On June 24th, 2022, the United States Supreme Court overturned the 1973 landmark case of Roe v. Wade. It was deemed that “the constitution does not confer the right to abortion” and the right to reproductive care was rescinded.
The decision took place only four years after the successful campaign to repeal the 1983 Eighth Amendment that banned abortion in the Republic of Ireland. In 2018, the Health (Regulation of Termination of Pregnancy) Act was codified, a motion that affirmed the right to the lawful termination of pregnancy with 66 per cent of the vote.
The overturning of Roe v. Wade created a global shock wave. Aideen Kane, director of The 8th, a documentary detailing the intricate history of Ireland’s abortion policy, fondly recalls how “the people of Ireland, with very little funding, got together and repealed the Eighth Amendment that had been in the constitution for 35 years in the face of all adversity”.
Having borne witness to the movement across Ireland, Kane says the repeal represents a “legacy that will live on forever”. Yet with Roe v. Wade overturned, Kane harks back to the words of abortion rights activist Ailbhe Smyth only a few days into filming: “we never win these rights forever”. She views the proceedings of the United States as a cautionary tale, one that she had seen before as a teenager in 1983 and is regrettably not surprised to see again.
First-hand witnesses of Ireland’s struggle now observe the US embarking on the same well-worn path and feel the underpinnings of the reversal must not be overlooked. Trinity’s own Dr Catherine Conlon, assistant professor in the School of Social Work and Social Policy, describes the overturn of Roe v. Wade as a “case in point that we should not rely on as broad an instrument as the constitution to safeguard reproductive rights”.
She pinpoints “the absence of political will and political courage to codify the decision” as “the heart of the problem”. In an interview with Irish Independent, Ailbhe Smyth concurs with Dr Conlon’s sentiment: “It was written into the way in which the constitution dealt with abortion by making it an issue of privacy”. Smyth warns that “in a patriarchal society… you can never take your eyes off of the controls that are there in relation to our reproductive and sexual lives”. The curtailment of reproductive freedoms afforded in the US rings alarm bells around the world.
And yet, the government of Ireland has demonstrated its commitment to upholding the right to reproductive care. A stipulation to ensure the efficacy of abortion care services can be found in Section seven of the Act: “The Minister shall, not later than 3 years after the commencement of this section, carry out a review of the operation of this Act”. The spotlight on abortion care access has shown this clause to be essential for successful health care administration, particularly at this moment in history.
The review includes research with service users, providers and public consultation. The aforementioned Dr Conlon leads the service user strand. She has been commissioned by the HSE to research the experiences of people who required abortion care in Ireland from 2019 to 2021 in what is called the Unplanned Pregnancy and Abortion Care (UnPAC) study. The study interviewed 58 women who availed of pregnancy termination services in Ireland.
The conclusions of the research bring to light the progress Ireland has made since the commencement of care and the areas of necessary improvement. The University Times sat down with Dr Catherine Conlon to discuss whether the 2018 Act is meeting the needs of those seeking abortion care in Ireland.
The foremost successes of reproductive care in Ireland lie in the model of care, according to Dr Conlon. She explains, “the legislation provides for a model of care that is as accessible to you as any community health service” – an individual would go to the same clinic for viral flu and for pregnancy termination. For people seeking abortion care under the 12-week gestation period, it is integrated into primary care with GPs as service providers. In addition to GPs, abortion care can be accessed in specialist women’s health centers such as the Irish Family Planning Association.
Another achievement of abortion care in Ireland is the HSE-funded free helpline. Dr Conlon explains the process of obtaining reproductive care using the helpline, which involves calling the helpline, making an appointment with a GP nearby, then taking the prescribed medication.
“You say what part of the country you’re based in, and they give you three GPs in the closest proximity. Then, you phone the doctors yourself and make an appointment, the first appointment is free”, she says.
“You cannot have the abortion in the first consultation, you have to have a three-day wait and then return to have the care administered. It is a medical abortion, and it will be principally self-managed”.
“You take the first medication in the presence of the physician, and you then return to a safe place with access to things you need like a comfortable place to be and a bathroom. You’re advised to have pain relief and sanitary towels”, she added.
Dr Conlon added: “administer the second medication 24 hours later, and you will pass the products of conception in a relatively short amount of time. You’re advised what to expect but if you’re concerned there is a 24/7 nurse on the HSE helpline, they will talk you through what to do or will advise you to go to the doctor from which you received care or a local maternity hospital”.
Many women from the study appreciated the local accessibility of care and the self-management of the process. Moreover, during COVID-19, the HSE was remarkably adaptive and made remote care available by phone or video link, which considerably enhanced access to abortion care.
