What happens when women have to travel: abortion, care and lessons from Ireland

By Deirdre Duffy and Claire Pierson

The incoming administration under Donald Trump suggests that constitutional protections on women’s ‘right to choose’ in the US may soon be rolled back. The Vice-President and senior administration members campaigned on anti-abortion platforms. To date, the politically-charged debates relating to abortion and abortion access has predominantly been presented by the media as a discussion of legal rights, morals, or the reasons why a woman may choose to terminate a pregnancy. What is less considered is the simple fact that, regardless of politics, abortions happen and women seeking abortions need care. Approximately 44 million abortions are performed globally every year. The need for women to travel for abortions, already mentioned by the incoming president, will have significant effects on care for thousands – if not hundreds of thousands – of women. In addition to the legal and moral debate then, the reality of abortion travel and the impact of restrictive abortion legislation on care need informed, focussed discussion.

When speculating on what happens to care when abortion access is limited, it is important to look to countries with more restrictive regimes. The Republic of Ireland has some of the most restrictive legislation on abortion in the world. This includes a constitutional protection of ‘the unborn’ (Article 40.3.3 or the eighth amendment) introduced by referendum in 1983 (see here, here, and here for detailed review and analysis). Women in the Republic of Ireland know the problems that arise when women must travel for abortions only too well. As a result of Irish laws, hundreds of thousands of Irish women have travelled to England and Wales seeking abortion and an increasing but unknown number travelling elsewhere in Europe.

This is more than an inconvenience. Our research with health professionals in Ireland and England as part of a study of the ‘Liverpool-Ireland Abortion Corridor’ (one of the ‘abortion trails’) indicates that the need to travel presents significant health risks. As referral for abortion care is legally prohibited, there is no systematically designed or monitored pathway for women seeking abortion outside Ireland. Abortion travel pathways from Ireland are almost entirely unregulated and the spread of misinformation by rogue agencies is widespread. The need to travel also worsens social and health inequalities. Travelling itself is expensive, logistically complex, and burdensome. It is for this reason that both the World Health Organisation and the Irish Health Information Quality Authority emphasise proximity in their health care quality frameworks.

The need to travel has been used in successive legal and political campaigns for liberalising Ireland’s abortion laws. Responding to these campaigns, the Irish government convened a Citizen’s Assembly (CA) comprised of 99 non-partisan citizens and chaired by a judge. The task of the CA is to decide whether a new referendum on abortion – which may lead to a repeal of the 8th amendment – should take place. On December 15th we submitted a report to the CA based on our research with health professionals in Ireland, Northern Ireland and England on one abortion ‘trail’ – the Liverpool-Ireland Abortion Corridor – the health problems created by the need to travel and the reality of care for Irish women seeking abortion. Within this report we make the following key points:

  1. Abortion travel presents a number of significant health risks for individuals in the short and long-term, this includes haemorrhage, infection and prolonged emotional trauma
  2. There is no consistent monitoring of patient experiences and no comprehensive analysis of patient outcomes or care quality
  3. There are no mechanisms for preventing the exploitation of women by rogue agencies
  4. There are no performance indicators or best practice frameworks for abortion travel
  5. There are no warning systems for emergent public health risks (including infection and the spread of disease)
  6. There is no systematic management or design of patient care and no means of preventing fragmentation or gaps in service

Should the objectives of anti-abortion campaigners in Trump’s administration be achieved, the present reality of abortion care for Irish women may be mirrored in the US. The findings of our report, based on a scoping study funded by the Wellcome Trust, show that women having to travel for abortions works to entrench and deepen already existing gendered inequalities in health care provision.

A copy of our report to the Citizen’s Assembly is available here

 

Further details of the Liverpool Ireland Abortion Corridor research project are available here.

 

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