Written by Dr Ben Kasstan (Research Fellow, University of Sussex) and Ms Anamaria Bejar (Director of Advocacy at International Planned Parenthood Federation, UK; Research student, London School of Hygiene & Tropical Medicine)

On Friday, 25 May 2018, voters in Ireland unanimously decided to repeal article 40.3.3 inserted into the Irish constitution by its Eighth Amendment, which, since 1983, has given a foetus an equal right to life to the pregnant woman carrying it. Access to safe abortion care has since been withheld from women in cases of rape, fatal foetal abnormalities, serious risk to maternal life, and in cases of unwanted pregnancies. Abortions have, of course, been occurring illegally since 1983, but without dignity and without compassionate care. Women in Ireland have been risking a fourteen-year prison sentence by procuring medical abortion pills (either misoprostol or mifepristone, or a combination of both) online with and without medical supervision. In many cases, these packages of medical abortion pills have been intercepted by Irish customs. As many as nine women each day have been forced to leave Ireland and seek care abroad at their own expense – whether they had the funds or had to gather them somehow.

What occurred on the 25th May in Ireland is nothing short of a revolution for reproductive rights, with 66% of the voting population demanding an end to the historical injustice that women have experienced when attempting to control their own fertility. As Leo Varadkar, current Taoiseach (Prime Minister), said, ‘the wrenching pain of decades of mistreatment of Irish women cannot be unlived. However, today we have ensured that it does not have to be lived again.’ Yet the referendum is also an opportunity to inspire activism, lobbying and legal reform in countries with restrictive abortion laws that are deeply embedded in religious doctrines. This momentum for reproductive rights must be seized and politicians must be held accountable for gender-hostile legislation, patriarchal control, and inequitable care practices in Northern Ireland, which stands alone in the United Kingdom for enforcing dangerously restrictive policies around abortion care.

It is one thing to grant the right to access abortion care in Irish law, and another to protect that right in practice. We call on activist groups and stakeholders to continue scrutiny in the following areas:

Firstly, how this decisive public demand for access to comprehensive sexual and reproductive healthcare will actually be implemented to ensure that safe and legal abortion care is readily available, free at point of use, and provided with the highest standards of quality and regulation. Particular attention is required to address:

• How healthcare providers who are set to deliver abortion care in Ireland will be trained (i.e. minimum standard of competencies and skills) in a timely manner to deliver compassionate and woman-centred abortion care in the context of legal transition.
• How all healthcare providers intersecting on abortion care from the public and private sectors will be trained to meet the needs of women without stigma and moral judgements in consultations, referrals, and at point of care.
• How clinical protocols and health system guidelines will be modified to ensure women have access to all abortion choices, including medical abortion with and without medical supervision at all points of health care.
• How safe abortion services will be publicly funded to ensure affordability to all women, regardless of their economic situation.
• How scaling-up of medical abortion will include quality assurance by ongoing supervision, monitoring, evaluation and systematic planning, management, guidance and support.

Secondly, how access to abortion care will be approached in the interim period, and specifically:

• How the Irish state will cover the expenses of women requiring abortion care abroad.
• To what extent will the above-mentioned interceptions and legal sanctions around medical abortion without medical supervision (procured online specifically from Women on Web or Women on Waves) be waivered to enable safe access and post-abortion care in healthcare facilities without the fear of law enforcement.

Finally, how the right to access abortion care will be protected:

• How will buffer zones be designed around abortion-care providers and how will new laws be developed and enforced to prevent anti-women’s health activists from intimidating and harassing people attempting to access abortion care, as recently happened in the UK.
• How will legislation include provisions that sanction denial of abortion care on the part of healthcare providers (in what is often and problematically described as “conscientious objection”)
• How comprehensive sexuality education will be provided in all schools ensuring that abortion care is presented as a safe option and legal right to end an unwanted or unviable pregnancy.

Paying close attention to these recommendations will do justice to the enormous public demand in Ireland for access to free, safe and legal abortion care as an attempt to improve the continuum of sexual and reproductive healthcare and women’s healthcare services.

Please note that blog posts are not peer-reviewed and do not necessarily reflect the views of RHM as an organisation.