects people's freedom, and we are thus asking the courts, in a preventive manner, to protect us if we become pregnant and want to interrupt the pregnancy," Las Juanas activist Gabriela Sosa told IPS.

Sosa, who is head of the organisation in the eastern province of Santa Fe and is one of the women who signed the writ of habeas corpus, said the present political and social climate in the country lends itself to making progress towards a law that would decriminalise abortion.

"Not long ago we could not imagine that Argentina would have a same-sex marriage law, and this year it was achieved because there is social concern and interest in debating these issues, and the politicians are picking up on and reflecting that," she said.

But she admitted that the 2011 elections are an obstacle, because "no candidate is going to want to pick up the hot potato of abortion" in a campaign year.

In Argentina, abortion is a crime punishable by prison, except in cases where the pregnancy is the result of rape, the expectant mother's life is in danger or she is mentally ill or disabled.

But every year some 460,000 to 600,000 women resort to abortion in this country of 40 million people, according to the report "Estimate of the Extent of the Practice of Induced Abortion in Argentina", prepared by experts from the University of Buenos Aires and the Centre for Population Studies.

In Latin America, abortion is only legal in Cuba, Puerto Rico and Mexico City. With the exception of Chile, El Salvador and Nicaragua, where abortion is illegal under any circumstances, in the rest of the countries in the region "therapeutic" abortion is legal in certain cases, such as rape, incest, fetal malformation or risk to the mother's life.

Nevertheless, more than four million illegal abortions a year are practiced in the region, according to different sources, and 13 percent of maternal deaths are caused by abortion-related complications.

In Argentina, unsafe abortions are the main cause of maternal mortality, the Juana Azurduy Women's Collective reports.

Against that backdrop, Las Juanas presented their legal action on Tuesday Sept. 28, observed as the Day for the Decriminalisation of Abortion by the women's movement in Latin America and the Caribbean since 1990.

The London-based Amnesty International joined its voice to the campaign. The deputy director of the rights watchdog's Americas Programme, Guadalupe Marengo, called for the repeal of all laws that penalise or provide for the imprisonment of women or girls who undergo an abortion under any circumstances.

Amnesty said the restrictions on safe, legal abortion put the human rights of women in the region in "grave danger."

For years, women's groups in Argentina have been campaigning for the decriminalisation of abortion, but have continually run up against the fierce resistance of the powerful Catholic Church and other conservative sectors of society.

However, this year the situation looks more favourable. Since March, the lower house of Congress has been studying a draft law that would decriminalise abortion, which has the backing of around 50 lawmakers from different parties.

The bill, which may be debated in October, was introduced by Cecilia Merchán, a legislator with the left-wing movement Libres del Sur, and would legalise first-trimester abortion on demand, similar to the law in effect in the Federal District of Mexico City.

None of the nearly 20 earlier bills on abortion introduced in the Argentine legislature over the years progressed. But the current draft law has already made it through several committees and is on its way to a full session debate in the lower house.

Merchán told IPS that the bill she sponsored is in response to the large number of abortions practiced in this country, and especially to the fact that more than 70,000 -- mainly low-income -- women are hospitalised annually for complications from unsafe abortions.

"Last year, 120 of the women admitted to public hospitals with abortion-related complications died: in other words, every other day, a woman dies in Argentina due to this cause," she said.

The lawmaker said "the present climate is favourable" to moving forward on the issue because "society has raised the need for Congress to address a question that has severe consequences for the lives of so many women.

"Just like in the case of the debate on same-sex marriage, society as a whole, even those who are opposed, don't want to keep hiding a reality that involves so many people," she said.

"For us, this is not a new issue, but we see that society's demands are now forcing legislators to discuss it," she added. There have also been declarations on the issue by sectors that in the past have been reluctant to take a public stance, like public universities. The deans of the University of Buenos Aires, for instance, backed the decriminalisation of abortion by 23 votes against one, in August.

In addition, there have been statements in favour by members of the Supreme Court, like magistrate Carmen Argibay, who said this month that the time to debate changes in the country's abortion law "is now."

However, while the legislators are preparing their offensive in the lower house, another bill has been presented in the Senate, which would merely expand the circumstances under which therapeutic abortion is legal.

The idea underlying the initiative by several women senators is that legal abortion would also be made available to women facing risks to their health, a concept that would be broadly defined as physical and mental health.

The women's organisations do not have the support of President Cristina Fernández, who has spoken out against the legalisation of abortion. But Merchán is confident that the president's position will not impose itself in the legislative debate.


Wednesday, September 29, 2010

Irish Medical Times: Research needed on illegal abortion in Ireland

September 29, 2010

Dear Editor,

I’d like to echo Dr Ruairi Hanley’s call for a referendum on the introduction of abortion facilities in Ireland, broadly similar to those in the UK (‘Addressing the great taboo’, IMT, September 10).

This would make a big difference to the rising problem of illegal abortion in Ireland. It would also make a huge difference to Irish obstetricians who have to cope with the extraordinary difficulty of not being able to provide termination on clinical and social grounds here in our own hospitals.

I hope that the medical community will continue to provide a strong voice to advocate for a modernisation of our reproductive laws in Ireland.

I also feel that research into the growing problem of illegal abortion would be a useful tool in assessing this need for legal change from a clinical point of view, because until now illegal abortion in Ireland has not been well documented and it remains a secret and covered-up problem with severe clinical consequences.

The maternity and emergency departments should be encouraged and provided with adequate funding to explore this cause of maternal morbidity and mortality as a matter of urgency.

Dr Juliet Bressan,
Amiens St,
Dublin 1


Tuesday, September 28, 2010

Huffington Post: New Global Maternal Mortality Data Offers Hope

Anika Rahman
President, Americans for UNFPA

Posted: September 15, 2010 10:04 AM

Today, along with advocates and women around the world, I feel a moment of triumph at the news that maternal death has declined by one-third globally.

According to a new report, Trends in Maternal Mortality released by the United Nations Population Fund (UNFPA), World Health Organization (WHO), the United Nations Children's Fund (UNICEF) and the World Bank, "the number of women dying due to complications during pregnancy and childbirth has decreased by 34% from an estimated 546,000 in 1990 to 358,000 in 2008."

For the last few years, I've relied on the staggering statistic that every minute a women dies in pregnancy and childbirth to draw attention to the dire struggle endured by women around the globe. The number has always stopped people dead in their tracks. For the first time in a long time, I can look down at my watch when the minute hand turns and think of something other than a woman needlessly losing her life.

While this progress is notable, the reality is that the current annual rate of decline in maternal death is less than half of what is needed to achieve the Millennium Development Goal - a gold standard for our collective global development objectives - target of 75% reduction in maternal death by 2015. Still, the new data shows that progress and maternal health is achievable, and it fuels my desire to increase U.S. efforts and involvement to improve maternal health globally.

In Africa and South Asia, complications during pregnancy and childbirth are one of the leading causes of death for women of childbearing age. I wonder how many people are aware of the frequency and pervasiveness of maternal mortality throughout the world.

So many articles come across my desk in a given week, but when I saw an article in the Hindustan Times I was particularly moved by the headline which read, "She gave birth, died. Delhi walked by." This article reveals the tragic story of a woman who gave birth on the side of a busy road in Delhi, India. The unnamed, unaided woman died shortly after giving birth because of lack of medical care. The article narrates how thousands of people on foot, on bicycles and in cars must have passed this woman as she gave birth. Sadly, no one noticed because this is the norm in regions throughout the world where reproductive healthcare is a privilege and not a right. Just four days later the new mother died on the side of the busy road, in the same location where she gave life.

The void that is created when women die during or after childbirth is inescapable. Children are left motherless, husbands are left without their wives, and communities are left without matriarchs. This tragedy is not limited to Delhi, India. There are countless women throughout the world who are left to face the reality of no access to reproductive healthcare.

I am reminded of women like Veronica Komba from Tanzania, whose story was recently featured in UNFPA's Mothers Saved. At the age of 14, Veronica was left homeless, hungry and pregnant. She came very close to death after collapsing in her village from high blood pressure, but her life was spared, primarily because she was able to access transportation to a hospital. A local women's group paid for the vehicle that transported Veronica 60 km to the nearest hospital for the C-Section that saved her life.

