International Legal and Services Context: Dr. Gilda Sedgh, Guttmacher Institute and Ms Leah Hoctor, Center for Reproductive Rights

I welcome members and viewers, who may be tuning into our proceedings on Oireachtas television, to the Joint Committee on the Eighth Amendment of the Constitution. We will be holding three separate sessions this afternoon. The first session will address international legal rights and services. Our second session will consider a view of medical law and our third session will look at risks to mental health. Before I introduce our first witnesses, at the request of the broadcasting and recording services, members and visitors in the Public Gallery are requested to turn off their telephones completely or put them in airplane mode. That really is an issue. The week before last there was an awful lot of interference, even on the RTÉ coverage. It is really important that mobile telephones are off, because it causes a lot of interference both for the staff working here and for the television studios.

On behalf of the committee, I would like to extend a warm welcome to the witnesses, Dr. Gilda Sedgh, principal research scientist with the Guttmacher Institute, Ms Leah Hocter, regional director for Europe, Center for Reproductive Rights, and Ms Katrine Thomasen, senior legal advisor for Europe, Center for Reproductive Rights. You are all very welcome to this afternoon's meeting.

Unfortunately, before we commence formal proceedings, I must advise witnesses on the matter of privilege. I wish to advise that by virtue of section 17(2)(l) of the Defamation Act 2009, witnesses are protected by absolute privilege in respect of their evidence to the committee. However, if they are directed by the committee to cease giving evidence on a particular matter and they continue to so do, they are entitled thereafter only to a qualified privilege in respect of their evidence. They are directed that only evidence connected with the subject matter of these proceedings is to be given and they are asked to respect the parliamentary practice to the effect that, where possible, they should not criticise or make charges against any person, persons or entity by name or in such a way as to make him, her or it identifiable. Members are reminded of the long-standing parliamentary practice to the effect that they should not comment on, criticise or make charges against a person outside the House or an official either by name or in such a way as to make him or her identifiable.

I now call on Dr. Sedgh to make her presentation.

Dr. Gilda Sedgh

Thank you for inviting me to give evidence to the joint committee. It is a privilege to be here. By way of introduction, and to add to the introduction the Chairman provided, I am a principal research scientist at the Guttmacher Institute in New York. We are a research and policy organisation and we conduct population-level research on reproductive health in the United States and globally. The Guttmacher Institute advocates for evidence-based policies that promote reproductive and sexual health. Our evidence is used by stakeholders on various sides of the discourse. I have been asked to present evidence on abortion trends worldwide and on the characteristics of women who have abortions.

I will start by giving a global overview of abortion trends, which can provide some context for abortion incidents and trends in Europe. This evidence was published in The Lancet last year, and it is based on work that we did in collaboration with our colleagues at the World Health Organization.

We estimate that worldwide approximately 56 million abortions took place each year between 2010 to 2014. The annual number of abortions has increased slightly since the early 1990s. It can be more useful to talk about how many abortions take place for every 1,000 women of child-bearing age. This is because the absolute number of abortions can increase as the number of women in a population increases, but the number of abortions for every 1,000 women, also known as the abortion rate, is not influenced by the size of the population. The 56 million abortions that take place each year translate to about 35 abortions for every 1,000 women of reproductive age. Another way of saying this is that, roughly speaking, about 3.5% of women of child-bearing age have an abortion each year globally. The global abortion rate has declined slightly over the past 25 years.

We have also estimated abortion incidence across the 17 major subregions of the world. We were not able to estimate incidence for every individual country because we did not have enough data on which to base country estimates. I refer the trends in the abortion rate in major parts of the developed world, that is, Europe and North America. We can look at northern, western and southern Europe together because the abortion levels and trends in these three sub-regions are similar. The abortion rate is much lower in North America and in Europe, outside of eastern Europe, than the global average of 35 per 1,000 women. It is about 17 in North America and 21 in non-eastern Europe, and the rate has declined modestly in both of these regions in the past 25 years or so.

Eastern Europe is a different story. As members are probably aware, the abortion rate was very high in eastern Europe during the Soviet era. It declined dramatically in the past 25 years to less than half of what is was in the early 1990s. The abortion rates in northern, western and southern Europe are the lowest sub-regional abortion rates in the world, and the decline in eastern Europe is by far the sharpest decline that we have seen in the world.

While we were not able to estimate abortion incidence for all countries, we compiled statistics from countries with good reporting systems for the most recent year for which such evidence was available at the time of our compilation. I refer to the countries where it is recognised that at least 90% of all abortions are included in the official reports. Across these 18 countries, almost all of which are all in Europe, the abortion rate varies from five per 1,000 in Switzerland to 18 per 1,000 in Sweden. In eight of these 18 countries, the abortion rate is fewer than ten per 1,000. Globally, when we grouped countries according to their abortion laws, we found that, on average, the abortion rate in countries where the procedure is prohibited altogether or allowed only to save a woman’s life is not significantly different from the rate in countries where abortion is allowed without restriction as to reason. The vertical lines around the points indicate the margins of error around these estimates and members can see they all overlap. This is a bird’s eye view of abortion rates in these groups of countries and it does not examine the various factors that could influence abortion rates in these countries.

We were also able to estimate the percent of all abortions that were obtained by married women and the percent obtained by unmarried women. We used data from the United Nations, which defines married women to include women in cohabiting unions. We estimate that about 73% of all abortions worldwide are obtained by married women, and 27% are obtained by unmarried women. In the developed world, about 69% of all abortions are obtained by married women. These are estimates across broad geographic areas, and there are variations across countries within each of these groups of countries.

I showed abortion rates in countries grouped by the legal status of abortion. Last month we published estimates of the safety of abortions performed worldwide, and in groups of countries classified according to their abortion laws. These estimates were also made with colleagues from the World Health Organization, and are also published in The Lancet.

As defined by the World Health Organization, safe abortions are those done by a trained provider or a trained person and using methods appropriate to the gestational age of the pregnancy. Less safe abortions are those for which only one of these criteria is met, and least safe abortions are those for which neither of these two criteria are met. About 31% of abortions are in the least safe category in countries where abortion is illegal on all grounds or only allowed to save a woman’s life or preserve her physical health. Less than 1% of abortions are in the least safe category in countries where abortion is permitted without restriction as to reason. We also found that abortions are also more likely to be unsafe in low income countries than in high income countries, based on the World Bank classification of countries. Countries with restrictive abortion laws tend to be low-income countries, and Ireland is anomalous as a high-income country with a restrictive abortion law, so it is not easy to assess the relationships of economic development and legal status with the safety of abortion.

We did not have enough information with which to estimate the ages of women obtaining abortions across the world’s sub-regions. Instead we compiled statistics from the countries with good quality reporting. These are countries with liberal abortion laws where at least 90% of abortions are included in the reporting systems. Across the countries with this information, about half of abortions are obtained by women in their 20s, and another third are obtained by women in their 30s. Across all these countries, adolescents of 19 years old or younger, predominantly adolescents of 15 to 19 years old, account for a smaller share of abortions than their share of the population - that is, the abortion rate is lower among adolescents than among women in their 20s and 30s. In almost all these countries, adolescents’ share of all abortions has decreased since the early 1990s. In the countries that further break down the ages of women having abortions into smaller windows, the majority of adolescents’ abortions are obtained by 18 and 19 year olds.

According to the statistics we compiled from 15 countries, 48% to 74% of women who obtained an abortion already had at least one child. In all but two of these countries, more than half of women obtaining an abortion already had at least one child.

We are currently preparing a report on the gestational ages of pregnancies when they are terminated across countries that have reliable statistics. I refer to abortions done in the first trimester of pregnancy. According to these preliminary findings, in all but three of these countries, 90% or more of abortions are obtained in the first trimester.

For four countries we have information from nationally representative surveys of women on the reasons for wanting an abortion, among those who have had an abortion. Women obtain abortions for a wide variety of reasons. In these surveys women were asked to give just their primary reason for having an abortion. For example, in Belgium, about one fourth of women said they sought an abortion for socioeconomic reasons, and another one fourth had an abortion for partner-related reasons - for example, their partner did not want to have a child or their relationship was dissolving. Approximately 18% wanted to space their children or postpone having a child, and another 13% already had as many children as they wanted or could manage. Approximately 1% of women in Belgium said that they were having an abortion because of issues related to the health of the foetus. In the other three countries, less than 1% of all abortions were for reasons related to foetal health.

In a survey in the United States, women who had an abortion were asked to indicate all their reasons for having the abortion. An interesting take-away message from this survey is that many women gave more than one reason. Financial issues, wanting to space or delay child-bearing and partner-related issues remained common. Approximately 30% of women said they sought an abortion because they needed to focus on the children that they already had at home.

I will shift gears and wrap up by giving a broad overview of abortion laws of countries across the world. Ms Leah Hoctor will go into more detail on this topic. Of the 199 countries and major territories in the world, 75 allow abortion without restriction as to reason or for socioeconomic reasons; 58 countries and territories allow abortion to preserve a woman’s physical or mental health; and 40 allow abortion to save a woman’s life.

Ireland is one of these 40 countries. In 26 countries, abortion is not allowed for any reason, although some of these make exceptions in cases of rape, incest or foetal anomaly.

Using the UN's classification of countries according to whether they are developed or developing, 41 of the 50 developed countries allow abortion without restriction as to reason or for socioeconomic reasons, five allow abortion to preserve a woman's physical or mental health, one – Ireland – allows abortion to save a woman's life, and three do not allow abortion on any ground.

I will end by summarising some of the key points from the review. The sub-regions with the lowest abortion rates are those in which most countries are developed, where abortion is legal on broad grounds and there are strong reproductive health programmes. Women obtaining abortions represent a broad spectrum of all women - young and old, single and married, childless and with children - and many who seek an abortion have multiple reasons for doing so.

I thank Dr. Sedgh. I call Ms Hoctor.

Ms Leah Hoctor

I thank the Chairman for her introduction and the committee for its invitation to present today. Receiving this request was an honour. My purpose will be to provide members with an overview of comparative European law on the termination of pregnancy. To that end, I will describe the grounds and timeframes on which abortion is legal in 46 other European countries. I hope that this information will assist the important and valuable deliberations that the committee is conducting on behalf of the citizens of Ireland, among whom I am proud to belong, in case my accent has not given it away.

