#abortiontravel Cordelia Freeman on “The Chile-Peru Abortion Trail and the Irish Experience”

This post is contributed by Dr Cordelia Freeman of the University of Nottingham. It is based on a full-length journal article available at: Freeman, C. (2017). The crime of choice: abortion border crossings from Chile to Peru. Gender, Place & Culture, 24(6), 851-868.

The Chile-Peru abortion trail is almost unknown but provides a useful way to reflect on the experiences of Irish women who travel to Great Britain in search of abortion healthcare. Drawing on research on the Chile-Peru case, this post reflects on some similarities and differences with the Ireland-Great Britain example.

Chile has had some of the most restrictive anti-abortion laws in the world. Until last yearabortion was illegal in every single case and now it will be permitted in three very strict cases; if the pregnancy was a result of rape, when the woman’s life is at risk, and when a foetus is not viable. The criminalisation of abortion has not prevented women from procuring abortions but instead has pushed the practice further underground with fatal results. The primary cause of maternal mortality in Chile is complications arising from clandestine abortions and mortality due to abortion is between 10 and 100 times higher in Latin America than in most European countries. The National Health Service estimates that in 2014 there were almost 34,000 admissions after abortions which had gone wrong. Women are quite literally dying due to state legislation. Continue reading “#abortiontravel Cordelia Freeman on “The Chile-Peru Abortion Trail and the Irish Experience””

#abortiontravel Cordelia Freeman on “The Chile-Peru Abortion Trail and the Irish Experience”

#abortiontravel Sydney Calkin on “The Changing Geographies of Abortion Access”

This post is from Dr Sydney Calkin of the University of Durham

Abortion access is fundamentally geographical: looking at abortion as an issue of space and power can help us to understand the continuities between contexts where abortion is illegal and where it is legal, as well as the gaps between abortion law and access in practice. In this post, I draw on a geographical approach to abortion to make two arguments:  first, spatial strategies to restrict abortion access often take the form of regulation of medical care that do not directly attack the legality of abortion but make it practically unavailable by making willing doctors scarce or distant. Second, medication abortion is transforming this landscape by challenging medical control over abortion and is prompting the state to respond to re-assert control.

Laws that ban abortion do not operate in a geographical vacuum: in a world of increased mobility, low-cost travel, and cross-border social networks, women who live in states with highly restrictive abortion laws can (and do) access abortion by going abroad. In Ireland, for example, 9-10 Irish women still travel to Englandevery day in pursuit of abortion access. Irish women are dependent on medical services in England, so that changes in healthcare availability in England has serious consequences for non-residents. The reliance on abortion trails is not limited to inter-state travel between states with different abortion laws; it happens as well within states where abortion access is deliberately constrained and made scarce. In places where there is legal provision for abortion, opponents of abortion rights deliberately create extra-legal obstacles that widen the spaces between women seeking abortion and doctors willing to provide it. Geography becomes a useful tool for widening and compounding inequalities to access and making abortion access dependent on a woman’s mobility, as a factor of her wealth or migration status. Continue reading “#abortiontravel Sydney Calkin on “The Changing Geographies of Abortion Access””

#abortiontravel Sydney Calkin on “The Changing Geographies of Abortion Access”

#abortiontravel Kath Browne & Catherine Nash on “Love both?: Naming Heteroactivism”

This post is from Professor Kath Browne of Maynooth University and Professor Catherine Nash of Brock University

It is becoming increasingly important to give a name to the ways in which gender and sexual rights are being resisted.  Those opposed to gender and sexual rights no longer employ the spectre of the ‘disgusting’ gay man or heap scorn on ‘fallen women’, as such tactics are barred, both legislatively (including criminalising hate speech) and culturally (Ireland as an egalitarian place is becoming core to national identities).

