An establishment view of the referendum that won Repeal - In the Shadow of the 8th review

Date:

Book length histories of the Repeal referendum have started to appear. That this second one is an autobiography is in itself a testament to how long the 8th Amendment ruled over us. The 8th amendment takes up about half the space of Peter Boylan’s ‘In the Shadow of the 8th’. Boylan was an obstetrician who retired from Holles St in 2016, he was a prominent spokesperson for Repeal in the referendum of 2018 and was then central to the implementation of abortion access in the aftermath of winning that referendum. In telling the story of his medical career he tells the story of how the 8th shaped it.

His perspective on the struggle against the 8th is very much an establishment viewpoint. Indeed the grassroots movement to force a referendum doesn’t get much of a look in at all, outside of the mention of demonstrations following the death of Savita in 2012. His account focuses on what was happening in medical and government circles in the years following 2012, with activism only reappearing when he is asked to speak at the March 2018 launch of Together for Yes. The Abortion Rights Campaign only gets 3 mentions, and all of the form of introducing a person as ‘X of the Abortion Rights Campaign’ in the section on the launch of Together for Yes. For the purpose of the review I’m not going to dwell on the obvious problems with his approach but rather on what useful information the book has to tell us about the successful campaign to get rid of the hated 8th. As such this book is another partial telling of a story, a story that cannot be told from any single viewpoint.

The middle third of the book is very much focused on the last 6 years of the struggle to get rid of the 8th amendment, a story Boylan starts with the death of Savita rather than the earlier protests against the Youth Defence abortion shaming billboards. The early chapters do provide some useful context, in particular for readers outside Ireland or indeed younger readers living here. In particular the chapter that tells the story of the struggle at the National Maternity Hospital from 1992-1994 to allow elective sterilisations (tubal ligations). At the time church control of the hospital meant these were banned.

When he announced that elective sterilisation were going to be provided in a 1992 newspaper interview he was summoned to the Archbishop's palace,
“Bishop Moriarty did most of the talking and got straight to the point in relation to the introduction of sterilization in Holles Street. What I was doing, in their view, was resulting in women having operations that were not medically indicated and were therefore unjustified. Their argument was based on the orthodox Catholic doctrine that the marital act, sexual intercourse, had to remain ‘ open to the gift of new life ’. … I also informed them that I was not going to reverse the decision, as I felt that that would not be in the best interests of women. Sterilization, I said, was a matter between a woman and her doctor, and the Catholic Church should not interfere in the doctor – patient relationship” (p. 48).

Three years later the number of sterilisations performed had risen from 10 a year to 445, which is not to say all restrictions on access have been lifted.

The horror of the 8th

The autobiography is most useful in relation to understanding the medical, legal and legislative background of the Repeal victory, and the limits of that victory. This isn’t the story of the movement in the streets, that has yet to be written, but of the impact of the 8th in the hospitals and the manoeuvrings of some medical workers to get a government to finally call a referendum to get rid of it. The chapters on the death of Savita Halappanavar and the denial of abortion and then imposition of a caesarean as an ‘alternative’ on Ms Y are essential if harrowing accounts of the dreadful impact the 8th amendment had on their lives. Savita and Ms Y were both migrant women of colour, a group for whom the 8th had additional impacts including in the case of Savita & her family not suspecting that such a piece of misogynist legislation existed.

It may be worth quoting from Boylan’s description of what Ms Y went through at length to underline the additional barriers migrant women faced under the 8th and some of which still exist today and others which have been removed.

He summarises it as
“The process was becoming positively Kafkaesque. Ms Y spoke no English, had no money, was severely traumatized and was living in direct provision accommodation

and then details just what many of the barriers were;
“The young woman who became known as Ms Y was a refugee from a particularly violent war zone in Africa. She arrived in Ireland on 28 March 2014. She had been raped repeatedly, and did not know she was pregnant until a test was done as part of a health screening check in early April …. On 8 April she was seen at the IFPA and the pregnancy was again confirmed. Ms Y, who did not speak English, became very distressed, but not (yet) suicidal, and requested a termination. The legal situation in Ireland was explained to her through an interpreter : she was not eligible for a termination in Ireland because her life was not at risk ... At the end of May, the question of adoption was discussed at a consultation at the IFPA. She was now fifteen weeks pregnant. Her response was clear – she would ‘ rather die than have this baby’. Ms Y was given forms to fill out, and it was explained to her that she would need nearly €1,300 in order to travel to the Netherlands for a termination ... She would have to arrange the appointment in the clinic herself, since the Regulation of Information Act 1995 specifically prohibited anyone making an appointment on her behalf. She also needed a Garda National Immigration card number, an up -to -date bank account showing sufficient funds to cover her journey, a copy of medical travel insurance, details of booked accommodation and details of return travel arrangements that could be secured only by making a credit card payment. Temporary travel documents from the Irish National Immigration Service also required that she have a PPS number ... On her own initiative she took a ferry to Liverpool around this time in the hope of accessing a termination there. UK immigration officers detained her on arrival and sent her back to Ireland." p111

Boylan brings us through all the medical details as well as the enquiries and picks apart the dishonest deflections deployed by anti-choice activists of whom he says “Describing oneself as pro-life has always seemed to me to be either a cynical or an unthinking attempt to occupy the moral high ground while demonstrating little or no empathy with fellow human beings who are mothers, sisters, friends and colleagues” (p. 76).