Before I turn to the substance of European laws on abortion, it might be helpful to clarify certain matters regarding the Center for Reproductive Rights as it relates to Ireland. As time is short, I will also refer members to the centre's website. The mandate of the Center for Reproductive Rights is well known. We work across the world, specifically in Africa, Asia, Europe, Latin America and the US, to advance the legal protection of women's reproductive health and rights. This means that the centre uses law to advance women's access to reproductive health care, including affordable contraception and family planning, safe and legal abortions and quality maternal health care. We also work to prevent child marriage and forced sterilisation.

As many committee members will know, the centre's work in Ireland has focused on representing Ms Amanda Mellet and Ms Siobhán Whelan in their complaints to the United Nations Human Rights Committee, OHCHR, and in all advocacy, governmental, media and political engagement related to those cases and the OHCHR's decisions on same. Both decisions held that Ireland was obliged under international treaties to provide effective remedies to Ms Mellet and Ms Whelan. The decisions specify that these remedies must entail compensation, psychological support services and reform of Irish abortion law in order to prevent similar violations in the future.

As the representative of Ms Mellet and Ms Whelan, the centre must call and advocate for Ireland's compliance with the OHCHR's decisions and the Government's provision of the specified remedies. All advocacy, political or governmental engagement by the centre in Ireland has been undertaken in the context of these two cases. The centre's general fundraising for its work in Europe includes Ireland in terms of support for its work on the OHCHR cases and its advocacy to ensure the required law reforms. The centre is not providing any funding to Irish organisations for campaigning or political activities. In addition to our work representing Ms Mellet and Ms Whelan, the centre has contributed modest amounts to the National Women's Council of Ireland, NWCI, and the Irish Family Planning Association, IFPA, to support expert events for lawyers and medical practitioners regarding international human rights law and World Health Organization, WHO, guidelines on safe and legal abortion, as well as events to provide women and men a diversity of views and an opportunity to engage in non-directive discussions about abortion.

Turning to the substance of my presentation, my goal will be to provide members with a quick overview of the laws on abortion in 46 other European countries. In particular, I will aim to outline the standard approach among most European countries to the legality of abortion. To assist with this, I will take us through eight slides. To supplement that information, we have provided a large chart to all members - there are hard copies in the room - illustrating the grounds and some of the timeframes on which abortion is legal in each of the 46. All this information is taken from primary legal sources, which can be independently verified. We have also submitted a booklet to members, containing copies of many or most of the relevant legal provisions. We have brought some hard copies as well.

As members will see from the slides and supplementary materials, the Citizens' Assembly recommendations on the full set of reasons and timeframes within which abortion should be made lawful in Ireland align almost in their entirety with the laws on abortion in almost all other European countries. As a result, if the recommendations on future legislation were adopted, it is safe to say that they would bring Irish law on abortion into line with the laws of almost all other European countries.

Regarding the standard legal approach to abortion across Europe, the first slide shows a map of Europe. Almost every European country - 40 in total - is coloured either green or light yellow. This means that they have made abortion legal either on a woman's request without restriction as to reason or for reasons of distress - those are the ones in green - or on broad socioeconomic or psychological grounds. The countries in red or dark orange do not allow abortion on request or on broad socioeconomic grounds and only in exceptional circumstances.

This map shows that 25 of 28 EU member states have made it lawful for women to access abortion on their request or on broad socioeconomic grounds, at least in early pregnancy. It also shows that 40 of 47 Council of Europe member states have taken this approach. As the committee members will know, all 28 EU member states are also members of the Council of Europe. Only three EU member states do not allow abortion on a woman's request or on broad socioeconomic or psychological grounds. These are Ireland, Malta and Poland. Within the 47 Council of Europe member states, these three EU countries are joined by only four micro-state jurisdictions - Andorra, Liechtenstein, Monaco and San Marino.

The next few slides will focus on the approach of the countries in green and light yellow. As we can see from the map, 36 countries have legalised access to abortion on a woman's request. The following slide shows a quick recap of these countries. In the majority, a woman does not need to give any reason when asking for an abortion. In a small number, as shown in the next slide, a woman must explain that she is seeking an abortion because of social or family circumstances or because continuing the pregnancy would cause her distress. The committee can see the breakdown across countries.

What about gestational limits? All these European countries impose a time limit on the legality of an abortion on a woman's request. We can see their time limits on this slide. A time limit in or around early pregnancy is the norm, with a 12 week limit the most common.

In addition to the 36 countries that are green on the map and that have legalised access to abortion on a woman's request, four European countries are light yellow on the map and these four have taken a different approach. They have not legalised abortion on a woman's request but on broad socioeconomic or psychological grounds. In these four countries, for abortion to be lawful doctors or sometimes social workers must certify the existence of the relevant socioeconomic or psychological reason. The slide on display right now shows the four countries, the different reasons and the time limits involved.

What happens in these 40 countries once the time period for abortion on a woman's request or on broad socioeconomic or psychological grounds ends? In almost all of them, after the time period ends, doctors can still legally perform abortions for one or more exceptional reasons. The next slide shows the usual reasons that are allowed under the laws of almost all European countries. Sexual assault and socioeconomic reasons are present in the laws of many countries as exceptional reasons but not always explicitly. The terminology and the approach differs across countries. In some of these countries, these exceptional reasons are each articulated as an explicit ground in the relevant law while in others, the grounds are implicitly included in other grounds. We do not have time to go through all of these grounds now but will focus briefly on women's health and on sexual assault. All of the grounds are listed in the chart that we submitted to all committee members, with a breakdown across the various countries.

In terms of women's health, I wanted to capture for the committee the fact that although legal terminology differs across countries, in almost all of the 40 countries we have looked at the laws explicitly or implicitly allow abortion when a woman's health is at risk. As members will see from the slide on display, the majority of these laws do not specify a time limit for this ground.

Finally, what is the approach across the 40 countries to the legality of abortion following situations of sexual assault? First, it is important to note that in all of the 36 countries where abortion is legal on a woman's request, women who are pregnant as a result of rape or incest can always access abortion within the relevant time limit under the on-request ground. In these countries, women who have survived sexual assault can follow a generally applicable process to obtain a lawful abortion and do not have to fulfil special procedures or report the rape. For this reason, many of these countries do not include an explicit ground for abortion in their laws. At the same time, about half of these countries do have an explicit ground for sexual assault in their abortion laws and this means that women who are pregnant as a result of rape can either access abortion in early pregnancy under the on-request ground or, often later in pregnancy, under an explicit, separate ground related to sexual assault.

I thank members for their attention. I hope this overview has been helpful and informative and I look forward to members' questions.

Thank you, Ms Hoctor. Is Ms Thomasen going to make a presentation?

Ms Katrine Thomasen

No.

Fine. We will now move to the lead questioners for today, the first of whom is Senator Ruane, who has ten minutes in total.

I will use five minutes now and reserve five for later. I thank the witnesses for their presentations, which were very informative. I have two questions for Ms Hoctor and one for Dr. Sedgh.

An issue of which we are aware is the difference between making abortion procedures nominally legal in State laws and ensuring practical and real access to abortion services for women. What are the common challenges that emerge in this respect and what should Ireland do to ensure practical access to abortion if we decide to change our laws, based on the experience of other countries? In our last meeting we heard detailed evidence on the issue of abortion in cases of rape and sexual assault, an issue that Ms Hoctor also touched on in her presentation. In the 21 countries she mentioned that have an explicit sexual assault ground for abortion, what types of verification processes exist to determine if the ground is met? What is her opinion of how they operate in practice and their impact on the women involved?

My next question is for Dr. Sedgh and I hope I am pronouncing her name correctly.

Dr. Gilda Sedgh

Yes, Sedgh is right.

Has any research been done on the impact of broad socio-cultural views on the acceptability or stigma surrounding abortion within a state on abortion rates or abortion access? I am a little concerned that after a potentially divisive referendum campaign the stigma surrounding abortion could become a practical barrier to access. Has this issue arisen in any other countries and what is its impact?

I will ask Ms Hoctor to respond first. While I do not want to put witnesses under pressure to answer, I must point out that we are under quite tight time constraints.

Ms Leah Hoctor

In the brief time available we can identify three factors which explain why - in some cases - laws that have allowed abortion, either on broad grounds or on very limited grounds, may not enable access in practice. Affordability and how abortion services are being covered by public health insurance or integrated into the subsidisation schemes of health systems is one factor that can impact access, even where abortion may be legal. Often in countries that have not legalised abortion on request or on socioeconomic grounds, the certification processes that must be followed to obtain access on a health ground or in situations of foetal impairment or rape, for example, can be onerous. These processes can often involve multiple levels that a woman must go through or multiple doctors and social workers being involved in certifying the existence of the reason. We see other barriers in some countries which can relate to waiting periods, for example, or mandatory and sometimes biased counselling requirements.

In the European countries that were green and light yellow on the map, while it is not true to say that there are not sometimes problems for women in accessing a legal abortion, in general these countries have taken an approach in their laws which enables women to access services early in pregnancy at least. That often means that some of these barriers create fewer problems. In terms of sexual assault, which I tried to address in my presentation, all of the 36 countries in Europe that have legalised abortion on a woman's request, mainly in early pregnancy, thereby allow women who have survived an experience of sexual assault to access abortion in early pregnancy through that ground. In that context, many women across Europe who have faced sexual assault and who then choose to have an abortion do so under the on-request ground. Many of those countries in Europe that have explicit sexual assault grounds in their laws include a particular certification process. The most common process is that a committee or a number of doctors and social workers must look at the case and agree that the reason exists and that there is evidence of a sexual assault. Some countries require a prosecutor or police certificate and speak to the need for clear evidence or sometimes for a criminal legal procedure to be initiated. Only one country refers to a process before a court in the case of sexual assault. It is very important to understand that 40 countries out of 47 in Europe allow access, in a general sense, on request for socioeconomic grounds in early pregnancy. It is probably in that way that women access abortion in situations of rape.

We will move on to Dr. Sedgh now.

Dr. Gilda Sedgh

The Senator's question was whether stigma around abortion can prevent women from having access to abortion services even when the law is changed to expand the grounds for legal abortion. Do I understand the question correctly?

Dr. Gilda Sedgh

The presence or prevalence of stigma tends to be aligned with the presence of restrictive abortion laws so we cannot fully disentangle the roles of the two. There are some countries where abortion is legal on broad grounds but still stigmatised, including Italy, for example. In other countries, like South Africa for example, the grounds for legal abortion have been expanded but it is still stigmatised.

