Savita Halappanavar ( Savita Andanappa Yalagi; 9September 1981 – 28October 2012) was a dentist of Indian origin, living in Ireland, who died from sepsis after her request for an abortion after a prolonged miscarriage was denied on legal grounds. In the wake of a nationwide outcry over her death, Irish voters passed in a landslide the Thirty-Sixth Amendment of the Constitution, which repealed the Eighth Amendment and empowered the Oireachtas parliament to make abortion legal. It did so through the Health (Regulation of Termination of Pregnancy) Act of 20December 2018.
Death Summary of events On 21October 2012, Halappanavar, then 17 weeks pregnant, was examined at University Hospital Galway after complaining of back pain, but was soon discharged without a diagnosis. She returned to the hospital later that day, this time complaining of lower pressure, a sensation she described as feeling "something coming down", and a subsequent examination found that the gestational sac was protruding from her cervix. She was admitted to hospital, as it was determined that miscarriage was unavoidable, and several hours later, just after midnight on 22October, her water broke but did not expel the fetus. The following day, on 23 October, Halappanavar discussed abortion with her consulting physician but her request was promptly refused, as Irish law at that time forbade abortion if a foetal heartbeat was still present, with her midwife furthermore stating that "Ireland is a Catholic country". Halappanavar developed sepsis and, despite doctors' efforts to treat her, had a cardiac arrest at 1:09a.m. on 28October, and died, aged 31.
Early reactions After her death, a coroner's inquest was held, finding that she died of medical misadventure. The Health Service Executive (HSE) and Health Information and Quality Authority (HIQA) conducted an investigation. Both criticized the team for not diagnosing the sepsis soon enough and for not using already-standard screening tools for detecting and managing maternal sepsis; for poor keeping of medical records, poor communication at shift changes, and failure to notify staff with needed expertise. The administration of the hospital was also criticized for the poor system in which the team failed. They made recommendations about training and policies for the hospital locally along with a number of national recommendations, including the creation of a laboratory system to coordinate a national response to emerging microbial threats. The HSE also recommended changes to the legal situation and training of doctors about the law.
The law in force at the time stated that the act of abortion, where continuing the pregnancy posed no immediate physiological threat to the woman's life, was a criminal offence punishable by life imprisonment. Following a ruling of the Supreme Court of Ireland in 1992 (the X Case), terminations are allowed where "a pregnant woman's life is at risk because of pregnancy, including the risk of suicide". However at the time of Halappanavar's death, there was legal uncertainty regarding the precise circumstances when this exception was allowed, as the matter had not been enacted in legislation.
On 3November 2012, friends and family of the Halappanavars contacted local abortion rights groups (Galway Pro-Choice) to find out what they could do, with dozens meeting in person on the 6th. Galway Pro-Choice put them in contact with The Irish Times journalist Kitty Holland on 7November. Abortion rights groups then organised on the Irish Choice Network (ICN) email group before the story broke.
Halappanavar's death became public knowledge on 13November 2012 when the TV programme Tonight with Vincent Browne showed front-page stories that The Irish Times and the Irish Independent had planned for the next day. This resulted in the news being disseminated on Twitter, including tweets by journalists Caitlin Moran and India Knight, and coverage by publications such as BBC News, the British edition of The Huffington Post, The Guardian, The Daily Telegraph, the Daily Mirror, and The Independent newspapers.
On 14November, more than 2,000 people gathered in her memory to protest against Ireland's abortion laws outside the Dáil in Dublin. In addition, candle-light vigils were held in Cork and Belfast the following day. The evening before the news story broke, the government's expert committee on abortion had handed in its report on the A, B and C v Ireland judgement to the Department of Health. Halappanavar's death led to protests in Galway, particularly from the local Indian community. The Daily Mirror reported that the University Hospital was the subject of several investigations. Halappanavar had been one of the organisers of the annual Galway Diwali festival, which was cancelled in response to her death.
There were calls upon the Taoiseach to start an external enquiry. There were also calls for a change in the law, as the legislation in effect at the time was an Act of the British Parliament of 1861when Ireland was part of the United Kingdomwhich declared that it was unlawful to "procure a miscarriage". On 16November, the Irish Health Service Executive established an independent inquiry into the circumstances surrounding Halappanavar's death.
On Saturday 17November, the Garda Síochána (Ireland's national police) estimated that between ten and twelve thousand protesters marched from Parnell Square to Merrion Square to demand a change in the law, with other rallies across Ireland and many other countries. The Gardaí announced that they were assisting the coroner in the investigation. Medical terminations had previously been performed at the University Hospital when complications arose in pregnancy, as it is permitted by Irish law to save the life of the woman.
