In October 2012, an Irish hospital denied an abortion to Savita Halappanavar, a dentist of Indian origin, even though she was in the midst of a life-threatening miscarriage in the 17th week of her pregnancy. Savita eventually died of severe infections, in a case that sparked international outrage against Ireland’s regressive anti-abortion laws.

Three years later, for many women in Ireland, Halappanavar’s death continues to endure as a symbol of all that hasn’t changed in the Catholic country’s attitudes towards abortion, no matter how endangered the life of a pregnant woman may be. This is evident in a new report released by human rights non-profit Amnesty International on Tuesday, which assesses the impact of Ireland’s restrictive abortion laws on women across the country.

The report, titled She Is Not a Criminal, describes Halappanavar’s death as completely preventable, and claims that Ireland’s abortion laws violate “women’s and girls’ rights to life, health, privacy, non-discrimination and freedom from torture”. Amnesty interviewed 60 women, activists and healthcare professionals for the report and everywhere, Halappanavar’s case was cited repeatedly as a point of reference for the worst possible consequences of Ireland’s laws and maternal healthcare system.

How close to death?

In Ireland, abortion is an illegal act punishable by a 14-year prison sentence for both the pregnant woman seeking it and the doctors conducting it. Even giving a woman comprehensive information about abortions can invite a 4,000 euro fine. Abortion is illegal even in cases of rape or severe foetal impairment.

The restrictions force an average of 4,000 women a year to travel to England or other countries to access safe abortions – at tremendous mental, physical and financial costs. Those who cannot afford to travel abroad – poor women, migrants, asylum seekers – are the most damned, because they are forced to resort to illegal and risky methods to induce abortions.

The regressive abortion laws are rooted in the harmful gender stereotypes perpetuated for years by the state as well as Ireland’s predominantly Catholic religious institutions – stereotypes in which motherhood is considered the natural role of women, and women are essentially vessels for reproduction.

Irish law allows abortions only if there is a major, immediate threat to the mother’s life, but not her health. This clause, the Amnesty report points out, is extremely unclear about what constitutes a threat to a pregnant woman’s life, leaving healthcare professionals confused about how to respond to complicated pregnancies. How close to death does a miscarrying woman have to be before they can finally induce a legal abortion?

For Halappanavar, it was never induced, and even though her death forced Ireland to make a change in its laws, little has changed in the past three years.

Savita’s case

Savita Halappanavar, a dentist living in Galway, Ireland, was 17 weeks pregnant on October 21, 2012, when she was admitted to Galway University Hospital with severe lower back pain. On examination, doctors realised that she was in the midst of an inevitable miscarriage, but Halappanavar and her husband, Praveen, were told that the only option was to wait for a spontaneous miscarriage to occur naturally.

That night, Halappanavar’s amniotic sac ruptured, increasing the possibility of maternal infection. Even though the foetus would certainly not survive, doctors insisted on monitoring foetal heartbeat instead of focusing on the prevention of maternal infection or sepsis.

Almost two days later, when there was still no spontaneous miscarriage, the Halappanavars asked if a miscarriage could be medically induced. They were told, however, that Irish law did not allow such abortions as long as there is a foetal heartbeat, unless there is evidence of a risk to the life of the mother. The hospital continued to monitor the doomed foetus’ heart rate, even as Savita Halappanavar developed an intrauterine infection that could lead to sepsis and fatal sepsis shock.

Three days after she was admitted, Halappanavar was diagnosed with sepsis. She finally had a spontaneous miscarriage, but her condition began to deteriorate very rapidly and by the sixth day, she died of multiple organ failure and a cardiac arrest due to septic shock.

In the national and international outrage that followed, the Irish government ordered an official inquiry into the case by the Health Service Executive, whose report concluded that it was a lack of clarity on Ireland’s abortion law that prevented doctors from intervening appropriately. The allowed abortions if there was a “potential major hazard” or “threat” to the pregnant woman’s life, but doctors were not sure what “potential major hazard” could mean.

The aftermath

Many of the women Amnesty interviewed spoke of the impact Halappanavar’s case had on them. The report cites the case of Lupe, a woman who was forced to carry a dead foetus in her womb for two months because the doctors at the same hospital where Halappanavar had died refused to induce a miscarriage – just in case the embryo was still growing. She was admitted to the hospital just three months after Halappanavar’s death, and she finally decided to seek a legal abortion in Spain.

“During that time, I was feeling really scared since it had become clear to me that, if any complication raised, [the doctors] would let me die, just as they did with Savita,” Lupe said in her interview to Amnesty.

After Halappanavar’s death, the European Court of Human Rights ordered the Irish legislature to introduce changes in its abortion law, and in 2013, finally complying with the order, Ireland passed the Protection of Life During Pregnancy Act. This new law, the Amnesty report points out, is deeply flawed: the only instance in which it decriminalises abortions is “if a woman’s life is at risk, including through suicide”.

This, says the report, has not really brought about any perceptible reform on the ground, because a “risk to life” is no more clearly defined than before. In fact, after the new law came into effect, a major case in which an abortion was denied involved a young, suicidal woman who was impregnated through rape. Even though she qualified for a legal abortion, she was forced to continue with her pregnancy and was made to deliver through a Caesarean section.

“Although [Savita’s] death provided the impetus for law reform, the [new law] failed to address the fundamental issues that led to this devastating situation,” the report says.