Recently, on the 22nd May to be precise, and on the third anniversary of the overwhelming vote to Repeal the Eighth Amendment to the Constitution, the Irish Times ran a story headlined: Legal abortion: Why are women still travelling to the UK every day? – Three years after Ireland vote, women are still being forced to travel to access terminations.

The story reminded us all that, even though we had performed our civic duty by voting to repeal the eighth amendment, the new abortion legislation has still left grey areas resulting in many women still having to travel out of the country for an abortion. Three years ago, 66.4 per cent of Irish voters opted to repeal the Eighth Amendment and allow for safe, legal and free abortion, but people are still being forced to travel to access terminations. Astonishingly, in 2019, the year that abortion services became available in Ireland, 375 Irish women travelled to the UK for an abortion: more than one person each day made the journey that voters had been told would be a thing of a past.

So why is this – what went wrong?
New legislation introduced by the Fine Gael-led Government allows for abortion without restriction up to 12 weeks and in limited circumstances after that up to six months. And it is in this ‘limited circumstances’ clause that the grey areas arise. As a review into the State’s abortion legislation by the Department of Health gets underway, pro-choice campaigners say that the existing legislation has serious limitations, which especially impact those in the most difficult of circumstances.

So the problem is this: Abortion is legal and free up to 12 weeks but once the 12-week limit passes, the legislation dictates that someone who wishes to terminate a pregnancy with a serious foetal anomaly can only do so if two doctors agree that the diagnosis means the foetus is likely to die before or within 28 days of birth. There are three diagnoses where doctors can generally agree on this and a termination is always offered – Edwards syndrome, Patau syndrome and anencephaly – but when faced with a rarer or more complicated diagnosis, it can be impossible to say with any degree of legal certainty how long a baby will survive for. Doctors have come across cases where an unborn baby is suffering from symptoms where medically it is clear that a fatal foetal anomaly exists but because the medical case is unique the legal basis for finding that the baby is not compatible with life does not exist. As there is no precedent for the condition, doctors cannot prove it. Given that doctors can still be criminalised for providing abortions – with a maximum sentence of 14 years in prison – most medical practitioners – understandably – take a very cautious approach, sometimes urging people to travel to the UK to access a termination rather than providing it here in Ireland. And this is borne out by the 2019 figures with 375 travelling to the UK for an abortion.

So there are two key issues here that need to be addressed:
• the decriminalisation of abortion for medical practitioners and
• allow a woman to make the decision about whether or not she’s going to continue with a pregnancy after a diagnosis of a foetal anomaly.

Access to Abortion services – almost half of maternity units fail to offer full abortion services

A third issue arises with regard to access to abortion services which can also be difficult to access depending on where you live. For example, in Sligo there are no GPs offering abortion services. Furthermore, a recent report sponsored by the Department of Sexual and Reproductive Health and Research at the World Health Organisation (WHO), stated that “there is an uneven or incomplete geographic coverage of abortion services both in the community and in hospitals, particularly in rural regions and in the west and north of Ireland”. The HSE has confirmed that, three years after the 2018 abortion referendum, almost half of hospitals (9 out of 19) with maternity units still do not offer full abortion services.

The WHO report maintains that “in the providing hospitals, abortion services have been set up by a handful of ‘champion’ doctors, nurses, and midwives” but that “in some hospitals it is clear that the leadership expected from the management is lacking”. In some hospitals where staff members are conscientious objectors, it can present staffing issues, limiting the amount of terminations that can be carried out. While Ireland has introduced a progressive policy of free, safe and legal abortion, serious anomalies still exist. Not all of the pledges that followed the landmark referendum have been delivered, meaning that in 2021 people are still forced to contend with stigma and shame as they make lonely journeys. That journey to England, for so long the most resonant symbol of a long-standing injustice, remarkably, still persists.

_{Note: The original article, written by Lyn Enright, appeared in the May 22nd 2021 edition of the Irish Times.}