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Hopefully, the tragedy of Savita will, at least, finally spur the Irish government to issue clearer guidelines that the life of the pregnant woman must be privileged over that of her fetus. But if the thousands demonstrating reflect changes already underway in Irish society -- including a growing dissatisfaction with the Catholic Church's influence -- perhaps some day Savita Halappanavar will be remembered as the woman whose death was a turning point in the long struggle for the legalization of abortion in Ireland.

Written by Carole Joffe for RH Reality Check. This diary is cross-posted; commenters wishing to engage directly with the author should do so at the original post.

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See all our coverage of the tragic case of Savita Halappanavar here.

The tragic and unnecessary death of Savita Halappanavar -- a 31-year old Indian woman who was denied a life-saving abortion in an Irish hospital -- has sparked reactions across the globe. Thousands have marched in Dublin. Demonstrations have taken place in India and elsewhere. An international day of protest is called for November 21. Tense meetings between Indian and Irish government officials are taking place. The overriding question now is: what will be the legacy of this horrible event, beyond the unspeakable grief of Savita's loved ones? After the demonstrations have stopped, will Irish hospitals -- where abortion remains illegal but is permissible in life-threatening conditions -- proceed differently in the future? Will the country finally move toward legalizing abortion?

This heartbreaking incident has led me to contemplate the long history of abortion struggles around the globe and under what circumstances, change takes place. It is not an exaggeration to say that throughout history millions of women have died and even more have been injured because of the lack of safe abortion. But only some of these tragedies capture the public's attention and become catalysts for change.  And sometimes public attitudes are affected even when a woman's death is not involved.

Consider the history of abortion in the United States. Two events that occurred in the 1960s were instrumental in moving much of the country toward an endorsement of legal abortion. The first, in 1962, involved Sherri Chessen Finkbine, a Phoenix woman pregnant with her fifth child, who learned that the Thalidomide pills she had been using as a sleep aid were strongly associated with severe birth defects. Her doctor was able to arrange a "therapeutic" (i.e. approved) abortion for her at a local hospital, but Finkbine, in an act of decency that would prove costly, went public with her story as she hoped to warn other women who were in her situation. Her interview with a journalist created a media sensation, and nervous hospital authorities cancelled her abortion. Ultimately Finkbine, unable to find an abortion anywhere in the United States, obtained one in Sweden, where she delivered a fetus with missing limbs. Doctors told her the fetus would have had no chance of survival. Finkbine's story spread beyond Phoenix to become a national story, including a cover on Life magazine. This incident, particularly the unprecedented visibility of abortion on the cover of the leading news magazine of the 1960s, "had a galvanizing effect on public opinion," in the words of the journalist Linda Greenhouse, a longtime observer of the trajectory of abortion rights in the United States.

The second incident, which took place in 1966, had a similarly powerful effect, this time within the medical community. Nine highly-respected San Francisco doctors, affiliated with university hospitals, were abruptly threatened with the loss of their licenses because they had been performing hospital-based abortions on women infected with rubella, a practice that was increasingly common in a number of states by the 1960s, as evidence of the link between this disease and birth defects became known. The sudden decision to prosecute this decision apparently was instigated by one individual, a strongly anti-abortion member of the California Board of Medical Examiners. The case drew national media attention and an unprecedented show of support across the country; more than 100 deans of medical schools protested this prosecution, and ultimately the charges were dropped. A few years later, the American Medical Association reversed its longstanding position on abortion and voted, at its annual meeting, in support of a resolution calling for legalization.

In retrospect, we can see that these two incidents not only precipitated changes, both in public opinion and among medical professionals, but also reflected changes that were already underway in American society. A majority of the public then, as now, believed that women carrying severely compromised fetuses should have the option of an abortion. American physicians then were growing increasingly dissatisfied both with the numbers of needless death and injuries from illegal abortion and the lack of clarity as to which abortions actually were permitted exceptions to the overall ban. Sherri Finkbine and the fine San Francisco doctors offered a human face to these complex policy issues.

It is too soon to know what impact the case of Savita Halappanavar might have in the long run. What makes her case somewhat different from the two U.S. incidents mentioned above is that the law was already on her side; Irish law, as mentioned above, does permit abortion in life-threatening situations. The problem was that those caring for her in the Galway hospital were interpreting this law in an extremely rigid manner -- by waiting for her fetus to no longer have a heartbeat before proceeding with an abortion, they were acting in accordance with the most orthodox reading of Catholic Healthcare Directives

The reality is that what constitutes a "life-threatening" condition in various medical situations, including failing pregnancies, and how much time exists for medical professionals to intervene is very often not clear-cut. Till now, the Irish government has apparently given no guidance to hospitals as to how to proceed in such cases and doctors are fearful of prosecution. As Marianne Mollman of Amnesty International has written of her own investigation of this problem:

In 2010 I saw that the European Court on Human Rights berated the Irish government for not regulating access to life-saving abortion clearly, creating insecurity for medical providers and patients alike. In 2011 the United Nations Human Rights Council issued various recommendations to the same effect....My research taught me that many medical providers in Ireland want clarity on when they can intervene and when they cannot.

Hopefully, the tragedy of Savita will, at the very least, finally spur the Irish government to issue clearer guidelines -- guidelines that make clear to clinicians that the life of the pregnant woman must be privileged over that of her fetus. But if the thousands of Irish citizens demonstrating in the streets and pressuring their elected officials indeed reflect changes already underway in Irish society -- including a growing dissatisfaction with the Catholic Church's influence -- perhaps some day Savita Halappanavar will be remembered as the woman whose death was a turning point in the long struggle for the legalization of abortion in Ireland.

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