Giving birth is especially risky in South Asia and Sub-Saharan Africa, where most women deliver without any access to skilled care. It doesn't have to be this way. With greater access to perinatal care, most maternal deaths could be avoided. We can live in a world where no woman dies in childbirth.

By endorsing the Millennium Development Goals ten years ago the U.S., together with 187 other countries worldwide, made a joint promise to women worldwide to reduce maternal mortality and ensure universal access to reproductive healthcare by 2015. On September 20-22, the Millennium Development Goals Summit will be held in New York to examine the progress being made on each of the goals to date. While progress is being made overall, the goal of improving maternal health lags behind others. As we draw nearer to 2015, it is evident that there is still work to be done.

1,000 women are dying every day and 20 times as many become ill or injured because of a lack of access to healthcare during their pregnancies and childbirth. Continuing to shed light on this issue is imperative. We at Americans for UNFPA urge you to join our Call to Action by signing on to our petition requesting that the U.S. honors its commitment to improving maternal health and implementing universal access to reproductive healthcare by 2015. Don't let another woman die giving life.

Join me in calling for the Obama Administration to put women's health and MDG 5 at the heart of U.S. government's global priorities over the next 5 years.

Join Americans for UNFPA for a tweet chat on MDG 5 from 3-4pm EST on Tuesday September 21st, using hash tag #mdg5.


Irish Aid: Report on Ireland's contribution towards achievement of Millennium Development Goals

Download report, factsheets and other news relating to the UN MDG Summit (September 2010) here.

Irish Times: Increase in single fathers opting for vasectomy

Health Correspondent

Wed, Sep 22, 2010

THE NUMBERS of single men opting for vasectomy has increased over the past decade, according to the latest annual report from the Irish Family Planning Association.

The single men seeking the procedure had all fathered children.

Dr Caitriona Henchion, medical director of the association, said the men, mainly in their 30s and 40s, were supporting children they had had in a relationship, but did not want to take on the financial burden or responsibility of any more “and were even cagey about new relationships” as a result.

The association, along with releasing its annual report for 2009 yesterday, published the findings of a survey of men who opted for vasectomy in the last 20 years.

More than 3,000 vasectomies were carried out by the association over that period. A review of 328 of the cases found the procedure had been most popular among couples in their 30s with two or three children.

“Vasectomy is seen by many men as a way of removing the contraceptive burden from their partner when their family is complete . . . It has become a very acceptable choice thanks to some brave men who broke the taboo and spoke about their own experience of vasectomy, such as the recently deceased broadcaster Gerry Ryan,” Dr Henchion said.

The number of single men opting for vasectomy is still small overall. The association report says that in the 1990/1991 period its clinics had no vasectomy clients who said they were single. By 1998/1999 2 per cent of 180 clients described themselves as single, increasing to 8 per cent of 106 clients in 2007/2008.

Asked about the fact that there were fewer men seeking the procedure at association clinics in 2007/2008 than 10 years earlier, Dr Henchion said she believed this was because the service was now widely available through GPs.

Meanwhile, the association’s report indicates it had to refuse appointments to about 3,000 medical card patients last year due to a cut in funding from the Health Service Executive.

Those who could not be accommodated were referred back to their GP. The association said this was entirely unsatisfactory, given that clients were referred to it by their GP, or sought association services because their GP would not or could not provide a comprehensive family planning service.

Dr Henchion said association clinics had funding only to see a certain number of medical card holders each month.

The annual report reveals 18 women attended association clinics for counselling last year after negative experiences at the hands of rogue agencies claiming to provide crisis pregnancy counselling.

The report said the association was certain the figures represented “the tip of the iceberg”.

The association was urging the bringing forward of statutory regulation for all pregnancy advice services, prescribing codes of practice and standards, the report said.

© 2010 The Irish Times


Irish Medical Times: Abortion should be part of 'best practice' in medicine

Dear Editor,

It was with surprise that I read Dr Ruairi Hanley’s article ‘Addressing the great taboo’ (IMT September 10, 2010).

He claims that it has taken him six years to summon up the courage to address the subject of abortion; he goes on to describe it as “the most contentious subject in Irish medicine”. He fears “irrationality and base hostility”, claiming they are part and parcel of an engagement with the issue; he even anticipates “hate mail”!

Having ventured into the area, he then criticises the pro-choice movement for allegedly concentrating on rare and emotive abortion cases. On the contrary, surely? As a founder member of Doctors for Choice — an organisation representing Irish doctors who support a woman’s right to choose abortion, seeing it as an integral part of her right to self determine her bodily integrity — we have consistently asserted that the key issue is the approximate 5,000 Irish women who travel each year to access abortion abroad. There is nothing ‘rare’ in these numbers.

It is variously estimated that between one in ten and one in fifteen Irish women of reproductive age have had an abortion. These women are our everyday patients. We are likely to meet them in our consultations at least once a day, yet don’t know who they are. These many thousands of women, as well as being our patients, are also our friends, our sisters and our children. This is the reality of abortion in Ireland.

It needs to be acknowledged that Irish doctors have been complicit in the silence surrounding the subject of abortion in this country. It is indeed time to end that silence. To this end, Doctors for Choice welcomes Dr Hanley’s (somewhat belated!) writing on abortion and his request for a rational discussion by Irish doctors; this debate is indeed urgently needed.

However, we would stress that the debate should remain firmly focused on the many, many thousands of Irish women who have had and continue to have abortions. A focus on patient autonomy, patient safety and equity of access to services must be at the heart of the debate. These values are also at the heart of best practice in medicine; it is time to include abortion as part of that best practice.

Dr Mary Favier,

Doctors for Choice


Guttmacher Institute: New study finds abortion does not cause mental health problems among adolescents

125 Maiden Lane, 7th Floor, New York, NY 10038
Ph 212 248 1111 Fax 212 248 1951

Rebecca Wind

Friday, September 24, 2010

Teens who have abortions are no more likely to become depressed or have low self-esteem than their peers whose pregnancies do not end in abortion, according to “Do Depression and Low Self-Esteem Follow Abortion Among Adolescents? Evidence from a National Study,” by Jocelyn T. Warren of Oregon State University et al., which is available online and will appear in the December issue of Perspectives on Sexual and Reproductive Health. The study found that the factors most closely linked with depression and low self-esteem after abortion are having experienced those problems in the past.

A 2008 study by the American Psychological Association (APA) found no evidence that induced abortion causes mental health problems in adult women, but because of a scarcity of evidence on teens, no conclusions were drawn at that time about the impact on adolescents. The new study is the first to look at depression and low self-esteem as potential outcomes of abortion among a nationally representative group of teens, and the results are consistent with the findings of the earlier APA report—induced abortion does not cause mental health problems in adolescent women.

While 34 states currently require that women receive counseling before an abortion is performed, seven of these states specifically require that women be warned of possible negative psychological consequences resulting from the procedure. “Paradoxically,” the authors of the new study suggest, “laws mandating that women considering abortion be advised of its psychological risks may jeopardize women’s health by adding unnecessary anxiety and undermining women’s right to informed consent.”

The study is based on data from the 289 respondents to the National Longitudinal Study of Adolescent Health who reported at least one pregnancy between the survey’s first two waves, 69 of whom reported an induced abortion.

The article is currently available online and will appear in the December 2010 issue of Perspectives on Sexual and Reproductive Health.


Think Pro Choice!

Calgary Pro-Choice Coalition has produced a fabulous and fun comic to counter an anti-choice misinformation campaign going on in Canada. Download the comic here!

Guttmacher Institute: The impact of medication abortion ten years after FDA approval

September 27, 2010

On September 28, 2000, the U.S. Food and Drug Administration (FDA) approved the use of the abortion drug mifepristone (in combination with a second drug, misoprostol) as an alternative to surgical abortion for terminating early pregnancies. In the decade since, use of early medication abortion has expanded substantially, with growing numbers of providers offering the service, and its approval has given many women a choice between medication or a surgical procedure when seeking an early abortion.

Both the number of medication abortions and the number of providers offering them increased dramatically between 2000 and 2007, even as the total number of abortions performed in the United States declined. In 2007, 158,000 medication abortions were performed using mifepristone, accounting for an estimated 21% of all eligible abortions (those performed prior to nine weeks’ gestation) that year. Preliminary figures suggest use of mifepristone has continued to grow 10–15% annually since 2007.