Boylan was involved in many of the investigations that followed Savita’s death concluding,
“At the end of all five investigations, there could be little doubt that had Savita Halappanavar’s pregnancy been terminated on either the Monday or the Tuesday, she would not have died. It was also clear that there were serious systemic problems in University Hospital Galway that gave rise to an environment that was not conducive to patient safety. As the HIQA inquiry made clear, these were not confined to Galway. The events in Galway shone a spotlight on chronic underinvestment in Irish maternity services over decades (p. 99).”

He doesn’t pull punches in talking about the problems created by our chronically under funded health service, both here and in the later chapters that talk about the problems this created when it came to providing surgical abortions.

His straightforward statements putting responsibility on the 8th for the death of Savita made him a target for the anti-choice movement in 2012 and the years that followed. Running through the later part of the book is a commentary on the anti-choice movement, the efforts they made to ‘get him’ and some well deserved scorn thrown in their direction.

He writes that on May 1st 2013,
“a group of eleven doctors wrote to the national newspapers, saying that ‘ much of the public attention appears to have been directed at the expert opinion of Dr Peter Boylan, who suggested that Irish law prevented necessary treatment to save Ms Halappanavar’s life. We would suggest that this is a personal view, not an expert one. ’ It was signed by eight consultant obstetricians, a consultant in emergency medicine , a consultant microbiologist and a consultant anaesthetist. All were known for their anti - abortion views, and some had spoken at anti-abortion events or in the media, including the lead signatory, Dr John Monaghan, as well as Professor Eamon O’Dwyer, Professor John Bonnar and Dr Trevor Hayes (p.89).”

Boylan presents this attack as managed by anti-choice campaigners including John McGurk. We are informed
“I subsequently reported all eleven signatories to the Medical Council on the grounds that the letter and its distribution by a known Pro Life campaigner was a concerted and coordinated attack on my professional reputation.”

And that,
“In the course of their responses to the Medical Council none of the signatories admitted knowing John McGuirk. This puzzled me . If none of the signatories knew of McGuirk, how had he managed to get a copy of the letter before publication?” However “The Medical Council did not find the doctors guilty of professional misconduct, and I decided not to take the case any further: as far as I was concerned my point had been made. I had learned something about anti - abortion campaigners, however, that proved useful in the years ahead. They agree a party line on an issue, and then various spokespeople advance it across multiple platforms – radio, television, print and social media – over a few days (p. 90) .”

Pills - direct action delivered

Boylan usefully admits that one of the major pressures for change was the direct action of thousands of people who were supplying and taking abortion pills illegally.
“The key point I had decided to argue to the Committee was that in 2017 the Eighth Amendment was unworkable. Thirty - four years earlier, when it was inserted in the Constitution in 1983, the internet was in its infancy and the abortion pill did not exist. Now, however, we knew that the number of women buying abortion pills online and importing them illegally was on the increase (p.187).”

Notable here is the work of Need Abortion Ireland, who worked with Women Help to provide guidance, advice and financial support for people wishing to secure safe abortion pills online. Need Abortion Ireland disbanded in January 2019 but access barriers still remain around access to abortion services for in people in rural areas, direct provision and homeless who may still rely on self administrating a medical abortion.

This point is repeated later in the book: “A major concern for the Institute was the increasing importation of abortion pills and their use without medical supervision (p. 203).”

There is valuable insight into the attitudes of medical professionals here. For years, Doctors for Choice was the only visible pro-choice voice emerging from the medical profession. Here they are mentioned only in the context of the Citizens Assembly on page 119. Boylan himself admits that,
“At the time of the 1983 referendum on the Eighth Amendment I was working day and night in Holles Street, and the campaign passed me by almost completely. Looking back, I find this ironic, given how central a role it played in my later life (p. 19).”

Fast forward and in the aftermath of the death of Savita he says, “With repeal of the Eighth in mind, in September 2014 I decided to stand for election to the position of chairman of the Institute of Obstetricians and Gynaecologists (IOG)”

For a very long period, the only medical workers taking a public stand were the small handful of GPs around Doctors for Choice.

