Abortion is now legal in Ireland. That doesn’t mean it’s accessible

While Ireland underwent a quiet revolution after the 2018 referendum campaign, socially conservative attitudes still endure in the country’s rural areas. 

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“A year ago, I would never have believed I would be sitting here handing out pills just in my day of work. I’ll see a baby with a virus, I’ll see a woman for an abortion, I’ll see an old lady for her blood pressure pills. It’s just part of my normal day. It’s fantastic.”

Dr Tiernan Murray, a GP in Goatstown, Dublin, opens a cupboard in his surgery office and gestures at the neat boxes of abortion pills, bundled together with elastic bands and lined up in underwhelming cardboard packaging like any other medication in his practice. 

It’s a sight that would have been unthinkable in Ireland before the country voted in a referendum on 25 May 2018 to legalise abortion. Previously, Ireland’s abortion laws were some of the harshest in the world, through a near-total ban embedded in the constitution. The referendum was fiercely fought on both sides, but the Yes campaign to repeal the ban ultimately won by a resounding 66.4 per cent.

The government moved quickly to enact new abortion legislation following the referendum, and terminations become legal on 1 January 2019. The new legislation is based on recommendations from a Citizen’s Assembly comprised of 100 randomly selected members of the public. In the months before the referendum, the assembly agreed a series of recommendations on the shape of new abortion laws in the event of a vote for repeal.

The assembly recommended legal terminations for any reason up to 12 weeks, or up to 24 weeks in case of serious risk of harm to a woman’s health, and beyond 24 weeks in instances of a fatal foetal abnormality. Up to 9 weeks, family planning clinics and GPs can perform abortions by prescribing a pill. Beyond this time limit, terminations primarily take place in hospitals through surgical procedure.

Murray, who campaigned for a “Yes” vote in the referendum and describes himself as having “always been pro-choice”, opted-in to be a provider of abortion pills and began the necessary training.  Murray was able to offer terminations in his surgery as soon as abortion was legalised. The first pill he prescribed felt historic. “It was all brand new. I’d never done this before, I had to keep checking… My emotion was just that it’s great to be able to help. And the women are just so grateful. 

“People say there’s nothing good about an abortion, abortions are bad. It’s regrettable that a woman needs to choose an abortion but there is such a thing as a good abortion… I feel good, the same way as a surgeon takes out someone’s… appendix, if I help a woman do what is really in her interests.”

Murray says the process has been smoother than expected. “Several training groups were set up. We always knew that the amount of training is minimal. A two hour workshop tells you everything you need to know. It’s not difficult”, he explains.

The late legislation of abortion in Ireland may have made the process easier. When many European countries legalised terminations in the 1960s or 1970s, the only available process was surgical, and therefore restricted to hospitals. Since then, advances in medicine and the use of termination pills have made abortion an increasingly simple procedure.

Nonetheless, Murray thinks the current legislation needs reforming. First, the mandatory 3-day waiting or “cooling-off” period between requesting an abortion and being able to receive one is “an insult to women”, Murray says.  The clause was introduced to persuade floating voters to back the “Yes” vote during the referendum, but it has little scientific basis.

He is also concerned that while residents in the Republic are entitled to receive abortions at no cost, women travelling from Northern Ireland (where abortion remains a criminal offence in almost all circumstances) are required to pay for terminations. The cost amounts to around 450 euros – a fee that could be prohibitive for people from lower-income backgrounds. And making contraception free (as it is in the UK) would be a sensible way to reduce the number of unwanted pregnancies from the outset, Murray contends.

Despite the apparent ease with which GPs have adjusted to the new legislation, Murray notes that a relatively low number of GPs have opted in. Recent figures suggest only 11 per cent of GPS have signed up to offer abortion services. The opt-in approach was originally intended to protect the rights of GPs who object to abortion for moral or religious reasons.

But the low sign-up numbers may also be due to workload – and the fear of protesters. “I know all the GPs around here, they’re all pro-abortion. They [can’t] be bothered because their workload is huge. A lot are saying ‘why would I take on more work’ that might upset some of my patients?”

One way of countering protesters could be erecting buffer zones around GP surgeries and rural clinics to shield patients.  During recent weeks, a group of anti-abortion protesters gathered outside Murray’s surgery in Dublin, a move he believes was also intended to intimidate other GPs from becoming providers.

In January, picketers organised outside a clinic in Galway, and a clinic in county Kilkenny contacted local police after receiving “nuisance calls” from anti-abortion activists. The following month, anti-abortion graffiti was daubed on the wall of a clinic in county Longford, after a GP said he would offer abortions in some circumstances.

But protests are small in number. “The anti-[abortion] people are clearly devastated, they have disappeared…gone, unheard of. They’re defeated, there’s no coming back for them. It’s done”, Murray says. The clear majority for repeal delivered in the referendum may have helped see off lingering anti-abortion sentiment.

Yet the story isn’t the same all over Ireland. Outside of liberal urban centres like Dublin, activists warn that rural Ireland risks falling behind in the new system. Sinéad Magner is an activist with Tipperary For Choice, one of Ireland’s more rural counties where just three of 60 general practice clinics have opted-in.

“GP coverage is low and South Tipperary General Hospital is not accepting referrals for abortion, [even] though it does have a maternity department; women must be referred on to Waterford, Cork or Limerick.

“This is proving to be a massive barrier to access, considering the quality of rural public transport provision, cost of provision, as well as creating additional issues for people with childcare needs or those in abusive, violent or controlling relationships.”

The three-day waiting period can make it difficult for women wishing to be discreet when travelling twice to a remote GP’s surgery. Poor transport in rural areas can make it easier to travel out of the county to a major city than to travel across Tipperary, Magner explains. Because of this, some women would rather travel to Dublin or Cork for three days.

“We also don't have any figures on whether women are continuing to buy abortion pills online but there is a possibility that this is continuing to happen too”, she adds.

While Ireland underwent a quiet revolution over the course of last year’s referendum campaign, socially conservative attitudes still endure in the country’s rural areas. Here, anti-abortion stigma is of a “Not In My Backyard” variety, where locals may be content for women to access services by leaving the county, but don’t want to think about abortions happening in the same GP surgeries and hospitals that they themselves use.

In reality this means that, as in Ireland’s pre-referendum days when people travelled to England for abortions, some women still face the difficult position of travelling hundreds of miles for a termination. For those working in precarious and zero-hours employment who are unable to make time-consuming journeys, this can prove especially difficult.

Figures on how many abortions are taking place since the vote to repeal are due to be published next year. Murray says that while Ireland’s new abortion system still needs some reforms, its success is clear: “It’s worked phenomenally well and we are now a model for the world. People from other countries will be coming here and asking how did they get it so right and so quickly?”

Siobhán Fenton is a Belfast-based writer covering gender, politics and Northern Ireland.