Choosing to Provide: Early Medical Abortion and Clinician Conscience in Ireland

Providers are essential to the delivery of abortion care. Yet, they often occupy an ambiguous space in political discourse around abortion. The introduction of a new abortion service in Ireland invites us to look afresh at providers. Since the Health (Regulation of Termination of Pregnancy) Act 2018 came into force, by far the most common form of abortion care has been early medical abortion (EMA). This is typically provided by General Practitioners (GPs), with approximately 10% of GPs having chosen to provide EMA. This article draws on an empirical study of providers to investigate their motivations for, and experiences of, provision and their views on colleagues who have not chosen to provide. The study shows that for many providers, the choice to provide was grounded in a moral commitment to protecting women's rights to autonomy and health and ensuring that the harms of the past were not repeated. The article argues that notwithstanding increased normalisation of EMA in Ireland, conscience still has a role to play in abortion care provision and it is important to reflect on the various aspects of this role.

Grief intensity following adolescent miscarriage or abortion: A descriptive study of recollections of adult women

Objective

The purpose of this study was to examine women's recollected lifespan perceptions of the effect of grief intensity following adolescent perinatal death.

Participants

Nineteen adult women who had experienced either a miscarriage or an abortion during adolescence. The study involved the recollection of events surrounding the experience which had occurred between three and 28 years previously.

Methods

A 55-item online survey was used to gather recollected perceptions of adolescent miscarriage and abortion experiences. The Perinatal Grief Intensity Scale was embedded within this survey. The participants were instructed to recall their responses to the perinatal loss at the time of the event as an adolescent (T1; Time 1) and how they feel currently as adults about their previous adolescent perinatal death (T2; Time 2). Data were collected at both T1 and T2. The Perinatal Grief Intensity Scale is accompanied by an appropriately weighted Excel scoring sheet which was utilised to analyse the data at both T1 and T2.

Results

As adolescents, participants perceived similar high and medium grief intensity when compared by type of loss (miscarriage, n = 6; abortion, n = 6). However, more women who had an abortion (n = 5) experienced low grief intensity compared with participants who had a miscarriage (n = 2). As adults, participants continued to perceive similar high and medium grief intensity when compared by type of loss (miscarriage, n = 6; abortion, n = 5). In addition, women who had an abortion continued to experience more low grief intensity (n = 6) compared with participants who had a miscarriage (n = 2). Approximately one quarter of adult female respondents, 26 % (n = 5) exhibited increased grief intensity as measured by the scores over time. Thirty seven percent (n = 7) exhibited no change in scores, and 37 % (n = 7) exhibited decreased scores over time in response to adolescent miscarriage or abortion.

Conclusions

Support for the adoption of the Perinatal Grief Intensity Scale to identify women in need of follow-up for grief intensity after an adolescent miscarried or terminated pregnancy is evident. The results of this study have demonstrated that grief can resurge or appear in adult females as they respond to events across the lifespan, including further reproductive experiences. Therefore there is a compulsion for health care professionals to identify women at risk of intensive grief responses due to previous contributory events.

Tweetable abstract

Healthcare providers should screen adult women who have experienced a previous adolescent miscarriage or termination for adverse mental health issues in adulthood.

Building infrastructures of abortion care in an un-caring state: acompañante's carework and abortion access in Peru

For abortion seekers, Peru is an uncaring state where legal and policy interventions have resulted in violence, persecution, and neglect. This state of abortion uncare is set within historic and ongoing denials of reproductive autonomy, coercive reproductive care, and the marginalisation of abortion. Abortion is not supported, even where legally permissible. Here we explore abortion care activism within the Peruvian context, foregrounding a key mobilisation that has emerged against a state of un-care - acompañante carework. Through interviews with people involved in abortion access and activism in Peru, we argue that acompañantes have constructed an infrastructure of abortion care in Peru through the bringing together of actors, technologies, and strategies. This infrastructure is shaped by a feminist ethic of care that differs from minority world care assumptions regarding high quality abortion care in three key ways: (i) care is provided beyond the state; (ii) care is holistic; and (iii) care is collective. We argue that US feminist debates relating to the emerging hyperrestrictive state of abortion un-care as well as broader research on feminist care can learn from acompañante activism strategically and conceptually.

'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.

Triumph and concession? The moral and emotional construction of Ireland's campaign for abortion rights

In March 2018, the Irish government confirmed that a referendum would be held on 25 May, allowing for the Irish public to vote on the legalisation of abortion. The same month, Together for Yes – the national civil society campaign advocating for a ‘Yes’ vote in the referendum – was launched. This article draws upon findings from 27 in-depth interviews conducted in December 2019 and January 2020 with Irish abortion activists, to explore the moral and emotional construction of abortion within the ‘Yes’ campaign. This research suggests that the ‘Yes’ campaign, which secured 66% of the votes cast in the referendum, framed abortion as a negative affective object and constructed the moral permissibility of abortion along rather conservative lines. Data from the first year of abortion provision in the Republic of Ireland reveals that abortion seekers still face huge obstacles in accessing services in the State. The legislation introduced in January 2019 allows abortion on request only until 12 weeks, whilst issues remain in relation to the refusal of care. This article, therefore, concludes that by framing abortion in conservative terms, the pro-choice campaign has not yet succeeded in destigmatising abortion in Ireland – an issue now translated into limited legislation and inadequate provision of services.

Abortion Im/mobility: Spatial Consequences in the Republic of Ireland

In the context of Ireland’s new legislation governing abortion, I outline and examine the spatial consequences of political decision-making. I argue that Ireland’s new abortion law and its clinical guidance permit travel for some pregnant people but impose fixity on others. I analyse the spatial consequences of legal limitations, including non-medically necessary delays in care and medical control of medication abortions, that necessitate travel for abortion. I demonstrate how current laws fix some pregnant people in place, including diverse migrant populations within Ireland, with no possibilities for abortion-related travel. This critique of the ‘new’ law demonstrates the Irish state’s continued political and medical control of abortion.

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.

Persistence and Change in Morality Policy: The Role of the Catholic Church in the Politics of Abortion in Ireland and Poland

On the issue of abortion, Ireland and Poland have been among the most conservative countries in Europe. Their legal and cultural approaches to this issue have been deeply influenced by the institution of the Catholic Church and its purported role as a defender of an authentic national identity. However, their political climates for abortion reform are increasingly divergent: Ireland has liberalised its abortion law substantially since 2018, while Poland is moving towards further criminalisation with the repeated introduction of restrictive laws in parliament. Both have seen active pro-choice movements who mobilise for reform and widespread non-compliance with their restrictive abortion laws, but the policy impact of these trends varies significantly. What accounts for this difference? This article draws on comparative analysis of Ireland and Poland to assess their divergent trajectories on abortion reform, arguing that the most significant driver of change between the two is the disparity in influence of the Catholic Church on politics and policymaking.