Although the introduction of mifepristone did not increase the overall incidence of abortion, it does appear to have contributed to a change in the timing of women’s abortions. A larger proportion of abortions take place at earlier gestations than they did before the drug was introduced. The Centers for Disease Control and Prevention report that although the proportion of women obtaining abortions in the first trimester has remained stable, the proportion of abortions obtained at nine weeks’ gestation or earlier has increased, as has the proportion obtained within six weeks’ gestation.

Prior to FDA approval, medication abortion was described as having the potential to change the nature of abortion provision in the United States. Abortion was expected to become more broadly available, particularly in rural areas without a surgical abortion provider. However, Guttmacher research published last year found that while use of mifepristone has become widespread—and has contributed to the shift toward earlier abortions—it has not substantially improved women’s geographic access to abortion services. Most medication abortions are provided at or near facilities that already offered surgical abortions.

Click here for more information:
Facts on Induced Abortion in the United States
The incidence of abortion in the United States
The effect of mifepristone on abortion access


Irish Examiner: Mentally disabled women try to hide pregnancies

By Juno McEnroe
Saturday, September 25, 2010

WOMEN with intellectual disabilities often experience negative attitudes from those close to them, as well as from service providers, when they become pregnant and may even try to keep their pregnancy secret, according to a report.

The report looked at research on challenges faced by people with intellectual disabilities in relation to crisis pregnancies.

Current Irish legislation criminalises specific sexual acts, including intercourse, among people who are "mentally impaired" unless they are married to each other.

The report calls for better support and education for people with intellectual disabilities and also warns they are particularly vulnerable to sexual abuse.

The findings of the Crisis Pregnancy Programme research are expected to help guide changing legislation on mental capacity.

There are some 50,400 people diagnosed with an intellectual disability living in Ireland, 40% of whom are women.

Health professionals met at a Dublin seminar yesterday to discuss the findings, as well as best international practice in assessing people’s capacity to access medical treatment and sexual relationships. According to researchers, paid carers or relatives already make decisions on behalf of women with intellectual disabilities in the area of reproductive health. Many children of those people are also often placed in care.

The Government’s proposed Mental Capacity Bill, originally published in 2008, suggests that there should be a presumption of mental capacity in a person and that they should not be treated as being unable to make a decision unless all practical steps have been exhausted. This also includes when it comes to decisions about medical treatment.

This story appeared in the printed version of the Irish Examiner Saturday, September 25, 2010


Irish Independent: Cervical cancer jab offer for older girls

By Eilish O'Regan
Health Correspondent
Tuesday September 28 2010

OLDER schoolgirls who will miss out on the free cervical cancer vaccine being rolled out by the HSE are being offered the jab for €300.

The Health Service Executive (HSE) is currently giving the first phase of the vaccine to schoolgirls in first and second year of secondary school.

However, health insurer Aviva yesterday announced its own catch-up programme in partnership with Point of Care.

It aims to make the vaccine available to 150,000 girls between third and sixth year of secondary schools. It said that 29 schools with more than 11,000 pupils had already expressed an interest.

"A number of schools in Dublin, Cork, Meath and Limerick have already signed up to the programme and vaccinations will begin this month."

The cervical cancer vaccine is offered free of charge by the HSE -- but only to girls in the first two years, and from 2011 will only apply to first years.

This scheme is costing €3m for 30,000 secondary school girls this year -- at a cost of around €100 per child.

In contrast, receiving the vaccine privately through a GP is estimated to cost around €600.

The catch-up scheme offered by Aviva will target older girls who are still teenagers but are too old to qualify for the free vaccine.


Aviva said it was offering the set of three injections at the "lowest price for vaccination in the country" -- it will work out at €300 per student where a group of 25 are involved. It will be cheaper for its own members at €249.

It said a recent survey of parents in second to sixth year of secondary school had shown that 93pc thought it would be a "good thing" for their daughter to receive the vaccine.

Up to 13pc said their daughter had already received it.

However, more than half (51pc) were not willing to pay for the vaccine saying it was too expensive.

Caroline O'Reilly is principal of Eureka Secondary School, Kells, Co Meath, one of the first schools to sign up to the programme. "We were getting lots of requests from concerned parents who had daughters who did not qualify for the Government's programme.

"We are now one of the first schools in Ireland to offer our 400 girls from third to sixth year access to this vaccine through the Aviva Schools Catch Up Programme, which will help protect their future health."

- Eilish O'Regan Health Correspondent


Monday, August 30, 2010

Irish Examiner: Pharmacists call for 'morning-after pill' to be available over the counter

Monday, August 30, 2010 - 05:06 PM

Pharmacists are renewing calls for the 'morning-after pill' to be available over the counter.

At present, women who wish to take emergency hormonal contraception require a prescription from a doctor.

The Irish Pharmacy Union (IPU) said its members have the skills to dispense such drugs and provide appropriate advice and counselling to patients.

"It is important that patients get timely access to emergency hormonal contraception and many often find it difficult to get a prescription at the weekend," said spokesperson Kathy Maher, a pharmacist in Co Meath.

"Pharmacists should be able to provide such a service and this could be done with appropriate advice, counselling and within agreed protocols."

Ms Maher emphasised that the morning-after pill "should never be the only form of contraception used" and said pharmacists could also refer patients back to their GP where appropriate.

The IPU represents around 1,800 community pharmacists across the country.


Read more:

Saturday, August 14, 2010

NYTimes: F.D.A. Approves 5-Day Emergency Contraception

August 13, 2010

WASHINGTON — Federal drug regulators on Friday approved a new form of emergency contraceptive pill that prevents pregnancies if taken as many as five days after unprotected intercourse.

The pill, called ella, will be available by prescription only. Developed in government laboratories, it is more effective than Plan B, the morning-after pill now available over the counter to women 17 and older.

That pill gradually loses efficacy and can be taken at most three days after sex. Ella, by contrast, works just as well on the fifth day as the first after sex.

Women who have unprotected intercourse have about 1 chance in 20 of becoming pregnant. Those who take Plan B within three days cut that risk to about 1 in 40, while those who take ella would cut that risk to about 1 in 50, regulators say. Studies show that ella is less effective in obese women.

The decision was greeted with enthusiasm by abortion rights groups and denounced by anti-abortion activists. But in recent years both sides have treated the emergency contraceptive pills as a side issue in the wider debate over abortion.

Studies have found that many women fail to realize they are at risk for an unplanned pregnancy after unprotected sex. So they tend not to use the emergency contraceptives even when they receive them free.

“Emergency contraception has no effect on pregnancy rates or abortion rates,” said Dr. James Trussell, director of the Office of Population Research at Princeton, who has consulted without charge for ella’s maker. “Women just don’t use them enough to make an impact.”

Still, the decision by the Food and Drug Administration to approve ella, less than two months after a federal advisory committee voted unanimously to recommend approval, marks a decided shift for the agency.

Under President George W. Bush, White House political advisers overruled united F.D.A. scientists, delaying the decision to make Plan B available over the counter and barring such distribution to women under 18.

Some advocates said Friday that the agency’s relatively rapid adoption of its scientists’ advice meant that its traditional separation from political considerations had returned.

“It’s really important the F.D.A. made a decision that’s based on the scientific evidence and not on the political controversy,” said Diana Zuckerman, president of the National Research Center for Women and Families.

But Wendy Wright, president of Concerned Women for America, which opposes abortion, said that political considerations were still at work inside the agency.

“The fact that the F.D.A. waited until late on a Friday night in August to release this when they hoped nobody was paying attention underscores that this is a political decision,” she said.

Ms. Wright warned that men might slip ella to unsuspecting women, and she said testing so far was not adequate to establish whether it was safe.

In studies, the most common side effects associated with ella’s use were mild to moderate headache, nausea, abdominal pain, painful menstrual cramps, fatigue and dizziness.

Ella’s approval may also intensify a long-simmering controversy about whether pharmacists and doctors can refuse to prescribe or fill prescriptions for birth control measures they find personally objectionable.