However, resistances to sexual and gender rights remain and they now take a different form than in the past: they employ a framing we name as ‘heteroactivism’.  Heteroactivism operates distinctively in places where ‘unnaturalness’ cannot be linked to the figure of the ‘disgusting homosexual’ because this figure is now generally seen as accepted as part of the nation.  Instead, heteroactivists focus on ‘natural’ procreation and genetics, thereby seeking to reassert heterosexuality as the ‘normal’, common sense and unquestioned centre. Heteroactivism relies on a particular form of heterosexuality (married, childrearing couples, composed of normatively gendered men/women), claiming not only that it is  ‘best for children’, but that such configurations are the ‘best for society’.  Whilst it may seem that the notion of heteroactivism most clearly applies to opposition to same-sex relationships and families (as well as to the very existence of trans people) heteroactivism is also a useful term to understand those who are opposed to abortion/choice. Continue reading “#abortiontravel Kath Browne & Catherine Nash on “Love both?: Naming Heteroactivism””

#abortiontravel Kath Browne & Catherine Nash on “Love both?: Naming Heteroactivism”

#abortiontravel Katherine Side on “Medical Abortion Use: Post-Referendum Possibilities”

This blog post is from Professor Katherine Side of Memorial University, Canada

Despite the lengthy process leading up to the May 25, 2018 referendum on Article 40.3.3 (the Eighth Amendment) of the Constitution, there is little direct discussion about medical abortion. Legal access to abortion in Ireland is long overdue, and pending a ‘repeal and replace’ vote, the Taoiseach and the Tánaiste propose a “doctor-led” protocol [1]Where doctors’ involvement provides clarity and support for medical abortion, it is likely to be welcomed. Where doctors’ involvement limits access, impinges on timeliness, and breeches privacy, it is likely to be unwelcomed. Medical paternalism, legal scholar Sally Sheldon notes, can be just as restrictive as state paternalism.

The referendum outcome could provide clear legalisation, safe practices, and expanded access. Consideration must be given to who is involved and how they’re involved in abortion. Medical abortions are safer with expanded access, not restricted access. Better health outcomes could be achieved through a state-supported model that balances access to medication and a wider range of qualified practitioners, with rights to safety, security, and privacy. Continue reading “#abortiontravel Katherine Side on “Medical Abortion Use: Post-Referendum Possibilities””

#abortiontravel Katherine Side on “Medical Abortion Use: Post-Referendum Possibilities”

Repeal and Replace?

In the last week, while the members of the Oireachtas were making statements in response to the report of the Joint Committee on the 8th Amendment as well as the Citizens’ Assembly recommendations which it discussed, the spectre of repeal and replace has arisen again. The Citizens’ Assembly recommended the repeal of the 8th Amendment and its replacement with a provision “explicitly authorising the Oireachtas to address termination of pregnancy, any rights of the unborn and any rights of the pregnant woman”. It is broadly agreed that in doing so the Assembly was reflecting a concern with the possibility of residual constitutional foetal rights existing that might, through subsequent litigation, be found to frustrate or circumscribe the Oireachtas in legislating for abortion. The Joint Committee acknowledged that concern but, finding the risk of it materialising in ‘real life’ marginal, proposed instead a ‘repeal simpliciter’ that would delete Article 40.3.3 and not replace it with anything. We now hear that both the Taoiseach and, potentially, leader of Fianna Fáil Micheál Martin are concerned with the possible ramifications of repeal simpliciter, so that repeal and replace is firmly ‘back on the table’. In this post I outline (a) whether this is necessary, and (b) if it were to be pursued what the options are. Continue reading “Repeal and Replace?”

Repeal and Replace?

Repeal or Replace?

