Savita Halappanavar: What Neither Side Wants to Admit about Choice
Reading Savita: The Tragedy that Shook a Nation, brought me back to a conversation I had three years ago when my then-partner and I were considering a move to Ireland, but she balked at living in a country where abortion was illegal. I thought that was a little dramatic. I couldn’t imagine a situation where we would be unable to travel to England for an abortion (as many thousands of Irish women do every year) if ever the need arose. But then I never imagined a story like Savita Halappanavar’s, first reported by Irish journalist Kitty Holland shortly after her death and expanded upon in book form.
Savita and Praveen Halappanavar relocated from India to Galway, Ireland, as a newly married couple in 2008. In July 2012, Savita discovered she was pregnant. Around October 20 she began to miscarry. The next day, she was admitted to hospital with an open cervix—a condition that put her at a risk of serious infection. The senior obstetrics registrar, Dr. Andrew Gaolebale, told her, “The baby won’t survive.”
What happened next is both tragic and startling. With no chance of the fetus surviving, Savita was denied a termination of her doomed pregnancy be-cause, as senior midwife Ann Maria Burke explained, “It’s a Catholic thing. We don’t do it here.” Abortion was not legal to protect the health of a woman, only to save her life (and even that was unclear). At that moment, Savita’s life did not appear to be in danger. Consequently, the medical staff waited until the fetal heartbeat stopped and fetal demise was confirmed. Fetal demise occurred 63 hours after the rupture of Savita’s membranes. An hour later she spontaneously delivered a stillborn fetus.
Savita likely miscarried due to septic infection. For 63 hours, however, her infection was poorly managed and she was left with rotting tissue and a dying fetus inside her. She catastrophically transitioned from sepsis to septic shock. At 1:09 am on October 29, Savita died.
On the surface, Ireland is a modern state with all the advantages of 21st century Europe. The schools are good, the water is clean, the transportation system works, the hospitals are modern and safe and so on. As Holland explains, “To this educated, worldly young couple Ireland was part of Europe and seemed to offer all that the West could have.” Savita’s death shattered that view. Here was an otherwise healthy young woman in the midst of a miscarriage. There was no prospect of the pregnancy continuing, and yet she was denied the most relevant treatment because of a “Catholic thing.” Suddenly, Ireland was revealed as something more ancient. The reference to Catholicism, Holland writes, “dislodged the comfortable notion that Ireland was now a worldly country that could act on the international stage unquestioned, could invite the best and the brightest young things to live and work here, people like Savita and Praveen, and show them a life as good as anywhere else.”
One enduring legacy of the overlap between the Irish state and institutional Catholicism is an almost implacable opposition to abortion. Various cases have demonstrated the extremes of Irish abortion opposition. In 1992, a 14-year-old girl (known as “X”) was repeatedly raped and became pregnant. Although she was suicidal, her freedom to travel was restricted to prevent her from obtaining an abortion outside -Ireland. Subsequently, X miscarried, but not before the right of pregnant women to travel was upheld in Ireland’s Supreme Court.
In 1997, a 13-year-old girl (“C”) was raped and became pregnant. Again, her right to travel was challenged. In this case, however, Justice Hugh Geoghegan clarified that C was entitled—not only to travel—but also to abortion in Ireland because of the risk of suicide. This interpretation of constitutional law, however, was not translated into statutory law, which would require an act of the Oireachtas (Irish Parliament). C’s pregnancy was subsequently aborted in a clinic in Britain.
Case by case, the Irish courts and government were being pressed to clarify the abortion law and to legalize abortion in Ireland in at least some circumstances. With the Savita case this pressure became imperative. Those trying to maintain a principled opposition to abortion found themselves arguing a difficult line. First, they maintained that Savita died because of negligent medical care and not because she was refused abortion. This argument had some purchase—Savita’s clinical care prior to her spontaneous delivery was woeful. Vital signs were not taken and important markers of sepsis were ignored, missed or downplayed. During the inquiry into her death, however, it became apparent that had she received an abortion when she requested it, she almost certainly would have lived. Moreover, not aborting certainly endangered her life regardless of any other measures that might have been taken. The infection was severe and its source remained—its management was always compromised with abortion precluded.