Much of the debate over the drug springs from an argument over how it works, which despite considerable research remains something of a mystery. It blocks the effects of progesterone, a female hormone that spurs ovulation. It is, however, a chemical relative to RU-486, the abortion pill, and there is some evidence that ella makes the womb less hospitable to a fertilized egg by reducing the lining of the uterus.

To the scientists on the advisory committee, whether the pill works by preventing ovulation or implantation was mostly immaterial to the decision about whether it is safe and effective. But to religious groups, the distinction is crucial, since they consider that preventing implantation of a fertilized egg is akin to abortion.

Animal studies showed that ella had little effect on established pregnancies, suggesting it acts differently from RU-486.

Ella, which was approved in Europe last fall, is manufactured by HRA Pharma, a small French drug maker. In the United States it will be distributed by Watson Pharmaceuticals, a company based in California and New Jersey, which plans to introduce it by the end of the year.

The pill was originally developed by the National Institute of Child Health and Human Development, part of the National Institutes of Health and now named after Eunice Kennedy Shriver. It decided in 2002 to finance a crucial study to assess the drug’s efficacy as an emergency contraceptive.

Studies have shown that more than one million women who do not want to get pregnant are estimated to have unprotected sex every night in the United States, and that more than 25,000 become pregnant every year after being sexually assaulted. Half of all pregnancies in the United States are unintended.


Wednesday, August 11, 2010

Reuters: Economic crisis rekindles Irish debate on abortion

August 11, 2010
By Marie-Louise Gumuchian

DUBLIN (Reuters) - Minutes after the test revealed she was pregnant, Amy saw only one option -- to leave Ireland and have an abortion in Britain.

Her architect partner had lost his job in Ireland's property crash and she was worried about hers, so the 29 year-old office assistant felt she had no choice.

"We found it hard enough to finance the abortion," said Amy, who declined to give her full name because of the sensitive subject. "So how could we effectively support a child?"

Women's activists say Ireland's deep economic crisis may have driven more women to consider an abortion. But a growing number cannot afford to travel to Britain for the procedure and may be forced into the hands of underground abortionists.

A year later, Amy has not told her parents. Growing up in mainly Roman Catholic Ireland, abortion was taboo and she recalls how women rumored to have had one were shamed.

"Abortion was a no-no then, and still is now," she said.

Terminating a pregnancy has long been a fraught issue in Ireland, where one of the strictest abortion laws in Europe allows it only when the mother's life is in danger.

Women who have an abortion still face a maximum sentence of life imprisonment, driving thousands abroad each year, mainly to Britain. Even that is a little more liberal than before a 1992 referendum which gave women the freedom to receive abortion information and travel abroad to terminate pregnancies.

Today, following the former 'Celtic Tiger's' slide from boom to bust, Amy is not alone in seeking that route, although statistical evidence is hard to find.

Last year, 15 percent of the 1,300 women who visited the Dublin Well Women Center cited financial problems as the main reason for seeking information on terminating a pregnancy.

"Financial pressure might have always affected a women's decision around whether she continued with her pregnancy but in the last year there was some sort of shift in the priorities," Alison Begas, chief executive of the center, said.

"She would say she had lost her job, or her salary had been cut or even those for whom the guy has lost his job."

Ireland crawled out of the longest recession of any euro zone country in the first quarter of this year, but sustained economic recovery is some way off.

Ann Rossiter, a London-based Irish author who for years helped Irish women seek terminations in Britain, has warned that the credit crunch could bring a return to illegal abortions.

Abortions in UK clinics start from 350 pounds ($551). There are also travel costs. "I see no reason why we wouldn't have a return to the backstreet or self-induced abortions," she said.

Between 1980 and end-2009, at least 142,060 women traveled for abortion services in England and Wales, according to the Irish Family Planning Association (IFPA).

Last year, 4,422 women providing Irish addresses had terminations in England and Wales, British figures show, down 178 on 2008. Numbers have fallen since 2001.

But IFPA says the figures are an underestimate as not everyone wants to provide their address for confidentiality reasons, and women also travel to the Netherlands.

"I think what makes it tougher is the stigma," said Mara Clarke, of the UK-based Abortion Support Network. "(Abortion) is one of the most commonly performed medical procedures."

Women in Catholic Poland also face strict laws. Official statistics show several hundred abortions performed annually but pro-choice campaigners estimate hundreds of thousands are performed underground or abroad, sometimes in poor conditions.

Traditionally Catholic Spain has changed its law making it easier for women to have a termination but some conservative-led regions have refused to allow their hospitals to perform them.

In decades of debate in Ireland both pro-choice and pro-life campaigners have had their victories.

A March YouGov poll for British sexual health consultants Marie Stopes showed 78 percent of those questioned supported abortion if the pregnancy endangers a woman's health or is the result of sexual abuse, rape or incest.

A month later, a poll for the Pro-Life Campaign showed support for a continued ban, with 70 percent in favor of constitutional protection for the unborn child.

"People in Ireland just don't want abortion to be introduced, and that's very clear from the polls," Cora Sherlock of the Pro-Life Campaign, said. "It's not really an issue, because people are happy with the status quo."

Ireland is defending its abortion law at the European Court of Human Rights, countering a legal challenge by three women who said it endangered their health and violated their rights. The two Irishwomen and a Lithuanian living in Ireland went to Britain for abortions.

"I think it could be the case that gets the political system really focused on trying to resolve the issue," said Niall Behan, chief executive of IFPA, which supports the women.

While the court is unlikely to rule on the substance of Ireland's abortion law, it could say it is deficient in respecting the right to private life of those concerned, said Adam McAuley, a law lecturer at Dublin City University.

But he sees no immediate change. "The state will probably dilly-dally, I can't see it being quick," he said.

"The reality is (politicians) can just see votes being lost on this rather than being gained."

Rossiter knows it will take more than a court case for change. She has performed a one-woman-show, "Making a Holy Show of Myself, An Abortion Monologue", to select Irish audiences.

"I got weary of the usual format of presenting talks on the abysmal state of Irish women's reproductive rights," she says in a flyer for her show. "But I am not hanging up my spurs to retire to one of God's waiting rooms just yet."

(Additional reporting by Alice Tozer in Madrid and Gabriela Baczynska in Warsaw; editing by Paul Taylor)


NYTimes: Argentina Faulted for Reproductive Policies

August 10, 2010

RIO DE JANEIRO — The government of Argentina’s president, Cristina Fernández de Kirchner, has reversed steps toward protecting women’s health and reproductive rights, and backtracked on its intention to guarantee access to legal abortions, according to a Human Rights Watch report released Tuesday.

Despite what seems to be a liberal social wave sweeping through Argentina — including Congress’s approval last month of a national law authorizing same-sex marriages, the first in Latin America — the Human Rights Watch report offered a scathing assessment of the reproductive rights policies under Mrs. Kirchner, who took over from her husband, Néstor Kirchner, as president in late 2007.

Women continue to struggle to obtain birth control, despite a 2002 law ensuring access to it, and doctors shy away from offering legal abortions in the predominantly Roman Catholic country, the report said. Argentine law strictly limits abortions, with exceptions that include physical or mental risk to the patient and pregnancies resulting from rape.

Researchers found that unsafe abortions continued to be a leading cause of maternal mortalities in Argentina. In 2008, more than 20 percent of deaths recorded as a result of obstetric emergencies were caused by unsafe abortions, according to government figures cited in the report.

The group said an estimated 40 percent of pregnancies in 2005 ended in abortions, most of them illegal and unsafe. “Little has changed for the women and girls who depend on the public health system,” the organization said.

The report’s author, Marianne Mollmann, wrote that anti-abortion voices continued to carry significant political weight, as in many Latin American countries. Last month, the Health Ministry “backtracked on its declared intention to guarantee access to legal abortion” under wilting questioning by the Argentine press, Human Rights Watch said.

A spokesman for Health Minister Juan Luis Manzur declined to comment on the report on Tuesday. Neither the minister nor Mrs. Kirchner addressed the issue publicly.

At an event on July 30, Dr. Manzur declared that the government was “against abortion,” noting that the president felt the same way.