On Monday 19November, the Roman Catholic bishops of Ireland met in response to Halappanavar's death and released a statement that the Catholic Church believes in the "equal and inalienable right to life of a mother and her unborn child" and that the Church has never taught that the life of an unborn child takes precedence over the mother.
Response from the medical community The staff of University Hospital as well as members of Ireland's Health Services Executive (HSE) Regional Health Forum stated that there is no "Catholic ethos" affecting treatment.
Dr Sam Coulter-Smith, a prominent obstetrics and gynaecology physician, said that current standards of care were legally unclear, saying, "We really do need legislation in this area, otherwise we're going to be at risk of doctors working outside the law, and that's not appropriate." Dr Rhona Mahony, Master of the National Maternity Hospital, said: "It is very disappointing that, 20 years after the 'X-Case', we don't have legislation" and that women "need to know that they are going to get the appropriate health care that they need" while doctors "need to know that they are also protected in their ability to do their job". Peter Boylan, of the Irish Institute of Obstetricians and Gynecologists, said: "The current situation is like a sword of Damocles hanging over us. If we do something with a good intention, but it turns out to be illegal, the consequences are extremely serious for medical practitioners."
Microbiologist James Clair stated in a letter to the IrishExaminer that the "main problem is being missed" in the case, suggesting that the real issue may be that the sepsis was caused by extended-spectrum beta-lactamase positive gram negative bacteria (ESBL), which "are now spreading rapidly within the Irish population" and are resistant to many known antibiotic treatments.
Political response in 2012 A week after the story broke, Taoiseach Enda Kenny stated, "I don't think we should say anything about this until we are in possession of all the facts."
Minister for Health James Reilly said that the public must not pre-judge the situation and that he was awaiting the results of the investigations, adding he had no evidence of a "Catholic ethos" at the University Hospital that prevented Halappanavar's life from being saved by a medical termination. He also stated that an inquiry into Halappanavar's death must stand up to international scrutiny. On 18December, after a panel of experts submitted its report to the parliament recommending that "the government legislate the issue in order to clarify what the current laws actually do and do not permit", Reilly stated, "We will clarify in legislation and regulation what is available by way of treatment to a woman when a pregnancy gives rise to a threat to a woman's life."
Brian Walsh, a Fine Gael TD for Galway West, said that Galway University Hospital had carried out terminations in recent years in accordance with the judgment in the X Case and the guidelines of the Irish Medical Council. He said that the University Hospital was not run or managed by any (Catholic) religious orders and did not have a "Catholic ethos".
Fianna Fáil leader Micheál Martin said that Halappanavar's death was tragic and harrowing. Martin said that Ireland had always prioritised a low death rate during pregnancy, but that this was "cold comfort" to Halappanavar and her surviving family. He called for an independent inquiry with experts from outside the country to establish the full circumstances. On 17November he said that "legislating for the X Case would not have stopped [the death of Savita Halappanavar]".
Response of abortion rights organisations in 2012
Abortion rights campaigners highlighted at the time that the lack of legislation clarifying the limited circumstances in which abortion is legal in Ireland contributed to Halappanavar's death. Several rallies and vigils were organised nationwide, calling for the Irish government to legislate in relation to abortion on the basis of the X Case case. Campaigners argued that legislation remained outstanding at the time of Halappanavar's death despite the European Court of Human Rights having instructed the state to clarify its laws on abortion after finding in A, B and C v Ireland (2010) that Ireland had violated the Convention by failing to provide an accessible and effective procedure by which a woman can have established whether she qualifies for a legal abortion under current Irish law.
Irish Choice Network allegedly emailed members, calling for an emergency meeting to discuss how to proceed with this "major news story".
In response to critics accusing abortion rights activists of exploiting Halappanavar's death, Kate Smurthwaite responded in a column in The Huffington Post titled "Yes, Savita Halappanavar's Death IS a Political Issue" in which she stated, "If I am ever a victim of an unjust legal discrepancy that infringes my human rights and leads to my untimely and unnecessary agonising death I want every man, woman and child on the streets immediately demanding that it never, ever be allowed to happen again."
Response of anti-abortion organisations in 2012
The Life Institute in Ireland accused "abortion campaigners" of exploiting Halappanavar's death to further the abortion rights agenda.
Michael Kelly of The Catholic World Report rejected claims that Ireland's abortion laws led to Halappanavar's death, writing that "medical experts and bioethicists have been quick to express their view that Ireland's ban on abortion had nothing to do with Mrs. Halappanavar's death. They insist that guidelines from the Irish Medical Council are perfectly clear that pregnant women must be given all necessary medical treatment." Father Shenan J. Boquet, president of Human Life International, said that there was no evidence to indicate that "a Catholic ethos" prevented responsible treatment of the mother, and called news reports that that was the case "demonizing the Church's position on abortion". He described the debate resulting from the event as "activism masquerading as compassion and moral outrage".
International response