The woman is the active agent: General practitioners and the agentive displacement of abortion in Ireland

After the legalization of abortion in 2018, Ireland needed clinicians to become abortion providers and make this political win a medical reality. Yet Irish doctors had next-to-no training in abortion care, and barriers ranging from stigma to economic pressures in the healthcare system impacted doctors' desire to volunteer. How did hundreds of Irish doctors make the shift from family doctor to abortion provider? Drawing on ethnographic research conducted between 2017 and 2020, this article explores the process by which Irish general practitioners became abortion providers, attending to the material impact of medical technologies on that journey. Drawing from medical anthropologists who have examined similar themes of agency, pharmaceuticals, and medico-legal frameworks within the topic of assisted dying, I build on Anita Hannig's idea of "agentive displacement" to frame the productive impact of abortion pills on this transition.

The Making of Clandestinity: Strategic Ignorance in Abortion Practices in Latin America

Abortion is a public secret in Latin America. It is highly restricted across the majority of the continent and yet millions of abortions take place every year. We use the sociological framework of 'strategic ignorance' to argue that convenient not knowing, erasure and concealment allow for the simultaneous negation and allowance of abortions in Latin America. By drawing on interviews with people involved in abortion activism and access across the continent we examine three sets of actors: the state, abortion providers and individuals. When wielded by the state, strategic ignorance reproduces the status quo of the criminalization of abortion but when wielded by abortion providers and individuals it creates the conditions for 'clandestine' abortions to be procured without prosecution. Strategic ignorance is therefore mobilized by the powerful as well as the powerless who are resisting state control of their fertility and reproductive lives.

'To be vigilant to leave no trace': secrecy, invisibility and abortion travel from the Republic of Ireland

Until 2018, abortion in the Republic of Ireland was banned in almost all circumstances under one of the most restrictive legal regimes in Europe. The main solution for Irish women and pregnant people seeking abortion services had been to pursue care abroad, typically in clinics in England. In this paper we focus on the hardships of waiting for abortion care experienced by Irish residents leading up to their travel for appointments in England in 2017 and 2018. Based on in-depth interviews with 53 Irish women collected at three British Pregnancy Advisory Services (BPAS) clinics in England we analyse women's experiences as they navigated an 'environment of secrecy' in Ireland. This included making specific secrecy efforts when navigating travel arrangements, conversations, movement, health records, and the travel itself. Despite the expansion of abortion access in Ireland in 2018, the need to travel abroad continues for many women. We argue that the continued need for secrecy when women have to travel abroad for care perpetuates this important phenomenon's invisibility. This argument also applies to other countries where abortion access is restricted, and women are forced to travel for care. We also caution against the presumption that all Irish residents are able to travel internationally for healthcare.

"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.

"No one should be alone in living this process": trajectories, experiences and user's perceptions about quality of abortion care in a telehealth service in Chile

Self-managed abortion is a common self-care practice that enables pregnant people to exercise their rights to health, bodily autonomy and to benefit from the advances of science even when living in contexts that do not guarantee these rights. In this interpretative qualitative study, we aimed to understand women’s abortion trajectories, experiences with self-managed abortion and assessments of the quality of care provided by Women Help Women (WHW, an international activist non-profit organisation working on abortion access). Grounded in feminist epistemology and health inequalities approaches, we conducted eleven semi-structured interviews in Santiago, Chile. We found that illegality, stigma and expectations surrounding motherhood and abortion determined women’s experiences. Participants perceived the WHW service as good, trustworthy, fast and affordable, and valued confidentiality and privacy; the quantity and quality of information; having direct, personalised and timely communication with service staff; being treated with respect; and feeling safe, cared for and supported in their decisions. Most participants considered self-managed abortion appropriate and acceptable given their circumstances. Fear was the dominant feeling in women’s narratives. Some participants mentioned missing instant communication, in-person support and professional care. We conclude that support, information and company are key to improving abortion seekers’ experiences and enabling their decisions, particularly in legally restrictive settings. Centring care in pregnant people’s needs and autonomy is fundamental to ensure safe, appropriate and accessible self-care interventions in reproductive health. Social and legal changes, such as public funding for abortion, destigmatisation and decriminalisation, are needed to realise people’s right to higher standards of healthcare.

‘A Hope Raised and then Defeated’? the Continuing Harms of Irish Abortion Law

Irish legislative engagement with abortion law reform has never been framed by recognition of the rights of pregnant women, girls and other people. Rather, where it has taken place at all, it has always been foetocentric and punitive, exceptionalising abortion and conceptualising law as a means of discouraging it. In important ways, the post-repeal landscape has failed to break decisively with this orientation. While in 2018 there was certainly more discussion of women’s entitlement not to be exiled from the country in order to make decisions about reproduction, the framing that dominated legislative and government discourses of abortion law reform was one in which the ‘problem’ being addressed was such that unsafe medication, exclusion from formal medical systems, and the undeserved punishment of people who had received diagnoses of fatal foetal conditions in the course of their ‘much wanted pregnancies’ were the focus. There was little or no engagement in legislative politics with the right to choose, reproductive agency, reproductive justice or the moral standing of pregnant people as ethical decision makers when it came to their pregnancies. As a result, post-repeal abortion law reform was more about managing risk than maximising agency. I will argue that this underpins and partly explains the shortcomings of the new law: the Health (Regulation of Termination of Pregnancy) Act 2018 (‘HRTPA 2018’). Within that new legal regime, I argue, pregnant people continue to lack decisional security when it comes to their reproductive lives and are exposed to significant constitutional and dignitary harms as a result.

Four Pieces on Repeal: Notes on Art, Aesthetics and the Struggle Against Ireland’s Abortion Law

The Repeal campaign articulated new and transformative relationships between law, reproduction and the political in Ireland. During the campaign, ordinary people took ownership of and participated in mutual teaching and critique of law on a wide scale. Art, along these lines, was often used to document and archive the injustices worked by the 8th Amendment. However, art also became a means of imagining law otherwise. In this piece, I use Jacques Rancière’s work on the relationship between aesthetics and politics to analyse artistic contributions to feminist legal discourses associated with Repeal.

Irish voters repealed the eighth: now it's time to ensure access to abortion care in law and in practice

This commentary discusses Ireland's 25 May 2018 Referendum result to repeal the Eighth Amendment and has two key aims. Firstly, it encourages policy-makers to grasp the full potential of legislative reform by enabling and protecting women's access to abortion care within a continuum of sexual and reproductive healthcare options. Secondly, it calls for urgent clarity about access to abortion care in the interim period of legislative transition.