Earlier in July, though, a ministry official said Dr. Manzur had signed a resolution backing a guide to legal abortion services. The guide would allow doctors to carry out abortions for rape victims without securing a police report. But a day later, the minister issued a statement saying he had not signed the resolution, and Argentine news outlets suggested that Mrs. Kirchner had ordered him to halt the effort.

In 2002, Argentina’s Congress dismantled an 11-year ban on the use and sale of contraceptives when it enacted the National Law on Sexual Health and Responsible Procreation. The law focused on providing universal access to contraceptives and information on reproductive health.

But researchers from Human Rights Watch have found that, in practice, women in Argentina have encountered barriers to making independent decisions about reproduction, obstacles that include lack of information, domestic and sexual violence, and economic restraints that the government had not adequately addressed. The group also found that public officials were not being penalized for failing to uphold the laws on the books.

Ginés González García, the health minister under Mr. Kirchner, installed guidelines and clearer laws, including a sex-education law, but the government’s efforts were undermined by “erratic implementation,” Human Rights Watch said.

When Mrs. Kirchner took over in 2007, the stigmatization of abortion increased, the group said. The president’s first health minister, Graciela Ocaña, declared abortion to be a matter of criminal law and repudiated the guide on legal abortion. It finally appeared on the ministry’s Web site in March 2010 after Dr. Manzur replaced Ms. Ocaña.

But in July, after republishing the guide, the ministry seesawed on the issue, eventually removing Web references to the resolution the ministry said a day later had not been signed by the minister.

Charles Newbery contributed reporting from Buenos Aires.


RHReality Check: IUDs: Now for Emergencies?

By Amie Newman
Created Aug 9 2010 - 1:22pm

According to the results of a study undertaken in China by the National Research Institute for Family Planning, the Copper IUD (sold under the name ParaGard in the United States) can be an excellent emergency contraceptive if inserted within five days of unprotected sex.

Researchers followed 2000 women who came to eighteen different clinics around the country for emergency contraception, within the five day window, and then were implanted with the Copper IUD. Women returned for follow-up visits, according to the study published in BJOG [1](an international journal of obstetrics and gynecology), at 1, 3 and 12 months post-insertion. Prior to or at the first follow-up visit, not one woman (all but 70 women returned) had become pregnant.

Women involved in the study did report some side effects: increased menstrual bleeding and menstrual disturbances (however vague that might be). Twenty-nine women "experienced a difficult IUD insertion process, requiring local anaesthesia or prophylactic antibiotics," notes the study.

It's an interesting find.

The old kid on the block, Plan B, the brand name for the emergency contraceptive (EC) pills sold in the United States, is effective at preventing pregnancy in 1 out of 100 pregnancies. Women have been encouraged to keep them "on hand" or in their medicine cabinet so, if there comes a time when they do need them, they do not need to struggle with finding a pharmacy open and available as soon as possible or finding a pharmacy that won't judge or refuse to sell the pills to you [2]. A recent study concluded that though women who keep EC on hand are not as likely to use the pills as previously thought, it is still an important option for women to have.

But how likely is it that a woman who is in immediate need of emergency contraception would actually choose to undergo insertion of an IUD into her uterus, have access to a health provider in a timely manner or be able to afford the "option," in order to make use of this successful form of emergency contraception?

From a Reuters [3] article on the study:

"...despite the benefits of Copper T, it's not easy to get for many women seeking emergency contraception in the United States. One deterrent is that while women 17 and over can buy Plan B over-the-counter at a pharmacy, Copper T must be inserted by a doctor - an extra step for women who only have a window of time when emergency contraception can work.

"The issue," Godfrey said, "is immediate access. In the U.S. it's easier just to go to a pharmacy."

And while Plan B runs for about $50 off the shelf, Godfrey said that depending on her insurance a woman could pay more than $500 to have Copper T inserted. "Cost could certainly be prohibitive," she said."

There are two different IUDs sold in the United States, currently. The hormonal IUD, sold under the brand name Mirena continually releases hormones into your body for up to five years; and the Copper IUD. Both work to prevent fertilization of an egg or to create an inhospitable environment for a fertilized egg to attach to the uterine wall.

The IUD is a more permanent form of birth control so if you use have one inserted, it's a one-time only occurrence (or at least a one-time every 5-10 years occurrence). While these sorts of studies are important from an efficacy perspective, they don't take into account the reality of women's lives. What are the real benefits of a study such as this one if most women cannot ultimately make use of the results?

Dr. James Trussell, a long-time proponent for emergency contraception, and head of the Office of Population Research at Princeton University was quoted as saying,

"It's too bad it's [Copper IUD] not used more often...If there were many, many more IUD insertions rather than emergency contraception pills (used), it certainly would have an impact on lowering pregnancy rates and abortion."

And while I cannot argue with his logic, it's the realistic implementation in women's lives with which I take issue. It seems to me that if we look at women's lives first and see how we can best address unplanned pregnancy rates given, well, the givens then we can "impact" said rates much more effectively.

I'm sorry if I'm short sighted here but the IUD, while effective at preventing pregnancy, is not the right method of birth control for every woman. Here's a basic run-down, from Planned Parenthood [4], on when you shouldn't use the IUD:

You should not use an IUD if you:

have had a pelvic infection following either childbirth or an abortion in the past three months
have or may have a sexually transmitted infection [5] or other pelvic infection
think you might be pregnant
have cervical cancer that hasn't been treated
have cancer of the uterus
have unexplained bleeding in your vagina
have pelvic tuberculosis [6]
have a uterine perforation during IUD insertion

There's a lot of room between thinking "you may have" an STI and finding out for sure. Would a doctor insert an "emergency" IUD in that case? What about not knowing if you have cervical cancer or not? Would a woman be honest about her symptoms if she were so intent on preventing pregnancy and getting an IUD put in place? This is a long list of "ifs" to me. I'm not discounting the IUD as a form of EC but I'm not sure this study would be enough to persuade me that inserting an IUD so swiftly is a bright idea, unless the woman has already done her research and was planning on having one inserted anyway.


Sunday, August 1, 2010

NYTimes: Another Pill That Could Cause a Revolution

July 31, 2010

Could the decades-long global impasse over abortion worldwide be overcome — by little white pills costing less than $1 each?

That seems possible, for these pills are beginning to revolutionize abortion around the world, especially in poor countries. One result may be tens of thousands of women’s lives saved each year.

Five-sixths of abortions take place in developing countries, where poor sterilization and training often make the procedure dangerous. Up to 70,000 women die a year from complications of abortions, according to the World Health Organization.

But researchers are finding an alternative that is safe, cheap and very difficult for governments to restrict — misoprostol, a medication originally intended to prevent stomach ulcers.

“I feel like people must have felt when they discovered the nuclear bomb,” says Dr. Beverly Winikoff, president of Gynuity Health Projects, a nonprofit research institution on reproductive health. “This technology is world-shaking.”

This pharmaceutical approach is called “medical abortion.” In the United States and Europe it typically consists of two sets of “M” pills. The first is mifepristone, formerly known as RU-486, and then a day or two later the misoprostol.

Using the drugs in combination produces a miscarriage more than 95 percent of the time in early pregnancy. But mifepristone is difficult to obtain in much of the world, because it is used only to induce abortions. In contrast, misoprostol is very widely available and can’t easily be banned because it is also used for ulcers and can save lives of women with postpartum hemorrhages. Whatever one thinks of misoprostol for abortions, it also is a potential lifesaver for women who hemorrhage after childbirth.

Researchers are finding that if women take misoprostol alone, effectiveness drops to 80 to 85 percent. That may sound low, but it’s typically far better and safer than alternatives that women turn to, Dr. Winikoff noted.

“Medical abortion represents a revolution in women’s reproductive health,” said Dana Hovig, the chief executive of Marie Stopes International, an aid group that provides women’s reproductive health services in 43 countries around the world. “It saves women’s lives and has enormous potential to increase access to safe abortion at minimal cost.”

Medical abortion causes a miscarriage that is indistinguishable from a natural one. That’s important for women in countries where they risk arrest if they seek help in a hospital after a botched abortion. The risks to a woman seem no greater than with a natural miscarriage, and there’s no known harm to a woman who turns out not to have been pregnant after all. One serious downside is that misoprostol is suspected of causing birth defects, perhaps 1 percent of the time, but only if it fails and the pregnancy continues to term.

