What do we really know about abortion?

I was born in 1976. Catholic family. Home-made white dress for Communion. A brief religious vocation at the age of nine (I decided the Medical Missionaries of Mary would cover all my ambitions).

I guess I first heard the word ‘abortion’ in 1983, when other words like ‘SPUC’ and ‘Pro-life’ were becoming part of the background hum on the news. No-one wanted to explain to the seven-year-olds what all of this meant, so we just assimilated the emotions that these words induced in the adults around us, which seemed to be universally negative. Shame, fear, embarrassment, anger — these seemed to emanate from grown-ups whenever the topic was raised.

All children are acutely tuned-in to adults’ emotions and it was very obvious to us that this was not a subject to be curious about, if you wanted to keep the peace and improve your chances of getting your pocket money.

So it was a mysterious, malignant word, which was something to do with babies, who had something to do with women but not the right kind of women, and there was definitely sin involved.

It was some time later, probably when I was around 15, that I came to fully know what an abortion really was. The deliberate killing of a baby (the word ‘innocent’ is usually inserted here, but I am not sure if that clarification ever needs to be made). Rumours of knitting needles and hot baths and bottles of vodka. Then further gruesome details came from wider reading: Dismembered bodies, crushing, vacuuming. It was completely obvious to me now why the adults had reacted so strongly to the idea. It was repugnant and evil and clearly, clearly wrong.

The years passed and the time came when I thought I could be pregnant when I didn’t want to be. Suddenly, the absolute firm conviction that abortion was abhorrent began to show some cracks. The crisis passed, the period came, and the decision never needed to be made.

Learning about embryology and foetal development revealed that while all zygotes are of course potential humans, the path from fertilisation to delivery is in fact incredibly precarious and by no means a foregone conclusion. The number of things that could halt or tragically alter the process seemed infinite. Much later on, I was to find out myself that pregnancy frequently does not result in life.

I was present when a baby with Trisomy 18 was born. There was utter silence in the room.

I went on to meet women who had had abortions. I started to learn language so I could discuss this with them. I have never once, though, heard first-hand what the experience is like, where they went, how much pain they had (physically or mentally). I was somewhat unclear on the law, and I figured erring on the cautious side is always a good rule of thumb. So I would acknowledge their experience, enter it as a private note on the software system, and make what I hoped were soothing but entirely neutral noises. I had no cultural or social framework around which to position myself, other than the ingrained ‘sinner’/‘murderer’/‘fallen woman’ narrative.

Any of us who has lived, learned and worked in Ireland for all of our lives are likely to be in a similar situation. We simply have no real concept of a society where abortion is a sad-but-true fact of life. We cannot envisage a world where there isn’t a number of lifetimes’ worth of secrecy and shame attached to the act. Getting our heads around the idea of this being a routine part of women’s healthcare is plainly mind-blowing.

We can look to other countries to learn from their experience. We can seek out the best evidence, the newest studies, the most up-to-date facts to help us to form a brand new service that matches or exceeds international standards. We can write protocols and develop service plans and produce guidelines. We need to do this to ensure patient safety. We also need to do this to catch up on all the years of education on this topic that we missed out on, because we never needed to know it. We need a crash-course on this, so that politicians and policy-makers with different agendas do not bypass our knowledge and experience and forge ahead with a substandard plan.

It is terrifying though, because it is completely outside our comfort zone. Our instincts will be to push this away. To say ‘yes, but not in my surgery’. To acknowledge the democratic decision of the people, but to balk from being the one who has to do the ‘dirty work’. To grapple with <em>primum non nocere</em>, and how it fits with what we are being asked to do.

There are no simple answers to this. It is not a clinical dilemma, or a diagnostic conundrum, or a therapeutic decision. It is a complete upheaval of everything we have ever been taught. We have  subliminal, cultural and emotional core beliefs around abortion that come from a lifetime of pushing it out of our minds. We can no longer push it out of our minds.

The START group (Southern Taskgroup on Abortion And Reproductive Topics) is one of a number of groups that have formed throughout the country recently, whose aim is to try to address these issues, and to accept that we can no longer keep our heads in the sand. If we want this done right, we need to start now.

See <a href=”http://www.startireland.ie”>www.startireland.ie</a>.