Editorial

182 www.thelancet.com Vol 382 July 20, 2013

For the Human Rights Watch report see http://www.hrw.org/

reports/2010/01/28/state-isolation

Last week, Ireland adopted a landmark law, the fi rst of its kind, which gives women access to abortion if their lives are in danger. The passage of the Protection of Life in Pregnancy bill follows months of heated debate over the issue, reignited by the tragic death of Savita Halappanavar last year. Halappanavar died at University Hospital Galway from sepsis after being denied an emergency operation during a threatened miscarriage.

In 1992, the Irish Supreme Court ruled that abortions are allowed when a pregnant woman’s life is at risk, including at risk from suicide. However, the ruling never became law, leaving ambiguity for women and doctors over the legality of abortion in the country under these circumstances.

The new law fi nally backs up the ruling and provides clarity on this issue. However, critics have said that multiple approvals from health professionals may delay or defeat access to a legal abortion. The law requires the certifi cation by two doctors that there is a real and substantial risk to the life of the pregnant woman before an abortion can proceed. It also allows for an abortion if

one obstetrician and two psychiatrists unanimously agree that the pregnant woman is likely to commit suicide.

There are other serious problems with the legislation. Abortion remains banned under most other circumstances. For example, a woman pregnant because of rape or incest, or whose pregnancy is not viable, will not be able to get a legal abortion in Ireland.

In this respect, the law will do nothing to change the situation faced by thousands of women in Ireland every year. In a 2010 report—A State of Isolation: Access to Abortion for Women in Ireland—Human Rights Watch detailed how women wanting the procedure struggle with the fi nancial, physical, and emotional burdens imposed by the country’s restrictive laws and policies that force them to seek an abortion abroad. Those who do not go abroad may seek illegal and possibly unsafe abortions in the country.

Although the new legislation is a step in the right direction, access to abortion is still far too restrictive in Ireland, putting the health and lives of women at risk.

The Lancet

Ireland’s abortion law: a start but not enough

Tobacco control: when economics trumps healthTobacco makes a lot of people a lot of money. This mantra should be repeated often during any discussion of the epidemic of tobacco use. Today’s discussion arises because WHO released a report on the global tobacco epidemic, stating that 2·3 billion people in 2012 were reached by at least one measure to reduce tobacco use, including warning labels, advertising bans, or high taxes. The report shows increases from 2010 in eff ective communication of the message that tobacco use is bad for health.

Gaps in coverage therefore exist for two-thirds of the world’s population. 37 countries do not dissuade cigarette use with suitable taxation, and 130 have minimal or no policies covering use of warning labels. Even in countries with nominal bans and control measures, lax enforcement and corruption eviscerates their eff ectiveness. Increasing the number of people covered by comprehensive control measures, such as WHO’s Framework Convention on Tobacco Control’s MPOWER, will need strong political will.

Such political will—especially moves to restrict advertising and sale of tobacco products—is vehemently

opposed by the tobacco industry on the grounds of free trade and intellectual property rights. New Zealand’s ambitious plan to reduce smoking prevalence to less than 5% by 2025 and Australia’s introduction of standardised packaging, which was targeted by cynical legal opposition, have set benchmarks in tobacco control. By contrast, the UK Government’s decision to pause the consultation about the introduction of standardised packaging (citing sparse data, economic grounds, and fears of rises in illicit trade) is a disgrace.

Eff ective strategies and strong leadership are needed to infl uence those countries without adequate tobacco control measures. What does the UK Government’s decision say, if not that economics trumps health? Despite proportional decreases in use, more people worldwide smoke now than ever before and tobacco use still kills more than 6 million every year. The UK should join Australia and New Zealand in setting an example to the countries looking to strengthen their resolve against the tobacco epidemic. The Lancet

For WHO’s The Global Tobacco Epidemic, 2013 report see

http://apps.who.int/iris/bitstream/10665/85380/1/

9789241505871_eng.pdf

For more on tobacco use and corruption see http://www.

plosone.org/article/info%3Adoi%2F10.1371% 2Fjournal.pone.0023889

For more on the components of MPOWER see http://www.who.

int/tobacco/mpower

For more on the eff ectiveness of standardised packaging see

http://phrc.lshtm.ac.uk/papers/PHRC_006_Final_Report.pdf

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