In the United States, only about one abortion in eight is done with pills. Partly that’s because by law, mifepristone must be taken in a clinic. But worldwide, the number of medical abortions is surging, accounting for nearly 70 percent of all abortions in Scotland, according to Marie Stopes International.

It’s not clear how late in pregnancy medical abortion is feasible. “It sounds like a simple question, but it’s not,” Dr. Winikoff said. In some form and strength, medical abortion seems to work “from Day 1 to the end of pregnancy,” she said — but the effectiveness and safety of later-stage abortions still need to be worked out.

In the United States, the pills can be taken up to nine weeks’ gestation. In Britain, inpatient use of the pills is permitted up to 24 weeks.

What do these pills mean for the political battles over abortion? To firm opponents of abortion, the means of ending a pregnancy doesn’t matter. But my hunch is that, for those in the middle, taking pills at home may seem a more natural process than a surgical abortion, and the result may be a tad more acceptance.

In any case, it would be tough to carry out a ban on medical abortion. Indian companies are producing mifepristone and misoprostol in a big way, and blister packs with the combination of drugs can be purchased for less than $5 — and then shipped anywhere.

In addition, misoprostol on its own can be found all over the world, from Internet sites to over-the-counter pharmacies in Delhi. In India, misoprostol costs just pennies per pill.

Misoprostol is likely to become even more widely available, because last year the World Health Organization expanded its uses as an “essential medicine” to include treatment of miscarriages and incomplete abortions.

Brazil and some other countries have tried to tighten access to misoprostol because of its use for abortion. But curbing access to misoprostol would mean that more women would die of hemorrhages.

As word spreads among women worldwide about what a few pills can do, it’s hard to see how politicians can stop this gynecological revolution.

I invite you to comment on this column on my blog, On the Ground. Please also join me on Facebook, watch my YouTube videos and follow me on Twitter.


Thursday, July 22, 2010

Irish Times: Abortion travel numbers to UK fall


Thu, Jul 22, 2010

The numbers of women travelling to Britain each year for abortions has decreased from more than 6,500 in 2001 to just under 4,500 last year, according to the Crisis Pregnancy Agency.

However the number of women 35 years and older facing crisis pregnancy has increased in the past 18 months, the agency says.

In its final report the research and funding body said that since it was established in 2001 the number of women going to the UK each year for abortions had dropped from 6,673 in 2001 to 4,422 last year.

The number of births to teenagers has dropped to 2,087 in 2001 from 2,223 last year.

The Crisis Pregnancy Agency was amalgamated in January into the HSE and becomes the Crisis Pregnancy Programme.

Speaking at the publication of the final annual report Minister for Health Mary Harney said she did not anticipate in the foreseeable future another abortion referendum, "whether it was the current Government or any possible alternative government".

She also said the agency should continue to produce an annual report and retain its influence. "I don't want to see any diminution of the responsibility of the agency to reduce the number of crisis pregnancies in Ireland and to assist those experiencing crisis pregnancy."

Chairwoman of the agency Katharine Bulbulia had expressed concern that it "would disappear into the HSE and lose visibility" but she was "really heartened" by the Minister's comments. "She did not want it to lose visibility, she actually instanced how it might retain it by producing its own annual report."

Director the agency Caroline Spillane said its research had shown that 28 per cent of women who have been pregnant have experienced a crisis pregnancy, while 23 per cent of men whose partners have been pregnant have experienced a crisis pregnancy.

The agency's report says that its counselling services have increased and that free support is available at more than 50 centres in the State.

© 2010


Huffington Post: The Myth of the Teen Pregnancy Epidemic

Kierra Johnson
Executive Director, Choice USA
Posted: July 21, 2010 07:58 AM

Driving down many highways in the US, one sees billboards that read, "Virgin: Teach your Kids It's Not a Dirty Word" or "Wait for the Bling." These billboards, funded by conservative organizations, perpetuate a myth that teen sex is a problem, a crisis and even an epidemic.

Conservative organizations are not the only ones that have bought into this mythology. Recently, a staffer from a prominent pro-choice organization was quoted in the New York Times as saying, "While we would all like and hope and prefer that young people abstain from having sex, that is not what many young people, unfortunately, are doing."

Is the fact that teens are having sex really so unfortunate?

People are having sex at every age. Sometimes it is safer. Sometimes it's not. Sometimes it is with informed consent. Sometimes it's not. Sometimes it's healthy. Sometimes it's not.

People are also, therefore, experiencing the outcomes of sex at every age. The outcomes can be both intended and unintended. The outcomes can be both physical and emotional. The outcomes can be positive or less than favorable.

People in every age bracket have sex, get pregnant, have abortions and have children. Sex and the outcomes of sex are not exclusively experienced by teens. Actually, according to the Guttmacher Institute, teens have a lower rate of sexual activity (46 percent) than other age groups, and teens make up the smallest percentage of pregnancies (seven percent, including 18 and 19-year-olds), abortions (six percent) and births (10 percent). The vast majority of pregnancies, abortions and births occur after the teenage years.

So, if people of all ages are having sex and facing the results, why are teen sex and teen pregnancy the problems?

They're not. Teenage pregnancy isn't the epidemic. The lack of information and support for people to make healthy decisions about their lives is the true epidemic. The culture of shame and scapegoating around sex is the real problem. And this epidemic crosses generations, with young people feeling the brunt of it.

Teens need access to the information to make informed decisions regarding sex and the resources and support to handle the outcomes of having sex. They need comprehensive sexuality education, access to affordable maternal and child care and contraceptive services, to name a few. They need nurturing environments where they aren't judged or made to feel shameful about having sex or being young parents. That's all anyone needs, really, regardless of age.

Teens are asking for this access to information and resources. One of Choice USA's youth activists from Texas told us, "The pressure of sex and relationships is an extremely important issue young people have to face. These pressures can result in consequential outcomes, which explains why I think that it is ultimately important for youth to receive a comprehensive education to make them aware of all the possible options and choices they have."

But teens aren't only feeling pressure from their peers. They are feeling pressure from individuals and organizations that perpetuate the myth of the teen pregnancy epidemic, from media that says teen sex is something to be ashamed of, from campaigns that stem from the idea that teen sex and pregnancy must be ended. Added pressure and stigma that exudes from many teen pregnancy campaigns does little to help the perceived problem of teen sex and pregnancy.

The National Latina Institute for Reproductive Health (NLIRH) has shown that teen pregnancy campaigns that rely on shame and stigma don't work. In a recent white paper, NLIRH suggests that we should support policies that promote access to information and resources but only as "part of a platform to increase women's ability to make informed choices that are relevant to their lives, and not to make choices for them."

When framing teen sex and pregnancy as a problem of epidemic proportions, when telling teens there is one acceptable choice, we undersell young people's ability to make responsible and healthy decisions about their lives. And at the same time, we are ignoring that people need information and resources about sex throughout their entire lives, not just as teenagers. We need to look at those factors that impact people's whole lives -- access to education, health care and employment -- and stop using teen sex and pregnancy as scapegoats for social ills.

Young people know they need more information and support, and they're asking for help in order to make healthy and informed decisions about their lives. This is the opposite of an epidemic, it is mature decision making. We need to praise, not devalue, this good judgment. We need to make these resources available to teens and people of all ages, but with no strings and no stigma attached.

Follow Kierra Johnson on Twitter:


RTÉ News: More older women seek crisis pregnancy help

Thursday, 22 July 2010 08:05

There has been an increase in women over 35 seeking help during a crisis pregnancy, according to a report from the Crisis Pregnancy Agency.

The agency, which was merged into the Health Service Executive this year, is to publish its final report today.

Ahead of the publication this afternoon the former chairperson of the agency has said the HSE must support its strategic focus.

Often a planned pregnancy can become a crisis one, due to relationship break-ups, unemployment or financial difficulties.

The increase in women over 35 seeking help has been a trend for some years, according to the agency.

Concerns over the merging of the agency with the HSE emerge in the final annual report from the Crisis Pregnancy Agency.

It now operates as the HSE Crisis Pregnancy Programme.

Former Chairperson of the agency Katharine Bulbulia has warned that society should not be complacent about dealing with such a prevalent issue.

