Four years ago this week, the people of Ireland voted overwhelmingly in favour of abortion access. It was a generation-defining vote and the message was clear: all women should be able to receive care at home and, with the support of their doctors, make decisions regarding their health. The resounding victory for the Yes campaign was a clear statement that no woman should be forced abroad for basic healthcare and that the stigma which surrounds women’s reproductive and sexual health must be challenged.
However, while constitutional change has enabled some access to care in Ireland and this is to be celebrated, there is much unfinished business which must be addressed in the ongoing review of our abortion legislation.
Ongoing restrictions of the new legal framework mean that many women and pregnant people continue to find themselves ineligible for care. Close to 600 Irish residents were forced to travel to the UK in 2019 and 2020, and many others will have taken abortion pills without clinical oversight or support.
This is linked to the fact that abortion currently is only available on request up to 12 weeks, with a three-day mandatory waiting period necessitating two GP consultations, as well as a gestational dating scan in some cases. After 12 weeks, abortion is only allowed on the grounds of risk to health and fatal foetal anomalies.
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In addition to the legal restrictions, geographical coverage of abortion services is poor. Just one in 10 GPs are providing abortion care in the community and only 11 of our 19 maternity hospitals provide full services in line with the law. Outside of our cities the picture is poor, with half of all counties having less than 10 GPs offering the service. When we map GP provision against population density, it appears that Mayo and Wexford in particular may be undersupplied.
The reality of poor coverage is an increased burden on service users, and this can make access to care within the tight 12-week time frame all the more challenging. Research by Dr Lorraine Grimes and the Abortion Rights Campaign suggests service users are having to travel considerable distances — 30 per cent of respondents reported travel of 4-6 hours to access abortion care. For those in the disabled community, women in situations of domestic abuse who do not have freedom to leave the house and lone parents without childcare, access can be a real challenge.
So, what can we do to improve this picture?
Firstly, we need to decriminalise abortion to support more practitioners to come on board. Under our law, anyone who aids or abets abortion outside the specific terms of the Act is liable for criminal prosecution, with a prison sentence of up to 14 years. This means health professionals, under the threat of prosecution, are essentially forced to police themselves, determining when and whether the statutory criteria for access to care have been met.
Using a criminal framework like this is not routine and sets abortion aside from all other aspects of healthcare. The World Health Organisation (WHO) strongly recommends decriminalisation to remove the chilling effect on healthcare providers. And robust opinion data suggests that the Irish public agree — a nationally representative poll from February found that 71 per cent supported decriminalisation, agreeing that abortion should be treated like any other medical procedure and should not be a matter for criminal law.
We also need to address the aspects of our law which are forcing women to travel. This means removal of the 12-week gestational limit, the three-day mandatory wait and the narrow grounds-based approach to care after 12 weeks. The WHO is clear that gestational age limits are not evidence-based and are out of step with international human rights law. It also recommends removal of mandatory waiting periods as they delay access to time-sensitive healthcare and “demean women as competent decision-makers”.
Finally, a key missing piece in our reproductive healthcare provision is access to universal contraception. While it is welcome that the Government will deliver free contraception for young women between the ages of 17-25 from August, we need to see funding to this scheme extended so everyone can benefit. This universal contraception scheme should be rolled out through our GP network but also our pharmacies, as has been safely done in other countries. Access through pharmacies is supported by the WHO and likely to reach more marginalised women for whom GP attendance may be barrier.
Reproductive healthcare, like all aspects of healthcare, is complex but some of the obstacles are clear. We must reduce risk of unplanned pregnancy through universal, accessible, free contraception, as well as reform our abortion law to tackle the ongoing legal barriers to access. Failing this, women will continue to be forced abroad for healthcare they should receive at home.
Orla O’Connor is director of the National Women’s Council