Stigma has prevented women from having access to abortion services where providers are allowed to invoke conscientious objection and mechanisms are not put in place to ensure women nevertheless have access to alternative sources of care. A literature review has brought together 14 studies of the effects of stigma on women who have had an abortion, which is not to say it has prevented them from seeking an abortion. Some of the summary findings of the review are that women who have abortions in these settings feel socially isolated, are afraid their loved ones will find out they had an abortion and suffer stress for these reasons.

I call Deputy Kelleher who has ten minutes. Members may contribute twice for five minutes each time.

I may not need five minutes as some of the questions I intended asking have already been answered.

On fatal foetal impairment and time or gestational limits, the committee heard evidence from obstetricians and gynaecologists that an anomaly scan will normally be carried out at between ten and 12 weeks into a pregnancy and one must wait until between 22 and 24 weeks of a pregnancy to obtain definitive diagnostic results. Ms Hoctor referred to a number of countries in Europe. Do these countries apply time limits in cases of fatal foetal impairment and, if so, how do these work in the context of diagnostic difficulties? I ask Ms Hoctor to elaborate on that issue.

When one goes beyond Europe, I assume in countries such as Gabon terminations are not carried out in cases of fatal foetal impairment because anomaly scanning services and knowledge of the impairment of the foetus are poor. I assume the absence of information on these matters, as opposed to cultural or other reasons, is the reason for not carrying out abortions. I ask Ms Hoctor to clarify that matter.

On the issue of culture, is there any evidence of partners or fathers forcing women to have a termination against their wishes? Has any research been done on that issue in the context of cultural differences across the globe to identify whether women are vulnerable to this potential threat of having a termination against their wishes?

I am interested in an issue on which the witnesses may have some observations to make. While terminations are carried out in Finland for various reasons, in one particular area the father may be given an opportunity to present his views prior to the decision to terminate the pregnancy being made, albeit only if there are special reasons that warrant doing so. I am not sure if the witnesses are aware of the specific circumstances but perhaps they could clarify or expand on what is meant by this aspect of Finnish law.

Ms Leah Hoctor

On the Deputy's first question regarding timeframes and foetal impairments, specifically fatal foetal impairments, the basic point to make is that while some European countries impose time limits, the majority do not. Some European countries do not distinguish in law between fatal and severe foetal impairments and will have a general ground for severe foetal impairment within which fatal foetal impairment would come. Some countries distinguish between the two, however, and will have a specific reference to severe impairment and another reference to fatal impairment. Some of these countries will impose a limit for severe foetal impairments but no limit for fatal impairments. However, the majority of European countries do not impose limits in the case of a severe or fatal foetal impairment. I believe the vast majority of them do not do so when the impairment is fatal. In all of these countries, a detailed certification process is involved whereby doctors confirm the existence and nature of the impairment. Where countries set out timeframes, these often fall at around 24 weeks, with some a little earlier, perhaps 20 or 22 weeks. The most common practice, as I stated, is not to distinguish between severe and fatal, and where a distinction is made, there is often no limit for the fatal impairment.

Dr. Gilda Sedgh

I might add that in the evidence that I presented and also in evidence in the paper, which goes beyond what I presented, on reasons women have abortions, including in countries where testing and diagnostic services are available, for example, Belgium, the United States, Sweden and a couple of other European countries which I will not attempt to list as I do not wish to identify them incorrectly, fewer than 5% of women who have an abortion indicate that fatal foetal impairment is the reason they are having an abortion. It is still not one of the more common reasons, even where the necessary services are available.

With respect to men forcing their partners to have abortions, I am not aware of any kind of systematic or large-scale evidence to that effect. I imagine that anecdotal evidence along those lines exists but I cannot speak to it.

Ms Leah Hoctor

On the issue of men - the father or partner - being involved in decision-making, I believe, although I could be wrong, that Turkey is the only country of the 47 Council of Europe member states which has a spousal consent requirement for a married woman. No other European country has any kind of provision along those lines. Finland has the provision to which the Deputy referred and a few other European countries also indicate in their laws that, if possible, the father - the woman's partner - should be involved in the decision-making process. However, my understanding is that a degree of discretion applies and it is always considered appropriate that the woman's decision-making and her perspective be front and centre, while her partner or husband, if he is accompanying her, may be involved. I believe Finland may be unique in specifying that a man may have a possibility of having his voice heard. That provision is more unusual. It is rare for the law of a country to include a reference to the views of the partner or husband being taken into account, where possible. In some cases, the partner or husband may be asked to attend the consultation with the relevant physician or clinician, if possible.

Does that happen in practice? From this side of the table, I expect this would be very complex for many different reasons. For example, the male parent may not necessarily be the partner, which would give rise to complexities. The whole issue of domestic violence also arises. Does this happen in practice in certain countries?

Ms Leah Hoctor

Is the Deputy referring to European countries?

Ms Leah Hoctor

No, I do not believe so. I believe these laws are meant to deal with circumstances in which a woman wants her husband or partner to be involved with her in the decision-making process. I do not believe these provisions are intended as a means of dealing with a conflict in views or surrounding decisions. In almost all of the 40 European countries we examined, with the exception of Turkey, the laws which allow access on request or on socio-economic grounds prioritise the woman's wishes and decision-making and those of the doctor working with her. There is also the right or ability of the woman to have her partner or husband involved in that process with her.

Senator Mullen has ten minutes to make his contribution.

With the Chairman's permission, I will ask one short question, to which I hope to receive a short answer, and use the rest of my time later.

That is not a problem.

Ms Hoctor is probably aware that advocacy groups were not supposed to appear before the committee. While I do not know if she was aware of that, I will draw attention to an email from the Center for Reproductive Rights dated 28 September which reached my inbox-----

I do not wish to interrupt but a telephone is ringing and causing interference with the sound system.

I am reading from my phone, perhaps I should have it on airplane mode. Apologies Chairman.

I am alerting the Senator to the interference for his own sake.

I appreciate that. The joys of modern technology; let me see if we can have a quick recovery.

The advertisement reads:

Harsh abortion laws put women at risk and deny them their fundamental rights. We are fighting back [and then there are maps of five countries, Ireland, Kenya, India, El Salvador and Nepal and around the world]. We will not stop until every woman has access to safe and legal abortion. Your support is essential to our fight for reproductive rights. Chip in now.

When you click you get the opportunity to contribute dollars. I also notice in the script that Ms Hoctor is upfront about her involvement in advocacy and political engagement in cases and decisions. The cases are mentioned and she also mentions donating to the Irish Family Planning Association.

I take it that Ms Hoctor would accept that she is a member of an advocacy group, par excellence, that advocates for abortion on fairly unrestricted grounds. In the light of that was Ms Hoctor surprised to get an invitation from this committee?

Ms Leah Hoctor

As I made very clear in my opening remarks and as is very clear from the centre's website, the centre works to advocate for women's access to reproductive health care and reproductive rights and this includes access to safe and legal abortion care. The centre's work on the human rights committee cases means that the centre is obliged as the representative of Amanda Mellett and Siobhan Whelan, to advocate for the remedies which include law reform to be fulfilled by the Irish State. Any fundraising that the centre does for Europe for its work on Ireland has been for the cases. There is a line in the email that refers to the fact that the centre uses legal action in its work to advance women's reproductive health and rights. I was very honoured to be invited by the committee to present to it.

I asked Ms Hoctor if she was surprised to receive an invitation from the Oireachtas.

Ms Leah Hoctor

I think the centre's work in Ireland, representing Amanda Mellett and Siobhan Whelan, meant that I was not surprised. I think we also have very deep expertise in the area of European comparative law, as I have just presented; the evidence that I have provided is evidence based.

Not withstanding the prohibition on advocacy groups.

That is a matter for the committee, Senator. In fairness to the witnesses-----

Thank you Chairman. I thought we had done with the Chairman cutting in on people's questioning. That concludes my question and I thank the witness for her reply.

I do not interrupt, I am just making a ruling. Deputy Hildegarde Naughton has ten minutes

I thank the witnesses for coming before the committee this afternoon. I wish to address a few questions to Dr. Sedgh in respect of slide 6. Will she clarify whether she is saying that in countries where abortion is freely available, the abortion rate is similar to countries where it is very restricted or not available at all and will she expand on that? I wish to ask Dr. Sedgh about her figures on the gestation duration of pregnancies where they are terminated. She states that 90% of abortions are obtained in the first trimester; does she have any detail on the reasons for the other 10% of abortions? Is there any reason to think that the reasons for women having abortions as outlined in slide 12, would be replicated here? The figures show that roughly 25% of abortions were for socio-economic reasons; 25% for partner-related reasons; about 18% in order to space their children; 13% for reasons for having as many children as they wanted; and 1% related to health of the foetus. Dr. Sedgh may not be able to give exact feedback but perhaps she has a viewpoint on it.

Would Ms Hoctor speak about her opinion on the so-called floodgates argument? Should access to abortion be broadened after the referendum in this country? Is there experience in other countries of a floodgate opening once abortion is allowed on demand? Ms Hoctor responded to a colleague's question on this but where there are restrictions on abortion inserted in the Constitution in other countries, how did that affect the policy and practice in those countries and how it impacts on women and on the medical profession?

We will start with Dr. Sedgh.

Dr. Gilda Sedgh

I was asked to expand on the slide, on the finding that abortion rates on average are similar in countries whether there are strict or liberal abortion laws. Let me make a couple of points. Within each of these groups of countries there is a wide variation in the abortion rates and these figures are averages. We do not see a strong relationship in an univariate correlation between laws and incidence. We do see a strong relationship between contraceptive prevalence and the abortion rate. We see it more clearly when we look at the proportion of women with an unmet need for contraception and the abortion rate. One would then see a much stronger relationship, if that is what we were looking at in this slide, rather than the abortion laws.

Deputy Naughton asked about late term abortions. Among the small proportion of women who do have late term abortions the reasons for late term abortions are where we will tend to see abortions for reasons that have to do with risks, to foetal health and to foetal life. Adolescents comprise a larger share of late term abortion than early term abortions and it suggests that it is restrictions or barriers to accessing abortion that causes some women to obtain their abortions later. Young women might not know they are pregnant, might be afraid to tell somebody they are pregnant and thereby also admit they have had sex, or they do not know where to go and who to ask. In countries with restrictive abortion laws, some slightly larger proportion of abortions are done later in pregnancy compared to countries where abortion is allowed on broad grounds, so that is another indication that access to legal abortion that can drive the proportions of abortions that are done late.

If it okay-----

Chairman, may I ask Dr. Sedgh to repeat the point on late abortions?