In the report she says it is vital the HSE supports the strategic focus of the Agency she once chaired, pointing out its crucial that happens so that those facing an unplanned pregnancy receive the support and care they need.


Irish Independent: Uptake of 80pc for teen girls' cancer jab

By Eilish O'Regan Health Correspondent
Wednesday July 21 2010

EIGHT in 10 of the teenage girls offered the cervical cancer vaccine in schools last term availed of the jab, new figures revealed yesterday.

The Health Service Executive (HSE) confirmed that 1,300 first-year girls received the first dose of the vaccine in May, as part of the limited rollout before it is extended in the autumn.

It protects against the types of HPV infection that cause seven out of 10 of all cervical cancers, and was offered to first-year girls in 21 secondary schools last term.

Parents were sent out information packs and consent forms in advance of the vaccination beginning.

Some parents have expressed reservations about vaccinating their daughters against a sexually transmitted disease at such a young age.

The rest of 30,000 first years, who will be going into second year this September, will be offered the vaccine next term as part of a catch-up programme.

Girls who enter secondary school in September will also be vaccinated.

The girls who received the vaccine last term will have to go to a health clinic this month for the second of three doses, which are part of the vaccination programme. A spokesman for the HSE said appointments had been given for the second dose and the vaccinations would take place in clinics before the end of this month.

A spokesman for the Irish Medicines Board (IMB) said it had received 11 reports of suspected adverse reactions associated with cervical cancer vaccines. One of these was linked to Cervarix, and 10 with Gardasil.

The majority of those reports received to date relate to expected adverse reactions for the product, and include cases of hypersensitivity, enlargement of the lymph nodes, fainting and an allergy-related skin rash.

The studies so far show that protection lasts for at least five years after a full course.

There are 250 new cases of cervical cancer diagnosed every year, and 80 die of the disease.

The full impact of the vaccine will take many years to be seen.

The rollout of the vaccine was controversially delayed due to funding problems, but a deal was reached with drug companies earlier this year, which saw the cost cut from €16m to €3m.


Meanwhile, a new study published in the 'British Medical Journal' today shows the vaccine is helpful in preventing warts and low-grade lesions related to HPV.

The vaccine for some types of HPV has the potential to prevent about 70pc of cervical cancers and 90pc of genital warts, but what contribution the vaccines make to low-grade growths was still uncertain. So an international group of investigators set out to find how useful the vaccines were in preventing low-grade disease.

They studied results from 17,622 women aged 16 to 26 enrolled into two studies between December 2001 and May 2003.

Results showed that amongst previously unexposed women who had received the vaccine, it was highly effective for preventing low-grade lesions attributable to those types of HPV for up to four years.

- Eilish O'Regan Health Correspondent


Tuesday, July 13, 2010

Newsweek: Should the birth control pill be sold without a prescription?

An over-the-counter version has long been called for, but it could soon be available if a group of practitioners and advocates have their way.

by Meredith Melnick

July 07, 2010

When Kelly Blanchard advocated to make oral contraceptives over the counter in a New York Times op-ed two weeks ago, she represented a decades-long movement among clinicians, researchers, and women’s-health advocates to remove prescriptions as a barrier to pill access. As early as 1993, Charlotte Ellertson—founder of Ibis Reproductive Health, of which Blanchard is now president—made a similar argument against the prescription status of oral contraceptives in the American Journal of Public Health.

Now a group of health workers and advocates are taking advantage of a mounting body of research that shows the pill could be safe for nonprescription use. They hope to have a proposal before the FDA within the year and an over-the-counter pill available in five years. And though their work focuses on female reproductive care, it offers a glimpse into what the future of American health care and medication could be.

Members of the Oral Contraceptive Over-the-Counter Working Group, a women’s-health clinical and research institution funded by the Hewlitt Foundation and administered by Ibis Reproductive Health, believe that prescription-only access to birth control is patronizing to women, limits contraceptive freedom, and is ineffective against intractably high teen-pregnancy rates. Teenagers are particularly vulnerable to access problems because it is harder for them to get to a doctor without a parent’s help. Almost 20 percent of sexually active teens who do not want to become pregnant are not using contraceptives, according to the Guttmacher Institute. And teenage girls who do not use contraception during their first sexual experience are twice as likely to become teen mothers as their counterparts who use protection.

“I think we see a range of problems with access today; clearly there are economic barriers to access,” says Amy Allina, program and policy director of the National Women’s Health Network and a member of the working group. “But there are also barriers that have more to do with the logistics of insurance, or the policy at the doctor’s office.”

To date, the FDA has never approved an over-the-counter drug that is a “chronic use” medication—a drug taken daily for an unlimited amount of time. Though people use over-the-counter drugs such as aspirin on a daily basis, they are not technically approved for such use.

The majority of the market in oral contraceptives is in “combined” pills, containing both synthetic estrogen and synthetic progesterone. The estrogen elevates the risk of stroke, heart attack, and blood clots, but it is also responsible for clearing up acne, mitigating cramps, and lessening flow. Because of these secondary benefits, combined pills are more marketable to the general public and favored by many women.

The working group is hoping to bring a progestin-only pill or “mini-pill” to the over-the-counter market. It helps that this synthetic hormone already has an over-the-counter application: emergency contraception. Plan B and Next Choice (FDA-approved since 2006), as well as the recently committee-approved Ella, all consist of progestin, a synthetic form of the hormone progesterone.

The mini-pill is typically used by women who are lactating or who have a higher risk of stroke or heart attack, such as smokers and women over 35. Because it has a lower risk of negative side effects, it might be safer to use without a doctor’s input. “The FDA would consider applications to switch oral contraceptives from prescription to nonprescription marketing status,” says Shelly Burgess, an FDA representative. “Companies interested in marketing an oral contraceptive as a nonprescription product would need to provide data to demonstrate that the proposed oral contraceptive can be used appropriately and safely by consumers without the input of a health-care provider.”

That last bit usually means a potentially expensive and time-consuming doctor’s visit as well as an invasive pelvic exam. The questions are: Is the pill safe to use without a doctor’s examination? And will women still get cancer screening if they don’t have to go to their gynecologist for a pill pack?

And should that matter? “Holding birth control hostage until women have had a pelvic exam is a paternalistic attitude to women’s health,” says Dr. Daniel Grossman, a senior researcher at Ibis and an active member of the group. “The Pap smear is for cancer screening, not contraception, and we shouldn’t spread misinformation by linking the two.”

Until recently, family-planning centers that received federal funds followed the American College of Obstetricians and Gynecologists guidelines to perform a pelvic exam and Pap test as part of each appointment to address family planning. New guidelines suggest that women with two consecutive normal Pap smears need examinations only every two to three years, but many clinics continue to follow the outdated norm.

“At the moment, gynecologists are gatekeepers, insisting on regular vaginal exams that are really unnecessary,” agrees a senior researcher at a university medical school who did not want to be named for fear of upsetting colleagues in the obstetrics and gynecology department. “If the control is transferred to the women themselves, that would amount to a loss of revenue [for gynecologists], and they’re going to fight it.”

A 2006 study in the journal Contraception found that 68 percent of women surveyed wanted an over-the-counter option, with interest highest for women who were uninsured. But women on federal programs like Medicaid could run into problems. “When any medication is offered over the counter, it becomes unaffordable for women whose insurance will not pay for an over-the-counter medication,” says Dr. Vanessa Cullins, vice president for medical affairs of the Planned Parenthood Federation of America.

When Plan B transitioned from a prescription to an over-the-counter drug, its cost skyrocketed. Advocates of the pill’s shift to over the counter are currently looking into ways to keep costs low. One strategy is pairing up with an off-brand production plant. “We could make safe, effective birth-control pills for pennies,” says Dr. Susan Harlap of the NYU School of Medicine, who is not affiliated with the working group. “Their low cost in many developing countries shows that pills are outrageously expensive here, and they needn’t be.”

But the actual cost of the pill isn’t the only consideration for low-income communities. Women who are more likely to have complications from it also tend to be from lower-income communities: poor women have chronic conditions such as cardiovascular disease and obesity in higher numbers, and are also more likely to smoke. Furthermore, a 2008 study in the journal Obstetrics & Gynecology of potential contraceptive users revealed that more highly educated women tended to be better at self-screening. “We tend to prioritize the needs of the group that is more marginalized, that has bigger barriers to health care in general,” says Amy Allina about her organization’s consideration of over-the-counter pills. “It pushed us toward the side of saying we don’t really think this is going to be an advance for the women we are most concerned about.”

