Abortion: The Struggles Still To Win

The removal of the 8th Amendment was a political and social landmark in Ireland’s history. One year on, however, and serious barriers to abortion services remain, particularly in rural areas. Steph Hanlon looks at how the system stacks up against the demands of the movement for Repeal.

We’ve not long passed the one year anniversary of the landslide vote to Repeal, but the enduring impact of the 8th Amendment still lingers; though the amount of people travelling to Britain is thought to be down by two thirds, one third are still travelling because of institutionalised barriers to access within the system.

Impediments to access

The mandatory three-day waiting period, after the first appointment and before an abortion can be provided, is one such barrier to provision. For some, the wait is too long. For others, any number of events like bank holidays or unforeseen family illness can mean that the mandated second appointments aren’t rescheduled until almost a week after the first. The inability of some to replan and pay for further child care or days off work is too great an impediment. Those without remaining statutory holidays have to lie to their bosses, and it is times like these when the lingering attitude of the state that implemented the 8th amendment can be felt.

In rural Ireland, whole counties remain without access and the patchy provision of ultrasounds to date a pregnancy means that for those in counties that do have GPs who will perform abortions, their pregnancies may not be dated in time to ensure they fall within the legal 12 week limit. It is these women, who fall outside of the 12 week limit but aren’t dealing with a fatal foetal abnormality, who are among those who have to travel to Britain for terminations.

The three day wait period, lack of access to ultrasounds, and the 12 week limit come together to make abortion access practically difficult under the new law for many women across Ireland. What makes the situation more galling is that the government insists on the three day period as a ‘time to reflect’ on the decision. The idea that women should have to take a three day reflective period before a termination when no other medical procedure provided by the HSE requires it is nothing short of patronising and demeaning, and a purpose built barrier to access.

The negative realities of Irish abortion provision after the referendum have been met with inadequate responses from those responsible. The HSE has responded to criticism of counties with no access to say that it is ‘satisfied with the geographic spread’. But for those in Sligo, Leitrim, Kilkenny and Carlow, who have to source the money for buses to other counties, or planes to other countries, the situation is far from satisfactory. And for those of us who fought hard in the referendum and those who fought in the decades before for free, safe and legal access to abortion services, this is not what we fought for. This is not what Ireland voted for.

The case in Rural Ireland

The area of Kilkenny is one which has seen a culmination of impediments to abortion access. That it is a rural area should be no surprise; while the provision of abortion services is sporadic and inconsistent across the country, it is worse in rural areas. All of the counties where abortion is completely inaccessible are rural.

The maternity unit in St Luke’s Hospital Kilkenny became the centre of controversy when the existing four obstetricians said it was not an “appropriate location” for abortion services.

Sent to the Ireland East Hospital Group Chief Executive, a letter said that it was “decided unanimously that the hospital is not an appropriate location for medical or surgical terminations”. The refusal to provide abortion services affects those in bordering counties, meaning women and pregnant people in Carlow, Wexford, Kildare, Laois and Tipperary North and South are without services, and are forced to pay to travel to Waterford or Dublin.

The letter asserts that even if staff were to volunteer for training in the termination of pregnancy, St. Luke’s Hospital would continue to refuse to carry out abortion services, stating that “in the event of professional and values training of staff willing to participate in such procedures, the hospital remains an unsuitable location for these services”. Such callous disregard for the health and needs of the women and pregnant people attending the hospital is unacceptable and reinforces the inequality that the Repeal movement sought to smash.

One of the consultants, Trevor Hayes, was a prominent anti-abortion campaigner during the referendum to repeal the Eighth Amendment in May 2018. In another letter to GPs, Hayes stated that: “Obviously, if a patient is moribund or with haemorrhage or sepsis, she will be dealt with in an appropriate manner.” No one reading those words could miss the significant similarities to the Savita Halappanavar case, a woman ‘dealt with’ in the way doctors deemed appropriate when abortion was limited, and who lost her life because of it.

Though all maternity units have been directed to provide terminations when a women’s life is at risk, and Hayes statement reflects at least that, the idea that an abortion will only be granted when a woman is at death’s door is a another sickening example of how the demands of the Repeal movement, which drove the massive vote for Repeal, have been ignored.

Anti-choice intimidation

Currently there is only one health clinic between Kilkenny and Carlow that has opted in to provide abortions to patients, and this is located outside of the city in Graiguenamanagh. People in Kilkenny have to travel over 30 minutes to get to the town, and for people in Carlow (where there is no abortion service), buses are infrequent and taxis cost €45 – €60 for a one-way trip. The health clinic has been subjected to three incidents of intimidation and harassment, including nuisance calls, picketing and targeting patients.

This issue is not isolated to Carlow. Right across the country, instances of intimidation from anti-choice protests have been reported. GPs have received personal letters, phone calls to their homes, been approached in public spaces and had their clinics picketed in an attempt to prevent them from providing abortions. For medical professionals, this mistreatment is unacceptable, and for the women visiting their clinic for advice, it has been unavoidable at times. For those carrying fatal foetal abnormality pregnancies, or any other kind of crisis pregnancy, this experience can be traumatising. A protest by anti-choicers outside National Maternity Hospital in Holles St, Dublin received widespread condemnation last week for placing three baby coffins at the entrance. Many took to social medial to condemn the protest as sickening; many of those outraged lost children or pregnancies and had to carry a similar tiny coffin themselves. The lack of compassion is sickening indeed.

Minister for Health Simon Hamilton promised draft legislation by the summer which would see buffer zones implemented – something which pro-choice campaigners have been calling for and have fought to have implemented in other parts of the world. The continuing lack of said legislation allows for the continued traumatisation of people outside hospitals and local GP services. In some of these areas, such as small rural towns, the inability to access advice or services privately and without exposure to these protesters is enough to force some to travel.

Disproportionate impact

Whether the barrier is anti-choice intimidation, lack of local services, the three day waiting period, the lack of ultrasound availability or the vague and inconsistent advice, the result always disproportionately impacts working class people and those are the fringes of society. People in abusive and controlling relationships cannot take multiple conspicuous trips, residents of direct provision centres, homeless people and people who are unable to drive such as people with disabilities and health issues, cannot travel in the same way as others. Myself and other activists in Carlow Choice and Equality Network and Kilkenny for Choice made a video to highlight this issue and have an online petition to St. Luke’s Hospital.

During the referendum, the voices of vulnerable people who faced extra barriers to abortion were magnified. There is a huge disjuncture between the demands of the referendum and the reality of access to abortion for pregnant people in rural Ireland. These barriers are doubled for more vulnerable groups, who, as always, will be the most affected. The hangover from the 8th amendment will continue to exist as long as there is institutional obstruction and refusal of care for routine healthcare procedures. It will continue to exist as long as pregnant people are made to jump through hoops because of citizenship status, disability, ethnicity or geographical location.

Abortion should not be a privilege. It should be a right. And it should be free, safe and legal for everyone. We removed the Eight Amendment but the fight for abortion access is far from over.