Abortion policy implementation in Ireland: Lessons from the community model of care

Abstract

Background In 2018, the right to lawful abortion in the Republic of Ireland significantly expanded, and service provision commenced on 1 January, 2019. Community provision of early medical abortion to 9 weeks plus 6 days gestation delivered by General Practitioners constitutes the backbone of the Irish abortion policy implementation. We conducted a study in 2020–2021 to examine the barriers and facilitators of the Irish abortion policy implementation. Methods We collected data using qualitative in-depth interviews (IDIs) which were conducted in-person or remotely. We coded and analysed interview transcripts following the grounded theory approach. Results We collected 108 IDIs in Ireland from May 2020 to March 2021. This article draws on 79 IDIs with three participant samples directly relevant to the community model of care: (a) 27 key informants involved in the abortion policy development and implementation representing government healthcare administration, medical professionals, and advocacy organisations, (b) 22 healthcare providers involved in abortion provision in community settings, and (c) 30 service users who sought abortion services in 2020. Facilitators of community-based abortion provision have been: a collaborative approach between the Irish government and the medical community to develop the model of care, and strong support systems for providers. The MyOptions helpline for service users is a successful national referral model. The main barriers to provision are the mandatory 3-day wait, unclear or slow referral pathways from primary to hospital care, barriers for migrants, and a shortage and incomplete geographic distribution of providers, especially in rural areas. Conclusions We conclude that access to abortion care in Ireland has been greatly expanded since the policy implementation in 2019. The community delivery of care and the national helpline constitute key features of the Irish abortion policy implementation that could be duplicated in other contexts and countries. Several challenges to full abortion policy implementation remain.

The Relationship Between Access to Abortion and Mental Health in Women of Childbearing Age: Analyses of Data From the Global Burden of Disease Studies

“…More specifically, this study was carried out to assess whether access to abortion has a broader effect on women of childbearing age, over and above its immediate effects on women seeking an abortion for various indications (Figure 1). This question is of importance when considering the possible societal impact of changes in abortion legislation, whether these are in the direction of greater restriction [1][2][3][4] or of broader access [10][11].…”

“…In contrast with the situation in the United States, the global trend during this period has been towards greater access to legal abortion - it is estimated that in the period 2000-2018, 27 countries enacted legislation that would reduce some of the barriers faced by women seeking abortion [ 9 ]. More recently, abortion access has also been broadened in Ireland and Argentina [ 10 , 11 ].…”

Information flow as reproductive governance. Patient journey analysis of information barriers and facilitators to abortion care in the republic of Ireland

“…The multi-step coding process of qualitative data included open and axial coding, and followed the “dynamic and fluid process” of the grounded theory approach( Corbin & Strauss, 2015 ). The qualitative methodology is explained in full in peer-reviewed publications related to the study ( Mishtal et al., 2022 ).…”

Ongoing need for education in abortion care

“…More than 3 years later, abortion is now an integrated part of women's health in Ireland. Most abortion care is provided by general practitioners where women receive mifepristone at a face‐to‐face appointment and then take misoprostol home to complete the abortion 3 . Over 9 weeks of gestation, abortion care takes place in one of the 14 hospitals providing care.…”

“…Most abortion care is provided by general practitioners where women receive mifepristone at a face‐to‐face appointment and then take misoprostol home to complete the abortion. 3 Over 9 weeks of gestation, abortion care takes place in one of the 14 hospitals providing care. After 12 weeks of gestation, abortion is legal if there is a fatal fetal abnormality, a maternal medical condition that would result in a severe risk to the health or life of the mother, or in an emergency.…”