However, abortion policy is never a ‘one size fits all’ affair. Women recorded that they would have preferred being in a clinical setting for their procedure as many lived with housemates, parents, or a partner that they did not wish to inform of their termination.
Dr Conlon also explains that the information regarding which GPs provide reproductive care is held solely in the helpline. Some women were unaware of the HSE helpline and others did not have access to it.
“Some assumed all GPs provided care so they self-presented to their own GP or another GP and were met with a variety of responses. Some had very negative interactions, some encountered obstructions, and others were very well cared for and helped to find the care they needed”.
Many women in the study shared sentiments of resentment toward the three-day wait between consultations. Dr Conlon feels that the mandatory waiting period demonstrates a “distrust of women to make a sound decision”. Women in the study expressed that “the mandatory nature of the wait was the problem” as they had already made their decision when contacting a provider.
If the intent of the three-day wait is to “facilitate clearer decision-making” by those seeking abortion care and not to improve quality of care, access is not being prioritised as promised. “There was anxiety about whether they would be able to access care. Women had nightmares in their three-day wait that their clinic had been bombed, or that the law would be reversed”, Dr Conlon reveals.
There are several points of contention over the harsh time restrictions in the 2018 Act. For instance, if you “time out”, or exceed the 12-week gestational period during your three-day wait, even if you’ve had the first consultation, you no longer qualify for care under law. Even in cases in which pregnancy termination is appealed due to fatal foetal anomalies, a limit stands such that termination is authorised only if death of the foetus is expected “either before, or within 28 days of, birth”.
Yet with medical technology, Dr Conlon explains, a foetus with a fatal anomaly is capable of surpassing 28 days. “In a society that doesn’t provide support for families caring for children with profound disabilities”, Dr Conlon notes, “this is crippling”.
Furthermore, abortion care service was “grafted on to an already overstretched primary health care service”. As GPs are heavily oversubscribed, many found the anticipation for an appointment “very distressing”. This is further complicated by the fact that only one in ten GPs opt to provide abortion care, and the motivations for their decisions range widely.
In the implementation of the 2018 Act, doctors who intend to provide abortion care must enter into an additional contract with the HSE naming them as reproductive care providers. On the other hand, infrastructural reasons allow providers to opt out of providing care, including conscientious objectors. Many providers claim they lack capacity or are concerned about being negatively targeted, as stigma against care persists.
Orla O’Conner, director of the National Women’s Council, describes the execution of care to be “patchy and piecemeal” – her argument is bolstered by the fact that 50% of counties have less than 10 GPs providing abortion care. For one woman in the UnPAC study, this meant a €90 taxi fee to the nearest provider. When the model of care requires two consultations, this becomes €180 taxi fare and a significant obstacle to accessing abortion care.
The American and Irish public share grievances against the national structure of reproductive care. Among the most troubling of issues is the criminalisation of abortion care. UnPAC found that there is a “chilling effect” in the interaction between provider and patient. The threat of penalisation if abortion is performed outside legal circumstances forces care providers to be “very cautious and worried about the consequences”.
Another concern is the pro-life movement targeting premises in which care is provided. In response, on August 5, 2022, the Irish government authorised the General Scheme of the Health (Termination of Pregnancy Services (Safe Access Zones)) for official drafting. The General Scheme of the Bill states that “the government [is] committed to ensuring that anyone needing a termination of pregnancy (TOP) can access services in safety”.
The zone would designate 100 metres around relevant healthcare premises as “exclusion zones”. Dr Conlon raises concerns regarding safe access zones: “The right of freedom of assembly and freedom of expression is important to safeguard and if the effect of safe access zones is to diminish those rights in our society that is a concern”, she says. Nonetheless – “it is more of a concern that people who need timely reproductive care have access to it”.
Despite the long journey Ireland still has before it regarding reproductive care, the achievements of the Irish people must not be undermined. Dr Conlon highlights the Citizen’s Assembly as an unprecedented moment – 99 randomly selected people led by a chairperson were charged with debating the topic of abortion care and formulating recommendations for the government. She describes it as “a protected space for a very balanced and lengthy conversation that wasn’t happening in sound bites and wasn’t being directed by extremist views.”
Director Aideen Kane also emphasises the monumental influence of the “civic debate that happened on doorsteps, in living rooms, and the one-on-ones where people listened and heard”. Open dialogue and compassion ultimately convinced the Irish people to legalise abortion services.
Both the United States and Ireland outlawed abortion on a religious basis. Both force their citizens to travel great distances for reproductive care, and both have had harrowing consequences as a result of their restrictive abortion policies. Yet, the Irish public has demonstrated how to coalesce as a society and spur seismic change. Now, we watch as American states attempt the same, and hope that they look to Ireland’s recent history for inspiration.
The full report of the UnPAC study can be found here.