Dr. Gilda Sedgh

Where access to legal abortion is more restricted, one will see more abortions being done later in pregnancy because of the delays in the person figuring out where to go, admitting that one needs to go somewhere and so on.

May I ask about the relationship between abortion and the availability of contraception?

Dr. Gilda Sedgh

A big determinant of the level of abortion in a country is the proportion of women who need but are not using a method of contraception, whether that be because they do not have access to or actually more often because they face other barriers to choosing a method of contraception. They need options and choices so that they can choose and not just have one method made available to them. They need counselling to help them navigate the side effects that accompany these methods. They think they can avoid getting pregnant because they think they are not having sex as often as other couples so they are operating under this misconception that they are not at risk of getting pregnant. These are some of the reasons that come up very often, both in developed and developing countries.

Deputy Billy Kelleher took the Chair.

Could Dr. Sedgh round that off by saying that sex education and knowledge about contraception is a part of that whole issue?

Dr. Gilda Sedgh

One of the pathways to reducing the level of unmet need for contraception is providing comprehensive sexuality education and improving not just the existence but the quality of services that are available. I may help Ms Hoctor answer a question that I think might be more in the Guttmacher Institute's area.

Deputy Naughton asked about the floodgates. We have tried to look at trends in abortion incidence before and after a large change. That is one aspect of the question. We are not able to do that very well because where abortion is illegal we often do not have a good fix on the number of abortions that are happening and then when abortion becomes legal, the number of abortions that are on the official record begin to increase, but we do not know to what extent that represents a shift from abortions that had been clandestine to abortions that are now not more common but more on the record. That will be the case in Ireland where we have accounts of women having abortions in England, Wales and in the Netherlands and some obtaining from Women on Web, but we do not fully know how many abortions are happening now.

Ms Leah Hoctor

Let me follow on from that point. We saw from Dr. Sedgh's slides as well that some of the lowest rates of abortion in the world are in the western European countries that we looked at in our map that would have access to abortion on request. I am living in Switzerland at present and that was the country with the lowest incidence of abortion on the slide.

What we can see from those data is that there is no correlation between the availability of abortion on request, in early pregnancy, for example, in the law, and a higher rate of abortion. In fact, WHO evidence indicates that once the law is changed, unsafe abortions then become safe. In the Irish context, this would mean women who are travelling outside the State for abortion care would, in most cases, no longer do so, and women who take an abortion pill in a clandestine manner would be within the law. Abortions had by Irish women outside the State would happen here.

I was asked about constitutions. The Irish approach, involving the regulation of abortion starting with a constitutional provision, is very rare across the world. In Europe, there is, I believe, only one other country in this category, Andorra. I do not have exact numbers but I believe Andorra has a complete ban on abortion. That protects the right to life before birth. It applies prenatally. Beyond Ireland and Andorra, it is virtually unheard of in Europe to include abortion within a constitutional provision. Some countries in Latin America, such as Chile and Honduras, and in Africa have constitutional provisions that address the right to life and whether it applies before birth. It applies prenatally in those countries. All these countries have highly restrictive abortion laws. Since Ireland, being in western Europe, is a country whose socioeconomic status is higher than that of Chile, Irish women can leave to gain access to safe abortion services in another country. In Latin America and Africa, however, we see, as a result of the very restrictive laws and constitutional provisions, there are very high rates of unsafe abortion.

Are there any more brief comments?

I have two agriculture questions to ask, so I must leg it.

Are they to be asked here or in the Dáil?

In the Dáil.

The Deputy should save the agriculture questions for the Dáil.

I could introduce them here. They are on horse racing, testing, etc. I apologise if I have to leg it before hearing an answer to my questions to the witnesses.

I was going to raise the floodgates issue. I note my question has largely been answered. On page 5 of Dr. Sedgh’s report, she refers to varying rates across countries where abortion is broadly available. The report touches on the point that it is not necessarily a question of legality or illegality in terms of abortion rates but a question of a range of other factors. Could Dr. Sedgh expand on some of the points on the variance within the countries where abortion is broadly legal?

With regard to the Siobhán Whelan case, it was stated in the media yesterday that she was awarded €30,000. While financial considerations are of far less consequence than the emotional damage being done to women, could Ms Hoctor outline the minimum criteria Ireland needs in its legislation to avoid this? I presume there will now be many other cases coming on stream that will highlight not only the emotional impact but also the financial cost to the State. What do we need to do in our law to prevent what occurred from happening again, making reference to the cases in which Ms Hoctor’s organisation has represented people?

My other point is on the preamble to the UN Convention on the Rights of the Child. It has been bandied around this committee a bit. It refers to the protection of the child before birth. Could the witnesses deal with that in the context of clarifying what has been alleged, namely, that this gives the foetus the right to life, as such, and, therefore, prohibits abortion? Clearly, it does not considering that all the countries among which we stand out like a sore thumb are signatories to the convention. A little more information on this would be very useful.

Senator Catherine Noone resumed he Chair.

Dr. Gilda Sedgh

I thank the Deputy for asking me to elaborate on whether the floodgates will open if the abortion laws changed. The slide with country-specific abortion rates shows that almost half of the countries have abortion rates lower than ten. The countries with the lowest abortion rates on record are countries where abortion is allowed on broad grounds. The countries where we see the sharpest declines in the abortion rate on record are countries that have allowed abortion on broad grounds throughout the period of the decline. These findings indicate that a liberal abortion law does not necessarily represent the groundwork or setting for a high abortion rate. I could elaborate but I will stop there because there is limited time and there are many questions in the Deputy's set of questions.

Ms Leah Hoctor

What the Human Rights Committee specified in the Siobhán Whelan and Amanda Mellet decisions is that, in regard to law reform, Ireland must amend its law on abortion, including, if necessary, its Constitution, to ensure similar violations do not occur in the future. It stated it must make abortion services practically accessible in a timely and effective manner in Ireland. What is really key here is the phrase "similar violations". The violations that the committee found in the decision were violations involving inhuman and degrading treatment, the right to privacy, and inequality before the law. The facts of the cases of Amanda Mellet and Siobhán Whelan concerned the circumstances of fatal foetal impairment and the really tragic circumstances the women were in. The analysis of the committee, however, and the decision on why the suffering the women endured was inhuman and degrading focused a lot on the experience of travel and what it meant to have to leave the country to gain access to care in another country, in addition to the breach in the continuum of care that they endured and the fact that they could not obtain health care here from doctors and nurses they knew and trusted. What is really key for Ireland, the committee and lawmakers as they move ahead is to understand that until Ireland changes its laws on abortion so women, whatever their circumstances, will not face inhuman and degrading treatment or violations of the right to privacy and equality before the law, it may happen that Ireland will continue to appear before the committee. I am not aware of cases that are pending.

Under international human rights law, making abortion legal is one requirement in a broad range of circumstances. Another requirement, however, is to make abortion that is legal under domestic law accessible and available in practice. This is really critical. Poland serves as an interesting example in Europe. In that country, abortion has been legalised on many more grounds than it is currently legal in Ireland. These grounds cover circumstances of severe foetal impairment, rape and the risk to a woman’s health, but do not cover abortion on request or socioeconomic grounds. Owing to the strictures and restrictive nature of the Polish law, however, it is very difficult for women to gain access to services in practice. Therefore, Poland has been held accountable by the European Court of Human Rights three times. We can see, therefore, that it is not simply a matter of the grounds on which abortion is legal in a country’s law; it is also a matter of ensuring that it is available in practice when it is legal.

With regard to the UN Convention on the Rights of the Child, the provision is preambular. It does not in any way refer to the right to life prior to birth, or prenatally. In fact, in the travaux preparatoires, which are the legal documents used to interpret the treaty, namely, the negotiations of the states that drafted it, it is very clear and specific that the inclusion of this preambular provision was not in any way meant to lead to the application of Article 1 of the convention, on the right to life, prior to birth or in a manner as to prevent the legalisation of abortion in countries that have ratified the treaty. In fact, we have seen from the jurisprudence and recommendations of the Committee on the Rights of the Child, which is the monitoring and adjudicative body that oversees the convention, that the body has called on Ireland and many other countries with restrictive abortion laws to ensure abortion is decriminalised and that adolescents and girls can gain access to safe and legal abortion services.

I thank the delegates for their presentations. It is useful to see how we compare with other countries, particularly countries in Europe, and the cause and effect when changes are made. I have a question about the position in Malta and Poland. As Ireland does not allow legal abortion, women travel. Do the delegates have any information on what happens in Malta and Poland? The system in Poland is less restrictive than in Ireland, but nonetheless it is very restrictive.

In countries where there is a legal framework in place, what role does the medical profession play within it? Is there a general trend in that regard in the regulatory process?

Ms Leah Hoctor

I do not have data for what happens for women in Malta and Poland. My understanding is that many women in both countries also travel outside the country, in Poland's case potentially to neighbouring eastern European countries and in Malta's case often to the United Kingdom. Although I do not have data, I also believe that, similar to the position in Ireland, women are accessing abortion pills and ordering them online. In Poland there are reports from non-governmental organisations that there are quite high rates of clandestine abortions. As the socioeconomic status of women in Ireland is obviously higher relative to that of women in Poland, travel might be easier for women in Ireland than for women in Poland. Does that answer the question?

Yes, that is fine.

Ms Leah Hoctor

The second question was about the role of the medical profession. In most of the European countries where we examined their laws the reform processes moved from a highly restrictive law on abortion in the 1970s and 1980s to the laws in place today. Medical professionals in these societies were very involved with legislators and law makers in crafting these laws and advising on what would be workable and bring about a solution in these countries. Many of them were dealing with very high rates of unsafe abortion and often the law reform processes occurred because of calls from within the medical profession for change because its members were seeing such high rates of maternal deaths as a result of unsafe abortions. Usually across Europe laws on abortion in legislation or primary legal sources are also accompanied by regulations, by-laws and often medical guidelines adopted by medical professional bodies.

With regard to gestation limits for requests, obviously they vary, but the limit is mainly the first trimester. Is there a big difference between, for example, ten and 14 weeks in terms of practicality? Is there any noticeable change or movement in any of the countries that have these limits in terms of changing because something is not workable?

Ms Leah Hoctor

It might not be true in every case, but it is my understanding the limit was decided in the law reform process and I do not believe we have seen change in a European country. A country that has set a ten or 12-week limit on request or a later limit has not shifted. Other requirements and facets of the law have changed and developed over time. The most common limit is 12 weeks. Although these countries' laws were adopted at a time when medical abortion, the abortion pill, was not available, it is interesting that the ten to 12-week period in place in their laws is the time period within which medical abortion is safe and now available. Even though that was not the case at the time, it is interesting to see that the time period they set also lines up with the time period for medical abortion being safe, as stated by the WHO.