Fiona de Londras | @fdelond

There is going to be a referendum on the 8th Amendment in 2018. That much is clear. What we don’t yet know is what proposition will be put to the people. In part, this is because the Citizens Assembly recommended that Article 40.3.3 “should be replaced with a constitutional provision that explicitly authorises the Oireachtas to legislate to address termination of pregnancy, any rights of the unborn and any rights of the pregnant woman”. In doing this, it is very clear that the Assembly was concerned to ensure that the Oireachtas would have the power to introduce wide-ranging abortion law reform should it wish to do so; this is evident from the legislative recommendations it then went on to make. Whether the Assembly meant that the Oireachtas should be given an express power to legislate, or whether it meant that the Oireachtas should have the power to create law that would be immune from constitutional challenge is unclear: I discussed this here. What is clear, though, is that the Assembly wanted there to be no dispute about the power of the Parliament to make law for abortion. Why, then, did it recommend repeal rather than replace? Continue reading “Repeal or Replace?”

Repeal or Replace?

An Abortion Law Immune from Constitutional Review?

Fiona de Londras @fdelond

In yesterday’s hearing of the Committee on the 8th Amendment to the Constitution talk turned to the idea that a new constitutional provision might be crafted and introduced which would provide that any law on abortion would be immune from constitutional challenge. In his presentation to the Committee, David Kenny made it clear that this was what he took the Citizens’ Assembly to have meant by its recommendation. In my evidence I posited a different interpretation, namely “as a proposal designed to make explicit the power to legislate for abortion to the extent recommended in the legislative proposals made by the Assembly”. On reflection, either understanding is probably sustainable. Reading the transcripts of the Assembly again, I still consider that the concern with ensuring the Oireachtas had “exclusive” competence to make law for abortion was intended to ensure absolute clarity about the power to legislate for the issue, but it could also be interpreted as saying that in doing so the Oireachtas should be empowered to make a law that would be immune from constitutional review. If the latter interpretation were pursued, would this be desirable and what would be the implications? Continue reading “An Abortion Law Immune from Constitutional Review?”

An Abortion Law Immune from Constitutional Review?

Ireland’s violation of International Abortion rights: A perpetual Déjà vu.

We are pleased to welcome this guest post from Aisling McMahon and Brid Ni Ghrainne.

Abortion is only permitted in Ireland when the life of the mother is in danger, making the Irish abortion framework one of the most restrictive in the world. This week, the Committee Against Torture questioned Ireland about its lack of progress in reforming Irish abortion law[1] and stated that it must explain its human rights obligations to the Irish public before any referendum on abortion.[2] This comes as little surprise as the Irish framework has previously been criticised extensively by four other international human rights committees.[3] The Human Rights Committee has twice found – in Mellet v Ireland[4] and Whelan v Ireland[5] – that Ireland violated Art 7 (right against torture, inhumane or degrading treatment), Art 17 (right to privacy) and Art 26 (right to non-discrimination) of the International Covenant on Civil and Political Rights (ICCPR) for not providing access to abortions to women whose pregnancies suffered fatal foetal abnormalities. The Committee on the Elimination of Discrimination against Women, the Committee on Economic, Social and Cultural Rights, and the Committee on the Rights of the Child have also urged Ireland to change its restrictive abortion framework.

However, no changes have yet occurred. Instead, in response to the decision in Mellet v Ireland the then-Taoiseach Enda Kenny dismissed the Human Rights Committees’ views as not being ‘binding’ and ‘not like the European court’.[6] This exemplifies the confusion that exists regarding Ireland’s international law obligations relating to access to abortion. In response to these recent developments, this post considers: (1) why Ireland should adhere to the views of the respective Committees, and (2) how Ireland can bring its laws into conformity with international law. Continue reading “Ireland’s violation of International Abortion rights: A perpetual Déjà vu.”

Ireland’s violation of International Abortion rights: A perpetual Déjà vu.

The Citizens Assembly Proposals: A Draft Bill

Lawyers for Choice has produced a draft bill that gives effect to the Citizens’ Assembly’s recommendations for abortion law reform. The purpose of the Bill is to codify the Assembly’s proposals, and to show how simply and easily that can be done. The provisions reflect the choices of the Assembly members’ and not those of Lawyers for Choice.