Boylan observes,
“Somewhere in the middle were a number of colleagues who had surprised me during the Citizens’ Assembly and Oireachtas Committee deliberations by expressing the view that the debate was of no interest or concern to them. Even more surprising: some of these colleagues were women. Irrespective of their views, they were detached from the debate, seeing it, I think, as a political or legal matter – a ‘women’s rights issue’ – that did not concern them in their day - to-day medical practice. Perhaps it was relevant that the political impetus for repeal had come from the Labour Party, which had opposed the amendment in 1983, and from radical left-wing politicians, not the natural milieu of many Irish medical consultants (p. 196).”

Boylan's eye view of the campaign

On the campaign itself, Boylan is hardly an expert witness. Indeed as he says,
“When I had turned up for the launch of Together for Yes on 22 March, I had not seen myself as ‘ campaigning ’ in a political sense. I had based my words that day on my medical experience and would have been more than happy to address groups who opposed repeal, but none invited me to speak ... So, while I didn’t consider myself a campaigner , when Amy Rose Harte asked me if I would become more involved with Together for Yes, I agreed . Since I had already been accused of ‘ campaigning ’, I figured I might as well be hanged for a sheep as a lamb (p.208).”

Boylan, who would be aware of the criticism the campaign came under from political journalists when it was in progress only for those same journalists to declare victory was always inevitable afterwards, is careful to credit the work done saying,
“It was obvious that the Together for Yes leadership was working to a clearly defined strategy that moved through well - planned phases , with the focus on personal stories and medical advice. Essentially, this was a campaign being run quite brilliantly by an exceptional group of women (p.208).”

In these chapters he namechecks dozens of the Yes campaigners he came across, even if there isn’t the available space to list all 19,000 who canvassed. He does write,
“Everywhere we met enthusiastic young volunteers . Their determination to make things right for women and change Ireland was palpable. All told of conversations they were having with parents and grandparents, and on doorsteps around the country. Some of those conversations were difficult, but they persisted. Sometimes, they said, they were pushing an open door (p. 210).”

Perhaps one of the hardest aspects of the aftermath is few of those foot soldiers can get a mention. Although thousands put their lives on hold to ensure victory, only a selection of their names can make it to the books that are now being written.

His observations on the anti-choice No side during the referendum are of interest as he was targeted by their leadership during and after in his various campaign appearances.

He notes that,
“The problem for the anti - repeal campaigns , however, was that as time went on and people understood the issues and heard personal stories, they realized that, far from being ‘ simple ’, the situations that women might find themselves in were complex and nuanced . And in such circumstances the No side campaigners had no solutions to offer (p.213).”

Of the infamous Clare Byrne Live TV debate, which he describes as like a “bad episode of The Jeremy Kyle Show or as I was to tell Pat Kenny on Newstalk the next morning, like something straight out of ‘ the Trump playbook ’”.

He then says,
“Because the No side had two separate campaigns, it was never quite clear in advance who would appear at debates, especially as relationships between the two groups began to deteriorate in the last couple of weeks before the referendum vote (p. 218).”

He adds that during the ‘debate’,
“not one parent from TFMR was asked to speak, even though they had been specifically invited and told they would have an opportunity to tell their stories. On the panel we could hear No supporters in the audience hissing and jeering the TFMR parents with taunts of ‘ murderers ’, but this was inaudible to the TV audience at home (p. 219).”

Overall there is little to argue with his analysis towards that end that,
“relations between the two No campaigns – Save The 8th and Love Both – were deteriorating. Between them they had fewer volunteers than the Yes side and were getting tired and stretched. Egos were also starting to dominate. Buoyed by her Claire Byrne Live appearance, Maria Steen believed she would be a strong performer in further media events, and this resulted in Cora Sherlock being marginalized . In the final week the No campaign imploded. A huge chink emerged in their central argument when they started hinting that something could be done for fetal abnormalities without repeal. Not only was this untrue, but the shift in position came too late, and, crucially, it undermined their core message that there were no problems with the Eighth and that termination was always wrong. Also, they couldn’t find enough doctors to present their case (p.223).”

Inside view on implementation 

Probably one of the most useful sections of the book will be Boylan’s account of what happened after the referendum victory when he phoned Minister Simon Harris and, “suggested that someone needed to drive the project and coordinate the different elements, and if he though it might be useful, I was available. The Minister agreed”.

As Boylan was central to the implementation process, his observations on it carry a lot of weight, between then and the end of the year he says he “attended 83 meetings, dialled into daily conference calls, and visited most of the maternity hospitals or maternity units around the country”.

In particular Boyle locates the most significant flaw in the legislation, the entirely medically unjustified 3 day waiting period in “a political compromise designed to give Táinaiste Simon Coveney cover to support the government's repeal position.” On page 249 he reveals there was even a last minute fear that the insertion of a 3 day waiting period into the bill might lead to defeat of the legislation in the Senate as “pro-choice Senators might vote against it.”