Later, some argued for a distinction between abortion to save a woman’s life and abortion upon request, with only the latter being a “real” abortion, which is to be understood as the deliberate termination of pregnancy. Whatever its merits, this argument also fell apart at the inquiry because, in the case of Savita, she progressed rapidly from being relatively okay, to being seriously ill, to being in critical danger. The abortion was needed when she was in the early stage, precisely so her condition would not rapidly deteriorate.
Some on the antiabortion side tried to draw the debate into muddy theological waters to avoid baldly stating that, while tragic, a case like Savita’s did not require the reevaluation of a hospital’s duty to save a woman when her interests compete with those of the fetus. Although there were holdouts who opposed any change in the abortion law, most notably among the Catholic hierarchy, the compromise position of accepting abortion to protect the life of a woman was eventually enacted in the Protection of Life During Pregnancy Act, which became statutory law at the beginning of 2014.
It’s worth considering what sort of victory this development represents for prochoice forces in Ireland, and what sort of defeat it was for antichoice forces. The victory only allows for abortion on health grounds—and very restrictive health grounds at that. Abortion is only permissible to save a woman’s life. If a woman seeks an abortion because she is suicidal, she has to be assessed by three doctors—two psychiatrists and an obstetrician—who have to unanimously agree that she is suicidal.
Very often, however, abortion is not about health, except in broad terms. Those broad terms include the mental health of the pregnant woman, but one doesn’t have to be mentally disturbed by a pregnancy to the point of being a danger to oneself to desire an abortion. Abortion can be chosen for other reasons (“I don’t want to have a baby right now”) and is thus open to attack by those who believe that choice to be wrong. For everything that the Savita case has done, the principle of abortion as a legitimate choice has not been won in Ireland.
At the same time, the challenge to the antichoice position may still be ongoing. The 2013 act only allows for doctors to perform an abortion when a woman’s life is at risk, not to protect her health. Thus, the law, even if in force in 2012, may not have saved Savita’s life—the risk to her health should have been obvious to her doctors, but the risk to her life became demonstrable only when it was too late. It seems likely that there will be further pressure for legalizing abortion when it is in the interests of a woman’s health—possibly through a liberal interpretation of the 2013 law, through further legislation or both.
Having already conceded that abortion is permissible in cases where a woman’s life is at risk, it is difficult to see how policymakers will resist actions or arguments for abortion to protect women’s health. If health includes the risk of pregnancy itself, then abortion is always the better option because, at least before 12 weeks, abortion is medically safer than continuing a pregnancy. Consequently, allowing for abortion to protect women’s health implies that abortion should be available upon request, at least in the first trimester. This measure would face opposition from the Catholic hierarchy and others who disagree on other religious and moral grounds.
There is a dishonesty about the position on both sides that does not sit right. On the prochoice side there is a failure to argue for abortion because it is what a woman wants and not just because it is sometimes necessary to protect a woman’s health and life. A law encompassing only the protection of women’s health will still deny abortions to some women. This means that some of Ireland’s women will be forced to go abroad to obtain an abortion if they cannot find some health-related reason to obtain care under the legal framework at home. On the antichoice side there is a failure to admit defeat and accept that women need abortions. Up until now, sending Irish women abroad for abortion has been a convenient way to avoid the reality that women do need abortions for a variety of reasons, and that sometimes, as happened to Savita, they can’t travel to get the care they need. After Savita, however, that reality is harder to avoid.
Ultimately, as tragic as the Savita case was and as much as it has exposed the cruelty of Ireland’s abortion laws, it cannot resolve the moral and political tensions that abortion creates. There remain hard arguments to be won and difficult principles to be defended or abandoned.
Savita: The Tragedy that Shook a Nation
(Transworld Ireland, 2013, 288 pp)