I have a question for Ms Hoctor. With regard to the Amanda Mellet and Siobhan Whelan cases, she said in her presentation that the Human Rights Committee's judgment detailed remedies which included reform of Irish abortion law and, if necessary, the Constitution. In her analysis of the judgment does she consider that it would entail changing the Constitution? In other words, within the current constitutional restrictions is it possible to implement the decision?

Ms Leah Hoctor

I cannot speak for the Human Rights Committee, but my sense is that its use of that language was because it was not for a adjudicative body of that nature to dictate the specific legal process that a state should undertake. It has set out an obligation of result - law reform - and will not dictate the legal model of law reform that the state must adopt. However, the Government in its response to the decision in both the Amanda Mellet and Siobhan Whelan case has specified clearly that in order for Irish law on abortion to be changed, the constitutional provision must change. The State made this argument in its pleadings and written submissions as the case was being considered by the committee. It is also the position it specified clearly in its responses to the committee. In order for law and legislative reform to occur, the constitutional reform must first take place. On that basis, it is our view that this is critical. Without constitutional reform, it is clear that legislative reform cannot occur.

That is useful for the committee to know. Clearly, it is a basic issue we must examine. Both delegates have answered about the floodgates being opened and so forth. I understand Dr. Sedgh's research is mainly on groups of countries and that it is hard to be specific about Ireland's case, but is there any other comparison in respect of women in one country who have easy access to abortion in another, as we do in Ireland, and to show how statistics might have changed when the law became more liberal such that women did not need to travel?

I do not know if the delegates have statistics for the use of the abortion pill bought online, but are there statistics in other countries? Judge Laffoy said the Citizens' Assembly was unable to deal with the issue in great detail, but it is one of the issues that have arisen for the committee.

Dr. Gilda Sedgh

On whether there are other precedents that can help us to understand what might happen in Ireland, the precedents being countries where women were previously able to travel somewhere else to have an abortion and then did not have to do so, none comes to mind. When the Deputy was asking her question, I thought about Zambia where women travel to South Africa for abortions, but we do not have the rest of the scenario described by the Deputy, where the abortion law or access to legal abortion changes, in Zambia.

I am hard-pressed to find a case where we know definitively what happens to the incidence of abortion before and after a change in the law because of the clandestine nature of abortions before that change. We have seen countries, my own home country of the USA among them, where the abortion rate declines after abortion has been legal for some time and that shift from clandestine to recorded abortions has taken place. It declines because women increasingly start to use contraceptive methods or else to shift from less effective to more effective methods. If there is concern at some point over the numbers of Irish women obtaining abortions then, all of the evidence from other countries suggests that what needs to be looked at is whether or not something might be preventing these women from using contraception.

Members asked about abortion pills accessed online and how prominent a role these might play as a proportion of total abortions being carried out. When it comes to medical abortion in general, these pills play a large role. The case-loads of online services like Women on Web, from which a woman can be sure she is getting proper pills, proper dosage and proper information, are not in fact very large. In countries with more restrictive laws, however, which are often developing countries, we see large numbers of women obtaining Misoprostal through the black market. Misoprostal is but one of the two drugs that make up that medication abortion regimen and women are obtaining it through a variety of means: from pharmacists; from what they call their "chemists"; and from open-air markets. The drug is often obtained in various doses and thus not necessarily the optimal dose or regimen, and without any guidance or counselling. I do not know if that speaks to Irish concerns in particular but my overall point is that medication abortion in general can play a major role where abortion is clandestine.

Generally speaking, however, the issue of whether contraception is freely and easily available is obviously a very significant one. One of our previous sessions here indicated that because Irish women who travel to Britain for abortions do not get the follow-on counselling, they do not always get information on contraception either. Would that be the case in general?

Dr. Gilda Sedgh

Yes.

Ms Leah Hoctor

It is also very interesting to look at the western European countries featured in Dr. Sedgh's materials. We can see that some of the lowest rates of abortion are in countries where the family planning and comprehensive sexuality education are quite strong. With regard to the regulation of medical abortion, many European countries have now developed health service protocols. These are not based in legislation but rather are practice guidelines set by medical professional bodies on how medical abortion be provided; how it be rolled out; what requirements there might be for women to have prior consultations with doctors; and whether women would take the pill at the facility itself or perhaps take some of it at home. This matter is properly regulated in most European countries, but within health practice guidelines rather than within legislation.

I call on Deputy O'Reilly. She has six minutes.

I will not need the full six minutes as my question is a very simple one. It concerns the word "risk". We know from the Citizens' Assembly what it is that we are asked to consider here. The assembly has a gradation of risk or "serious risk" to use its own term. There are various definitions of what does or does not constitute risk. In Dr. Sedgh's experience, is it possible or even desirable to try to grade risk in legislation? Is it simply a matter of "risk" as determined by medical professionals? Or can or should we consider including a definition of what does or does not constitute sufficient risk? We are being asked to consider the Citizens' Assembly's recommendations here and risk is listed as one of the grounds.

The assembly also listed sexual assault among its recommendations, so this too forms part of our deliberations here. Ms Hoctor mentioned that there are some countries which operate through possible prosecution certificates or indeed legal processes. That sounds quite shocking to me. Are these measures on the statute books of those countries without necessarily applying in everyday use? In other words, do these countries have other ways around the matter? Or is it actually the case that such certification has to be obtained? I would like to ask Ms Hoctor to talk us through the process of how a woman might go about obtaining this as it sound to me like a very tough thing to do. Without wishing to stray outside of Ms Hoctor's area of expertise, I wonder if she could talk to us briefly about the potential impact that having to obtain such certification might have on a woman who has been the victim of a sexual assault. Finally, what possible implications might that have on time? Legal processes can be long and drawn out - is this a quick process? What are the mechanics of it?

Ms Leah Hoctor

When Deputy O'Reilly talks about "risk", I presume she means on health grounds. I just want to be clear.

Yes. My apologies. I should have been clearer.

Ms Leah Hoctor

Most European countries include an explicit health ground in their law and most do not impose any time limit on that. Some countries do impose such a limit. Some countries do, as the Citizens' Assembly did, and differentiate between a health risk and a serious health risk. The most common practice, however, is to have a health ground and not to impose any time limit.

I have put together a quick run-down of the terminology involved: "health is at risk"; "damage to women's health"; "continuation of pregnancy endangers women's health"; "medical reasons" is also a common terminology; and "necessary to prevent". Of the 40 European countries we looked at, given that I focused mostly on the green and light yellow countries that also have socio-economic access and access on request, there is no qualification on the risk. Some countries use the language of "serious", "severe" or "grave" health risk but most, approximately 25 or more of the 40, have no such qualification. That is because, as Deputy O'Reilly mentioned herself, there is a view that best practice in law-making is to treat women's mental or physical health as a clinical matter for the relevant doctors and physicians and for the woman herself. That is the best practice approach.

In response to Deputy O'Reilly's other question about sexual assault, it is critical to understand that the 40 countries we looked at by and large allow access to abortion in early pregnancy on a woman's request or for socio-economic reasons. Where these countries have an explicit assault ground in their law, then, it co-exists as a separate ground side by side with the on request ground. As we saw, only 19 or 20 countries have that explicit ground in their law. I was not around in the 1970s when these countries were in the process of reforming their abortion laws and in the 1980s I was too young to be aware of such matters. I would not be surprised, however, if part of the reason why many European countries have a request ground but no explicit sexual assault ground is because they were concerned about the situations of survivors of sexual assault and thus did not want to set up and then put these women through an onerous certification process. They knew that legalising abortion in early pregnancy would mean that victims of sexual assault could get access to services within that timeframe. Someone would have to actually go back to look at the legislative records in the relevant parliaments, however, to understand whether or not that was a consideration.

Also, it is important to understand that where these countries would have a sexual assault explicit ground in co-existence with a non-request ground or a socioeconomic ground, they would have a later term limit usually associated with that. It is quite few that would. In the majority of these countries, the process would involve medical professionals, and sometimes social workers. It would be a similar process to that applied in the situation of a health risk. I cannot give the committee information about how the few that refer to prosecutors or police authorities - these are in the minority - operate in practice. In one country in Europe, Poland, which has legalised access to abortion on grounds of sexual assault but has not legalised access to abortion on request, we see evidence that it is difficult for survivors of sexual assault to access abortion in practice under that rape ground. I would refer the committee to a case that came before the European Court of Human Rights, called P. and S. v. Poland. That case illustrates, as was mentioned, some of the severe impacts of these kind of certification schemes. Poland is one of the countries that requires a certification from a prosecutor. That case concerned a minor, an adolescent girl who had been raped and who faced very severe impacts and barriers in attempting to gain access to what was a legal service.

I thank Ms Hoctor.

Most of my questions have been answered. I thank the witnesses for appearing before the committee and for giving us the opportunity to discuss this matter and to ask them questions. That is important for us.

The map made for quite stark viewing. Obviously, Ireland is depicted in bright red. We are not surrounded by any other red countries. Everyone is depicted in green or yellow - very different from the picture here in this country. A picture paints a thousand words, and that is a very powerful one.

Of the other European countries depicted in green and yellow, how recently have they provided these services? Are there any countries within Europe where it is only recently or in the past number of years that they provided these services and was there a debate in the country concerned? What was the process there?

Obviously, Ms Hoctor works not only in Ireland. Is she aware of the perception across Europe of how we are dealing with this situation? Is there a conversation happening? What do people externally think of our current situation and the debate that we are having?

Ms Leah Hoctor

To answer the first question, I would say Malta and Andorra, which are small on the map, are also in red. Those are very tiny countries.

Looking closely, I can see them now.

Ms Leah Hoctor

It is true that it is a stark picture. Ireland has a number of interesting peers in Europe that have changed their abortion laws and moved from an orange situation or even a red situation to now becoming green. These would be Switzerland, Portugal and Spain. In Switzerland and Portugal, those processes involved a public referendum. I live in Switzerland and I am aware that they vote on everything there - they vote on what side of the road they will drive on. They liberalised, or changed and reformed, their abortion law through a public referendum process. There would have been a legislative proposal put forward to the people of Switzerland by the legislature in 2002.

Spain and Portugal are the most recent. They legalised in 2010 and 2008, respectively. In Portugal, there was a public referendum. It may be also of interest to the committee to look at that process. Then Spain also moved from a restrictive model, from being orange on the map, to now being green. Those are the most recent.