Regrettably, the Assembly’s deliberations on legislation were confined to grounds for accessing abortion only. Experience worldwide shows that, even where grounds are well-drafted, abortion can be difficult to access. The Oireachtas must pay attention to barriers to access such as obstructions outside of clinics, the circulation of misleading information on abortion, underfunding of services, and conscientious objection. Any final legislation must make provision for these matters.

In addition, we regret that the Assembly was unable to consider the decriminalisation of abortion, which is clearly required by international human rights law. Continue reading “The Citizens Assembly Proposals: A Draft Bill”

The Citizens Assembly Proposals: A Draft Bill

Barriers to first trimester abortion care.

We are pleased to welcome this guest post from Dr. Deirdre Duffy from the Liverpool-Ireland Abortion Corridor Project.

As the Citizens’ Assembly turn to the ‘when’ of abortion access, many are highlighting that allowing first trimester abortion in specific cases is highly problematic. The question of access and first trimester care is complex so it is worth summarising the key problems with first trimester focused access.

Barriers to access

A central problem in the timely administration and delivery of high quality care is the existence of ‘barriers to access’. These barriers can be structural, organisational, social, or personal and are usually a combination of a number of factors which prevent those who need care from getting it. By ‘getting’ here it is vital to recognise that patients are not passive – care is a dynamic process of requesting/approaching and being given care.

Importantly for Ireland, barriers to access are not just imposed from above but are embedded in cultures of care. So removing a barrier is more complex than simply funding an abortion clinic (for example) or making abortion legal as while the clinic may exist it may not have trained staff or have staff willing to perform abortions.  

Access and abortion care

In addition to questions about availability of trained professionals, financing of facilities, and proximity, abortion care has to factor in further barriers relating to abortion stigma and attitudes to abortion and women seeking abortion. As a result of abortion stigma, women may not approach care facilities for fear of repercussions. This barrier can be compounded by underlying norms and social factors both within and beyond caring institutions. If, say, a religious organisation which opposes abortion in all circumstances is placed in control of a hospital, a significant barrier to abortion care will inevitably result.

Abortion care access also needs to recognise the ‘timings’ of care-seeking and care-giving. Women may not know they are pregnant until well into the first trimester. Furthermore, health problems (foetal and maternal) become more apparent as pregnancy progresses. Acute care needs may only be detected in the second trimester or later and even then access may be limited by a lack of geographically proximate facilities.

What does this mean for a first trimester focused law?

The key problem with a first trimester law in Ireland is that barriers to first trimester abortion care are not impacted by liberalisation of abortion under 12 weeks gestation. Doran and Nancarrow’s systematic review (http://jfprhc.bmj.com/content/41/3/170.short; paywall) on barriers and facilitators for abortion care in countries where abortion is legal and the Guttmacher Institute’s regular reviews of barriers to care in the United States highlight core barriers which may not be impacted by this sort of change. These are divided into patient and provider perspectives in the table below.

Women’s perspectives Provider perspectives
Lack of proximate services Moral opposition
Lack of appointments/waiting lists Lack of training
Negative attitudes of staff Too few physicians
Associated costs of abortion Staff harassment
Insufficient hospital resources

Synthesis of barriers to first trimester abortion care – from Doran and Nancarrow (2015)

What would this mean in practice?

If a first trimester liberalisation is instituted then the front-line of sexual and reproductive and maternity care in Ireland will need to be closely explored. As research I have already been involved in highlighted (see here: https://mcrmetropolis.uk/blog/what-happens-when-women-have-to-travel-abortion-care-and-lessons-from-ireland/) communication between services in Ireland is not consistent. There are also significant issues relating to the cultures in hospitals – particularly if the Sisters of Charity are to be given ownership of the National Maternity Hospital, the key destination for acute maternal and foetal medicine – which will not be addressed by a legislative change.  

 

Barriers to first trimester abortion care.