In terms of the review of legislation in late 2021 the removal of that waiting period has to be a key demand. Even establishment figures like Boylan present it as resulting from internal Fine Gael maneuvering. This further underlines why it has to go. Likewise its also worth remembering that the Citizens Assembly had a majority for abortion on request/demand. It was the politicians who reduced that to the current 12 weeks.

It’s worth noting in passing that the documents outlining the significant flaws in the legislation prepared by the Abortion Rights Campaign and other activist groups don’t even get a mention in this section. One would wonder if they were even read in the return to business as usual once the work of winning the referendum was done and policy returned to the realm of politicians and senior medics. Boylan reveals here the very limited scope activist groups had to influence the legislation through lobbying and thus the importance of street protests like the annual March for Choice.

This section of the book underlines the chronic lack of investment in healthcare. The discussion on the practicalities of ensuring hospitals provide surgical abortions is far more caught up in the problems of a medical services already stretched beyond breaking point than it is in anti-choice sabotage and conscientious objection. Many of the current problems with abortion provision are problems of the state of the healthcare system in general and the way it treats women in particular. Repeal was never going to change that, Fine Gael neoliberalism remains at the helm there.

While the closing chapters on the finalising of the legislation after the referendum and then its implementation are of great interest, it’s also were Boylan’s account setting gets out of hand. Up to this the point, his scorn has been directed at various bishops, anti-choice medics and the anti-choice campaigners. In Chapter 19, which focuses on post-referendum implementation, he rips into a range of medical figures whom he considers to be have been too hesitant when it came to implementation, in particular those involved with the Dublin maternity hospitals.

He says ‘at the time of writing’, so presumably around August, that 10 out of 19 Irish hospitals are proving full abortion services with the goal of all 19 doing so. However, he worries that smaller units like Kilkenny may be sabotaged if all the consultants there claim to be conscientious objectors. After a slow start 325 GPs have signed up as abortion providers. 80% of abortions are provided by GPs (who can provide medical abortion up to 9 weeks), that average is rising towards 90%.

Winning seldom means the end of a struggle

Returning to an earlier chapter Boylan tells the story of how in 1978, a doctor Dermot MacDonald working at the National Maternity Hospital, ‘wanted to perform a sterilization operation on a woman who had serious medical and social problems. He informed consultants and other staff, and also the archbishop of Dublin, Dermot Ryan, chairman of the hospital board, of his intention.

After protests from some staff grew,
“Archbishop Ryan put it to Dr MacDonald that this might be a resigning matter . MacDonald, however, was determined and proceeded with the sterilization, assisted by Declan Meagher, his immediate predecessor, and a number of younger nurses”.

In the aftermath,
“John Stronge, in conjunction with the ethics committee, laid down a policy expressly forbidding the procedure as a method of family planning. It was permitted only for medical reasons, where it was clear that future pregnancies would be dangerous for a woman (p. 45).”

I remember speaking at an anarchist conference in Spain around 1994 and as part of an introduction to Ireland saying there was no divorce. Uproar broke out around the hall and someone explained that they thought the translator had made an error and that I meant you could not remarry in church. No, I had to explain, there really was no divorce at all. Two years later, by only 0.3%, Ireland voted in a referendum to introduce very restrictive divorce provision.

I turned 18 the year of an earlier failed attempt to introduce divorce. In the decades since I went from being handed an injunctions for simply distributing the Womens Information Network phone number, through the period where books with British clinic contact details were removed from public libraries to the current situation where an estimated 5,000 abortion will be provided in Ireland this year . Even in the first month of operation the number of women giving Irish addresses while accessing abortion in the UK had fallen by ¾ according to BPAS figures. The 25% initially having to still go to Britain reduced further as access spreads, the most recent figure we found suggested it was 15% in March 2019. It is the case that because some are left behind by current legislation there will always be some forced to travel, and worse still others unable to access abortion here but also unable travel.

For people in countries where abortion provision has existed for decades, the limitations of what has been achieved stand out. For those of us who lived for decades under ‘the shadow of the 8th’ the victory of May 2018 still seems overwhelming, something few of us expected to see. Boylan’s account perhaps helps to understand just how transformative Repeal was, even as we move to tear down the restrictions put into the legislation by the politicians jockeying for position.

Andrew Flood (Follow Andrew on Twitter)

Addendum: This and the previous Its a Yes book I reviewed mean we now have a top down view of much of the process behind the referendum win. Huge gaps remain in the story and I’m interested in helping to fill those. Few people can write books (or lengthy reviews) so in particular if you consider yourself an anarchist and you want your story recorded email me at andrewnflood AT gmail.com and I’ll record and upload an audio interview with you. See https://anarchism.pageabode.com/andrewnflood/winning-repeal-lessons-abortion-ireland

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