Was there a public vote in Spain?

Ms Leah Hoctor

No. It was a legislative process.

Before Ms Hoctor moves on from that, has she any more detail about the process in Switzerland and in Portugal? How did the referenda go? What were the percentages in terms of vote? In the debate leading up to the referendum, what was the tone and what was the general feeling?

Ms Leah Hoctor

This is something that I would like to look into a bit further and come back to the committee on because I think there is information we can give. In Switzerland, the percentage in favour of the change was in the high 60s or up to 70. That is my understanding but I would need to double-check. It is possible we could suggest names of members of the Swiss legislature or Government at the time, and their counterparts in Portugal, who may be able to share this information in more detail. I will certainly look into that and come back to the committee.

I thank Ms Hoctor.

Ms Leah Hoctor

On how Europe is looking at this, our sense would be that Europe is watching and waiting. Ireland is a valuable European partner for many European states and there would be a sense of interest in the matter in the hope that Ireland can find a resolution.

I thank Ms Hoctor.

Senator Ned O'Sullivan has six minutes.

I have only a couple of brief questions which I will address to Dr. Sedgh. She stated that there are very few unsafe abortions in countries where there is a reasonably open and liberal abortion regime and there is almost a 30-fold increase in unsafe abortions in countries where legislation is very tight. I wonder how does that apply vis-à-vis Ireland where we have the right to travel and where we are in such close proximity to the UK. Do those figures hold up for Ireland?

Dr. Sedgh also stated, which surprised me when I saw these figures previously, that 73% of abortions are performed on married women as opposed to 27% on single girls. That would surprise people and raise a lot of eyebrows around the country because the narrative, especially, by those who are very much against abortion, is always centred on helpless young women who are probably confused, etc., whereas, in fact, the vast majority of abortions would seem to involve women who, because they are married, I assume, are older, more settled and more mature. I would like to check that figure with Dr. Sedgh to determine am I right.

Finally, there is one statement Dr. Sedgh made that surprises me and that I cannot rationalise. Russia jumps out on the map as being all green and, therefore, would be, I imagine, very liberal, yet Dr. Sedgh stated there was a reduction of 50% in abortions in Russia since the war or Stalinist period. It does not add up how they are still in the green box. What happened to cause such a reduction?

Maybe it is a nicer place to live.

Whatever, but it is a question that interests me. By the way, I welcome the witnesses and thank them for the helpful and informed information.

Deputy, sorry, Dr. Sedgh first.

Dr. Gilda Sedgh

I thank the Chairman for that complimentary mistake.

With respect to this general correlation whereby where abortion law is restrictive abortions tend to be unsafe, Ireland appears to be an anomaly because of its proximity to Great Britain and to some extent the Netherlands where some women also seem to go for abortions. We do not know all of the women who are having abortions and we do not know all of the conditions in which they are having abortions but it appears to be anomalous.

Senator Ned O'Sullivan's next question was on the marital status of women having abortions. There is variation across these countries. Across developed countries, it may not be that in all of them the majority of women having an abortion are married but on average it definitely pans out that way. One should bear in mind that married women includes cohabiting women.

It is interesting to me also that the unmarried women are the ones who get so much of the attention.

As they get the attention, it gives the impression that they account for the majority of abortions. It makes some sense because it could be argued that the consequences of an unintended pregnancy are greater for a young, unmarried woman who has not yet finished her education and for whom the opportunity costs of having a child might be higher. It could be argued that the stigma of having both an unintended pregnancy and an abortion - having had sex before that - are all compounded. It is useful to be reminded of that statistic because it is surprising.

In Russia and eastern European countries, although I hope life has got better in Russia, abortion rates have decreased because access to family planning services has increased dramatically with the ending of the Cold War and because of increases in trade, exposure to the West and the presence of non-governmental organisations providing services. The number of women using a contraceptive method has increased substantially from 1990 to the present. The prevalence is still not as high as in western and northern Europe and women are not as likely to be using effective methods as women in northern Europe or using them well because of the variability in the quality of service. We still see higher abortion rates in eastern Europe than in the rest of Europe and these are some of the reasons from the evidence we have seen. It comes back again to contraceptive use; it is why rates decline or remain high.

I welcome the delegates and thank them for their participation. In Ireland's case we are in the area where the purpose of an abortion is to save the woman's life. It is also true, of course, that it does not necessarily have to be an abortion. My definition of abortion is to terminate the life of the child still to be born to achieve a result. As we know, it is possible to intervene to save a woman's life without killing the child. Will Dr. Sedgh comment on this?

I am a little confused about the statistics for Germany as compared with those for the United Kingdom, for example. There are liberal or readily available abortion services on socioeconomic grounds, but there are considerable restrictions in Germany related to the provision of counselling and advice. There is a thorough examination of the person presenting, whether she is single, married or whatever the case may be. There seems to be a heavy reliance on counselling and the provision of support services that do not seem to be a feature in the United Kingdom, for example, and certainly are not a feature for Irish women availing of abortions in the United Kingdom. With regard to abortion rates across various countries in which abortion is legal on broad grounds, we can compare the likes of Sweden with Switzerland. There is a dramatic difference in the level of abortions in the two countries. Is that for some reason we have not spotted? There seems to be something obvious that is not jumping up to hit me.

I am a little concerned about the suggestion the European Union is watching us and might be on our case again. There are a number of matters on which we are watching it also. I am a little uneasy about that slant. This is an independent state and we observe EU law in almost every case. In some recent times there has been a tendency for us to feel we must reiterate our right to exercise our own options. Will the delegates comment on these matters?

Dr. Gilda Sedgh

On the variations in abortion rates across countries or the extremes, I am not interested in a systematic analysis or assessment of what explains the differences in abortion rates across countries. I am aware of research within some countries which indicates that the rate of unintended pregnancies and abortion is higher among minority and disadvantaged women, or women whose access to contraceptive, family planning and reproductive health services might be compromised. It is possible these inequities are more pronounced in some countries than in others. It is also possible the proportion of women who face these barriers or who are disadvantaged in some way is higher in some of these countries than in others. I am uncomfortable in even going there because I am speaking a little beyond the evidence. I am starting with evidence and speculating based on it. Otherwise, I do not know that I can explain well or find evidence to explain the differentials.

I take the point about Germany. These are broad categories with respect to abortion laws in various countries. On the whole, Germany is classified as allowing abortion on broad grounds, as is the United States. In some countries, including these two, restrictions are enacted, including counselling requirements, waiting periods, etc., which allow for cause degradation across countries in which abortion is allowed on broad grounds with respect to ease of access to legal abortion. However, I take the Deputy's point.

There is the human rights element and there was much reference to human rights. There is the UN Convention on the Rights of the Child, for example, which makes a comment in that regard. The EU Charter on Fundamental Rights also makes a comment. Does Ms Hoctor wish to comment on either of these? If we are to be even-handed in our debate, we must ask about the human rights of the woman and those of the child.

Ms Leah Hoctor

The important point of which to be aware is that under international human rights law, including the conventions mentioned by the Deputy and other treaties, the right these treaties contain and their provisions do not apply to pre-natal life. They do not apply before birth and only begin once a person is born. That is the starting point for international human rights law. It is very clear from the jurisprudence of all of the adjudicative bodies that oversee implementation of the treaties that they are of the view that women's human rights are violated or undermined when they are not able to access abortion care safely and legally. That is the legal approach to human rights in this matter.

I will also address the Deputy's original point about abortion to save the life of a woman. It is very important to understand almost all abortions - perhaps 90% or more - in European countries occur in the first trimester of pregnancy. That is a critical fact to keep in mind. There may be cases later in pregnancy in which women face difficult situations and may need to access abortion care and it is very important that they can do so legally. In Europe the vast majority of abortions take place within the first trimester.

I thank the delegates for their replies. I was a member of the convention on the European Union Charter on Fundamental Rights. We spoke for a long time about a reference before coming to the conclusion that everybody had the right to be born. That is from memory. The UN Convention on the Rights of the Child also states everybody has the right to be born. To be absolutely sure, I would like a comment on that issue.

Ms Leah Hoctor

I believe I addressed this issue earlier as Deputy Clare Daly asked a similar question. The wording in question in the UN Convention on the Rights of the Child is in a preambular paragraph. It is not in an article or a provision. It states the child "by reason of his physical and mental immaturity, needs special safeguards and care ... before as well as after birth". It is very clear from the drafting negotiations on the treaty that it was agreed by states that this provision did not mean that there was a right to life that would apply prenatally.

It was agreed that Article 1 of the treaty, enshrining the right to life, would apply from the time of birth and that is in line with the language of the Universal Declaration of Human Rights. It may be in a state's interests to take measures to protect prenatal life but human rights standards and jurisprudence have made it very clear that doing so cannot undermine the human rights of women. It is critical that states take an approach to law and policy around reproductive health care that places women's health and rights at the centre and works out from there.

I will have to check this but I believe that even the Holy See, in the negotiations of the convention on the rights of the child, understood that the language in the preamble did not prevent states from liberalising and legalising access to abortion care.

The centre for reproductive rights brought Ireland to court to seek changes to our abortion laws. Does Ms Hoctor consider that the pre-born child has any rights, in particular the right to life?

Ms Leah Hoctor

The centre for reproductive rights represented Amanda Mellet and Siobhan Whelan in their cases to the human rights committee. They were two women who had obtained diagnoses of fatal foetal impairment and were told by doctors and nurses here that they could not legally end their pregnancies here because of Irish law on abortion, so they travelled to the UK where they were able to access medical terminations. These women were of the view that they had suffered grievously in different ways and they wanted to work to ensure that other women would not suffer in the same way. Accordingly, they wanted to take their complaints to the human rights committee and they claimed violations of their human rights, which the committee found.

The question I asked was, "Does Ms Hoctor consider that the pre-born child has any rights, in particular the right to life?"

Ms Leah Hoctor

As I said to Deputy Durkan, under international human rights law the right to life, as enshrined, for example, in the international covenant on civil and political rights, is a right that accrues from birth and does not apply to prenatal life.

That answers the question but I do not agree with Ms Hoctor. The United Nations committee on the rights of persons with disabilities stated that legalising abortion on disability grounds was a violation of the human rights of people with disabilities under the convention on the rights of persons with disabilities. I travelled with some people to the UN in 2015 and attended the committee. What comment does Ms Hoctor have to make on that point?

