Abortion, emotions, and health provision: Explaining health care professionals' willingness to provide abortion care using affect theory

Information flow as reproductive governance. Patient journey analysis of information barriers and facilitators to abortion care in the republic of Ireland

Background

Information flow - information communication and transmission pathways and practices within healthcare systems - impacts patient journeys. Historically, regulating information flow was a key technology of reproductive governance in the Republic of Ireland. Pre-2018, law and the State sustained informational barriers to and through abortion care in Ireland. An expanded abortion service was implemented in January 2019.

Method

Patient Journey Analysis (PJA) interrogates informational facilitators and barriers to/through post-2019 abortion care in Ireland. We focus on information flow at the interfaces between the 'public' sphere and 'point of entry', 'point of entry' and primary care, and primary and secondary care.

Materials

The paper uses data from a mixed-method study. A tool for assessing online abortion service information (ASIAT), desktop research, and qualitative data from 108 in-depth interviews with providers, policy-makers, advocacy groups, and service users informed the analysis.

Results

Abortion patient journeys vary. Information flow issues, e.g. communication of how to access services, referral systems, and information handover, act as barriers and facilitators. Barriers increase where movement from primary to secondary is needed.

Applications

The article identifies good practice in information flow strategy, as well as areas for development. It illustrates the significance of information flow in accomplishing reproductive governance.

Analysing MyOptions: experiences of Ireland's abortion information and support service

BACKGROUND

In 2018, the Irish government enacted a liberalised abortion law permitting expanded access to abortion from January 2019. A dedicated information and support service - MyOptions - was established to provide non-directive counselling and clinical advice about unplanned pregnancy. MyOptions provides contact details for abortion providers but does not make appointments for abortion-seekers. In 2020, the Abortion Rights Campaign (ARC) conducted research into Irish residents' experiences of abortion care under the new law, including their experiences with MyOptions.

METHODS

Between September 2020 and March 2021, ARC administered an online survey. Qualitative data were coded using NVIVO software and analysed through thematic analysis. Quantitative data were analysed descriptively. This article analyses a subsection of these data to answer the question: What were abortion-seekers' experiences of using MyOptions?

RESULTS

Many respondents were unaware of MyOptions before becoming pregnant. Some described MyOptions as useful and compassionate. Others noted a lack of clarity from MyOptions about the scope of its service and a lack of information on accessing abortion after 12 weeks. Respondents reported frustration that the service did not arrange appointments, explaining that having to contact general practitioners (GPs) themselves was stressful and time-consuming, as was GPs' refusal to provide care or refer to a willing provider.

CONCLUSIONS

MyOptions primarily benefits abortion-seekers whose pregnancies are under 12 weeks and who are comfortable contacting a GP themselves. The addition of an appointments booking service and guidance on how to access abortion for medical reasons and abortion after 12 weeks could improve the service.

"The kind of doctor who doesn't believe doctor knows best": Doctors for Choice and the medical voice in Irish abortion politics, 2002-2018

This article examines how the physician advocacy organization Doctors for Choice articulated a collective pro-choice "medical voice" over the course of sixteen years. This voice was central to the successful 2018 campaign to repeal Ireland's Eighth Amendment, which had imposed a virtual ban on abortion in the Republic of Ireland since 1983. I examine how DfC set itself in opposition to the powerful cadre of anti-abortion Catholic physicians who had dominated Irish public discourse on abortion for decades. DfC not only had to provide a strong alternative argument, but also had to distance itself from a legacy of physicians as gatekeepers to abortion. Based on oral histories and documentary sources, I argue that DfC developed a collective pro-choice "medical voice" and a politics of physician advocacy by leveraging the cultural authority of physicians and using discourses of medical expertise and patient autonomy. Doctors have been called upon to use their social position to fight health-related social inequality. By providing a detailed case study based on individual experiences of and perspectives on physician advocacy, this article examines the framework of "physician advocacy" in practice. It identifies affective and structural barriers to physician engagement in abortion politics across medical specialties. Finally, it considers how, in the face of these barriers, a small group of physicians helped to set the terms of a movement for accessible and equitable abortion care in Ireland.

