Marginalised women face significant barriers to abortion care in Ireland, new report highlights

The National Women’s Council (NWC) has published the findings of a new report exploring the experiences of women, pregnant people and healthcare professionals of abortion services in Ireland since their introduction in 2019.

'Accessing Abortion in Ireland: Meeting the Needs of Every Woman' outlines NWC’s recommendations for policy and legal changes ahead of the upcoming three-year Government review of the current abortion legislation.

The report highlights ongoing barriers and obstacles for women and pregnant people to access abortion care in Ireland since the 8th Amendment was Repealed on this day three years ago.

At least one woman or pregnant person a day is travelling to the UK for an abortion according to the latest available figures from 2019, with the majority of these procedures being later term abortions.

Three years since we #repealedThe8th the latest available statistics suggest that every day at least one woman or pregnant person still travels to the UK for abortion care because they could not access abortions here. - Dr @SineadmKennedy #AbortionAccess pic.twitter.com/zAx9KQAW1e

— Womenscouncilireland (@NWCI) May 25, 2021

Only 1 in 10 GPs are providing abortion services in Ireland, the report says. Although GPs who provide early medical abortions are very committed, coverage remains a significant barrier to accessing abortion. As of April 2020, 373 GPs had signed contracts with the Heath Service Executive (HSE) to provide EMA, and medical professionals who took part in this research suggest this has increased slightly to approximately 385 providers.

Only just over half of maternity hospitals provide abortion services, while women in rural areas and from marginalised backgrounds face extra challenges in accessing abortion care. Access also remains particularly difficult for women and pregnant people facing the devastating news that their baby has a severe or fatal foetal anomaly.

Statistics published by the UK Department of Health and Social Care (2019) show that 375 women travelled for abortions to England and Wales in 2019, with the majority seeking care in the second trimester.

Figures released from the Department of Health in Britain show that black, Asian and Chinese women with Irish addresses are significantly represented (almost 9%) in the figures for women travelling abroad for abortion, suggesting that they face very significant barriers to accessing abortion care in Ireland.

Speakers at the launch event included: NWC Director Orla O’Connor; Dr Sinead Kennedy, Maynooth University and Coalition to Repeal the 8th; Nem Kearns, Disabled Women Ireland; Dr Mary Favier, Founding Member of Doctors for Choice and current Co-Chair of Global Doctors for Choice; Ailbhe Smyth, former Co-Director, Together for Yes; Claire Cullen Delsol, Terminations for Medical Reasons.

Spoken word activist Sasha Terfous also performed a number of testimonies of women and pregnant people who travelled to the UK for abortions, provided by the Abortion Support Network.

“The introduction of abortion care in Ireland in 2019 was a historic moment for women’s healthcare and reproductive rights," Orla O’Connor, Director of the National Women’s Council said.

"We welcome that many women and pregnant people who need abortions can now finally access this care in their own country. However, our research clearly highlights that there are ongoing obstacles and legal barriers forcing at least one person a day to travel abroad. We urgently need better availability of abortion care throughout Ireland. This must include nationwide coverage of abortion services in primary care settings and all maternity hospitals. We also must ensure that conscientious objection can never prevent women and pregnant people from accessing urgent healthcare.”

NWC is calling for legislative changes, including an extension to the 12-week limit, an end to the 3-day waiting period and to the criminalisation of abortion.

The organisation also urged the enactment of exclusion zone legislation, saying it "is a matter of priority to create protest exclusion zones within a defined radius of a facility where abortions take place."

"Abortion care, like all aspects of health care, should be decided in the context of a trusting and supportive doctor-patient relationship, whereby medical needs are met in line with clinical best practice and patient preferences,” O'Connor added.

“The upcoming Review of the Termination of Pregnancy Act is an essential opportunity to take stock and address the barriers. We call on the Minister for Health, Stephen Donnelly, and his Department to honour the commitment to an external review – as promised by former Minister for Health, Simon Harris and guarantee a process that is independent, women-centred, transparent and inclusive.”

Dr Sinead Kennedy, Maynooth University and Coalition to Repeal the 8th who conducted the research on behalf of NWC, noted the severe obstacles which disproportionately affect the most vulnerable sections of society.

We also additional barriers to #AbortionAccess for women and pregnant who are the most marginalised and vulnerable, including those from Traveller, migrant, disabled, and LGBT communities. Access remains also difficult in more rural areas. @SineadmKennedy pic.twitter.com/Ms9yo4DwnG

— Womenscouncilireland (@NWCI) May 25, 2021

"The decision to criminalise medical professionals continues to create a chilling effect among doctors," Kennedy stated.

"The unnecessarily restrictive nature of the legislation means that many women and couples facing a diagnosis of fatal foetal anomaly continue to be denied treatment in Ireland. These are complex pregnancies that should be decided through doctor-patient consultations and clinical best practice. Rather than continuing to force these families to travel under heart-breaking condition because they fall outside the narrow legal framework, we need to provide the necessary healthcare here in Ireland.”

The NWC also recommended that termination of pregnancy should be fully integrated into all aspects of the medical, nursing and midwifery undergraduate curriculums and advocated for universal access to contraception as a key aspect of reproductive healthcare.

"There should be immediate introduction of free, universal contraception as outlined in Report of the Joint Committee on the Eighth Amendment of the Constitution (2017) in line with the commitment in the Programme for Government (2020)," the report recommendations read.

"A mandatory, comprehensive, rights-based relationships and sexuality education curriculum is urgently needed in Ireland. There is a relationship between effective sex education and lower rates of crisis pregnancies. The Programme for Government commitment to ‘develop inclusive and age-appropriate RSE and SPHE curricula across primary and post-primary levels, including an inclusive programme on LGBTI+ relationships’ should be implemented as a matter of priority."

Case Studies and Quotes were also provided by the Abortion Support Network (ASN), and can be read here.

Only just over half of all maternity hospitals provide abortion services, 10 out of 19.

They include:

National Maternity Hospital, Holles Street, Dublin
Rotunda Hospital, Dublin
Coombe Women & Infants University Hospital, Dublin
Midland Regional Hospital Mullingar, Co. Westmeath
Our Lady of Lourdes Hospital Drogheda, Co. Louth
University Hospital Galway, Galway
Mayo University Hospital, Castlebar, Co Mayo
University Maternity Hospital Limerick, Limerick
Cork University Maternity Hospital, Cork
University Hospital Waterford