Ms Leah Hoctor

I think the material referred to by the Deputy is a submission to the committee on the rights of people with disabilities from a few weeks ago. My understanding is that the committee on the rights of people with disabilities has never said that women who received diagnoses of severe fatal foetal impairments should not be allowed legally to access abortion care in their countries, or that a state should prohibit women's access on these grounds.

The committee raised concerns regarding the legislative modality through which a state does that and gave its view that states should not include explicit legal terms in their laws regarding foetal impairment. The committee has never expressed any concern about a woman being legally allowed to access abortion care and services. Some countries in Europe, such as Switzerland and Sweden, have a health ground in their law but no explicit ground for access to abortion for foetal impairment. Germany also has such a ground but in all these countries women obtain legal abortion services when they receive a diagnosis of fatal foetal impairment and the committee on the rights of people with disabilities has never expressed any concern with the laws of these countries. In fact, along with all the other human rights mechanisms, the committee has stressed how important it is that women can access sexual reproductive health care, including access to abortion care. The committee's concern is around the legislative modality, as opposed to whether women who are suffering due to diagnoses of fatal foetal impairment should be allowed legally to access care.

I attended a meeting of the committee and one of the women present had had a fatal foetal diagnosis but her child is now aged 11 and was with us. The committee made a statement on this quite recently, though the presentation was made in 2015. Two weeks ago, a UN committee also stated that "fatal" and "incompatible with life" were terms that should not be used.

Ms Leah Hoctor

Those terms are used by clinicians and physicians and are common in medical practice. The committee on the rights of disabilities did not state that women should not be allowed to access services when they receive a diagnosis of fatal foetal impairment - it simply raised the question of how the law does that and how the law should enable women to make decisions in the course of a pregnancy with a fatal foetal impairment. It also discussed whether or not the law should include an explicit term around foetal impairment.

I profoundly disagree. The HSE has issued new guidelines in recent times, discontinuing the use of the terms "fatal foetal" and "incompatible with life" and using softer terminology. I have brought forward a Private Members' Bill on the issue but the HSE has acquiesced already, with more compassionate and sensitive language on pregnant mothers or couples presented with such diagnoses. There is a clear conflict with what the committee has stated and the quotations Ms Hoctor has given from the United Nations. I do not accept her answers and I totally discount her answer to Deputy Durkan's questions to the effect that no life exists before birth.

The statistics given by Dr. Sedgh were very useful. They included the statistic that the majority of abortions are requested by married women, that more than half of women are between 20 and 29 years old, that most women who have abortions have at least one other child and that most abortions happen by the ninth week. These are very important scientific statistics that show that there is a lot of myth from those who oppose people's right to abortion in this country. We stick out like a sore thumb on the map, as an island isolated from the rest of Europe in this area.

Dr. Sedgh said we had no way of knowing exactly what the statistics are for Irish women seeking abortions abroad. Many Irish women go to Britain but many of them do not give Irish addresses and this is probably also true of Irish women who go to Holland. We have no way of gathering real statistics around women, abortion and this country. Dr. Sedgh is not a health professional but she informs health professionals. Does she, as a scientist, believe that not having absolutely correct and full statistical knowledge of how abortion impacts on Irish women is not a good thing for the health of Irish women? Does she believe that it is not good from the point of view of getting a full picture of the full reproductive health of Irish women or for informing ourselves as legislators?

As a scientist, does Dr. Sedgh believe it is unhealthy not to have knowledge of the full statistics?

I have questions for Ms Hoctor about the availability of abortion services. She talked about the stress and distress caused in having to leave one's country to have an abortion elsewhere, regardless of the reasons involved. As the doctor showed, there is a huge variety of reasons women seek to terminate a pregnancy. Having to leave one's country and suffer distress is a big issue when it comes to where Ireland falls down in protecting women's rights and, therefore, compensating them. Can Ms Hoctor add to that aspect? Importantly, statistics here prove that socioeconomic reasons are another huge factor for women. In other words, if one is poor or does not have the financial resources required, one will often, as the doctor said, be subject to procuring an abortion much later rather than as early as possible in the pregnancy. One is also put under much more stress and strain by having to get onto an aeroplane or a ferry and stay overnight in accommodation. On top of this, one cannot take one's partner or pal along because that would cause further stress and financial strain. Does Ms Hoctor think the socioeconomic reasons we are considering in women seeking to have an abortion are a big element in terms of the countries that allow women to access abortion services?

Dr. Gilda Sedgh

I thank the Deputy for her comments and questions. Before I discuss what we do not know and how useful it would be to know more, I acknowledge that for the women who travel to Britain for an abortion and admit that they are from Ireland, we have statistics for their ages and the gestational age at which they have an abortion. A very small share are obtained by adolescents and they are mostly performed within the first 13 weeks. I work in an organisation the mission of which is to conduct policy-relevant research and to support evidence-based policies. From that perspective, yes, it is unfortunate that we do not have direct evidence within Ireland on the reasons Irish women have an abortion, the numbers of Irish women who have an abortion and the circumstances in which they have them.

I have mentioned that Ireland seems to be an anomaly with respect to the proportion of abortions that are unsafe. We do not know how many of the clandestine abortions are performed by a trained person. Even among those who have an abortion that is medically safe, we do not know what proportion of women who have an abortion experience stress related to the stigma they experience having had an abortion or the stigma they are afraid they will experience. I have mentioned a review of 14 papers that comment on the pervasiveness of that experience among women who have had an abortion. In the absence of this evidence directly from Ireland, I hope evidence from other countries in the region and the developed world can help us to get a sense of the circumstances experienced in Ireland. To the extent that the Deputy's question is also a comment, I appreciate her comment that we need evidence to inform policies both here and throughout the world.

Ms Leah Hoctor

On the question of social inequality, it was something to which the UN Human Rights Committee pointed in its decision in the Amanda Mellet case as one of its considerations in what it termed the Irish law's failure to take account of her socioeconomic circumstances and the difficulties she would have faced in travelling to another country to access services there. It was a component part of the cruel and inhuman treatment the committee found she had suffered. It was also a component part of the finding of the committee of inequality before the law that she faced discrimination because of her socioeconomic status.

I refer the committee - I do not have the exact page number - to the World Health Organization's guidelines on safe and legal abortion. The WHO also specifies very clearly that one of the results of restrictive abortion laws is the creation of social inequalities.

I welcome the delegates for whom I have two questions, the first of which is for Ms Hoctor. I note that all of her comments were focused on making the case for abortion. Therefore, it would be fair for me to say hers is a campaigning organisation.

Ms Leah Hoctor

No.

Has the organisation ever criticised any aspect of the abortion industry? I do not expect Ms Hoctor to comment on specifics, but she may be aware, for example, that in recent weeks the Care Quality Commission in the United Kingdom brought to light information that Marie Stopes International gave bonuses to its staff members for convincing women to go through with an abortion, even in situations where they had decided not to go through with it. That is appalling behaviour in the name of choice. I assume that Ms Hoctor is aware of some horrifying stories from the United States, but I will not go into graphic detail. As a multi-million dollar organisation that campaigns on the issue, has the center ever commented on cases such as the one I have cited involving Marie Stopes International or is the abortion industry always given a free pass?

Ms Leah Hoctor

As I said in my opening statement, the Center for Reproductive Rights is an organisation that seeks through its legal and legal advocacy work to advance women's reproductive health and rights. It is important for me to clarify that it is a legal advocacy organisation which uses the law to advance women's reproductive health and rights which include access to safe and legal abortion care, quality maternal care for women who are in labour and access to affordable contraception services. We also work to prevent child marriage and forced sterilisation.

Has the center ever criticised anybody?

Ms Leah Hoctor

No; I am not aware of anyone.

Is Ms Hoctor aware of the organisation-----

Ms Leah Hoctor

Yes; I work for it.

No; is Ms Hoctor aware of the organisation that pays its staff members bonuses?

Ms Leah Hoctor

Is the Deputy referring to the report of the Care Quality Commission in the United Kingdom?

Ms Leah Hoctor

What is really critical about the example given by the Deputy is that it is the regulatory body in the United Kingdom that regulates and oversees medical practice. It is critical to understand all western European countries have highly effective regulatory bodies in place that oversee and monitor the provision of health care, including reproductive health care and abortion services. Also, if there are allegations of or concerns about malpractice or inappropriate service provision, the relevant regulatory body should investigate. That is what the regulatory body in the United Kingdom is engaged in, which is an appropriate response. That is why there are such bodies.

I have referred to vulnerable women who had made up their mind not to have an abortion, yet bonuses are paid to staff members who convince the women in question to change their mind. The centre must criticise such a practice. It cannot stand for it for one moment. To me, such a practice is totally and utterly wrong. Committee members have said women leave Ireland and spend a lot of money in travelling to the United Kingdom. However, staff members have been paid bonuses to encourage women to have an abortion.

Ms Leah Hoctor

I am not aware of the specific report or allegations mentioned by the Deputy. As I am not aware of them, I would not like to comment on or address them further.

In that sense and from a procedural point of view, it is important for Ms Hoctor not to comment on them.

I must leave to attend the meeting of the Select Committee on Finance, Public Expenditure and Reform, and Taoiseach which is taking place next door at which a vote will take place. I will return in about five minutes to ask Dr. Sedgh my final question. Is that okay?

Senator Paul Gavan has indicated that he wishes to make a comment. Of course, I will accommodate Deputy Peter Fitzpatrick if he makes it back. Deputy Kate O'Connell may want to ask a question too.

I thank the witnesses for their presentations. Today again validates the process we are going through. We are here to listen to facts and evidence. I do not think anyone can question that we are receiving an awful lot of good information, hard evidence and facts here today. I welcome that. Frankly, all my questions have been answered apart from one, which I will highlight. With regard to the sixth slide of Dr. Sedgh's presentation, some people will find it fascinating, although I was not surprised, that in the countries where abortion is prohibited, 37 out of 1,000 women have abortions while in the countries where abortion is available on request, that number is 34. In other words, there is a lower level of abortion where it is legally available. That might come as a surprise to some members of the committee. I know Dr. Sedgh has touched on this point already, but will she elucidate why abortion rates are lower in countries where it is available as against countries where it is prohibited?