Normalising abortion: what role can health professionals play?

BACKGROUND

Despite being a common gynaecological procedure, abortion continues to be widely stigmatised. The research and medical communities are increasingly considering ways of reducing stigma, and health professionals have a role to play in normalising abortion as part of routine sexual and reproductive healthcare (SRH). We sought to investigate how health professionals may normalise abortion and challenge prevailing negative sociocultural narratives.

METHODS

As part of the Sexuality and Abortion Stigma Study (SASS), qualitative secondary analysis was conducted on two datasets containing health professionals' accounts of providing abortion in Scotland and England. A subsample of 20 interviews were subjected to in-depth, thematic analysis.

RESULTS

Four key themes were identified in heath professionals' accounts: (1) encountering resistance to abortion from others working in SRH; (2) contending with prevailing negative sociocultural narratives of abortion; (3) enacting overt positivity towards abortion provision; and (4) presenting abortion as part of normal, routine healthcare.

CONCLUSIONS

It is clear that negative attitudes toward abortion persist both inside and outside of healthcare systems, and need to be challenged in order to destigmatise those accessing and providing services. Health professionals can play a key role in normalising abortion, through the ways in which they frame their work and present abortion to women they treat, and others more widely. Our analysis suggests a key way to achieve this is by presenting abortion as part of normal, routine SRH, but that appropriate support and structural change are essential for normalisation to become embedded.

From Feminist Anarchy to Decolonisation: Understanding Abortion Health Activism Before and After the Repeal of the 8th Amendment

This article analyses abortion health activism (AHA) in the Irish context. AHA is a form of activism focused on enabling abortion access where it is restricted. Historically, AHA has involved facilitating the movement of abortion seekers along ‘abortion trails’ (Rossiter, 2009). Organisations operate transnationally, enabling access to abortion care across borders. Such AHA is a form of feminist anarchism, resisting prohibitions on abortion through direct action. However, AHA work has changed over time. Existing scholarship relates this to advancements in medical technology, particularly the emergence of telemedicine and the increased use of early medical abortion. This article goes beyond those explanations to explore how else AHA has changed by comparing the work of AHA before and after the Republic of Ireland’s referendum on abortion in May 2018. Based on this, I argue that there is a visible shift in the politics of AHA. Drawing on qualitative data from research on AHA organisations along the Liverpool–Ireland Abortion Corridor, specifically those based outside Ireland, the article argues that in the aftermath of the referendum, Irish AHA has increasingly moved towards decolonising feminist activism, thus drawing attention to the relationship between abortion health activists (AHAs) and broader political discourses entangled with abortion law reform.

Cheeky Witnessing

Feminists witness legal worlds as they observe, document and share nothing less than the reproduction of life itself. The world of the abortion trail, where people and things move across borders to change life’s reproduction, has generated a rich variety of legal sources, figures and objects for feminist witnessing. In watching how feminist activists improvise with sources, figures and objects of legal consciousness on the abortion trail, this article seeks to contribute to critical understanding of a plurality of witnessing practice, particularly as it emerges in diaspora space. Focusing on Murphy’s concept of immodest witnessing, with its attention to bodies, protocols and apparatuses as constituents of knowledge, the article thinks with the diasporic feminist performance group, Speaking of I.M.E.L.D.A., about how they used self-examination, collaboration and knowledge-sharing on the trail to repeal Ireland’s 8th Amendment. The article argues that their improvisation with legal consciousness of reproductive choice enacts ‘cheeky witnessing’. Cheeky witnessing has three dynamics as a method of observation. First, it is messy and irreverent in innovating with names to display the mixed genealogies of feminist knowledge. Second, cheeky witnessing generates novel subject-figures who make connections between different reproductive labourers as observers of the trail in diaspora space. Third, cheeky witnessing places funny objects, knickers in this instance, so as to join up particular public locations and make them more, if unevenly, comfortable for sexual and reproductive bodies. Cheeky witnessing shows us how committed and partial practices play a role in speaking across interests and experiences, in stretching the legal imagination and in sustaining the everyday grind of making a better world.