Evidence from countries where birth control is available without a prescription goes against these arguments: they do not have higher instances of at-risk women taking pills. Further, researchers in Mexico found that women who buy pills directly from pharmacies often have greater understanding of the contraindications than women who visit clinics.

And evidence suggests that there is no harm done to cancer screening either: a two-year pilot program of pharmacy access to hormonal birth control in Washington state revealed that 98.6 percent of the women who were getting their pills over the counter had had a pelvic examination within the previous 24 months.

“Now, with health-care reform, that balance has shifted,” says Allina. “We see that [low-income] women are going to be able to get access to health services in other ways. It makes us less concerned about some of the unintended consequences to vulnerable populations.”

Meredith Melnick is a freelance journalist in New York City.


Feminist News: Louisiana Abortion Bills Become Law

July 7, 2010

Louisiana Governor Bobby Jindal signed three bills on Tuesday instituting new restrictions on abortion rights in the state. The first law requires women seeking abortions in Louisiana to undergo an ultrasound prior to the procedure. There will be no exceptions for victims of rape or incest Opponents remain concerned that the ultrasound requirement, an expensive procedure that may not be available at free clinics, will increase costs and make obtaining abortion services more difficult for women.

The second new law excludes providers from medical malpractice coverage for elective abortion procedures, reports the Associated Press. The third anti-choice bill signed by Governor Jindal yesterday prevents insurance providers in the new federal health insurance exchange from covering abortions.

Last month Governor Jindal signed House Bill 1370, a law that gives Louisiana's health secretary greater power to revoke abortion clinic licenses when there are health or safety concerns. According to Associated Press the law allows the health secretary to immediately suspend a clinic's license in the case of urgent health or safety risks. The health secretary is also granted broader discretion to refuse the renewal of existing licenses, as well as to deny new licenses to abortion clinics.

Media Resources: Associated Press 7/6/10; Feminist Daily Newswire 6/17/10; Louisiana State Government


Irish Times: 2006 Act which makes underage sex a crime is constitutional, court finds

by CAROL COULTER, Legal Affairs Editor

Mon, Jul 12, 2010

THE 2006 Act which criminalises underage sex is constitutional despite the fact that it discriminates between boys and girls in relation to prosecution for acts of sexual intercourse, the High Court has found.

The Criminal Law (Sexual Offences) Act 2006 was introduced in the wake of the Supreme Court striking a section of the 1935 Act criminalising sex with an underage girl on the grounds that it did not allow for a defence of honest mistake as to the girl’s age.

The 2006 Act does permit such a defence and also redefined the crime of underage sex to include boys and homosexual sex within its remit. Heavier penalties were provided for in cases involving sex with children under 15, and where the perpetrator was in a position of trust or authority.

However, the Act discriminates between boys and girls in that boys can be prosecuted for sexual intercourse with girls under the age of 17, even if the sex is consensual, while girls cannot be prosecuted for sexual intercourse with underage boys, though they could be for other sexual acts.

In September 2007, a 15-year-old boy was charged with having sex with, and buggery of, a female person under the age of 17.

He took judicial review proceedings seeking declarations that sections 3 and 5 of the 2006 Act, under which he was charged, were contrary to the Constitution on the basis that they discriminated against him on the grounds of gender. One section provided for the offence, the other for the prosecution of boys only. The case was heard by Ms Justice Elizabeth Dunne in the High Court and judgment was delivered in March, but has only recently been placed on the Courts Service website.

In it, she found that the Act was constitutional on the basis that, while it was discriminatory, such discrimination was justifiable because the consequences of sexual intercourse (early pregnancy) bore particularly heavily on girls. The case is being appealed to the Supreme Court.

© 2010 The Irish Times


Irish Times: Church's stance on sexuality no longer helpful


Sat, Jul 10, 2010

EVEN IN the mid-1960s, 1,700 babies were born to females under 20, and over 300 of these young mothers were under 18. However, because of social pressures then, four-fifths of these under-20 females had married by the time their babies were born.

Perhaps because most of the births were thus within marriage, there does not seem to have been much concern about the fact that so many young females were becoming pregnant.

Over 30 years later the total number of pregnancies involving those under 21 had almost doubled, increasing the under-20 birth rate by half when demographic changes are allowed for. However, by the 1990s pressures on pregnant young women to marry before the birth of their baby had largely disappeared, and this had the effect of increasing over seven-fold the number of non-marital births to females in that age bracket.

That change in behaviour seems finally to have alerted society to the undesirability of so many births involving young women, and in 2001 the Crisis Pregnancy Agency was established to address this issue.

The work of this agency has had very positive results. Since 1999 the pregnancy rate for females under 20 has been reduced by over one-sixth and the reduction in births to those under 18 has been almost 30 per cent. Moreover, the abortion rate for those under 20 has fallen by 40 per cent.

It is also interesting that the earlier continuous rapid increase from 3 per cent to 33 per cent in the proportion of non-marital births between the mid-1960s and 1999 came to a halt after the latter year, and this non-marital birth rate has remained around that 33 per cent figure.

One cannot help wondering why none of this good news seems to emerge in our media, with the result that there is little public recognition of the progress made in this social area.

I have great admiration for the work of the Crisis Pregnancy Agency whose young staff relate well to teenagers, and whose research has yielded evidence-based data that has been shown to carry conviction with young people. In particular, teenagers, extremely subject to peer pressures, tend to be credulous about the extent of sexual experimentation within their own age group – many of them believing the myth that 70-80 per cent of under 17s engage in sexual activity. Persuading that age group that serious research shows this to be false, and that only 20 per cent of girls and 30 per cent of boys are sexually active before the age of 17, has been an important part of the agency’s work.

Other factors that have been found to discourage early sexual activity are factual information on the scale of sexually transmitted infections and the research which has shown that both men and women who have had their first experience of sexual activity at an early age are more likely to regret that timing than others who have waited until later.

The success of the agency’s work has been due to the fact that it is careful to avoid a normative approach: its staff do not attempt to tell young people how they ought to behave for they know that if they try to go beyond their brief in this way they could quickly lose their effectiveness.

Yet young people need to be helped to understand that their long-term happiness is likely to derive from establishing a successful intimate relationship with a partner – a relationship in which sex will play a major role.

Traditionally the role of providing this kind of guidance was left to the churches. And up to the 1960s, church teaching about avoiding sexual involvement before marriage carried widespread acceptance.

As recently as 1981 well over half of all women were married by age 24. Today, with earlier puberty; with education to a much later age; with four-fifths of women aged 25-34 engaged in paid work (as against one-quarter 30 years earlier); and with women reluctant to have children before their late 20s or early 30s; that traditional situation has been transformed. Today the proportion married by 24 has been reduced to just 8 per cent.

Today’s long gap between puberty and child-bearing in a stable relationship, together with the ready availability of contraception, has for most young people made unrealistic the traditional concept of abstention from sexual activity for a period that can now be as long as 15 or 20 years.

Church teaching has not adjusted to this new situation yet for very many children at school religious instruction is the only guidance they receive on this crucial issue. The problem is that our past excessive dependence on the churches has left a most unfortunate gulf in this key area just when within second-level education there is a clear need to supplement discouragement of early sexual activity with more positive guidance about the role of sex in establishing stable relationships.

Unhappily, church teaching on sexual matters has ceased to be helpful. Indeed, this traditional teaching has now become something of an obstacle to providing young people with realistic guidance that will help them to understand the crucial role of sex in establishing a stable long-term relationship.

In the absence of such relevant and credible guidance there is clearly a danger that many young people may succumb to the attraction of sexual activity for its own sake. That may make it more difficult for them to establish a stable long-term relationship.

Relationships and sexuality education within the framework of Social, Personal and Health Education (SPHE) offers the key to this problem, but despite much progress by the Department of Education the continued absence of a senior-cycle curriculum for SPHE and resistance to sex education in some schools continue to delay progress.

© 2010 The Irish Times