Dr. Gilda Sedgh

I thank the Senator. The statisticians on our team would say that I was remiss if I did not point out that there is no statistically significant difference in the abortion rate of countries with restrictive abortion laws and those with liberal abortion laws because of the margins of error. Having said that, the Senator is correct. The point estimate is such that the abortion rate is actually lower on average in countries in which it is allowed on request. It is probably worth reinforcing what seems to be behind what we are seeing. First of all, in countries in which abortion is allowed without restriction as to reason we see some of the lowest abortion rates on record and also some of the highest rates on record. Those are the countries in eastern Europe and the average rate comes out to approximately 34. What differentiates the countries with high abortion rates from those with low abortion rates is not the legal status of abortion in those countries, but the level of unmet need for contraception or the proportion of women who wish to avoid getting pregnant and are not using a method of contraception. We would see a completely different chart if, along the bottom axis, one was looking at the level of unmet need for contraception. One would see very different abortion rates in those groups of countries. I hope that makes sense.

It does. One other point occurred to me. Dr. Sedgh or Ms Hoctor pointed out, rightly, earlier that there was quite an unusual situation in the Soviet Union and the other eastern countries, and that is why we have seen this dramatic reduction in the abortion rates. Allowing for that and assuming the rate continues to drop, the differential between lower rates of abortion will actually be larger between countries with freely available abortion and those where it is prohibited. Would that be a fair comment?

Dr. Gilda Sedgh

If the abortion rate were to decline further in eastern Europe, we would see an even lower abortion rate in the group of countries where abortion is allowed on request, yes.

I thank Dr. Sedgh.

I have just a few quick questions. I apologise if I am repeating anything which was asked recently, I was in the Chamber for another matter. Is there any other country in Europe where there is this constant argument or discussion about the life of the live mother, who is walking around pregnant, being given equal weighting to the life of the unborn child? It seems to be a constant discussion in this country. Have other countries dealt with the same issue and, if so, how did they get through it?

On the ninth week of pregnancy, is Dr. Sedgh counting from conception, implantation or date of last period? Will she clarify that? When we look at the hard copy of Ms Hoctor's presentation, particularly the slide on time limits for unrestricted access, do all these countries use the same standard? Do they use either conception point or date of last period? Perhaps the witnesses could clarify that. I have noted from some of the documentation that perhaps we are comparing apples and oranges in some cases. For this chart to be truly, factually correct for the committee, the starting point needs to be the same. We do not want the committee to fall out over the number of weeks. If we are doing this, we want to do it correctly.

Ms Leah Hoctor

We have sent copies of all the relevant laws which are referenced in the chart to all members of the committee and we have hard copies here. It would be possible to check which countries have the ten week limit, for example, and to assess where the starting point for that limit is. The practice across Europe differs significantly in respect of the starting point.

What I am really getting at it is whether a ten week limit could actually be a 12 week limit, depending on where one begins to count from. Does Ms Hoctor understand what I am saying?

Ms Leah Hoctor

We would need to check but we can do that for the Deputy.

It would be helpful so that we would not have to deal with so many starting points.

Dr. Gilda Sedgh

It would be better to wait until Ms Hoctor is able to check but, from what I recall, it is more common for the clock to start at the last missed period. Therefore it might be that a ten week limit is actually an eight week limit. It is more likely that abortions are happening at an even earlier gestation than is shown in these charts.

That is what I take from the information myself, but I would like the witnesses to clarify it if they have the capacity to do so. It would be helpful to the committee to know if one country's limit is 12 weeks, but that it is actually ten. Will the witnesses comment on the balancing of the rights of the woman walking around pregnant and the unborn child? How have other countries dealt with that?

Ms Leah Hoctor

No other country in Europe has a constitutional provision like that. Andorra, Malta and San Marino, which are very small countries on the map, have highly restrictive abortion laws and do not allow abortion at all or only to protect a woman's life. Of those, I believe only Andorra has any form of constitutional provision on the question but it does not equate the right to life of a woman with the right to life prior to birth. It just speaks about recognising the right to life and protecting it in its different phases. There is no equation of the rights. My understanding is that the Phillipines may be the only country in the world to have a similar provision to the Irish Constitution. Again, we would have to check this and come back to the Deputy. I believe that provision was adopted after the provision in the Irish Constitution was.

I would like to thank both witnesses very sincerely for their time here today. It has been very helpful and will help the committee with its work.

I should point out that Deputy Fitzpatrick wanted to come back in if he had returned. I will perhaps try to delay by asking a question.

Just in the interests of Deputy Fitzpatrick. I would not want him coming in and-----

I thank Deputy O'Brien for extending the session.

I will have to come up with a question now off the top of my head. Somebody better give Deputy Fitzpatrick a shout and tell him that we are finished in two minutes. He is at the Select Committee on Finance, Public Expenditure and Reform, and Taoiseach.

He is here.

That is grand. I will ask the question anyway. There has been a lot of talk around equating the right to life of the mother to that of the unborn child. I think we sometimes get away from what is in the best interests of women's health. That is what the committee should be looking at in my opinion. If we were to start with what is in the best interests of women's health and women's health care, in Ms Hoctor's expert opinion would it be fair to say that standards of women's health care are better in countries where there is a more liberal regime in respect of terminations than in countries where there is a very restrictive regime? Would that be a fair assessment in Ms Hoctor's expert opinion?

Ms Leah Hoctor

In my expert opinion, when one takes a global perspective, yes. As a general rule, countries that allow abortion on a woman's request or on broad socioeconomic grounds, which are mainly countries in Europe or other OECD countries, do not see high rates of unsafe abortion or of maternal mortality. In countries where there are highly restrictive laws and which do not take a women-centred approach to law-making around reproductive health and abortion, which are largely countries outside of Europe, there are often much higher rates of unsafe abortion and maternal mortality and morbidity.

I am not differentiating between physical or mental health but, for the general health care of a woman, it would be better to have termination on request up to a certain point.

Ms Leah Hoctor

Most European laws we looked at, and we looked at 40 countries in some detail, would have a general provision on health. In almost all cases mental health would either be explicitly listed there, together with physical health, or else implicitly interpreted into the ground.

Thank you. On a point to Deputy Fitzpatrick, the Marie Stopes organisation has a statement on its website with regard to what Deputy Fitzpatrick had referred to earlier. It is up to the witness whether she wishes to respond. The Deputy can take up where he left off.

Dr. Gilda Sedgh

The Deputy was going to move on to ask a question of me. I think Ms Hoctor had answered his question to the best of her ability at that point.

Ms Leah Hoctor

Yes, I felt I would not be in a position to comment.

I apologise to the Chair but there was an issue with the Finance Bill.

My question is for Dr. Sedgh. I know that in recent years she has severed her links officially with the International Planned Parenthood Federation, IPPF, but I think I am right in saying she has a long historical link with that group, which is one of the largest abortion providers in the world. I note that, in her presentation, she talks a lot of facts and figures but she does not talk about how many people have been saved by the eighth amendment. My question to her is this: does she think anyone has been saved by the eighth amendment?

Dr. Gilda Sedgh

I appreciate the Deputy bringing up our relationship with Planned Parenthood Federation of America, PPFA. That is on our website, the information is available and I am happy to make it available here. When the institute was founded in 1968, we were housed in the corporate structure of PPFA. In 1977 we became an independent organisation with an independent board of directors and our affiliation with PPFA was eventually dissolved.

I am familiar with estimates or assumptions about how many abortions have been averted by virtue of restrictive abortion law in Ireland. I think the assumptions on which those numbers are based are dubious. I could get into that if one wanted me to.

The question I am asking is whether Dr. Sedgh thinks any lives were saved by the eighth amendment. It is not a hard question.

Dr. Gilda Sedgh

I am trying to comment on whether abortions have been averted and I am not sure the extent to which abortions have been averted by virtue of the eighth amendment. I think that is my answer to the Deputy's question.

Sorry, I do not understand. What is the answer - yes or no? Have any lives been saved by the eighth amendment?

Dr. Gilda Sedgh

I think the Deputy is asking me to take a position on whether a terminated pregnancy is the end of a life and that is not something on which the institute has taken a position. The position of the institute is that there are a lot of perspectives on when life begins and that women's reproductive health is best ensured when women are able to make decisions regarding their reproductive lives and reproductive health in consultation with their partners, with their faith leaders and with their health care providers. That is the position of the institute and I think that is what the Deputy is asking me.

As a bottom line, there could be one, two or 100,000. Dr. Sedgh just does not know.

Dr. Gilda Sedgh

I cannot speculate on that.

But she has severed her links with the International Planned Parenthood Federation. That is gone a good while now.

Dr. Gilda Sedgh

Planned Parenthood Federation of America. Yes, we are no longer with affiliated with PPFA and we are not affiliated with IPPF.

I am very disappointed that the two organisations present will not give me any comment about the eighth amendment. They seem to know everything else and seem to have answers for everything else. I just asked a simple question about the eighth amendment, which is a massive issue here in Ireland. In fairness, we invited both here today and I am sure they knew the main issue was the eighth amendment. One would think they would have done some kind of investigation into the eighth amendment. The taxpayer pays for these people here today. I am asking a simple question and I cannot get a simple answer.

In fairness, there is no obligation on a witness to give a "yes or no" answer under fair procedures. I think they can answer the questions in whichever way they wish. Perhaps it is an area of speculation that we would like the witnesses to venture into. In fairness to them, I think they have answered in the way they wish to answer. Deputy O'Brien has a point of clarification.

I think it is fair to say claims have been made that lives have been saved as a result of the eighth amendment. I think we have a group coming in who made that-----

In fairness, I did not ask the Deputy. I asked the two witnesses this question.

I am not talking about the Deputy. I am not even commenting on what he is saying.

Deputy O'Brien did not ask a question so that Deputy Fitzpatrick could ask his question. He did not use all his time so I was allowing him back in, to be fair.

That is fair enough.

I believe a group is coming before the committee whereby we will get the opportunity to discuss the methodology they use in their claims. I think we should reserve judgment until we get to question them.

They are not coming.

They are not coming so we will not get to question their methodology. However, it is also fair to say it is beyond dispute, given the evidence we have heard before this committee from people in the medical profession, that the eighth amendment has actually cost people their lives as well. I think that should also be put on the record. That is the only evidence that has been presented before this committee which I can stand over, namely, that the eighth amendment has actually cost at least one life and we do not know how many others. I have not heard any evidence before this committee that the eighth amendment has actually saved any lives. If somebody wants to come forward and present that evidence, I am sure the committee will be more than happy to deal with it.

We will be more than happy but I will not ask the witnesses to comment on that because it is in the area of speculation to some degree. I thank Dr. Sedgh and Ms Hoctor most sincerely. We will suspend before calling Dr. Fletcher.

Sitting suspended at 4.28 p.m. and resumed at 4.30 p.m.